Petersburg Borough: Hospital Board Meeting September 2026

Okay, I think we're— I think we're good to go. Thanks for hanging out with the board. You ready? And I'll go ahead and start. Okay, go ahead and call meeting to order.

Roll call. Joni? Here. Jim? Here.

Joe? Here. Heather? Here.

And Marlene is not here. Cindy? Here. And I am here. Chair?

Um, do any board members have a conflict of interest or a potential conflict of interest with respect to any item on today's agenda that should be disclosed?

No, hearing none, moving on. Uh, do I have approval of September 24, 2026 hospital board meeting agenda? Do we approve the board minutes from last month? That'd be— I'm looking for agenda right now.

I'm looking for approval for the agenda. Yes, approve. And I will second. All in favor? Aye.

Approval of board minutes. Approval of the August 27th, 2026 Hospital Board minutes. I make a motion to approve the August Hospital Board minutes. Second. All in favor?

Aye. Thank you. Any visitor comments?

None. Board member comments?

And then committee reports. Resource?

Uh, the Resource Committee met on Monday. Patient visits are up in part due to specialty clinic visits, and there are a fair number of MRIs last month. While home health, the lab, and radiology were down, visits to the ER were— were at an all-time high. On a potentially more positive note, we were able to move one patient from swing bed to long-term care, and occupancy is currently at 66% of capacity. On the money side, revenues are strong compared to budget, and by the end of summer, we Revenues are generally strong, and they will normally decline some in the fall.

On the expense side, we're under budget in salaries and wages, as well as the cost of supplies and utilities. Cash on hand is down slightly, and days in AR have had a slight increase. However, staff have been busy with contract work with the school, other administrative details, and addressing the audit and cost report. So I've had a number of competing priorities. We do expect that AR should improve again over the next few months.

There are other aspects that are or will be affecting our bottom line. On the employee insurance side, we formerly paid a monthly flat fee, but are now paying actual costs and expect to see reductions by year end. We also briefly discussed the potential impacts of HR 1, which will implement major cuts to Medicaid when it comes in force on January 1st. As Phil noted in our meeting, Alaska is the worst state in terms of enrollment, and due to state staffing reductions and federal funding and other changes, individuals, the state, and PMC will see negative impacts as a result of implementation. On that happy note, we move on to welcoming our new grants administrator, Dave Crosson, who replaces Katie Bryson, and Dave reported that 3 RHDP grants have been made.

Other grants are being applied for as well, and one expense that we may be able to reduce over time is that of housing for visiting healthcare professionals. Doing so would help free up a tight market for housing for Petersburg residents and those hoping to relocate here. Housing grants are available and will be closing soon, and PMC should be a competitive applicant, and this could help us move in a more, more self-sustaining direction. Other grants news is that HRSA grant awards are winding down. Among other things, we'd like to use funds to invest in vehicles needed for various hospital needs.

And as far as our investment funds, there was a slight loss in our Schwab account, which bounced back as of Monday. Of course, if you look today, it looked like it bounced back the other way today, but we briefly discussed some possible shifts in investments at some point, but are not ready to move money yet.

Any questions on that report?

Thank you, Cindy. Critical Access Hospital Quality Committee. So the Critical Access Hospital Quality Committee did meet, but I messed up and was not where I was supposed to be, so there's no report.

Okay, thank you. Pharmacy. Any questions on pharmacy and Yeah, my report is—. I think it's up there. Oh, okay.

I have it somewhere, the agenda. Questions on the report? You want me to read the report? No. Okay.

Highlight maybe.

The biggest thing is we recently implemented the VIXIS system. And so far it does seem to be working mostly well. It's a tremendous improvement with the controlled drugs. Previously, the nurses had to count all the controlled drugs available to them every shift. Now they only have to count the items that were accessed during the shift, which is a big improvement.

Also, it lets me have more items available to them, so there's less Oh, we need this now. Please come in at 2 AM and get it out of the cupboard so we can use it. More items are available but don't have to be counted every shift because they're not usually accessed. I do get a report every day that says what needs to be refilled so that I actually know what needs— I know what stock needs to be where. It, it, for the items that are stored in the Pixis machine, it makes stocking and outdating much easier.

It, unfortunately, our machines are not big enough to store everything, so we would kind of like to expand our Pixis system.

Um, yeah, that's the main thing that's new.

Oh, go ahead, Cindy, or Joni, whichever one wants. I just wanted to ask about, um, shipping, because everybody's had concerns about shipping things in and out of town, and, um, what you see in the future and what, what kinds of things you're doing to deal with that. The earlier part of this year, I was dealing with a lot of severe delays in in shipping. Urgently needed medications were taking weeks. Sometimes like, uh, uh, medications worth thousands or sometimes many thousands of dollars were shipped in a box with ice packs and might be 3 weeks in transit.

And we— there was a whole lot of getting that credit back from the company because we are not paying for that. And the distributor has lost a lot of money on our account because they haven't figured out a way to get product to us in a timely manner because they only use FedEx. Our routine deliveries, I order by 2 PM, and I received them the next day. It's just the specialty products that take a long time to get here. Sometimes it's unreliable.

Recently, uh, shipping times have been better, but it's not predictable or reliable.

Using Gold Star or something like that? Uh, Gold Streak is— Alaska Airlines Gold Streak is a very good system, But our distributor, well, our distributor does use it for my routine deliveries. If I order Tylenol, it's here the next day. If I order a $15,000 vial of medication that needs to be cold, it might take a couple weeks. So unreliable.

They use FedEx to do that. They use FedEx. Can they deliver it to AML or something like that? And then they'll stick it in the cold pack and—. We attempted something like that.

We had a company in Anchorage that was willing to receive and reship. And we tried to implement it and the distributor said they can only ship to the address on our DEA license. So they have to reship to 103 Fram Street and nowhere else. Fine. Tony?

Yeah, I just had a curiosity question with the Pyxis with expanding. It has the capacity, it's just a matter of taking time to get those medications in? We are, we are at capacity with the machine in the ER and we are near capacity with the acute care machine. The acute machine does still have a little bit of space in it so that when we get a patient who needs an unusual medication, I can transfer it into the machine. And that's handy.

Uh, the Pyxis machine, uh, it's full. Okay. So we'd have to buy more drawers. Yeah. You just buy another module that—.

Yes. Goes on the side or underneath. Yeah. Yeah. Okay.

Yes. Underneath. You don't need—. On the side. It's just the drawers.

And the drawers, it's more drawers. It does. It would need to be installed by a representative. But yes, we've discovered that it's a good system and we'd like more of it. Thank you.

Thank you. Thank you. Anything else? No, thank you.

Rehabilitation.

Sent me a message. She's out of town. Um, happy to just share a few things that she had wanted to summarize with her report. She said she's really getting a lot of compliments from people on how they appreciate having more open space for moving in the new, new gym. It's more privacy, no longer elbow to elbow with each other.

So a huge thanks to Wolf and the crew for making that happen. Very, very complimentary about that. Um, they'll be fully staffed for OT and speech throughout the winter. They're trying— currently trying to get more PTs, but it might be limited to 3, uh, 3 PTs for the time being until they can get, um, capacity and workload for 5.

Any other questions on that report?

Uh, plant maintenance.

Wolf Brooks here. I got a short summary of my report. I'll read that off and see if anybody has questions. Overall, the maintenance department has made a lot of progress over the past 6 months with the addition of our new electrician, maintenance technician, and seasonal landscaper. We've catch up on backlog work and put more focus on preventative maintenance and completing projects in-house.

Some of our larger accomplishments include, uh, completing the new PT gym, several lighting and electrical upgrades, and continued improvement in our heating and cooling system throughout the facility. Overall, the age of our facility continues to be the biggest challenge. We recently dealt with issues involving the emergency generator, main boiler, and aging water and sewer systems. Fortunately, we've been able to address these issues while keeping the critical systems operational. Of course, though, financially, we've been slightly over budget, primarily due to the aging infrastructure and increased in-house projects, but we're starting to see the benefits of having staffing and capabilities to complete more of this work ourselves.

Sorry. Overall, I've been very happy with how our department's been doing, been Can't say probably a bad thing about the people that we have working in maintenance. Yeah, anybody have any questions? Um, with the fall/winter coming on, uh, do you foresee any major issues with the ongoing problems that we've been facing? Um, yeah, I mean, so when we go into winter, I think There's the biggest concerns I have is, uh, our heating system most, and our backup generator probably.

They kind of go hand in hand though, because in the event of like an extended power outage, our generator can't carry our heating boiler. And also it was, um, like, like I think I said before, we're starting to show signs of our fairly new heating boiler, uh, corroding, which is just kind of a show of like, we have very, very hard water here and it's not very— well, don't want to say this and bash the city— it's just not, not very well cleaned, I guess. So a lot of our heating elements are corroded. For this, we've been actually— we've now doubled the amount of additives that we're putting into our hydronic heating system. But it's always a very big concern of mine.

I mean, thankfully we do have a backup heater or a backup electric boiler. However, it is the oldest operating electric boiler in the state of Alaska. That's very much not large enough to heat the entire building. But it's— I always have quite a few concerns with that. But we stock every part that we can to, uh, you know, that at least I could foresee being an issue.

So if, you know, in the event something does happen, we should be able to fix it fairly fast. But yeah, any other questions for—. Do you have sediment filters and things like that on the On that feed, not for the main water. Uh, well, sorry, for domestic water or for our heating? Well, your heating is closed system.

Yeah, it is, unless we have a large loss, then we have to add it in. It is filtered though. It has kind of like a— it's not a traditional filter, it's kind of an older style where it goes into like a low-pressure tank, which then most of the sediment should get filtered out. I don't fully believe it does. It's not a great system.

There's a reason it's—. You use distilled water then when you restock the—. Yeah, we just use water and we add additive to it, like a glycol mix additive. I don't know exactly what it is, but right. Yeah, thank you, Environmental Service.

I'm here for Gracel. She's busy. Um, so, uh, environmental services has been going very strong. Uh, right now we're fully staffed. Uh, the biggest thing that probably is not in the report, but when we submitted the report, we were actually up in Anchorage.

Graisel, Rachel, and myself were all receiving training for a program called TCHEST. It's an acronym, so it's a train-the-trainer program for certified healthcare environmental services technicians. So now, uh, Graisel, Rachel, and myself are able to train our EVS staff to become CHEST trained, I guess, or CHEST employees. Yeah, works. But, um, yeah, it's actually very exciting.

Quite a few— or not, it's been a couple hospitals, uh, around Alaska that are implementing this. It's just kind of a, uh, program that really helps create growth in a department that often kind of struggles with it. So I'm very much looking forward to that.

Yeah, yeah. No, you just got back, but do you have a training planned? We do not, not one scheduled yet. There was kind of some issues with us actually getting all of the registration from this program called AHA, American Hospital Association. So we just, I actually was the last one that finally completed my post-test today.

So I don't, I guess, have quite scheduled one scheduled yet, but exciting. It is. Yeah, we're hoping, I mean, within probably a month or two, I would like to have at least a program going. That's going to be very interesting because, you know, we have 3 days of training and then all one of us will be having to stand up and actually teach this course. So it's a good, good program to— that's a good way to, yeah.

To jump into it, I guess. But I think to start things off, I'm probably going to pull a couple aside and just practice speaking in front of them, teaching a class, because I'm not very good at that at the moment. But yeah, anything else? Thank you. Thank you.

I'm sure you're great at it.

Uh, new facility.

It's here. Oh, there it is. Good afternoon. Yeah, so I didn't have a lot of updates on my report. We're kind of—.

We're still in the same condition as last month in terms of kind of where we're at with the future site and then the work building being complete. And then based on our last month's report, I did include kind of a concept duplex, um, rendering. And then for this report, I did add, um, based on some comments from the last meeting, um, an alternative 20-plex. And you can kind of see that rendering there and kind of a shot of the interior space. And the concept behind this would basically be kind of an open parking lot, um, a 3-story basically single-unit 20-plex with the, with the first floor having some shared common space like a lobby, and then there'd be some stairwells on either side, and then you'd probably have some areas for like washers and dryers, and then essentially all the, all the units would be like a studio apartment style living.

So just kind of a really early, you know, rough concept, just a rendering only we put together, and that was just kind of based on last comments as another alternative. And I think we'll update it on the next report, but I did do a little bit more research on the duplex, and there is an opportunity to take away those garages and turn it into a triplex. There's a little bit more complications when you go try to do a fourplex because it would require a sprinkler system. But according to the State Fire Marshal, if it's a three— if it's a triplex, then there's no sprinkler required. If you go to the fourplex, then it does need a sprinkler.

So there's some, you know, there's some considerations to be made there with, with a which direction you would go with that. But anyway, I just wanted to kind of update that and propose some new concepts. And that probably ties into kind of the high-level view of what does the development look like for that Lot 2 over there.

And so yeah, any questions on that?

I guess I have a question just based on a comment from Cindy's report about the housing grant. Does the housing grant parameter influence design or design influence that? Was that a consideration in the grant? Do those two things go together? Are they separate?

I haven't had an opportunity to see any of the contract or the language in that grant, so I wouldn't be able to speak to that very well. But I'm just kind of at this point putting out some different alternative options, but we could definitely look into that.

Any other questions for—.

I did put in there just an estimated ROM budget based on square footage. Obviously there's a lot that goes into that with site development, but I just kind of used some square footage numbers and I came up with about $10 million for a 20-plex, which is about, you know, it averages out to about $500,000 a unit. That it would include all those shared spaces to kind of, you know, there'd be boiler rooms and mechanical rooms and those kind of things also. So that includes all that, and it includes some site work, but very specific to that structure. So if there was any other road developments, additional utilities or anything like that, that does not include that.

So.

Yeah, thank you. It's good to have some different options or different things to look at, but it's all going to be good. Cindy, I just had one other question, and I'm sure that's why you've made the choice that you have. How much additional does having to add a sprinkler unit add to the cost of the project? Um, it kind of depends on— there's some parameters there with water pressure and, uh, flow.

But I think the good thing that's working in our favor there is that they just brought in some, uh, some new main lines. Um, so that can be one concern because sometimes if you don't have the correct pressure or the water volume input, then you have to use like tanks. Storage tanks to where they can draw down on specific tanks and have enough volume of water. Those are kind of some risks in terms of cost for the sprinkler. But generally speaking, for something like this 20-plex idea, the total cost of that particular discipline would be around roughly $200,000, $250,000, I think, for sprinkler.

For a $10 million building. So some— somewhere in that ballpark. Okay.

But then you gotta consider maintenance and some of the issues that Wolf was addressing too. Yes. Yeah, that would become a— yeah, but, but like on the 20-plex concept, it's a requirement, like for sure.

But, but with the triplex idea, That basically there's an exception for that because, you know, the level of occupants basically.

Thank you. Thank you.

Quality Report. Yes. Hello. Good evening. I just wanted to, in honor of Alaska's first Fall Prevention Awareness week, mention the Community Wellness Department has a beginning tai chi class that just started Tuesday, and that will run through November 19th.

If they're— I believe they're still accepting participants if anybody's interested. And then part of my section as well, the 2025 Community Health Needs Assessment is in the packet. This is a detailed report of the findings in the plan that was presented in May of 2025. So the, the shared health priorities and the strategies that are outlined here have been informing programs and funding since your approval May before last, and quite a bit of progress has been made to realizing some of those success measures that were outlined in the plan. And you'll also notice that current RHTP requests align pretty heavily with these priorities.

Julie said that she would have this report posted to the website by next week. It's also been shared with community partners, and there'll be some printed copies available for you all soon. So happy to take any questions on it or my report.

Any questions on the report?

Thank you for that report.

Infection prevention.

Any questions on Rachel's report?

None.

Thanks, Rachel, for that report. And grants report.

Oh, is grants on there already? It's on there. Okay, but I was going to cover— if you don't mind, I was going to cover that.

So, okay, financial, sir. Oh no, the executive. Executive. Okay, no, I'm saying If we go down the deal, if I go past grants and financials is next on the agenda. Right after infection prevention was, was my report.

So, right. That's just my error. So I apologize. I'll change. Okay.

Yeah, I'm looking at the agenda here. So I'm looking at this one. Okay. You got it. So, if we're going to stay on that, we'll go with financials and then we'll come back to.

No, let's do financials. All right. I think Joel is on in Jason's place today. So, yeah. Hi.

Yeah. Can everybody hear me? Yes. Yes. Yes.

Awesome. Sorry, I've been trying to figure out how to get my camera to work. I'm on my laptop. And so anyway, maybe it'll start working here in a second, but let me see if I can share the financial documents that we shared with the Resource Committee.

It's a good page. Something's happening there.

All right, is everybody able to see the document? Yep, it's on screen. Awesome. So I think we typically start off just discussing the volumes a little bit. And, you know, Cindy always does a great job of recapping the meeting.

And to her point, basically, if you look over to the right-hand side on the percent change, that's, you know, percent change from the same time last year. And you'll notice that everything really is up except for long-term care. So we started last year, long-term care significantly higher in terms of number of people in beds, so we're down a little bit with that, but, and a little bit of swing bed volume, you know, you can also see that that's down just slightly, but everything else is up and really looking fantastic, so it's been a busy summer.

So before I move on, any, any questions on the volumes?

Okay. Okay. We'll move on. Now, this is the, you know, traditional profit and loss statement. And this, you know, like most of our prior months, is very, very much in line.

We're seeing strong revenue, you know, $3.1 billion, you know, towards the top of the financial statement right up here, you know, with $3.1 billion. In total revenue against the budget of $369 million, and, you know, 12.1% over prior year, as you can see over on the right-hand side. So still really strong revenues so far this year, partially helped by, I mean, obviously the MRI. We've done a number of MRIs, and those have definitely helped us.

Contractuals and most other expenses in line. I think that Cindy also mentioned that, you know, salaries and wages was looking good, and she also talked about employee benefits. So employee benefits was definitely higher than budget, but mostly because of the claims issue where we may have some months to come where we have, you know, lower claims payments that we have to make, and we may have months where it's a little bit higher. And so it'll fluctuate a little bit, but I think nothing to worry about at this point. And bottom line over here, I don't know if you can see my cursor, but the bottom line is $315,000 to the positive this month and $483,000 positive for the year.

So everything looking great so far on the P&L. Any questions?

Don't see any. Hearing none. Man, this is easy. I thought I was going to be grilled. It's not over yet.

Yeah. So, you know, traditional balance sheet now, as Cindy mentioned, cash is down just slightly, but mostly because Medicare believed that we owed them a little money. And so they took $700,000 from us. So that's caused cash to dip, but we're already starting to recover a little bit, and we believe when we file our cost report this fall or this, you know, during the fall/winter period, that we'll end up getting that money back. But outside of that, I don't know that there's anything notable on the balance sheet unless there's any questions.

I don't see any. Hearing none, then we'll go on to the final slide here, which is just some metrics, key metrics that are interesting. Contractual percentages this last month, 16.1%, which is much better than prior year. You can see prior year we were 20%, and we'd like that number to continue coming down. But so far, you know, really good trend this year for contractuales.

Charity, how much we write off for charity care has been very consistent also.

Cindy mentioned that, you know, down on line 7 and 8 is where we measure how much, how many days worth of accounts receivable that we've piled up before we're able to collect it. And obviously you'd like that to be 30 days or something like that. Those numbers, you know, based on the last 2 or 3 years are still very strong, but they are a little higher than we were 3 or 4 months ago. So we're going to, you know, dig in this winter and, you know, hopefully once revenues come down and we can dig back into the issues, we can bring those numbers down. But days cash on hand, you still see well over 100.

So still good even with Medicare playing games with us. But yeah, I think that's what I would share on that unless there's any questions.

Go ahead, Joni. I had a question that's more about my understanding than anything. And so with the new year, when the Medicaid/Medicare policy goes into effect, you know what, and we're talking about significant cuts to reimbursements, like what percentage or what, what does significant mean or what does it look like? Do you know? Is it in our—.

Is it forecast in our budget? Well, I don't know that we have it forecast, and Phil might want to take this one. I think I'll just say a couple of things, and that is that I think most of the problem that we're expected to have or expecting to have is just fewer people that qualify, and therefore it just won't be reimbursed. You know, they'll just be a self-pay person if they don't qualify for Medicaid. Medicare is a little bit different in that, you know, we get our yearly Medicare report with them determines what our rates are.

And so I don't know that there's a lot of concern on the Medicare part, but that's my concern on Medicaid. But Phil, Phil's an expert on it. And Phil, do you want to open up? Not an expert, but I'm happy to share what I learned last week on the HR1, which is the the January transition. So just to be clear, they're not viewed as cuts.

And so the Medicaid population that we typically are talking about are not, you know, not going to be affected from, from the regulations that are in place. This is more towards people who have work eligibility requirements. A lot of the and not the low income and not the, you know, in long-term care, those elders, those are not necessarily going to be the ones affected. Where we are going to see effect, and I spoke to this at the— on KFSK today, is that it's going to be harder to stay on top of Medicaid eligibility and redetermination. And so even though that the majority of the population of Medicaid in Petersburg is not, doesn't go under this change, even though it'll affect some, don't get me wrong, it'll affect some.

It will not affect our Medicaid population from that standpoint. But the problem is the staffing and the focus on the state side to manage the changes will affect just because there's not enough staff to do that right now. As Cindy reported at our resource committee, it's hard enough. We're one of the worst states when it comes to keeping people in the Medicaid system because of procedural or administrative burden that the state imposes, largely potentially due to staffing, their systems issues at the state level that they have actually spoken on there. They are trying to resolve, and work on.

But, uh, but my feeling is when HR 1 comes into place, it's going to be really challenging for the state to focus on the other normal eligibility because the focus will be on these other changes. And I think that's where we'll see a lot of challenges, um, on our level. And so to plan for that, forecast for that, we need to work on developing staffing that can help educate the community. So Brandi has a class already scheduled here in the next month or two to try to educate the community on those changes and what impacts those changes, including SNAP benefits, which normally we don't, you know, deal with. But on the benefits side, it does have, have some impacts in educating, you know, people, recipients who are, will be impacted is going to be really important.

And just making sure it is, you know, people are very well aware that these will have impacts on, you know, with some of the reg changes that are occurring. But we have— the states has problems right now. That's what I'm saying. In the old system. Yes, that's right.

Meeting requirements. That's correct. I mean, trying to get docked. Yes. So it'll just get worse.

Exactly. And so taking that system and applying these new regs will, you know, to me it's just a very easy math problem, right? You know, so when it comes down to the impact of that, so it's not a percentage cut, it is a burden, administrative burden that we're going to have to manage in an indirect way. I mean, a good example is just long-term care, that there's several people in queue And the state, it's just taking forever to get the paperwork. I mean, Jennifer can talk.

Can I give an example?

Right now we had a person in the community who was using our building to make a call to go to a scheduled— this was yesterday— a scheduled meeting. They had a hearing for SNAP benefits between 1 and 3. Person came, called at 1. By 3:30, 4 o'clock, no answer yet. They're still in the queue.

So they eventually hung up and the benefits were denied because they didn't make their hearing. Um, and so now Brandy's been— we've got Brandy involved yesterday afternoon. Brandy's been calling in case now they can make a new hearing for 2 months from now because they they missed their hearing, but nobody answered the phone. And now they have to wait for 2 months to have another hearing. And these are, you know, and unfortunately these are the people who have the fewest resources, the fewest abilities to have a phone even.

And then, you know, so that's the case that we are having now, and then it's gonna get worse from there, so.

Any other questions for Joel? Yeah, have we attempted to make any— and, and this sounds crass because people are going to be impacted, but have we tried to make any assessment of how this will affect our bottom line?

I mean, I don't think it'll— I mean, go ahead, Joel. No, I was going to ask if you wanted to talk to that one.

I mean, there's really no way to know. I mean, that's fair. Theoretically speaking, it shouldn't affect our bottom line. Well, yeah, because we're not providing services because they can't get into the program, right? So we're not—.

Well, we provide the services. We provide the services. We're still providing the services. Yeah. I mean, I mean, the bulk of our Medicaid is in long-term care.

And that is not— the program is not affecting that program. Okay. But my fear is the eligibility and determination, which is already a challenge, is going to be that much harder because of staffing. And I guess, yes, we will still be providing some services, but I'm anticipating that some people who need services will not seek them because they can't afford them.

And that will affect us financially too. Yeah, well, yeah, I mean, I can speak to some of that on my executive report. I have some, some solutions. Okay, good. Anything else for Joel?

Thank you, Joel. Thank you. We move into executive summary.

Thank you.

Any questions on my report before I can— and I can dive into a couple of responses to some strategies. So the RHTP funds, you know, just again, the state has negotiated with these changes in the Medicaid side with Rural Health Transformation Funds. In a way to transform healthcare and kind of offset some of these changes on the Medicaid side. And with that, we want to utilize, we have received 3 projects through that process in the order of roughly around $1 million. We have not budgeted, we have not added that to the budget because we were unknown about that.

So that will be an add-on to our budget that, that will help potentially offset any of those Medicaid changes, but also to invest in some of the programs that we are, we are working on, including telehealth program, behavioral health, which we've spent some time investing in and adding to some staffing. So Pat Sessler's here. We've added a behavioral health associate, and we're still recruiting for another counselor. So we're posting for that position, and that is also helping with the telehealth program because that's already in place with Dr. Sonkus as a telehealth provider. So those are some good things with the RHTP.

In addition to that, we have maternal child health program that we received for that. Now, with those, we have a budget that we, we sign and agree with the state at the next board meeting. I will probably want to put those on a motion to approve for each one of those. So to accept the grant funds for the state, for the telehealth, for the behavioral health, and for the maternal child health. And then if we want to pursue the housing grant that we had talked about, and I did, David and I did talk, met today, And we had spoken quite a bit about, um, putting an application in.

It doesn't, uh, obligate us, but it's something also— it's under the grant parameters we're going to have to put in as a motion, uh, on the next agenda. So there'll probably be 4 motions related to grants, um, that, uh, the time, uh, uh, and I— if David's on, I wouldn't— I would like to maybe have him just talk a little bit about that housing grant that we potentially can be eligible for and apply for. It's roughly around $700,000, and we have to match, I think, something around 10% of that to have a product. But David, do you want to just mention— and introduce David, of course. He's our new— Katie, who is transitioning, we're sad to see her go, obviously.

But David, do you want to mention a couple of things about that? That program or that grant. Absolutely. Um, hello, my name is David Croson and I'm pleased to be, pleased to be joining you all. Um, uh, the, uh, yeah, the housing, uh, grant, it's up to $700,000.

It's a 15% match, so, um, $123,000 um, in required match. I will be sending that information to Joel— or not Joel, um, um, to, uh, Justin tomorrow, um, and, and hopefully beginning to work with him on, on how to pursue that, um, and it's due November 9th or 7th.

And, and to One of the things we'll probably have to talk to Justin about is, you know, we want a finished product of some kind. And so what can we actually do within that amount and what kind of project we want to kind of have to completion and timeline as well. Is that—. Isn't that right, David? Yeah, that is.

Yeah. Yes. All right. Any questions on those? Parts of the grant or RCP.

A lot of changes coming. And with that, I'm going to have a work session. My annual work session is October 8th. We'll be in this room and we'll probably spend the day revisiting the past year and also talking about how we're going to maybe tackle some of these changes and discuss some strategies with that as we go forward.

LTC, I want to compliment long-term care. They won an innovation and safety, quality and safety award at the Alaska Hospital and Healthcare Association conference and meeting last week. It was really great. Jennifer, Dr. Hess, and Helen were all down there, received the award, which was nice. So real kudos to them.

That award was related to some of the support services that go into the quality of life of those residents. So for example, we have Jill and Matt here in the back IT. We had a false prevention system that was put in, which was very technology-based. And in Jill's report, she'd been reporting out on that and other things such as meals and nutrition, focusing on diet. We're also looking at pharmacy policy, pharmacy reduction projects that we are looking at.

So a lot of these projects that run through our quality, quality program are really having some traction and really improving some of the quality of life. And those are the things we want to reflect in and acknowledge on, on long-term care. So So kudos to them. We talked about HR1 on Medicaid. More to update.

I think that there's a lot of uncertainty, and I think that's something I'll keep on a placeholder each month to make sure that we are abreast of that. Flu is in the community, so encouraging getting flu shot, working with public health on getting this room here as a pod, a public, you know, making available for a— what's a pod stand for, Jennifer? Again, a point of dispensing. Dispensing. I should know.

I should know that. But getting some flu shots. Just be like, odd. Yeah. And in the clinic, contact the clinic if you need some flu shots as well.

I forgot to mention that on the radio today, so shame on me. And then another project that I'm actually very excited about in helping manage the costs of healthcare is direct primary care. And I knew it was going to be a slow roll getting the project together. And really it's a subscription-based model, but we're starting to see some people enroll in the program, which is very exciting, and use the program. And so once the— once word gets out on that, I have a really strong feeling this is going to snowball into a big project, and that is to help reduce the cost of care, especially primary care.

And when you look at the cost of that, You know, if you walk into Hammers and you get a couple of bags of groceries, it's probably more than the annual— the monthly subscription, which is $120. $125. $125. Thank you. It's a little less for kids.

So really excited about that. I mean, and when I talked to the state last week, the commissioner was there and the deputy commissioner was there, and I talked to them about projects. They're very interested in that. They'd like us to maybe submit that to an RCP for next round as a project and evaluating some of the data that comes out of that. So looking forward to writing, or Dave is looking forward to writing for that project, which we talked about today.

You got to hear me go on and on about all sorts of stuff related to that. So, but we're working with specialties, trying to get ortho, orthopedic, clinic here, which is, um, we're actually very close to that, so I'm excited about that one. We had Dr. Rasta here recently, uh, ENT. Uh, Jennifer's working on the next, uh, colon scope clinic, which is coming— what is that? October 1st and 2nd.

October 1st and 2nd. So those are just humming along. We have MRI working and, um, doing really well on our— I think it's close to 80 studies now. Ourselves. So really great on that go-live as well.

So I think that's probably all I got. Any questions? You gonna put it on the marquee sign, MRI? Oh, on this sign over here? Yeah.

I got a question on the pod. Didn't even think about that. Shots for virus or flu, they include the COVID also? Right now I think it's just flu. Just flu?

Okay, because you can take them at the same time.

I don't know that the new COVID shot is even out. You know, it was approved a few weeks ago, but—. Okay, yeah, I think—. I don't think this— we haven't seen anything that is available to us. Okay, that's good to know.

You have the senior dose for— okay. Joe, um, I just wondered if you'd had any, um, further updates or leads or anything for the 4th physician hire? We, um, not permanent. However, we do have a physician that came here and visited us, and we are— have a permanent, um, traveling physician for a little bit, which is not— it's a middle, middle ground, um, solution. So, uh, once, um, they sign the contract, I'll, I'll let you know the person's name, but they came here, visited us, did a site visit.

We're very excited about that, and they are trying to establish some established locums work, and that's— it's not terrible to be able to have somebody that's familiar with us and does travel as well. So it's— at this point, it's a locums contract, but we still have our two— we have our nurse practitioner Angela, we have Eric, Dr. Hulebek, Dr. Hassen, Dr. Burt, and hopefully this other person will join us as well. Okay, thanks. Yeah, any other questions for Phil? Thank you, Phil.

Um, moving on to housing update. Hello.

So I wanted to give you a little bit more of a comprehensive update since I've been just telling you, well, it's kind of the same. Um, it's still kind of the same, but at least you'll have a little bit more knowledge on it. So we have 1 studio, 18 1-bedroom, and 4 2-bedroom apartments. That's quite a bit. Um, right now that's a total of 23 apartments, although, um, 1 is designated for the student.

The University of Washington reimburses us for an apartment because we are in that program. And so right now, the way it is broken out is we have 9 set up for nursing, which can be CNAs, LPNs, or RNs. We have 2 set up for radiology, which currently is an X-ray tech and an MRI tech. We have 5 for therapies, which is OTs and PTs. We have 3 right now for food service, um, only because our, um, manager's apartment didn't work out and she was a little bit panicked and needed a place to live.

So this is an interim basis. And then we have one also for our behavioral health because his place isn't ready yet. So when I mentioned that we have travel staff, we have interim housing, which is temporary. And we also do for interim housing, let all employees know that if they're going to stay in our place, that it is— if it's a benefit, then they get it comparable on their taxes. So, IRS Publication, I think it's 200.

Joel could probably tell you exactly, but we have it all set up in our payroll system so that it shows up as taxable income. If they're in it and they've already exhausted their benefit, then they're expected to pay the rent. And we don't actually pick rent. What we do is one of the two realtors have given us how much a studio average cost, uh, a one-bedroom average cost, and a two-bedroom average cost. And that's what we use because that was part of the IRS guidelines, so we wanted to follow that.

Um, let's see. So what can I say about housing right now? I don't really anticipate a reduction in the need of housing or apartments in the near future. Um, PMC and our, our department, which right now is 2 people, but we're hoping to make it a third here shortly, um, is, uh, looking for ways to explore how to grow our own. And also how to recruit.

And as one of the things we found with recruitment, it's just, as you know, in any field, difficult. Part of our problem is our location. People who, you know, could be professionals may not want to move here. So, you know, that could be kind of a hindrance. And then also, you know, some people when they come, They want the Alaska experience for maybe 2 years.

Sometimes they stay for 20 or so or more, and sometimes they are ready to leave. So you get kind of the 2 different types of people, which is fine. We'd rather have you for 2 or 3 years than have a traveler, which we have nothing against travel staff. We, we, we like them, but we'd rather get some permanent employees. The other thing we do, and Jennifer has been a big proponent of this, is grow your own.

We started our CNA class for the high school, which is very exciting, and I— it's, it's a large amount, like 9 or 10. There's 10 of them, so, uh, very exciting. Our first class started at 12, and I think they graduated 8. So there's— I mean, it's very exciting, and quite a few of those, my daughter included, is a nurse, uh, today. So it's a very exciting thing to have the grow your own.

We grow our own, but that doesn't mean they're always going to stay here. And I think Jennifer reported on that one time, just to let you know that However many nurses we've graduated, they don't always remain. We'd like them to, but we also know that people, you know, family or just wanting to travel, be young, maybe they're not ready to like live here for the remainder— not remainder, but for a lot of their life, you know, stuff like that. So it is unique. I think you all know because you're professional people that it's hard to get people to want to live here, to raise their family here.

So that's one of the things we're looking at. And then just as an FYI, you probably already know this from the national news, healthcare professions, there's a shortage. So, you know, sometimes high schoolers, we've been talking to these interns, they'll say, you know, oh, you know, I don't want to know what I want to be. I say, I will say, you know, that's okay. A lot of us don't know what we want to be, especially when we're 18.

Or, you know, 20, and that's fine. But healthcare is a great, great career. And so we're just trying to let our intern program know that, you know, there is a future here for you in Petersburg, Alaska. And they don't all have to be at the hospital, though we want them to be. But we're here and we're hoping to grow our own.

We're hoping to recruit people. And, and I'm hoping we don't need 22 apartments in the future, but that's kind of where we're at. So I hope that kind of explains. I thought when I've been saying, yeah, and then, oh, Russell down a physician. So we do have physicians come and the specialties.

So we try to house those as well. So it's just a lot of places, a lot of moving parts.

Any questions?

Thank you. Well, under this heading, and I probably should have done it on our new facility, but I think it's important that we put together some kind of group that will do a study on this, on where we would want to put something if we get there, so that we're not get down this road too far and then have to stumble over some locations. Um, and I don't know who the right people would be for that because I think some of them would be outside of this organization as also involving the borough and whatnot. But as far as, um, there's going to be costs associated with any location as far as street improvements with utilities. And so we kind of got to know whether we're going to be able to put it on the area that we have, or if we're going to have to look at other possible lots around the community.

And I think I would rather see us start pursuing that study sooner than later. So that we don't stumble over that down the road if we do get qualified for a grant or so. Okay. We had, um, okay, yeah, we had the facility steering committee. I don't know if that's something that makes sense to do something similar, or I mean something.

I don't know what the right group or right people are, but I know that when you, when you start looking at something like that, you got to look at, uh, utilities coming in. You got to look at power coming in, um, what property— what mustangs work, what don't, and the layout up there of— and then the future of the, the whole, um, property as to what we want to tie up and what we don't. Because once we start putting, uh, structures on it, then you have spacing, you have— you start, um, dictating what you can do in the future with it. And so I want to make sure that we at least look at it and kind of come up with a long-term plan before we just start have fun stuff on it. If you don't mind, I'll put together an action plan related to that.

That'd be great. Sort of long-term on probably the whole campus. Yeah. So if you're looking at putting things on it, what type of things? I'll work with Justin on— and we'll put some things together.

We'll also maybe make some recommendations on who should be on that.

Anything else? Anything else under housing?

Next meeting scheduled for October 29th. I will not be here for that one. I will not be here either. I will not be here. I can't zoom in on that either.

Does that work for everyone else? I'll zoom in.

I should be here. So we have Cindy, we'll have Joni, we'll have Jim. Jim, that's for Heather.

Okay, okay.

Um, do I have a motion to go into executive session?

And this is to consider reappointments, uh, to consider reappointments and to discuss legal and/or financial concerns. Second. All in favor? Aye. Yeah, if it helps, I'll have some coffee.

I'll be back either late Monday or—. Seconded. Um, yes, thank you. I just had sent other, uh,.