Dr. Claude Dharamraj, director of the Florida Department of Health in Pinellas County, advises Pinellas County Commissioners to find a way to use grant money from the federal government during a June 3 meeting.
CLEARWATER – Despite encouragement to “build something” from the director of the county’s director of health, Pinellas County Commissioners chose to schedule a work session for more discussion before making a final decision on construction of the Bayside Health Campus.
Time is growing short to comply with terms of a $5 million federal grant. An extension will be required, if commissioners decide to go forward.
But, commissioners are struggling to determine if a “bricks and mortar” clinic, offering full “wrap-around” care is the best way to provide for the homeless. “Warp-around” care includes podiatry, pharmacy and respite.
Area hospitals favor having a place where homeless patients can recover after they are released. Those with no place to go other than the streets, often have to be re-admitted for additional hospital care, which is expensive. A respite care facility would provide cost avoidance.
Ongoing cost is a big issue. The federal grant would pay for construction of a 15,000 square foot facility, but provide no money for operations or maintenance.
Latest estimates show it would cost about $3 million a year to provide the level of care staff recommends. Officials still have to solve the problem of how to get those who need care to a fixed location.
If the state had accepted federal money to expand the Medicaid program, the health campus likely would have been a breakeven operation, said Lynda Leedy, director of Health and Community Services, told commissioners during a June 3 meeting.
A consultant estimates an annual loss of $872,000 in operating expenses without increased Medicaid money to pay for care of newly eligible clients. Cost to provide pharmacy and specialty care is estimated at an additional $2.2 million a year.
Commission Chair Karen Seel would like to explore expanding the mobile medical unit program. The commission also continues to work with local agencies that are currently providing care to the homeless population.
Everyone supports that there is “lots of unmet need, but not for profit organizations have no money to support” a new facility, Leedy said.
Leedy has talked to the federal government about the probability of getting a grant extension to meet construction deadlines. Repeated delays in moving ahead mean the county now cannot be finished in time.
Leedy said it was likely the county would be given an extension.
“As long as we can demonstrate progress, it should not be a problem,” she said.
Interim County Administrator Mark Woodard added that getting an extension wasn’t a sure thing.
“The issue is can we afford to do this and pay for services,” said Commissioner Susan Latvala.
She suggested raising the millage for the health department to bring in more money.
She said the issue was another “chicken or the egg.”
“We are all committed to the homeless, but there is not enough money,” Latvala said. “This is an opportunity we all agreed would do great service.”
Woodard said several related issues needed to be resolved with the most important being, “what are we trying to do and who are we trying to serve.”
“We went from providing a bridge to providing a highway to help people find services,” said Commission Chair Karen Seel. “What is our vision for health care? This clinic is just one piece.”
Commissioner Janet Long requested a report on how much money was being spent on indigent health care.
“We keep reinventing the wheel and forget about the person on the street who needs services as we debate how to move forward,” she said.
Commissioner Norm Roche concurred with Long and agreed with Latvala that a millage increase for the health department could be the answer.
“There are a lot of issues on this and we need to move faster,” he said. “I don’t think we have another year to get this solved.”
“We don’t want to move fast as much as make sure we do this right,” said Commissioner Ken Welch. “We got here for a reason. Maybe it is time to change the model. Maybe it is time to hit the reset button here as well,” he said.
Dr. Claude Dharamraj, director of the Florida Department of Health in Pinellas County, encouraged commissioners to find a way to accept the federal grant. She suggested that a smaller facility be constructed that would meet the terms of the grant, but not over-extend the county’s capacity to provide services.
“We don’t want a black mark on Pinellas County as we have in the state of Florida,” she said.
She suggested a compromise.
“You don’t need a Taj Mahal for $5 million. You don’t need that big,” she said.
She suggests building something smaller at a cost of $500,000 to $800,000. Instead of turning down the grant, the county would ask the federal government for a smaller one. A clinic could be located at Safe Harbor, which is taxing Largo Fire Department’s resources due to emergency calls for health care. It also would be close enough to serve Pinellas Hope.
“Go back and say we cannot use the $5 million, but we want a smaller project,” she said.
Dharamraj is not in favor of relying on the mobile medical unit, which often experiences mechanical problems.
“Care is always better in a building than a van,” she said.
She added that once the county had an operating clinic, it would allow them to apply for grants to pay for operations.
“If you build a building, you would be eligible to get money,” she said. “No clinic, no money.”