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Home My WebLink About1979-01-30 Info PacketW CITY OF IOWA CITY CIVIC CENTER 410 E. WASHINGTON SI. IOWA CIIY IUWA 52240 (319) 3521 I8(o.) January 26, 1979 PRESS RELEASE Statement by Neal G. Berlin, City Manager In recent days, there has been a great deal of controversy concerning Linda Eaton. The real issue has been lost in the rhetoric of emotion. The issue is the right and obligation of the City to establish non- discriminatory work rules and to direct the work of employees. That right is established in the Code of Iowa, Section 20.7, which provides that "Public employers shall have...the exclusive power, duty, and the right to ...direct the work of its public employees." In addition, the City has entered into a collective bargaining agreement with Local 610 of the International Association of Firefighters, AFL-CIO. This contract provides management the rights "(t)o direct the work of all its employees" and "(t)o develop, implement, and enforce work rules, safety standards, performance and productivity standards." These work rules cannot impose a special benefit or a special burden upon any employee or any class of employees. The City believes that these questions, which are both complex and emotional, should be resolved in as expeditious a manner as possible for the following reasons: FIICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES 217 PRESS RELEASE 26/79 Linda Eaton Page 2 1. The emotional nature of the issues has obscured the legal considerations relating to non-discriminatory work -rules. 2. A long court battle will expend a great deal of energy, in dollars and in personnel, which can be directed to more positive and productive efforts, both by the City and groups who are interested in Linda Eaton and her concerns. 3. A long court battle will continue an emotional debate which will be detrimental to the City and the Fire Department, will detract from the mission of the department, and may harm working relationships within the department. The effectiveness of the department depends upon a team effort. The firefighters must depend upon each other in life threatening situations. These relationships must be maintained. 4. The courts generally are not a satisfactory means for resolving sensitive, emotional, personal issues. 5. When vocal segments of the community believe that the City is being unfair or that its work rules are unfair, whatever might be the legal merits of the City's position, such pronouncements and attitudes will seriously detract from the City's commitment to carry out an aggressive affirmative action/equal opportunity program. MICROFILMED BY JORM MICROI_AB CEDAR RAPIDS•DES M0INES I PRESS RELEASE- 16/79 Linda Eaton Page 3 i i 1 6. Linda Eaton's attorney has indicated in her court petition that one of the reasons for resorting to the Court is because "...no internal grievance" remedy exists. Therefore, for the foregoing reasons, the City proposed to Linda Eaton's representative on Wednesday, that both parties agree to submit all of the issues raised in the controversy surrounding Linda Eaton to a neutral third party for resolution by binding arbitration. This is a process similar to that provided by contract between Iowa City and Local 610, but which currently is unavailable to Linda Eaton because she is a probationary employee. Both parties wall be committed to completing this process as soon as humanly possible, and will accept, as final, the decision made by the neutral party. Also I am taking several other actions: 1. A group of City staff members will review the operational requirements of the City departments and the operational procedures and working rules of the departments to ensure that the working conditions and rules of the City are non- discriminatory. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES 140INES PRESS RELEASE- ^_6/79 Linda Eaton Page 4 2. Concerned individuals and groups are invited to bring to the attention of and discuss with me, the Iowa City Human Rights Commission and the Civil Rights Specialist working conditions and rules of the City to ensure that these do not adversely impact women, members of minorities, or any other employee in a discriminatory manner. The Human Rights Commission and the Civil Rights Specialist will, when appropriate, make recommendations for change to the staff committee and the City Manager. Such recommendations will strengthen the City's affirmative action/equal opportunity program. These efforts and suggestions are invited. It is believed that these actions will provide for expeditious resolution of the current issue in a manner which will benefit both the City's interests and Linda Eaton, establish a process for the thoughtful review and consideration of the City's general concern for women in non-traditional roles, and provide a framework for ensuring that similar issues will not arise in the future. All concerned parties are invited to assist in encouraging timely resolution of the issues. From: Administrative Offices Ulm MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES 140INES -) City of Iowa Ci'v MEMORANDUM - DATE: January 26, 1979 City Manager TO: City Council FROM: Lyle G. Seydel, Housing Coordinator RE: Draft Minutes of Special Housing Cam-Lission Meeting - 1-25-79 The attached draft of Housing commission Minutes are provided in draft foam at this time because of items on the formal council Agenda. IGS/cf enclosure MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIRES 2 23 `......may.• � .. -- M=F S OF SPECIAL HOUSING WIM1SSION MEETING HELD THURSDAY, JANUARY 25, 1979 MEETING CALLED 'ID ORDER AT 3:37 P.M. BY VICE CHAIRPERSON, JON GRAHAM. ME45ERS PRESENT: GRAHAM, KLAUS, HILLSTROM, GIBLIN, OWENS, POLTACK STAFF PRESENT: BURKE, KUCHARZAK, SEYDEL, FLINN, SHMS I. Minutes of Subcommittee meeting January 10, 1979 were approved as mailed on a motion by Klaus, seconded by Owens, 6/0. Minutes of Housing Commission Special Meeting held January 10, 1979, were approved 6/0 on motion by Owens, seconded by Klaus. II. Housing Assistance Plan - Sheets Sheets distributed copies of performance report to members present. Sheets explained the charts of the Housing Assistance Plan as mailed to the Commission nxmbers, data base utilized, three year goals and anticipated requests. Following discussion, Klaus moved and Giblin seconded that the Housing Commission recommend to the City Council that they accept the three year goals of the Housing Assistance Plan as presented. Approved unanimously. Letter regarding goals of Housing Commission - Sheets a. Housing Information Pamphlet - Discussion revealed Pollock and Smithey had served on subcommittee previously delegated the task of developing such a pamphlet. Discussion revealed that purpose and need is unclear, but it was the consensus of the Commission Members present that the subcommittee should be reactivated to review the needs. It was moved by Pollock and seconded by Klaus that the Chairman be authorized to appoint a subcommittee to investigate the needs and report to the Commission at the next meeting its recommendations. Motion approved 6/0/ Subcommittee appointed by Graham to include Smithey,. Pollock and Hillstrom. b. Revision of Housing Occupancy and Maintenance Code - letter from Housing Board of Appeals to City Council - Inquiry was made regarding response to that letter. Commission was ad- vised that since it was the desire of the Commission to have the letter sent directly to Council Members hone rather than going in the packet, the item did not appear on the Agenda for discussion. Follow-up was advised. C. Education 1. 235 Program inappropriate - contractors and here builders non interested. 2. Report from State Housing Finance Authority - reoomnended Fredine Branson be invited to speak. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 110111E5 2- 1-25-79 I 3. Invite representatives of old Capitol Associates and Ecumenical Housing Corporation to provide status re- ports of their projects. III. Rehabilitation Task Force - Quasi Minutes written by Graham and mailed to Commission Members discussed. opinion expressed that older persons concerned with total disruption of life style as required by previous program. Kucharzak advised that draft for administrative manual is being prepared and would like meeting date set for discussion of draft. Hopes to have program in opera- tion by March 1, 1979. IV. Housing Appeals cases - backlog of Appeals cases awaiting legal action discussed by Kucharzak and Burka. Commission was advised that legal Department is currently understaffed and unable•to handle these cases at this time; however, federal monies are available that could be utilized to hire outside help to prose- cute . Moved by Pollock, seconded by Owens that a letter be written to City Attorney, John Hayek, with copies to City Manager and Council Menbers (through Council Packets) that it is the recomendation of the Commission that action be taken on the housing cases according to the recommendations of Kucharzak. Carried 6/0. V. Amendment to Code re Checklist - Concern expressed that mandating Checklist ccnpletely exceeds bounds of Minimum Housing Code stan- dards of "safe, decent and sanitary". Further concern was expressed that Council would change a proposed ordinance and proceed with re- quired readings over the written objections of its citizens' com- mission without consulting said commission. Following discussion Of position, Hillstrom moved that Commission recamend to City' Council that this amendment be adopted. Motion died for lack of a second. Owens expressed opinion that Checklist belongs in Model Lease, Klaus moved, Cora seconded, that Housing Commission not recommend the Ordinance as Amended and recommend that this be put in the Model Lease. Graham expressed concern that it should not be Part of Minimum Housing Code. Pollock indicated it would be ad- visable to have a Checklist, but that it should not be part of the Code. Motion carried 5/1 with Hillstrom dissenting. VI- HM Allocation for caning year - Seydel presented staff recommenda- tions for 50 units Section 8 Existing Regular, 30 units Traditional Public Housing - New, and 10 units Traditional Public Housing - Rehab• Moved by Klaus that oamnission accept recommendations of staff for housing requests and that Commission recommnends that City Council approve said requests. Second by Hillstrom. Motion carried 4/1 Graham dissenting. Cora moved recommendation to City Council that Resolution and Applica- tion for 50 units of Section 8 Housing be adopted. Seconded by Elmer. Approved 5/0. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 3- 1-25-79 Discussion regarding remain to be discusse VI. Moved by Gib] carried 5/0. W--� Jon Graham, Temporary City of Iowa City MEMORANDUM Date: January 25, 1979 To: Neal Berlin and City ouncil From: Dick Plastino Re: Ralston Creek Koutnch Detention Structure Stanley Engineering has completed the preliminary design for the south branch detention structure. The costs are as follows: Two dams -. $717,000 One dam, 18 feet high - $474,000 One dam, 19 feet high - $507,000 These costs do not include land acquisition or soil investigation. The first alternate consists of two dams as originally proposed. The upstream dam was for the sole purpose of providing an embankment for a subdivision road to pass over. The Planning and Zoning Commission and Planning staff have reviewed this and do not feel this dam is necessary. This alternate will be disregarded since it is higher in cost. The second alternate is for an 18 foot high dam. The design of this dam assumed that the Storm Water Management Ordinance would be in effect upstream. Since the rainwater would be stored upstream as the area developed, the dam needs to be only 18 feet high. The third alternate assumes that the upstream area would not be under the Storm Water Manage- ment Ordinance. By making the dam one foot higher the area can be exempted from the Storm Water Management Ordinance if desired. At this time, Public Works plans to give Stanley Engineering direction to proceed with.final design on alternate number three. At the same time the City will begin land acquisition from the four property owners involved. We will attempt to recover the higher cost of alternate number three by lessoning land purchase price if this is possible. By going to alternate number three, Public Works is not necessarily recom- mending that the Storm Water Management Ordinance not be in effect in the upstream watershed. There are still several reasons for keeping storm water management in effect even with the higher dam. These include: 1. Water running off individual subdivisions may still create a nuisance or cause flooding. 2. The additional storage provided on individual tracts provides an additional safety factor for the large storage dam. 2zy MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES IIOIIIES t 2 A question was asked about the extension of Seventh Avenue to serve Regina land. Plastino stated that he did not know what the intent of Planning and Zoning was on this matter but that it was known that one or more lots at the north end of Seventh Avenue were open until this matter was resolved. Plastino stated he would check on the status of this situation. There was a description of the appraisal process and how an offer would be made to land owners behind the Hickory Hill dam. There was discussion about why out-of-town appraisers were being used as opposed to local appraisers. Plastino stated that bad feelings had developed several years ago concerning local appraisers but the exact details were not known. A question was asked as to whether the area bordering the detention pond along Regina land could be fenced. The answer was affirmative. There was discussion about a sanitary sewer running east behind Regina High School. While the report from Stanley Engineers stated that this sewer could be put in at any time, some members expressed interest in having it installed at the time the dam was being built to avoid possible water saturation problems when water stored behind the dam frequently during the construction season. There was discussion about an area assessment. A question was asked as to whether the sewer behind Regina would cost more than a standard sewer. Plastino stated that it was likely since it would require extra strength pipe and water proofing of manhole covers. A suggestion was made that extra compensation would be due someone for these extra cost items. There was discussion about the extention of First Avenue. Plastino stated that it was the intent of the report to assume that developers would pay for the extension of First Avenue north of Rochester and would pay for any bridge construction costs over the branch of Ralston Creek. A member asked if the general areas of the property acquisition for Regina High School could be staked or a swath mowed through areas where there was only grass. Plastino stated this would be done. The meeting ended on the assumption that Regina Board members would present this information to a larger Regina body and a future meeting or communication would occur between Regina and the City. cc: City Council Neal Berlin Robert Vevera Jim Hall Dick Plastino Bill Sueppel Nory Wagner Bruce Glasgow Frank Boyd Larry Waters Msgr. Cletus Madsen Don Gannon MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES Mo InES 3. Storm detention ponds would aid in sediment control which will prolong the life and minimize maintenance of the large site. At this time, Public Works does not want to make a firm conclusion or recommendation regarding implementation of the Storm Water Management Ordinance. We are recommending, however, that we go with the higher structure to provide us with flexibility. Unless Council advises otherwise, Public Works will take the following action at this time. 1. Authorize Stanley to proceed with final design of the 19 foot high dam. 2. Begin land acquisition procedures. bdw3/10-11 cc: Ralston Creek File No. 18 a PII:ROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES TO: FROM: RE: DATE: January 23, 1979 Neal Berlin/City Council Dick Plastino, Director of Public (Yorks Master Street Maintenance Plan (Needed for`Informal CIP Meeting) Maintenance of City streets consists of mudjacking, repairing and replacing joint seal on concrete streets, crack sealing on asphalt streets, fog sealing, chip sealing, slurry sealing, and asphalt overlay. The City Street Division has a master street maintenance plan which ties these maintenance methods together. For purposes of maintenance we have broken streets into the following categories: 1. Major streets and bus routes (both asphalt and concrete) .2. Residential streets (both asphalt and concrete) 1. Major Streets (both asphalt and concrete) Year 0 - New street. Year 5 - Mudjack and repair joint seals as necessary. Year 10 - Rout out all joint seal material and replace completely. Year 15 - Mudjack and repair joint seals as necessary. Year 20 - Possible end of service life (cheaper to overlay than repair). Year 2T - Overlay with asphalt. Year 23 - Seal cracks. Year 24 - Fog seal. Year 27 - Chip seal or slurry seal. Year 29 - Crack seal. Year 30'- Fog seal. Year 33 - Second asphalt overlay. Cycle continues Please note that asphalt arterial and bus routes are the same as the above sequence, but start 'at year 21 as though it were a new street. This sequence is shown on Figure A for clarity. 2. Residential Streets (both asphalt and concrete). This sequence is much like that for major streets but the time periods are extended. Year 0 - New street. Year 16 - Mudjack and repair joint seals as necessary. Year 20 - Rout out all joint seal material and replace completely. Year 30 - Mudjack and repair joint seals as necessary. Year 40 - Possible end of service life (cheaper to overlay than repair). Year 41 - Overlay with asphalt.if necessary. Year 4S'- Seal cracks. Year 46 - Fog seal. Year 5,1 - Chip seal and slurry seal: 2 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES I40INES -2 - Year S5- Crack seal. Year 56 - Fog seal. Year 61,- Second asphalt overlay. 1 Note: Asphalt residential streets are same as above but begin at year 41 as though it was a new asphalt street. Please see Figure B for a graphic presentation of this. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES 1401NES ■ t FIGURE A Maintenance Schedule Major Concrete and Asphalt Streets and Bus Routes Note: Asphalt arterial and bus route streets are same as above, but start at year 21. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES W u a N 0 New street U C u 5 Mudjack and repair joint seal m 10 Rout out joint seal and replace T U $4 15 Mudjack and repair joint seal m T 20 Possible end of service life (cheaper to overlay Ln than repair) T Cd N 21 Overlay v 0 23 Seal cracks N Cd 24 Fog seal N U Cd 27 Chip seal or slurry seal ro T 29 Seal cracks 30 Fog seal u T w 33 — Asphalt overlay Cycle Continues # Note: Asphalt arterial and bus route streets are same as above, but start at year 21. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES W FIGURE B Maintenance Schedule Residential Concrete and Asphalt Streets Note: Asphalt residential streets are same as above, but start as year 41. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES u u 0 New street u U a 10 Dfudjack and repair joint seal U 20 Rout out joint seal and replace U U U 30 hfudjack and repair joint seal H ro u � 40 Possible end of service life (cheaper to overlay c than repair) 41 Asphalt overlay if necessary H - 45. Seal cracks °. ' 46'. Fog seal Cd u o a m 51'. Chip seal or slurry seal H Cd U T 55. Seal cracks u T N U 56• Fog seal H Cd 61. Asphalt overlay N Note: Asphalt residential streets are same as above, but start as year 41. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES - ) City o4 Iowa CIV. 1 Date: January 22, 1979 To: Neal Berlin and City�ncil t From: Dick Plastino Re: Contour Modelo North Branch Detention Structure The most feasible model would have a scale of 50" per foot horizontally and vertically. This would call for a model approximately 8' by 81. Unfortunately even with this scale the vertical depth of the model would be only *2". The estimated cost by the consultant is approximately $5,000 to $6,000 due to the extremely large size of the model. If such a model would prove to be essential later in the project we might discuss this again but until the need is shown I recommend putting this on hold and will do so unless advised otherwise by Council. jml/10 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 110114ES zz6 RECEIVED .:,., 2 21979 (?, Johnson county regional planning commission 0' 221/2 south dubuclue street, iowc city, iowc 52240 (319) 351.8556 January 19, 1979 Mr. Joseph W. Duncan, Director Office of Statistical Policy and Standards U.S. Department of Commerce Washington, D.C. 20230 Dear Mr. Duncan: Isabel Turner tra,o Emil L. Brandt oww This letter is written in response to the proposed criteria for designation and definition of Metropolitan Statistical Areae that were published in the Federal Register of November 29, 1978. Writing on behalf of the local governments in the Iowa City -Johnson County area, we wish to indicate our concern and opposition to one of the elements in the proposed criteria. We take strong exception to the recommendation that the total population of the SMSA must be at least 100,000 and offer the follow- ing points in support of this position: 1. The urbanized area minimum population requirement will continue to be 50,000. By increasing the total SMSA population requirement to 100,000 from the existing 75,000 minimum the significance of the urban portion of the SMSA is substantially reduced. The urban/non-urban ratio could change from the existing ratio of 50,000/75,000 (or 2:3) to 50,000/100,000 (or 1:2). Since the urban center is the principal focus of an SMSA it seems inappropriate to diminish the significance of the urbanized area. 2. Many important` growing urban centers that had a population in the 35,000-49,000 range during the 1970's and which could be expected to achieve the 50,000 population threshhold in 1980 may never be eligible to achieve SMSA designation because of the substantial increase of the minimum population requirement of the total SMSA. At the same time, some areae which had previously achieved designation but whose populations are still below 100,000 will apparently maintain their designation. The pro- posed criteria will be unfair to many growing urbanized areas throughout the nation. 3. By changing the population requirement outside the urbanized area to 100,000, the potential for treating similar urbanized areas in an incon- sistent manner is increased. The attached graphic shows a hypothetical urbanized area of 55,000. In Figure A the urbanized area is situated in the center of a county with a large geographic area. The area meets the proposed criteria and would be designated as an SMSA. In Figure B the urbanized area and the outlying population are the same as Figure A. However, the urbanized area is near the county boundary and several 227 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140INES 1 2. outlying communities are in the adjacent county. in this case the area would not be designated because of the location of the county boundary, although the population and other infrastructure relation- ships are similar to Figure A. In Figure C the situation is the same as Figure A. However, the county geographic area is smaller, and several outlying communities are situated in different counties. The area would not be eligible for designation. We contend that the above situation is unfair and every attempt should be made to minimize these possibilities from occurring when establishing criteria that are to be used in the designation process. The proposal to raise the popula- tion minimum to 100,000 will increase the potential for these situations to occur. In summary, we feel that the proposed criteria change will lead to unequal treatment of urban centers in the 50,000 - 100,000 population category. The existing 75,000 minimum population will reduce the chances of inequity. we recommend that the existing level be maintained. We also recognize that the original purpose of designating urban areas as SMSA's was to obtain important statistical information. However, to the nation's urban areae the primary impact of the designation has become financial, with millions of dollars in federal and state assistance funds tied to designation status. This fact alone makes it imperative that your proposed criteria treat all our nation's urban centers equitably. As a final point, changing the minimum size criteria for metropolitan areas from that employed in previous census periods will make analysis of statistical trends of the nation's metropolitan areas more difficult and less reliable. We'appreciate the opportunity to comment on the proposed criteria and would be happy to answer any questions you have about our comments. Sincerely, Mary Neuhauser, Chairperson MN/fb CCi Senator Culver Representative Leach L.iowa City Council, Attention: Neal Berlin Johnson County Board of Supervisors Coralville City Council University Heights Council Governor Robert Ray National Association of Counties National Association of Regional Councils National League of Cities, Attention: Craig Caywood MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 3 SMSA DIAGRAMS Below are diagrams of three arrangements of county boundaries around an urbanized area, one of which results in SMSA designation (with at least 100,000 county population) two of which would not be designated SMSA's. I The diagrams illustrate the fact that the proposed criteria would depend more on the arrangement of county boundaries, and the resultant low density rural territories, rather than on the existence of an urbanized area itself. I I COUNTY - �WITH: 3,0000 10,000: • Urbanized Area of 55,000 ;I i • Large Geographic Area O URBA:5� O AREA • Urbanized Area Centered i6.000 " 5,000 I in County; Outlying Com- munities Also Within Same RURAL:15,000 County. 0SMSA? YES ( (TOTAL..101,000) • 3�o i O BI COUNTY WITH: i 3,000 • r :. :) 10,000. • Same Urbanized Area as <I "A", Above URBANIZED I • Large Geographic Area AREA:. 66,000 .>..O • Urbanized Area Off -Center in County; Some Outlying Communities Thus Located in Adjacent County SMSA? NO Ic COUNTY WITH: • Same Urbanized Area As in "A" amd "B", Above • Smaller Geographic Area • Some Outlying Communities Located in Adjacent Counties SMSA? NO 7-27 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 01 3,0000 10,000 0 URCANIZEO - I O AREA: 56,000 :,;, 15,000 5,000, -` - RURAL: 10,000- O(TOTAL: 51000 20,000) �... ..�.�. .—.—.— � -- ..+..� •o . I 3,000 • Urbanized Area Off -Center in County; Some Outlying Communities Thus Located in Adjacent County SMSA? NO Ic COUNTY WITH: • Same Urbanized Area As in "A" amd "B", Above • Smaller Geographic Area • Some Outlying Communities Located in Adjacent Counties SMSA? NO 7-27 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES Bilandic l !ter get tout h on drivers , ltiAb A CANDIDATE for rstleclloo, Mayer llandlc wants everybody to love him. ;•However, being mayor of Chicago requires making some tough and often unpopular decl- fobs. So Ivan though Bllandlc may flak oflenat- Othouurtds of voters, he Is golf? to have baro his teeth and stop trying to be a nice SW whenever an emergency threatens Chica- 110. . He's going to have to atop attempting to toes Chicagnens Into moving their perked on off of main arterial streets after a Sweden. tow SEx f~LeId �hnm�idlatey�ifh�r two or more of new snow have fallen on city. HE'S GOING to bare to get across le the people of Chicago that he means exactly what he says. And that what he U doing is Aidually the heal for all of Chicago. Then, he's going to have to hope and pray that a majority of the people who ordinarily IvnWd vote for him reelection will be fair enough to recognise that what he did was the Only pnmsible remedy for the potential persly. da of the city. In short, Mayor Bilandle Is going to have to get tough. JIY going to have to Inmimt that motorists y the emergency mow routs 0151 hang- ing from lamp posts along the city's major dreets. ' To back up that edict, he's going. to have to siiucate sea atl with a Deet of Mw trucks and lichee -writing police officers that clearly mean business. Sure, we'll undoubtedly whimper andpry at i1reL Wa'o lash out d arbitrary poi tickw 11 seemingly panic at the first glimpse of a snowflake. Bob. BUT IN THE Ing ran, well prommy Bed ourselves graidul for the fact that our main stresta have lass completely cleared of matt right tW to the- avhe. And that the We and commerce ofYba city can con lmu unabated mbsO�Meom ebarderss trnroortatkm system m - Hight now, the emergency sow route eipn -And rin �uellyy donpaam lehe city "rep the regula- tions lnches of &new have take. two or more City Hao didn't dart towing and ticketing cars after the New Year's weekend snow until four or five days later. And this time, the city falhere didn't order tow bucks Into that streets onto leaf Moseley, mane then two do" dW that latest liMard had cranked up. In fact, It was only then that Mayor BI- lendk (huffy tat his pdlenee asst erdatred. aackdown a Ille{aoy parked ea» batause of the (allure rf many molortsle to cooperals In moving the'r auto. BUT BY TBLN, Bundle's pique wick ta- eoapeativa mearhts was academic. Drivers couldn't have moved their can, even If they waisted to. The care were burled along major And the dde streets wars, n blocked by drifts and staoad can, that there would have D rf Aw � /1,2/ - been no place to move them anyway. The time to act should have been Saturday, Jan. 17, while the new fallen crow still was not as deep and had not yet from tortes a conerel►like consistency, lawsm ofab-rare temperatures. And, had City Hall already established is . track record for enforcing its anew parking ban ordinance, motorists would here remade It . their business to get out of the way who* them still was a chance to do eo. However, people had become: convinced that the emergency snow route rake were e joke, bio they I BllendicY wklefy publl- cired pleas kr cooperation unto 0 wu'tdo Late. And by then, moat d the city had ground to a halt 4::! its memo lrensporhlion system was In a masa. ODVIOVBLY. CHICAGO needs a so-oos. tense, comprehensive, emergency, snow re. novel plan that citizens wll! aceept as law. Chicagoans will sufrpart their publicMO cilia if they believe they know what they are doing and are not fighting future storms with - kneegerk rewtiowe Instead of careful plan. Like chodrto, people will try to get iwp with as much a the authorities, will Pant Bat Y bay realize they will be Witais meet of !bass wW go sting with the pWam.• pa my money. Mayer Bllstdle did dimew. strata highly vidble leadrsidp during Dr' dell stnrma. City wnrkam did hreak:OlNr backs trying to dl{ a out. .' r - BUT IT Ig elrvlen !kat there weq!.aw firm master plan to gukle their efforts. Titers was more spontaneity then dralegy. And though the first wine medals In war- time, the second win battlas. And what Is a bfleard but a battle between mankind and Mother Nature? � 22� MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES I40NIE5 IF johnson c aunty, regional planning commission UJ 221/2 south dubuque street, towo city, iowa 52240 (319)351-8556 January 27, 1979 MEMORANDUM TO: Iowa City Council Iowa City Staff FROM: Human Services Project Isabel Turner cm,ra,— Emil L. Brondt e,.t,. 0,,.v Carol Spaziani, Chair - Human services Committee Pam Ramser, Project Director Emil Btandt, Executive Director - Johnson County Regional Planning Commission Attached please find copies of the two most recently completed profile reports on human services in Johnson County, those on Child Care and Nursing Homes, for your review and use. Each report is designed to provide a picture of the human service system in the particular area. The nature of the problem which that particular area of service attempts to alleviate, a descirption of services available in the county, and an analysis of needs which are not currently being met by the system. In December, 1977 you received the first eight profiles: - Counseling - Mental Health -,Substance Abuse - Emergency Assistance to Residents - Emergency Assistance to Transients — Juvenile Justice - Adult Corrections - Protection of Elderly Adults You will be receiving four additional profiles in the next month or two: - Disabilities - In -Home support Services - Neglected/Displaced Children - Family Planning The reports provide an initial description and assessment of the human service delivery system in Johnson County. We hope to use it as a base from which to provide more direct assistance to policymakers and agencies in improving management and coordination of the service delivery system. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES tI01RES 2-229 Mtf- Pel HUMAN SERVICES STUDY Report on CHILD CARE December, 1978 Prepared by: Family and Individual Life Services Subcommittee B Elizabeth Bunge James Harris Faith Knowler Ronald Larson David Schutt Florence Spaine Human Services Staff Marianne Salcetti Pamela Ramser Larry Allen Human Services Project Johnson County Regional Planning Commission 22� South Dubuque Street Iowa City, Iowa 52240 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES II CHILD CARE TABLE OF CONTENTS Page PREFACE............................................................ i GOAL............................................................... 1 SERVICE AREA DESCRIPTION ........................................... 1 PROBLEM DESCRIPTION ................................................ 3 SERVICES PROVIDED/POPULATION SERVED ................................ 8 Family Day Care Homes and Child Care Homes .................. 8 ChildCare Centers .......................................... 14 Ancillary Child Care Services ............................... 18 UNMET NEEDS ........................................................ 21 Child Care Home Providers ................................... 21 Child Care Centers .......................................... 22 GENERAL RECOMMENDATIONS ............................................ 28 RECOMMENDATIONS.................................................... 31 FIICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401NES LIST OF TABLES Page 5 TABLE 1 - Live Births In Johnson County 1972-1977 ........ TABLE 2 - Births in Johnson County Hospital,- TABLE 3 - Iowa City••••• School Census Figures .•••... for Ages 0-5 (197r,-1978) ...... * TABLE4 of Johnson County Population _ ProjectS.ons Ages C to 14 Years.... ......................... ................... TABLE 5 - Responses to Child Care Survey •••••• " ........... TABLE 6 _ provider Fee Structures .-•••••• TABLE 7 - Client Percentiles According to Age ^j .... - and Number of Centers Serving Those Age Groups... **** �I Impressions of ........ { TABLE 8 - Child Care Centers ' ......... Community Services .- 64 W 6 7 10-11 12 17 24 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES IIOINES APPENDICES I APPENDIX A - Child Care Centers of Licensed Early „ •...• ............. ••••••'•' Johnson County•••••• " " ' 35 i 39 APPENDIX B - APPENDIX C - .......... Child Care Survey questionnaires ... and Limit Description of Title XX Program ... of Six Children for Each Child Care Provider....... 47 'f _ APPENDIX D tion of Regulation:: and Programs ...... Descrip .. .. for Family Day Care Homes ..............• •• 49 ; APPENDIX E - Description of Iowa Regulations and Programs for Child Care Centers.-*,****' ' ........ .. 51 56 APPENDIX F APPENDIX G - 4'C's Report on Sick Child Care Needs.... .......• - Local Pediatrician's Views on Feasibility of a Sick Child Care Facility.... 58 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES IIOINES ACKNOWLEDGEMENTS - The preparation of this report would not have been possible without the involvement and support of the Family and Indi- vidual Life Services Subcommittee members. The talent, time, and energy contributed by them were invaluable to the success of the project. Appreciation is also due to the many human service agencies, organizations, and concerned individuals in Johnson County who contributed their knowledge and time to the project and supported us in our planning effort. Finally, we thank the Regional Planning staff for reeffortnabled and support above and beyond the call of duty, which us to complete the report you are about to read. STAFF PARTICIPANTS Emil Brandt Pamela Ramser Marianne Salcetti Bernice Weinberger Larry Allen David Chancey Frances Blommers Ellen Mills Judith Waterman Executive Director Project Director Planning Assistant Planning Assistant Planning Assistant Research Assistant Secretary Secretary Graphics This study was prepared by the Johnson County Regional Planning Commission for the City of Iowa City's Comprehensive Planning Program. It was funded in part through a contract with Iowa City from the City's Com- munity Block Grant allocation. FIICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1101NES 11- �y 6; JOHNSON COUNTY REGIONAL PLANNING COMMISSION COMMISSION MEMBERSHIP Johnson County (5) John Dane Charles Duffy Joseph Marak Donald Schr J. Patrick White City of Iowa City (9) Carol deProsse Dorothy Douglass James Barris Letha Lovelace Mary Neuhauser David Ferret Glenn Roberts Isabel Turner Alan Vestal City of Coralville (3) James Cole William Stewart Lee Strottmann City of Hills (1) Larry Culver City of North Liberty (1) David Roberts City of Oxford (1) Donald Saxton City of Shueyville (1) Jerry Cisar city of Solon (1) Harry Kral City of Swisher (1) Ron Saddoris City of University Heights (1) James Stehbens Universitv of Iowa (1) Richard Gibson Citizens Advisory Committee (1) Herbert Jordan HUMAN SERVICES COMMITTEE Carol Spaziani, Chair Doris Bridgeman Jeannie Williams Russell Prefitt Betty Bunge Gladys Benz Katherine Kruse Rodger Darnell Carol Fracassini David Sc:huldt William Eckhardt Faith Knowler i Nicholas J. Karagan Paul Sandia Jeanette Carter James Harris David Schutt ?tike Townsend Rex Honey Lorada Cilek Margaret Stephenson Lori. Springer i Florence Spaine Susan Simon Kathy Kelly Nancy Warner i Benny Leonard Mardi Cooper Roald Rolfson Andy Anderson Al Colston Andy Burton Verne Kelley Michael Rose Lee Graham Dameron MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140114ES Preface I. BACKGROUND OF THE PROGRAM The Johnson County Regional Planning Commission, at the request of Iowa City, as well as other interested groups in the area, has undertaken a county- wide human services planning program. The program will provide input into the Iowa City Comprehensive Plan in the human service area and will provide guid- ance to other policy-making groups in the community on future directions of social services. Up to 75 percent of the financial support for the planning effort comes from Iowa City Community Development funds via a specific con- tract with the City of Iowa City. The balance of the funding is being pro- vided by the Regional Planning Commission. A Steering Committee was appointed by the Commission in early September, 1976 to develop a preliminary work program and to determine priorities for program directions. The committee met on a weekly basis into December when it submitted recommendations to the Commission. Steering Committee members were: Carol Spaziani, representing citizens; Florence Stockman, representing Johnson County; Neal Berlin, Dennis Kraft and Linda Schreiber, representing the Iowa City Administration; Doris Bridgeman, appointed by Iowa City; Faith Knowler, repre- senting United Way of Johnson County; Emil Brandt and Isabel Turner, represent- ing the Johnson County Regional Planning Commission. Staff assistance was provided by Emil Brandt, Regional Planning Commission Executive Director, and Mary McCue:, Research Assistant. After the work program was adopted in January, Constance Echternach was hired as the Human Services Project Director and Pamela Ramser as Assistant Planner. Ms. Echternach resigned in December, 1977, and Sally Baldus served as Project Director from January through July of 1978. Pamela Ramser replaced her in August, 1978 and is the current director of the program. At the recommendation of the Steering Committee, a Human Services Committee of the Regional Planning Commission was created to provide overall policy advice for the study. This committee, composed of approximately 35 members, includes 1) representatives of local funding bodies, (i.e., Iowa City, Johnson County, and the United Way); 2) human service board members; 3) staff from public and private human service agencies; 4) consumers of services and informed citizens; and 5) representatives of the University of Iowa. -i- FIICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES W II. GOAL AND OBJECTIVES OF THE PROGRAM w I i The goal and objectives of the human service planning program, as recommended by the Steering Committee and adopted by the Regional Planning ' Commission, are: 1 Goal: To make the planning and implementation of human services in ^ i Johnson County as efficient and effective as possible by providing Policy makers with the information necessary to make sound decisions ... about needs and resources for programs such as health, recreation, social services, economic opportunity, education/information and transportation. Objectives: 1. To supply data about existing programs and agencies. a. To provide for meaningful organization of existing data. b. To gather new data as needed to supplement or to fill gaps in existing data. 2. To identify the human needs of the residents of Johnson County i and to determine the extent to which these needs are being met. 3. To analyze and correlate the information on human needs in order to make it useful for decision makers in formulating programs and allocating resources. 4. To establish a mechanism for ongoing I~ 4 4 planning and coordination of human services, to include a way for keeping information on services and needs current and available. r Because the area of human services encompasses a variety of resources, priority areas needed to be set. The Steering Committee used the following criteria in selecting the priority areas for the first two years of the pro- ject: 1) the programs in each area would have some degree of local funding (i.e., from Iowa City, Johnson County, or United Way), thus assuring some local program ` leverage; 2). there was a feeling on the Part of the Steering Committee that .- substantial unmet needs and other related concerns existed in the program area; and 3) the study of the service systems could be accomplished within the time frame of the project. The Steering Committee which organized the planning effort was disbanded after formation of the Human Services Committee. The members of the newly formed Human Services Committee were each assigned to one of the four subcommittees established to deal with the four major areas - under study. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES III. ORGANIZATION OF THE PROGRA14 ORGANIZATIONAL CHART Iowa City (1) Johnson County Regional Planning Commission (2) Human Services Planning Staff (3) Human Services Committee (4) Steering Committee (5) Family & Individual Emergency Life Services (6a) I I I I I Assistance (6c) Mental Health/ Public Protection & Chemical Dependency (6b) I I Justice (6d) Program Development (6e) 1) Iowa City: Contracts with the Regional Planning Commission for Human Service Planning. They receive reports, conclusions and recommendations and regarding programm- ing and funding for human services and can act or not act upon them. 2) Johnson County Regional Planning Commission Is responsible for fulfillment of the terms of the contract. It has over- all responsibility for the results of the study and recommendations made by it. RPC delegates responsibility for carrying out the plan to the Human Service staff and committee. 3) Human Services Planning Staff: , Guides and directs the study, prepares materials for committees, conducts research and data analysis, prepares reports, arranges meetings and carried out reporting requirements. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401NES 9) Human Services Committee: Has overall responsibility for guiding the study, approving actions and recommendations made by the subcommittees and the assimilation of data into a unified plan. The Human Services Committee delegates responsibility for plan development in specific service areas to subcommittees. 5) Steering Committee: Coordinates the work of the subcommittees, consolidates subcommittee re- ports, recommends joint efforts between subcommittees when appropriate, and has primary responsibility for A-95 review. 6) Human Service Subcommittees: Prepare work plans for individual service areas, provides information on data that is available,data that is needed, and appropriate ways of collecting data. Identify existing resources, provide information on how the service delivery system works, and identify knowledgeable people to be brought into the study. They recommend how data should be organized and prepare conslusions and recom- mendations for service areas. Those subcommittees which published reports in 1977 (see below) have also worked to help inplement some of the recommendations made in those reports. 6a) Family and Individual Life Services: Includes such programs as child care, in-home support services, adult day care, rehabilitation, home management/functional education, family plann- ing,'and alternative living arrangements. Has been divided into two groups (A and B) for the second year of the program. Group A has studied the areas of Disabilities, Nursing Homes, and In -Home Support Services; Group B has studied the areas of Child -Care, Neglected/Displaced Children, and Family Planning. Reports to be issued between December, 1978 and March, 1979. 6b) Mental Health/Chemical Dependency: Includes mental health, substance abuse and family, individual, and group counseling programs. Issued reports on Counseling, Mental Health, and Substance Abuse in November, 1977. 6c) Emergency Assistance: Includes short term assistance with food, shelter, transportation, medical care and jobs for transients and permanent residents in crisis situations. Issued reports on Emergency Assistance to Residents and Emergency Assistance to Transients in November, 1977. 6d) Public Protection and Justice: Includes juvenile justice services, adult community-based corrections, and protection of the elderly from abuse, neglect, and exploitation. Issued reports on Juvenile Justice, Adult Corrections, and Protection of the Elderly in November, 1977. —iv— MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIIIES r - 6e) Program Development: Includes development of a program proposal for a human services support 1979 (after of network to begin in July, teinformationof handphase referral stud ' the Human Services Planning Program), Y ofl John- services, and other activities to make the delivery of services in John- _ son County more efficient and effective. s chart is composed of the NOTE: The Steering Committee dealt with in thi Chairpersons of the five sub -committees and should not be confused with the Steering Committee used to develop the Human Services Project - initially. Iv. DATA COLLECTION AND PRIORITIES OF PROGRAM AREAS s collected from a variety of local Data on human services and unmet needs wa resources through questionnaires, personal interviews, and group meetings. t '7` effort was made to use data included in previous studies and surveys, both within es and individuals contacted and the and outside of Johnson County. The agenci !i This information is available methods used are too numerous to recount here. Regional Planning Commission. through materials on file at the Johnson County Reg' The data which was collected has been compiled into fourteen service area profiles, the major sections of which are: Goal, Service Area Description, Problem Description, Service Population, Services Provided, and Unmet Needs. Recommendations were developed from the information contained in the Unmet Needs portion of the profiles. The profiles were then sent to relevant agencies for their review. Corrections submitted by the agencies were incorporated into the profiles. 1. Counseling 2. Mental Health 3. Substance Abuse 4. Emergency Assistance to Residents 5. Emergency Assistance to Transients 6. Juvenile Justice 7. Adult Corrections 8. Protection of the Elderly 9. Child Care 10. Nursing Homes 11. Developmental and Acquired Disabilities 12. Neglected/Displaced Children 13. In -Home Support Services 14 Family Planning Recommendations made for each individual service area gave been assigned priorities by the Human Services Committee, Steering Committee, and Subcommittees. Several general recommendations, relating to all service areas, have also been developed; these are reprinted in each of the profiles. There has been no formal _v_ MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•OES M0111ES ranking of individual service areas against each other. However, of the eight service areas studied during 1977, the area of Emergency Assistance to Transients was informally given first priority. Of the six service areas studied during 1978, the areas of In -Home Support Services and Child Care were seen to be of high priority, while the areas of Disabilities and Foster Care developed as low priority. -vi- MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 6e) Program Development: Includes development of a program proposal for a human services support -- network to begin in July, 1979 (after the termination of this phase of _ the Human Services Planning Program), study of iformation and referral services, and other activities to make the de:ivery of services in John- son County more efficient and effective. NOTE: The Steering Committee dealt with in this chart is composed of the i — Chairpersons of the five sub -committees and should not be confused with the Steering Committee.used to develop the Human Services Project I " initially. IV. DATA COLLECTION AND PRIORITIES OF PROGRAM AREAS -�' Data on human services and unmet needs was collected from a variety of local resources through questionnaires, personal interviews, and group meetings. An --• effort was made to use data included in previous studies and surveys, both within and outside of Johnson County. The agencies and individuals contacted and the I methods used are too numerous to recount here. This information is available through materials on file at the Johnson County Regional Planning Commission. The data which was collected has been compiled into fourteen service area profiles, the major sections of which are: Goal, Service Area Description, Problem Description, Service Population, Services Provided, and Unmet Needs. Recommendations were developed from the information contained in the Unmet Needs portion of the profiles. The profiles were then sent to relevant agencies for their review. Corrections submitted by the agencies were incorporated into the profiles. _ 1. Counseling .I 2. Mental Health 3. Substance Abuse 4. Emergency Assistance to Residents "7 5. Emergency Assistance to Transients 6. Juvenile Justice 7. Adult Corrections 8. Protection of the Elderly 9. Child Care -' 10. Nursing Homes _ 11. Developmental and Acquired Disabilities 12. Neglected/Displaced Children 13. In -Home Support Services 14. Family Planning Recommendations made for each individual service area have been assigned _ priorities by the Human Services Committee, Steering Committee, and Subcommittees. . Several general recommendations, relating to all service areas, have also been developed; these are reprinted in each of the profiles. There has been no formal _v - MICROFILMED BY JORM MICROLAS CEDAR RAPIDS -DES MOINES GOAL To provide comprehensive and consistent child care which fulfills the varied needs of families and their children. SERVICE AREA DESCRIPTION Child care service could be considered as diverse a system as the types of families and methods of care rendered to children. Two-parent households, single parent families, homes with one child or several siblings, homes with full and part time working or student parents - all are groups which have need of child day care. The care of children is offered in a variety of settings. Children may be cared for in their own homes, taken to another residence providing child care, or enrolled in a community child care center. Another facet of child care services is the wide range of ages and growth levels involved in the children cared for. For this reason, child care services must be geared towards various stages of developmental, physical and emotional growth and provide specific services such as after-school care for the older child. Children in Johnson County are cared for in many ways. The care situation usually depends on the particular family and child's needs. A family with par- ents working full time and school age children has different child care require- ments than a single -parent family with pre-school toddlers. Because the care of children is such a diversified service, the following terms should assist the reader in understanding the specific elements involved. When not attributed, the definitions were culled from research into local child care offerings. Child Day Care - The care, supervision or guidance of a child by a person other than the parent, guardian, relative or custodian for periods less than 24 hours per day per child on a regular basis. (Iowa Department of Social Services.) Day Care in a Family Day Care Rome - Day care services for children for a portion of the day, but for less than 24 hours, in a registered family day care home that cares for six or fewer children and meets state and federal child care standards. (Iowa Department of Social Services.) MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES too IBES P I MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 14011JES 2. .j Babysitter's Home - A self -perceived definition developed from responses to the local child care survey of day care homes not registered with Social Ser- vices. Respondents generally felt the care they provided was of a more unstruc- tured sort than that offered in a child care center but still contributed to a child's development - particularly in the area of emotional growth and loving ,. care. (See Child Care Homes - Group B - survey results, P. 14.) Child Care Home - A self -perceived definition from responses to the local _ child care survey. The majority of these homes were not registered with Social Services. Respondents said they provided children with a regime of activities emphasizing physical, mental, and emotional development. A very definite sense of doing more than "babysitting" the child permeated these responses. (See Child F Care Homes - Group B - survey results, P. 13•) Day Care in the Home - Care in a child's own home for a portion of the day, but for less than 24 hours, provided by a person meeting state and federal child ... care guidelines. (Iowa Department of Social Services.) Day Care in a Licensed Center - Day care services for children for a por- tion of the day, but for less than 24 hours, in a licensed center caring for seven or more children and meeting state and federal child care standards. (Iowa Department of Social Services.) Infant Care - A highly specialized and personalized form of care for chil--- dren 12 months of age and younger. While many child care homes and centers care for infants along with other pre-school age children, expansion of infant care services has been identified as a community need. Before and After School Holiday Early Release Child Care - Primarily supervisory, somewhat structured care of children in grades one through six dur- ing those hours of the day when school is not in session and the parents are at work or school. This type of service has also been identified as a community need. While the myriad of services and child care needs may overwhelm the reader, parents are similarly faced with unraveling the service structure to find the most , L - compatible care for their son or daughter's needs. This profile does not intend to define the "best" type of child care available in Johnson County. The purpose of this report is to examine those existing services and outline additional community child care needs as perceived by child care providers and persons involved with the delivery system itself. _ MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 14011JES ■ PROBLEM DESCRIPTION Child care is needed by a family when either both parents or a single parent cannot be at home with the child.because of occupational or school -com- mitments. The absence of the parent(s) from the household for a portion of the day is a growing phenomenon across the country. . The percentage of working mothers in the nation's labor force increased from 35 percent in 1965; to 49. percent in 1976. Forty percent of the children in the United States under age six have working mothers or mothers seeking em- ployment. About 5.4 million employed women have children under the age of six, with this group accounting for nearly two-fifths of all working mothers. of that 5.4 million figure, 2.8 million had children three to five years of age, while 2.5 million had children under three years of age.l .A similar national increase in the number of working mothers-wi th chil- dren three to five years of age is apparent, with a rise from 27 percent in 1960 to 38 percent in -1971 to 47 percent in*1976. The labor force participation_ rate of women with children under three years of age rose from 27 to 34 percent between 1971 and 1976. In 1960, working mothers with children under three totaled 17 percent of the work force. 2, The increasing frequency_of households headed and supported by one par- ent is noted in the Labor Department's repott: _ "Mothers with husbands absent (widowed, divorced, separated) were more likely to be in the labor force than those with husbands, regardless of the ages of'their children. Even with very young children (under six years of age), mothers with husbands absent had a labor force participation of 56 percent. One of. every 7 families in the Unites States is headed by a woman. The number of children living in families headed by women more than doubled between 1960 and 1974. Forty-five percent of the children,born in 1977 can be expected to live in a single parent household be- fore reaching the age of 18.Today, women head more than 90% of single parent families."2 According to the Iowa Council for Children, national statistical pro- jections indicate a 32 percent increase in the number of working mothers with children under the age of five between 1975 and 1.985. 1"Working Mothers and Their children", U. S. Department of Labor, Women's Bureau, 1977, P. 1 "Working Mothers and Tieir Children", Op. Cit., P. I MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 3. V 4. Research by the Iowa Council for Children also found that: In 1975, 39 percent of mothers with pre-school children work outside the home in Iowa. -- About 53,000 Iowa families are headed by women. These families have an average income of $6,000. According to an Iowa Department of Social services estimate, in 1977 there were 100,000 children in Iowa potentially in need of daily child care.3 It should be mentioned here that the actual number of single parent households headed by men on a national or local level was not obtainable. However, newspaper reports of child custody case results around the country indicate that the occurrence of the single father is becoming more commonplace. A profile of child care services in Iowa was completed in 1976 by the Institute of Public Affairs and Administration at Drake University. According to that report, there are over 56,000 working women in Iowa with children under the age of six. The report indicates that, "there is room in licensed center facilities for only 15,032 of these children. The number of children cared for in unlicensed and unregistered centers is not known."3 Statistics on Johnson County's future growth and age breakdowns are available from several sources. These figures generally indicate the child care needs of working or student parents with pre-school age children. A report compiled by Russell Lenth uses an already established percen- tage figure of Iowa City pre-school children and number of working mothers in Iowa City. This figure of 49.1 percent of pre-school children in Iowa City with working mothers, was reached by Dr. Ruth Updegraff in her 1964 study of child �. �. .. care services in Iowa City. The 49.1 percent figure was applied to 1976 school censuses from the ne Tree Community School districts Iowa City, Clear Creek, Solon and Lo . At that the age 1 percent toof six rted in these27 censuses time, there were 4,427 children under as residents of Johnson County. Applying 49 that there were 2,175 pre-school children with working mothers in Johnson County ~ during 1976. 311Child Care in Iowa: A Profile of Services", M. J. Giese, Drake University, The Institute of Public Affairs and Administration, 1976, p. 4Updegraff, Ruth, "A Survey to Ascertain Needs for Day Care Services in Iowa City, Iowa", The University of Iowa, 1964. B4 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DLS MDIMES 5. The 49.1 percent figure was also used as an estimator for the 1978 school censuses of the Iowa City, Solon, Clear Creek and Lone Tree school districts. This computation showed 2,057 pre-school children in the county with working mothers, a decrease of 118 from the 1976 calculation. The above calculations provide only a general baseline estimate. Updegraff's 49.1 percent calibration was derived from Iowa City pre-school fig- ures and the reported number of working mothers in Iowa City. Lenth observes, "...nor does this include children from single g parent/father families, nor children whose mothers go to school. Let us assume then that this is a conser- vative percentage to use.5 1. 1 Updegraff's study notes in addition that, "The U.S. 1960 census showed that Johnson County had a higher percentage of married women in the labor force than did any other county in Iowa. There were, percentage -wise, more working mothers with children under six"6 years of age Another element inthe'likely conservatism of the 49.1 percent figure is'the increase of women "students from .. _.....:.. the early sixties seeking professional careers and using the University's aca- demic resources to achieve this. Other resources indicating the level of child care needs are county birth rates. The Iowa Department of Health's section on Vital Statistics says that an annual average of 1,050 live births occurred in Johnson County from 1972 to 1977. The figures for Johnson County are shown in Table 1. TABLE 1 Live Births in Johnson County 1972-1977 1972 1973 1974 1975 1976 1977 1,079 954 1,066 1,013 1,049 1,148 17 Mercy Hospital in Iowa City also reports a steady eight to ten percent,1 j increase in the number of births for the past several years. University of Iowa Hospital reports a slight decrease in the number of births over the last two,fis- cal years. The majority of Johnson County births occur at Mercy Hospital... Information from both hospitals is presented in Table 2. SLenth, Russell, University of Iowa Statistics Department, ' 6 Updegraff, Ruth, Op. Cit., p. 2 i I i i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES r MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140114ES kf 6. TABLE 2 a•. Births in Johnson County Iowa City Johnson County Mercy Hospital (Excluding Iowa City) Total .. 1976-1977 (fiscal year) 457 641 1,098 i 1977-1978 (fiscal year) 490 693 1,183 .. Y. h � Y University of Iowa General Hospitals 1976-1977 (fiscal year) 372 2 1977-1978 (fiscal year) 355 ! y, While the above public records give specific birth rates, the hospital figures and vital statistics quite likely do not reflect all the births in JohnsonCounty. Those births which occur at home whether by design or accident, b, may or may not be registered with the state's vital statistics department. The Iowa City school census for 1978 notes a definite trend toward decreas- ing numbers of children from newborn to five years. This information is presented in Table 3. pj I TABLE 3 •" ' { Iowa City School Census Figures I for Ages 0-5 (1970-1978) i Ages 0-5 Amount of Decrease •-• 1970. 5,547 104 (1.8%) 1972 5,035 512 (9.28) „_• 1974 4,457 578 (11.5%) 1976 3,828 629 (14.1%) L'. 1978 3,514 314 (8.2%) For children between the ages of newborn and five, the following age break- down was recorded in Iowa City's 1978 school census: Under 1 Year 1 Year 2 Years 3 Years 4 Years 5 Years 576 591 570 603 581 593 TOTAL: 3,514 Figures from the Iowa Office for Planning and Programming indicate a rather .., stable population projection for ages 0-14 in Johnson County for the next forty years. In 1980, state demographers calculate that there will be 5,587 children �. 0 ind � years, 5,481 in the 5 to 9 year age group and 5,066 r MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140114ES 7. from 10 to 24 years of age in Johnson County. The 2020 prediction estimates an increase of 326 (total of 5,913) children aged 0 to 4 years, a decrease of 312 (total 5,169) for ages 5 to 9 and a decrease of 542 children (total of 5,324) in the 10 to 14 year age bracket. These figures are presented in Table 4. TABLE 4 Projections of Johnson County Population Ages 0 to 14 Years* 0-4 Years 5-9 Years 10-14 Years 1980 5,587 5,481 5,866 2020 5,913 5,169 5,324 + or (-) +326 (312) (542) *From-Iowa.Office for Planning and Programming, 1978. _ The various figures of birth rates and population figures discussed on the preceding pages point out obvious discrepancies in available records and .the need -for a definitive information base. It is reasonable to assume there has been no decline of working or student parents with young children in Johnson County. Current economic conditions combined with. the increasing.phenomena of both single parent families and two - career families, produce a situation where the need for child care is not likely to lessen. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES 1 8. SERVICES PROVIDED/POPULATION SERVED The Iowa Department of social Services, Iowa City Office, serving Johnson County (DSS) is the registering agent for child care homes and centers in Johnson County. Local residents offering child care services which are funded through the federal Title XX program in their homes must be registered with DSS. As of October 31, 1978, there were 83 Family Day Care Homes registered with the DSS. There are 142 children in Johnson County receiving child care services through Title XX funding. Of that number, 75 are in Family Day Care Homes and 67 in Child Care Centers. (Title XX figures from September 30, 1976 DSS records.) Child care centers in Johnson County number 33 as of October 31, 1978. (See Appendix A for complete listing.) These centers differ in the type of care offered ranging from structured activities to free play, in the times services are offered.(on a part or full-day basis), and in the age groups served. Of these 33 centers, eight participate in the Title XX program to serve children from low-income families. Some centers accept infants, others do not. Some centers provide before and after school care while others prefer a consistent, full-day pace. Three methods of surveying local child care opportunities were used in this study to determine the availability of various types of care: Child Care Centers: Late last year, a questionnaire was mailed to child care centers in Johnson County. The list of centers in operation was obtained from Community Coordinated Child Care (4 C's). Twenty-three centers returned the survey to form a data base for this group. Family Day Care Homes: Another questionnaire was mailed last year to Family Day Care Homes registered with the DSS. This list of respondents was expanded in August 1978 with an updated list of providers from the DSS, bringing the response group to 35. ChildCom, are Homes: The same questionnaire used for Family Day Care Homes was employed for another child care group. It was felt many children in the community were receiving care at provider's homes who were not registered with the DSS. Reasons for not registering included not wanting to take care of children who were Title XX recipients and reluc- tance to register with a government agency. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401t1E5 9. Accordingly, a sample group was developed from those persons advertising child care services in the Iowa City Press Citizen for the month of August,1978. This "child care homes" group of 19 respondents were asked the same questions as the Family Day Care Home group. A telephone inter- view was conducted as only the respondents' telephone numbers were avail- able in the newspaper advertisements. Several questions to probe the res- pondents about why they were not registered with the DSS were included at the end of the original instrument. Three of the 19 respondents in the Child Care Homes group were registered with the DSS but had not been surveyed in the previous effort. These responses are analyzed with the Child Care Home Group. A total of 23 child care centers were surveyed and a total of 54 residents providing home-based child caro in Johnson County were interviewed. Family Day Care Homes and Child CareHomes The responses of the Family Day Care Homes (Group A) and Child Care Homes (Group B) are shown in Table 5. Both,groups of home providers were asked the amounts of their fee schedules for child care. :results indicate that providers in Group A,and Group B charged a'slightly higher rate for child care funded through Title XX than for care paid for with parent fees. Members of the committee preparing this report speculated that this fee difference may be attributed to the Title XX rule whereby fees are not paid when the child is not at the provider's home. Whereas most providers charge a fixed fee for private paying clients to cover a child's absence, the loss of Title XX funds with the child's absence was cited by sev- eral home and center providers as a problem in meeting operational costs of care as well as budget requirements for such items as food and toy purchase.. Information on fee structure is presented in Table 6. Types of Families Served by Area Child Care Home Providers - Of the 35 respondents in Group A, 20 said that trey served children from single -parent families. Of those single -parents, 25 percent were students and 75 percent were working. Twelve of the 19 respondents in Group B said that they served single -parent families in which 35 percent of the parents were students and 65 percent workers. Of the 35 respondents in G:oup A, 28 said that their clients MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES II0I11ES Questions TABLE 5 RESPONSES TO CHILD CARE SURVEY (In Percents) Family Day Care Homes (Group A) How do parents usually learn about your service? 32 11.4 • Newspapers 60 Other parents 45.7 Friends/Relatives 0• 2.8 4 C's 77.1 • social Services _ 8.6 other sitters 2.8 Posted signs Criteria for accepting or rejecting children? (^ 21 45.7 Age A 11.4 Behavior Parent(s) work schedule regular Parent 28.6 Parent(s) ability to pay 0 Specifies,no infants 14.3 Fulltime children only 8.5 Ceiling of six requirement 22 9 gumber- of siblings. 0 8.5 Never reject any children r- Age groups Served?. - 74 74 34.3 Infants: 74.2 Two year and under 60 Three years old',- 65.7 years old , , ,Four Five years and up (includes 60 after school care Number of families served and means of payment? 79 Parent fees 15 Title XX fees. 2 sponsorship Sliding scale' 7 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401NES 10 Child Care Homes (Group B) 79 37 32 0 0 0 0• 68 47 (^ 21 21 16 I 11 0 11 5 32 63 r- 79 74 74 79 93 4 0 0 MICROFILMED BY JORM MICROLAB ' CEDAR RAPIDS -DES MOIMES 1 - 1 11. — TABLE 5 (Continued) Questions (Group A) (Group B) �_ •'-i How is back-up supervision provided in emergencies? Neighbors/friends 52.4 47 Relatives, 22.9 68 ,Parents make plans 25.7 21 - Other sitters - 8.6 16 I--, What is done when child becomes ill while at your home: '-' Call parent(s) 83 95 Problems in contacting parent(s) in emergencies? None 91.4 84. Participation in job-related training programs? None 64 95 Insured against incidents in- -, volving child care service? No 60 69 Yes 37.1 31 Now applying 2.9 0 Interested in,organizing with other child care providers? Yes 60 64 .. _ Receive requests for services not provided? No 40 26 Yes 60 74 J (of the above group answering "Yes") Weekend care 76.2 71 Care past parent(s) work time 71.3 43 Most pressing problems or needs a as child care provide? i None .. .- .. 34 32 Toys 20 16 iInsurance 11 11 j Parent(s) paying 9 11 .-7 Social Services paying 3 0 . i No answer 9 0 MICROFILMED BY JORM MICROLAB ' CEDAR RAPIDS -DES MOIMES 12. TABLE 6 _ PROVIDER FEE STRUCTURES (With number of respondents for appropriate category) Group A Group B RATE PRIVATE FEES TITLE XX FEES PRIVATE FEES TITLE XX FEES Hourly: 750 - 850 11 5 t $1.00 9 3 3 $1.25-1.50 2 d Daily: i L i Ii hly.rate $4.00 1 $5.00-5.50 3 $6.00-6.75 5 4 $7.00-7.50 3 2 $8.00 2 12. TABLE 6 _ PROVIDER FEE STRUCTURES (With number of respondents for appropriate category) Group A Group B RATE PRIVATE FEES TITLE XX FEES PRIVATE FEES TITLE XX FEES Hourly: 750 - 850 11 5 2 $1.00 9 3 3 $1.25-1.50 2 1 Daily: i L i Ii hly.rate $4.00 1 $5.00-5.50 3 $6.00-6.75 5 4 $7.00-7.50 3 2 $8.00 2 Weekly: $20-25 1 $26-29 11 $30-35 ; . 8 3 11 $37.50. 1 Set scale for more than one child: $40-45 2 (3 siblings) $50 2 (2 siblings) $55 1 Monthly: None gave a mo $100 1 $120 2 1 $125 1 $140 1 1 $150 1 "Two respondents from the Child Care Homes sample (Group B) did not provide this information. fIICROFIIMED ?Y J, -,r.10 MICROLAB CEDAR RAPIDS•DES 140INES 1 2 r- None reported i L i Ii hly.rate L 1 13. included two-parent families, with 15.9 percent of those both being students, - 56.1 percent both workers, and 28 percent with one being a student while the i other worked. Nineteen of the respondents in Group B served two-parent families _ with 5 percent of those both being students, 78 percent both working and 16.3 percent having one student and one worker. Not included in the, tabulation of Group B was one respondent who served 11 two-parent families, but was not sure of the occupational breakdowns. Hours of Child Care Service - The time period from 6 a.m. to 6 p.m. was used as a general baseline of child care operations to correspond with most - parents' working hours. Four of the 54 responding child care home providers offered care outside of this time frame. It appeared those four respondents' hours of operation fit local shift schedules, such as 2:50 p.m. to 12:30 a.m. in one surveyed case. Four respondents from the total group also indicated. that they provide care on weekends or on a 24-hour basis. One respondent who Iy said she was available on a 24-hour basis mentioned that she was assisted by_ � her husband. I—' Nutritional Content of Meals served by Providers- Providers from. Group A and Group B were asked to check items.in the major food groups which they -. served to children in their care. Those food groups were: milk, fruit or l juice, meat or other protein food, bread or cereal, vegetable and butter or margarine. The overwhelming majority (85 to 100 percent for all food categor- ies) answered they did serve food meeting these nutritive requirements. Some respondents noted that parents of infants under their care often brought the infant's own food or formula. -' Both the Family Day Care Home Group and the Child Care Homes Group were asked if they were interested in organizing with other child care providers and what they perceived as their most pressing problems as child care providers. These responses are presented in the Unmet Needs section of this profile. Providers in the Child Care Homes Group B were asked if they considered themselves to be babysitters or day care providers. Of those respondents _ answering the question, ten said they considered themselves babysitters while six called themselves day care providers. The self -defined day care providers ` felt they did more than "babysit" the children. Individual responses included MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MONIES ■ s 14. "Babysitting means sitting the child"; " good care of them and am more Ili take g hes television"; "I try important than a teenage girl who comes in and watc to teach the children something and not let them sit around and watch television "a babysitter doesn't have many activities - I have music, art, story time, etc". Self -perceived babysitters felt they provided the child with a loving, warm and home -like environment. As one respondent said, "Day Care is more impersonal and clinical. It's a situation where many children are engaged in a variety of activities over a structured period of time." B said that they sixteen of the 19 respondents in Child Care Homes GrouptB s have not con - those saying were not registered W1ReasonsDSS, givenwith forinotfregistering included: perceiving the Bidet o registering- limit of six children per child care home as a Social Services ursement1forent TitlerXX Title XX children only; too much bureaucratic hassle: : and registering with Social Services doesn't provide a children takes too long means to improve quality of care or community credibility. It was the committee's feeling in preparing this profile that the comments above indicate a general lack of awareness about the registration process cited state law, a child care home pro - and possible benefits to the registrant. Y lies vider may not have more than six children in his or rT her XXechildren. This rul(See to all homes, including those homes not caring When a home provider Appendix C for Title XX and State Law clarification.) When to care for Title XX registers with Social Services, he or she is not required children as a requirement for registering. felt that more public education is n The committee _.eeded to inform providers registering, such as participaton in the Federal Food Pro - about advantages to meals, provider training programs, and a built-in referral gram for child care m services. A registered home provides system for parents needing child care parents with a degree of assurance that the home meets criteria for standards of care. (See Appendix D for Social Service Requirements of Family Day Care Homes.) Child Care Centers Twenty-three local child care centers answered a questionnaire mailed n late 1977- (See Appendix A for complete list of centers.) These centers offer a variety of child care services ranging from half-day to full-day sessions and MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES ls. from a cooperative arrangement to a pre-school or day care center schedule. Nineteen of the 23 centers said they directly provided developmental education as an integral part of their program; 11 said they indirectly offered a physical health component. Nine said that special therapies (speech and hearing) were a direct service, while four said that these were an indirect component of their services. Nine indicated that they provided social services for the family as a direct component, while four said such services were provided indirectly. Ten said mental health was an indirect component of service; one said it was a direct service. Six centers said career development was an indirect component of service. Nineteen of the 23 centers said that they were not planning to expand services, hours of operation, or client capacity. In order of highest number of responses (in parentheses), the most frequent requests received by the centers were for: all day care (8), be- fore and after school care (8), care of sick children (6), Title XX slots (4), infant care (2), transportation assistance (2), weekend care (1), and summer care (1). Seven of the responding centers had Title XX contracts with the DSS, whiel 16 did not. Two of those centers without contracts noted that they were contemplating application for one. Sixteen of the centers said they have not been asked to refer Title XX eligible families elsewhere. Eleven of the 23 centers said that licensing and review procedures of their programs were conducted by various governmental agencies; nine said their centers were evaluated by the DSS; three were reviewed through state fire inspection procedures and one said it was evaluated by United Way of Johnson County. Seventeen of the centers said they thought a program review was useful. Child care centers registered with the DSS are expected to meet certain standards of operation. (See Appendix'E for list of requirements.) Seventeen of the centers said they did not have a sliding scale fee basis, while five responded that they did have one. Places to which clients with special needs are referred or referrals made when a center is operating at capacity (followed by number of respondents)were: 4 C's (5), Area Education Agency (5), other child care centers (5), and MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MIRES 1 W f; 16. the Department of Social Services (4). The sources of referrals to centers, followed by the number indicating each source, included the Department of Social Services (6), parents (6), 4 C's (3), area physicians (2) and Area Education Agency (1). The majority of clients served by the responding child care centers reside in Iowa City. This is logical, since most of the centers are located in Iowa City. Nineteen of the 23 centers said that less than ten percent of their clients were from Coralville. Those centers located outside of Iowa city cared for children living in the county's more rural areas. Child care center providers were asked what percentage of their clients-� were in the following age categories: 0-2, 2-3, 3-4, 4-5 and 5-12. Table 7 shows the number of respondents indicating what percentage of the children w N1 served is in each age category. The majority of child care centers appear to care primarily for children between the ages of two and four. !-1 Twenty-one child care centers said they served a total of 1,380 children during their preceding respective fiscal years. Twenty-two centers said they Fa cared for a total of 929 children at any given time last year. This averages 14 - out to 42 children per child care center. Fifteen centers indicated they had F� a total of 260 children needing child care services on theii waiting lists. t-1' Conspicuous by their absence in this profile are the comments and con- cerns of parents whose children are in the local child care delivery system. y rl To get this cross-section of responses would have required a full-scale survey which is beyond the scope of this study. �i fd qj { �I I m HI rl M i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES I40111ES 6..A Wmad OWN" Nona PwAmm N� 010" ommm inn" WAMIR 0"" 23 10 9 V0) 9 7 6 C4 5 tw 0 4 3 2 1 of Group AGE GROUP TABLE 7 CLIENT PERCENTILES ACCORDING TO AGE AND NUMBER OF CENTERS SERVING THOSE AGE GROUPS MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MONIES �iGiO��C��iiO u�:��nn�i�i�� nni N 1111111 III oi ��iiiiCi ,inii �l11,E mom MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MONIES 18. Ancillary Child Care Services Several community organizations and groups are involved in the child care delivery system in a more supportive role rather than direct service. These groups assist in improving the quality of child care through educa- tion, actual supplies or providing a support network for the providers themselves. The groups include: Resource Library Project (Toy Bank) A grant from the Hawkeye Area Community Action Program (HACAP) enabled local teenagers to be reimbursed for their toy -making services this past sum- mer. The toys are now part of a Resource Library Project which has recently opened at Center East. The toys available through the resource library are '- geared for learning rather than amusement purposes. Educational materials ' such as peg boards, counting boards, number books and puzzles will be avial- .r able on a check-out basis. A basis problem at the present time is funding for staff. The library is sponsored through the Inter Day Care Council which includes Friendship, Alice's, Boleo, Dum Dum and University Parents child~ care centers. A memo will be sent to child care home providers inviting them to par- ticipate. Toys and materials may be checked out by members for a two-week ti period. A five dollar monthly fee will be required for membership. This will be used to cover breakage and replacement costs and make new purchases.. The center is open twice a week'for three hours each day. Community Coordinated Child Care (4 C's) Four C's began in 1972 as part of a nationwide effort to stimulate citizens to identify and implement plans for meeting the needs of children I in their community and to achieve the goal of quality child care. The 4 C's Committee provides child care information, educational materials, and work- shops to teachers, child care providers and parents. ~ The group's information service includes a directory published yearly with program explanations and a map of the licensed Early Childhood Centers of Johnson County. The directory assists families in finding the child care center which best meets their individual needs. various pamphlets and articles giving criteria of what to look for in good child care are available from 4 C's. The coordinating secretary of 4 C's assists individuals with child care needs or problems. 4 C's also maintains contact with state and national organizations involved with child care issues. i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MoI11ES 19. Projects planned by 4 C's for 1978-1979 are a 4 C's Digest and a series of workshops. The Digest is published quarterly with summarized -, articles from child care journals and periodicals. It also has sections i on creative ideas for parents and teachers and ways to meet specific children's needs. Training workshops for child care providers and parents are given on topics requested by the participants. jAfter -School Elementary Recreation Program (ASERP) The After -School Elementary Recreation Program (ASERP) began after a 1970 Iowa City community survey indicated that young people were not using their leisure time constructively. The program, sponsored by the Iowa City Parks and Recreation Department, intends to develop a variety of skills in children by offering diverse programs such as: soccer, astron- omy, dramatics, puppetry, macrame, and nature appreciation. ASERP is not considered to be an after-school babysitting service since most classes are offered only two to three times a week and end before 5 p.m. There is slight cost for some classes, although program fees for low income children will be paid by Social Services. Some program instructors are paid while other programs are led by volunteers. i The 1978 fall enrollment in the ASERP program was 302 students in grades one - through six. i Johnson County Family Day Care Association The Johnson County Family Day Care Association was formed in August 1 1978 by local child care home providers. A major impetus for the associa- 'I tion's formation was to developa referral network both for providers need- ing children and for parents needing child care. -- An emphasis on quality child care is part of the group's goals in educating both parents and providers according to the group's organizers. Educational information and group support is also offered for provider's with problem children as well as providers' back-up for emergency care. The group is also open to parents. Iowa State University Child Development Training Program Numerous local home providers and child care center personnel have par- . -' ticipated in training programs offered by the Department of Child Development at Iowa State University. The training program is funded from the Title XX formula — grant training program through the Iowa Department of Social Services. Classes I are held durinq the evening at convenient locations throughout the state. Judith Baron is the trainer for the Iowa City -Cedar Rapids area. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES k The training programs cover several areas of child growth and development and are divided into three parts: Creating A Safe and Healthy Learning Environment, Providing Chrriculum Experiences and Nutrition. A variety of equipment for young children is offered on a check-out basis to participating providers. The training program also affords providers an opportunity to meet other persons also caring for children. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES w 20. -- J UNMET NEEDS 21. There are several areas in which a greater number of resources for child care may be needed. These include care of children whose parent(s) work in- volves time schedules which are not the usual eight to five o'clock time period and overnight care for small children and on an emergency basis. Not addressed in the survey is the role of local working establishments, such as factories, in being supportive of working parents with children needing care during odd hours of the workday. The concept of child care offered at the parent's work site has been tried in other cities with varying degrees of success Child Care Home Providers The particular needs and constraints experienced by child care home pro- viders are discussed below. Responses of Family Day Care Home Group A and Child Care Homes Group B from the survey are combined. The question about organizing with other child care providers produced the category of Informational and Support Needs, as expressed by the providers themselves. Informational'Needs included: 1. How to better understand and respond to children's moods. 2. Different ways of taking care of children, providing interesting activities. 3. How to deal with children from broken homes or those going through the upheaval of divorce. 4. Menu planning and different ways of fixing appealing, nutritious and cost-effective meals. 5. How to deal with both children and parents in instances of parental neglect, concerns about a child's cleanliness and health, and/or parents not picking up their children on time or paying the provider regularly. 6. Disciplining older children while also caring for younger ones. Several respondents said they were currently involved with local provider groups such as the Johnson County Family Day Care Association. Their reasons for participating were for exchange of ideas and mutual support as child care providers. A category of On -The -Job Needs was developed and includes providers' responses to the survey question about their self -identified problems and needs. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 22. On -The -Job Needs included: 1. The lack of indoor activities for small children (2 to 5 years of age) in the winter. The Iowa City Recreation Department was men- tioned by several as a service needing expansion to meet these varied demands. 2. The Iowa City Public Library was cited as a service which needs to get out to the people more, particularly during the winter. Providers said the logistics of "packing -up" a group of small children for a library trip discourages usage. The need for a bookmobile was mentioned. 3. Need for a toy bank with play equipment and books along with some means to meet the high cost of replacing toys by the provider. 4. General scheduling of types of activities to motivate children and occupy their time in a learning environment. 5. Expense of liability insurance for providers to cover their homes,' equipment and general premises. 6. Community education about the service demands of quality child care and an appreciation that child providers do not usually undertake the care of children due to profit motivations. Many providers surveyed conveyed feelings of frustration with their work. A sense of being perceived by the general public and even by parent clients as low -skilled workers was conveyed by a number of providers. In actuality, a significant portion of the home providers were previously employed in occupa- tions such as elementary teaching, child development, nursing, nurse's aides and occupational therapy. It seems probable that many home providers left the so-called traditional work force after having a child of their own. Child Care Centers Trends in child care service and problems with delivery were generally contained within a cost versus quality framework. Several centers noted that higher costs of operation proved a problem, with trying to pay staff members a decent wage while simultaneously keeping child care fees down for clients. Ir MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES I 23. A need for a more supportive community base and increased financial support was mentioned, particularly in the area of providing better staff training. "Is the availability of resources keeping pace with the demand for child care and the existing priorities of tax money where child care is concerned?" was a question asked by one center respondent to the survey. Respondents from child care centers were asked to check service, age and income categories based on their impressions of available child care in the community. The numbers recorded in the various sections (see Table 8) indicate the centers' responses in each particular caregory. The reader may note that a curve of sorts developed from the answers. Care for newborn to three years of age was named as a need by a majority answering the question, while care for older preschool children was considered fairly available. Child care needs based on income were not readily known by the center providers. Before and after school care was emphasized as a service available only to some families in the community. The fragmentation of child care delivery is partially due to the nature of the service, the types of care resources and client's needs and care in or centers on a full or part-time basis. However, some fragmentation exists because there is no central, coordinating process which serves parents and providers of all types. Resource Center A Children's Resource Center could address some of the existing gaps in service delivery already mentioned in this study and better coordinate those existing programs. Providers from both centers and homes have expressed a need for more toys and educational equipment. A resource center could house these materials along with nutritional information and menu ideas for home providers. Films, records and tips on how to handle different child behavior situations are but a few examples of the various items that could be available on a check-out basis. It was the committee's feeling that a resource center could also provide local parents with a wide variety of child education material and parenting information. Iowa City is considered a transient community because of the student population, with situations occurring where first-time parents may find themselves without a traditional family network available to answer questions or lend support. some local prepared childbirth classes educate MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES TABLE 8 AREA CHILD CARE CENTERS' IMPRESSIONS OF C014MUNITY SERVICES 24 Variables Available to to all who need it Available to most Do not Know Available onlyto Some Not Available _ Number of People not Ages being served who need 0 - 2 2 - 3 3-4 4 - 5 5-12 0 1 3 qti 1 2 7 12 12 5 2 2 2 1 5 13 10 q 3 q 1 0---- 3 the service I j Family Income Under $3,000. $3,000-$5,000 $5,000-$10,000 $10,000-$15,000 $15,000 6 Over 1 1 2 2 5 1 0 2 6 3 10 12 11 10 � 6 q 2 1 0 0 0 0 ,..i a,�+ I •�1 Before and After �•°f School Day Care' Before School After School Care of 0 0 q 6 10 11 1 p i K,I Sick Children 0 0 i i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES zs. Prospective parents up to the time of the child's birth• Other classes inform par- ents about the first few months of an infant's life and what to expect. Both Mercy Hospital and the University of Iowa Hospital offer prepared parenting courses. University Hospital covers newborn care in two of its five pre -natal sessions which are offered free of charge. New mothers and fathers may attend parenting classes on hygiene, safety and care of the sick child while mother and child are still in the hospital. The Emma Goldman Clinic also offers information to pregnant women about immunizations, childhood illnesses and expected physical and emotional changes in its late pregnancy course. A Resource Center could bring together different spheres of child care in a positive and productive display of community support. Ideally, the resource center could be located in an already existing community facility to promote general accessibility. Care of Sick children The issue of sick child care raises a spectrum of considerations, which can not be resolved with this study or even solved with a single program or Policy. While care of sick child remains essentially a parental responsibility, employers need to be enlightened about the existence of ever increasing numbers of families with two working or student parents and single -parent families. Sensitizing employers to this reality could result in flexible work hours for the parent when the child is ill or utilization of employee sick leave for a child's illness. (See Appendix F for background of local report on sick child care needs). Registration of Child Care Homes While it is impossible to estimate how many private residences are offering child care services and are not registered with DSS, it is apparent that they do exist in Johnson County. Parents and providers need to be educated about the utility in registering with DSS. Parents will then be assured that the home meets a criteria of quality service and providers will be able to participate in services like the federal food program and training sessirns. Registering one's child care home also insures referrals through DSS and a degree of community publicity. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES I401HES a 8 Child Care in Iowa --A Profile of Services, M.J. Giese, The Institute of F ij public Affairs and Administration, Drake University, p.11. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES I40INES 26. L{ In -Depth Child Care Study While this profile attempts to comprehensively examine the issue W of child care in Johnson County, there is a need for an in-depth, scientific study on the matter. A study on the par of Ruth Updegraff's 1969 study on child care is needed, where the findings reflect an empirical cross -sampling of both ! providers and parents. A definitive information base of population figures and child care needs lend credence to a planning process which addresses services in a qualitative, cost-effective fashion. t' Financial Base of Care w� An expanded financial base for child care centers is needed, along with Ci more staff training opportunitiesThere is a limit to what . i parents can pay for child care and a limit to what centers can charge. This Al condition results in facilities subsidizing actual costs b iY paying low salaries to x center personnel. This produces a situation where it is difficult to attract and keep quality+ j staff members. A 1976 survey of child care facilities in Iowa notes, "No r? is benefits whatsoever (health, sick leave, life insurance, retirement) were <a offered to child care personnel in 38.9 percent of the centers surveyed."8 ...( Title XX Changes sd The system of child care fees needs adjustment to include sliding scale fees for families whose income is just above Title XX guidelines. .., There is a need for legislative lobbying to change Title XX billing F, I ,I procedures from a daily basis to a monthly one, similar to the system currently used by residential treatment centers. Centers and child care homes holding Slots for Title XX children are penalized when the child is absent and are not inclined to seek Title XX funds when private paying clients assure a consistent —' budget and cash flow. Transportation - �� Local transit system regulations need to be altered so that children up to six years of age can ride free of charge. Presently, children must be five years or under which excludes children between the ages of five and six served by child care centers and homes. ' T J a 8 Child Care in Iowa --A Profile of Services, M.J. Giese, The Institute of F ij public Affairs and Administration, Drake University, p.11. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES I40INES F 27. Activities There is a need for consistent and conspicuous advertising of events for children, which could be utilized by parents, home providers and centers alike. A community calendar published in the local newspaper on a bi-weekly or monthly basis would alert interested persons. Some child care centers and home providers said that additional children's activities at the recreation center are needed. In addition, a better offering of program activities at neighborhood facilities which are closer to a child's care location would be optimal. Care For School Age Children The need for before and after school care for young children and care on early dismissal days and school holidays remains a key need noted by centers, child care home providers, and local child care professionals. Where this responsibility should be vested is difficult to analyze. Because the schools are a focal point of a day's activity for children in grades 1-6, it seems reasonable to explore the feasibility of offering such a program under the auspices of the school district, or at least utilizing school facilities. Funding such a program would require support of various community sectors: the schools, parents themselves, city government or community service agencies. The After School Elementary Recreation Program (ASERP) is offered by the Iowa City Park and Recreation Department for city elementary school children. However, the program's various activity offerings are not held on a regular Monday through Friday, 3:30 to 5:00 P.M. basis. Several of the homes and centers responding to the child care survey said they do care for elementary school children in the neighborhood. Usually, the provider was already caring for one or two younger siblings from the same family. It is this committee's feeling that the needs of children merit as much thoughtful consideration as those of other age groups. Some members of our community have either made a conscious decision not to have children, already have grown children, or are just reaching a stage of maturity themselves. However, as a community, there needs to be an expanded awareness of what quality child care means and its future impact on the quality of the community itself. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOIRES Priority Problem GENERAL RECOMMENDATIONS Recommendation Agencies Affected Possible Funding Sources The following problems and recommendations relate to all of the service areas studied during the first and second years of the Human Services Planning Project. Because they relate to all areas, they will not be tailored to each individual area. However, their importance to each of the service areas should not be diminished due to this manner of presentation. - - - - - - - - - - - - - - - - - - - - - - - - - - - - COIMfUNICATION, COORDINATION, INFORMATION Inadequate communication and coor- dination among agencies providing service results in inconsistencies, particularly in the way clients with multiple problems are handled. Delays in the provision of service and misunderstandings or disagree- ments regarding service provision may occur when two or more agencies are involved with the same client. Regular meetings among agencies have been attempted but have been less than successful. Organizing and convening such meetings re- quires staff time and effort not available from any one agency. Inadequate knowledge on the part of service providers concerning the functions and programs of agencies can result in inapprop- riate referrals or lack of referral to a needed resource. in addition to clients getting lost in the system and not finding the Agency directors and staff pro- viding similar programs or ser- vices to similar client groups should meet together on a regu- lar basis to: 1) Share information about programs. 2) Explore solutions to common problems. 3) Acquaint them with the staff of other agencies to facili- tate the referral process and increase trust levels. 4) Share information on clients within the confines of confi- dentiality. Human Service planning staff may be assigned the.responsibility for calling and organizing such programs in order for them to succeed. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOISES All public Johnson and private County Re - providers gional Plan - serving John- ning Commis - son County sion; State clients. and federal sources of funding should be explored. i Priority Problem GENERAL RECOMMENDATIONS (Continued) Recommendation appropriate services, service pro- These agency sessions might be vision is often carried out without used to address many of the spe- consulting other agencies which pro- cific recommendations found in vide similar or complementary ser- each of the profiles. vices. The result is that services are delivered with less than optimal efficiency and effectiveness. DATA ON CLIENT CHARACTERISTICS iformation on client character- isLics (e.g., age, race, sex, in- come, residence and problems pre- sented) is not available at the present time through many agencies. As a consequence, it is difficult, to assess portions of the popu- lation which may be inadequately served and for which programs should be developed. Agencies Affected Possible Funding Sources Assessment of data requirements All public Johnson is needed by 1) agencies to and private County Re- assess existing programs and not -for -pro- gional Plan- a) funding bodies to make allo- fit agencies ning Commis - cation decisions based on commun- providing sion, City, ity need. A common data collec- service to County,. tion and retrieval system should Johnson Coun- United Way; be developed which would place ty, United State and minimum demands on agency staff Way federal fund - time and be economical. Funding ing sources agencies should make inquiries should also into systems of evaluation used be explored. for services. Accountability should be emphasized. The Human Services planning staff should be available to coordinate the de- velopment of this effort. MICROFILMED BY JORM MIC-ROLAB CEDAR RAPIDS -DES 110111ES GENERAL RECOMMENDATIONS (Continued) Possible Agencies Funding Priority Problem Recommendation Affected Sources FUNDING General revenue sharing funds should be considered as a possible funding source for many of the recommendations. Wherever possible, recommendations should be met by agencies already in existence. This may involve coordination of existing services, addition of a new program or program component to an existing agency, or shifting the focus of a current program to meet an identified need. It is recommended that a new agency be established in response to an unmet need only when the efforts of existing agencies have failed or when it has been satisfactorily determined that it is not feasible for an identified need to be met through such efforts alone. This approach will help ensure that additional costs are minimized and fragmentation of services avoided. HUMAN SERVICES SUPPORT NETWORK A continuing program to provide support and assistance to local human service agencies has been proposed by the Program Development Subcommittee of this project (December, 1978). This program would assist in the areas of coordination of agency services and data collection (see preceding Recommendations in this section). It would also provide for joint program and budget review by local funders of human service programs. (See Proposed Program for Implementation of a Human Services Support Network for further detail.) It is recommended that local funding bodies share the cost of providing this support network and that they require participation in this process by human service agencies applying for funding locally. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES FIOIIIES W O Priority Problem RECOMMENDATIONS Groups Possible Recommendation Affected Funding Sources 1. Child Care Financing Expanded financial base Expand financing of Child care Available Dept of Soc,Services of child care centers child care centers centers, employ- funds from the Child Care needed. Staff training beyond parent fees ees parents and Financial Assistance Fund and benefits needed to and Title XX. children. (State origin) for pur- upgrade centers' chase of toys, equipment operations. and staff training for .. non-profit centers serving children from low income families. Lack of flexible fee Encourage more Child care Title XX funds. structure for child flexible fee strut- centers, homes, More aggressive local grant care services in ture on providers' employees and, seeking. centers and homes part and match this ultimately, Increased disbursement of for low to moderately with additional children and state funds. low income families. fiscal support. their families. Better community linkage with program and staff offerings through the University of Iowa Education Department. 2. School-age Child Care Existing demand for and Better inform and Young children Volunteer involvement. apparent lack of educate school of- with working Parent fees. ' . before -and -after- ficials, parent- parent(s) City and County participation. school care for child- teacher organi- needing this ren in grades K zations and parents type of care. through 6 throughout the county about the School districts. need and shared responsibility among these groups. (over) r — MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES NOIRES w r Priority Problem RECOMMENDATIONS Groups Possible Recommendation Affected Funding Sources School-age Child Care (cont'd) Lack of consistent care Explore possibility of Young children for children in those after -and -before- with working grades on holidays and school time programs parent(s) early dismissal days. offered under the needing this auspices of res- type of care. pective school districts. School districts. When feasible, explore possibility of flexible work times with area employers. 3. Infant Care Apparent lack of accessible and personalized infant care. 4. Coordination of Community Resources Lack of coordination and availability of children's materials, toys and educational material for child care providers and parents. Volunteer involvement Parent fees. City and County participation. Encourage receptive Working and Parent fees. child care providers student families Title XX. ! to offer infant care with babies. Possible 4 C's involvement through training Child care pro- Use of existing agencies programs and com- eiders. hospital programs and hospi- d munity support tal programs. Training through the Title XX form - Better publicizing ula grant for providers. t of already existing ' infant care services Children's Resource Child care Volunteer support by users. Center (see p. 23 for homes, child United Way. further explanation). care centers, City and County participation. parents, 4 C's workshop program on providers. child care N r - MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIRES Dow 1 Priority Problem RECOMMENDATIONS Recommendation Groups Affected Possible Funding Sources - I Coordination of Community Resources (cont'd) Need for parenting Children's Resource Child care Volunteer support by users. education on infant Center (see p. 25 for homes, child United Way. and young child further explanation). care centers, 4 C's workshop program on care. parents, child care. providers. Need for an Better coordination Child care accessible community and distribution of providers. calendar publicizing information through Children and children's events. existing community their parents. i publications. "- Insufficient More offerings on a Child care User fees, possibly through recreational act- city and county basis providers. parents and Title XX. ivities at existing Children and City and County participation. ,(particularly indoor, wintertime) facilities. their parents. I for pre-school age . - children. 5. Child Care Home Registration Non -registration with Encourage registration Home providers. Dept. Soc. Services Dept of Soc Services of through community Dept Soc Services. many existing child education, training care homes in sessions and publicity Johnson County. about benefits like the Federal Food Program for home providers. W W (over) f' MICROFILMED BY l JORM MICROLAB CEDAR RAPIDS -DES 140PIES .. MICROFILMED BY JORM MICROLAB CEDAR k`PIDS•DES MOIRES Groups Possible Priority Problem Recommendation Affected Funding Sources 6. ,Title XX Fees Impact on operations Work to legislatively Center and home with loss of money change Title XX fee providers. incurred by child care structure from a daily Dept. Soc. Services center and home to monthly basis. providers when a Title XX -funded child is absent due to illness or personal reasons. 7, Sick Child Care Lack of care for sick Sensitize employers Parents, employers, Existing agencies and convalescing to parents' needs. providers, general children. Encourage existing community. health care and home service agencies to address this need. 8. Transportation Children between the Public transportation Child care homes ages of 5 and.6 years regulations be changed and centers, are not eligible for to allow free bus children and par - free bus rides with the rides for 5 and 6 year ents. public transportation olds - system. MICROFILMED BY JORM MICROLAB CEDAR k`PIDS•DES MOIRES APPENDIX A LICENSED EARLY CHILDHOOD CENTERS OF JOHNSON COUNTY* W N *Prepared by 4C's Community Coordinated Child Care of Johnson County MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIIIES Axces Bijou Boleo Childoaro Chilaoris Christian College Street Coral Nursery Durn-Dum . Eedescbool Cooperative Cama Garden Preschool Coop Playgroup Day Care Childcare Coop 1107 Kirkwood CL Day Cara 113 Varsity Heights 617 Brown W. Melrose and 320 E. CNlege Center Inc. 309 Wiese Ave. Karen, Eadns Center (E. end of Melena Kay Acherson Mamon Trek Tri. Episa Church 8G6131h Ave. Greg Lowenberg 337.2644 121 htelrese Ave. UMV lot 26) 3389555 (Christ King Ch( Marloda Cramer P.O. Box 5703 3535771 Su%nn OePrnrga Wmitcon T. Jaimt Hail. Ci:. 3370331 Cof,dwIli 353.6714 McClinton Ann Hasse, reg. Vicky Pari Dir. 3X14G58 337.3796 354.5650 We -la. Licence 81187.70 current Feb 1978 current. current current current.,..-.., current- -..._, No. of Chlldrdn 15 20 30 16 25 families 30 20 75 _._._ ... Age Range 7 m yrs 3.10 yrs 2-6 yrs. 3-5 Via. 2mo:5yrs. 3yrs.• 2.6 yrs. 2'6-6 Vs. Kirdagaden _ Houm Open 7.00 am -5:30 Pm 7:30am-Midnight 0:00.11:304m(ext. 9:0011:30am 9:0011:30 am 7A0 am -5:30 Pm 7:30 am -6,00 pm 9:00 111TI-3130 am to 1:00 at) (12:303:00 sm. Ext. tyre - MWF catty) belureialla Days Opnd hl -F F M -F M -F M_ M -F M F - M.F ►h!llha OPan 12 12 IO Seol-May ._. 9 (snmm. Pass.) 12 .-.--, -_12 1015 Artangements: yoslyas yns'yes yesyes Rh am 3 yrs. ynslyus lull Pm0 any yns!ycz yosycs Part OaylVitWr MWF am 3 A 4 yrs. MWF pm 4 yrs. Eligibility pai health lam, laid• medical term and ioilatdranah modlad lam lalel-Irainad Inuuly bwobnrnanl medical loan, POPcy' participation (rained. neceptanco immunization medical tom medal ram interest to cwp day irderviow by membership rme Food SeMce arrvpm snack. am,pm,evotmackii lunch,snack snack em snack am.'pm snnL6 bicai.lasl. noon am!lxn snack been meal lunch A_dnner ^_ nuon,moal amtPot snack FoNChlld -- •_•---5251monl'n duos-__S351tnwlh Mraio contribution 5120imonth $45'm.3 -day 3-doy S Jany $ $4g Pad ante soSO$37,01 S651mo lull wk .._._-. _ _..._..__.__..._ _ _ ... ......-. . _ Required Work wotki:g with adrk.ae voluntary childcare volunteers welcome Y tail teens Required nine G hr:Jwcak'lamily 4hrsA-,ccipmm,'l Iam'week 0.10 hrsiwrek .. ....... ._ ._ Required— workdays par R.)ub Reid lops R allnnl meviitgs dr_.____.___._.__.__._____...colymmdinga monthly work nrnlod monlhl Olhcf —'—.•_.----- 4.8 hrsmwth VwOe varies 12hwtslwo-k ktaVWftl Tlme • ImmuMzellan required for all children over 18 months attending school or center. W N *Prepared by 4C's Community Coordinated Child Care of Johnson County MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIIIES APPENDIX A (Continued) Early Friendship HACAP Feith HACAP Happiness is Happy Timm Jack and All Kirdedarm Childhood Day Care Comer UNled Head Head Sian Preschool Preschool Nursery School R.A4 Education Cantor 127 Malrose Siad CeNor Preschool 601 Green Acres Dr. 2934 Washington 1214 Highland Cf. Phyllis Tucker U at 1. Jacque Kunis 1609 DeForest Cantor Salon, Iowa 52333 Manonno Lake Petition Cushing 351-3458 207 North Hall Ann Rosen Carol Chadwick 525 W. Benlon Pal ken Joyce Ward 338.3890 Jan Cronin 353.6033 330.0041 Carol Framssirk Carol Ni.hol 337.4234 school 353.6971 351.8550 644-26431644.2615 081&4& License curere current current current current current currant current Mo. of Cuptlnn 8/ 30 15 50 18 18 de 37 Ape flange 2 mo -5 yrs 2.5 yrs 3.5 yrs 2-5 yrs 21h-5 yrs 3W-5 yrs 3.6 yrs 3.5 yn Noun open 790 am -5:30 pm 7:00 am3:30 pm 9.00 m 1:00 pm 8:00 am4:00 pre 9.00.11:30am 9:00-1 t:30 am 6:30 am -5:30 Pre 8:45.11:15 nm fulli 8:30.11:30 am Pre• 1:003.00pm school 190.4:00 pm 4 Ins D!L'l Ope^ M -F M -F 2daysMk M -F 1/-F MWF; TTh MF M•F �^Ns^ As but Aug 12 _ 35 Wks _ _ Septi 1 -July 15 9: summ sesxion 9 12 11 Arrangements: Part DayfWak daycare—lull limo yds'yes mkno nano yes/yes yn-slyes yes;Yes. y s e y s'yes only; prerrhod-5 dayiwcek E11plEl'lti, Polley- meecallarm,sops. todal-Immed las income family requires full tolet-trained, mod. medical form toilet -trained medical tare means only Mar;Apr _ day Cara: law In, Ical lorm, family Info. tomo, phys. exam Food SoMe, m'pm snack am'pm snack am snack oreaklst, noon meal snack snack lunch am/pm snack noon rtical noon mcal norm meal am'pm snacks nmlgn snack FeWChild Eaycaros100'mo s128'mofull no lea Ives or sliding amid $3.00'session _,- $2.751Sossion $I IS'mo $751mo 5 -de Preschool 5150'sam s70imo—am S&Wwk1day s75/halFhme s45'mn 3 da y IM Parunt Want BYy Pu poraop,76on volurdears welcome oncaumged Required Time panicpalim _... _._ _.. .... _ . Required— 2 pnnchild edue. volunlary bus sm. remit, other honovis,Wnrionth M. d. fat I Rsqulred Time t , Immunization required tor WI children a,, 18 months adendirg school or tamer. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOPIES W ch APPENDIX A (Continued) ''. w...... ,.n r: ,vd� n 1. r..f .'..lance aver IB n•,•ntbs utlendinq uher4 nr cmba MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOPIES W J The Little Melrose Day Monlessori School Nanne and Nelson Play and Play School Preudl School Proschooi School House Care CONK of have City Poppies House Devolopmemal Learn 2803 Wayne Ave. of Music Developmental 901 IS; Ave. 701 Mdroso Ave. Inc. 312 Main, Box 44 Center 230 W. Main Sl. Ju;,,,o Emda Morning pro0mm Class G. Drain+udl BoM2e Afro 502 Nerw Hills, Iowa 52235 114 2nd Ave. Solon I.wa 52.333 330.4444 534 N. Jdmcnn Horace Maim 351.5618 33d•1605 Sa¢Irn Honey May L. Harman Caald;052241 Ellen Skwt Dais P,Nrc'I School 338.9650 679-2080 Mary Green 644.3850 Yywma O.::i:n Lym111anson 351-2.5:0 337 4766351.5927 337.4131 Dow -In. License current current current in process current c'.rrC01 _ current p.WA'rg I.C. Pub. Grhad Y.P. of Children 60 40 96 20 17 44 20 10'rlass A9 il eFm� o 3 yis-kmdergatlon .._ .. _..__ ...__..... 3-5 yrs .... ._.. 244.6 yrs all ages __.._.._..__... hin h.21yis 2.6yrs .. _.._... 2%4.6 yrs ....._ ... _. 3'h-5 Y. __. .. .re .... _.. _. 3.7 yrs _ __. .. _._...__.._.... Hours Open 6:30 am -5.30 pm 7:30 am. UO pm 8:00 am.990 pm 6:00 am -6:00 pm. 9.00 Am -5:00 pm 9:00.1190 am, 7:15 am-S3U pm 9:0011:30 am 900.11:20 nm 12,103.15 spoor art. pmschool: pm _. 7:30 am -5:30 pm Days C•pen M -F M -F __._. M -F____ _ M -F M -F M F ....._ M -F .. M:1- M-1- Gor.02 Open, . - 12 12 91summ 6weeks) 12 9(summ.8 weeks) 12 12 Srpt•Jmw Sopl-Juno ye.yos Yosho yeti yosfycs mono panday, weekly yesino MWF. TTh Ian Doylft3k ............. .._ ..._ _.. _.._ G0bil4y I61et4raimw mcd,al ram, lo'm•Im'nOd. medical farm reflected, smanly med'ed form medical form modiml term rater to spec 1M. PaOcy mad00f lata immunization card medical farm hunkanup'A Iilware, emphasis eaed, Grant Woad A.E.A., PAM Green gen. m slim 351.2510; dew. - delays in I Or moo areas Food Sarvice_amrPm snack amlpin snack amlpm snack oreukfasl. now norm m,ral nrNpm snack Prwpm snack smack snacks .. - noon weal lawn meal mow. supper nuohmual none meal FewCMld $120mu lull $120 mu full varies; SS'day I chat ou lee 52.50 am preschool $11 Slmo full -limo S451mu3-day 590imu ball with $721mu half -days $1440iyr ext. fire $7,day 2 that $500 full day $7750Imo half. $30:mo2•day lunch S445.5G'yr 34v, 3• SlWday3 ehd S2.50 2nd child days, lull week day (call la dalais) . ;. ._. .._-. _. .__._:.._.. Bcnnned Werk ... .,-.... voluniearswelcono ,._. _........__._-..--_.. voluntewswelcome maillleW Ca _..._._______.____...___.... .--" — . . .......... visit, volunteer f:. Pa.. ni t,,:.;.., vA tun,. _I work day Y<_.. 1, .,-1- pmunt advis. rip. infants: lanmla, parent imohonerl Anand weekly violin ...., Immvo. I ncomagrd food, dinpors encouraged Insson(:10 mn) sVbcal do teals p....:. A Umr ''. w...... ,.n r: ,vd� n 1. r..f .'..lance aver IB n•,•ntbs utlendinq uher4 nr cmba MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOPIES W J APPENDIX A (Continued) ��: ..�: �i .�1 �r '.�� ._.�.. ,_�. ..�, ...marl r.�1 er•rmd L!� � r: MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1'I0I11ES SwNo Stepping Sunnyside Title University University Willowmnd Registered Planned Stones Preschool Preached Parents Care Preschool Shod Day Care 1006 W. Bordon Preschool Inc. 2914 Eastw•,od 521 N. Dodge Cotl�c wo 212 Myme 416 E. Feirchilo St. Hanes Apt. E-109 29116 Raven Margaret Davin (Horace Mznn 221 Monaco Ave. Kav Pledger Barbara Schold Johnson County L'ovla Williams (Truely Rimd Chi 338.4508 Schad( Susan Ullcdahl 3534387 338.6061 Social Services 338.7471 Shirley Myers Dorothy Honderson 359.5715 Brenda Williams 338.9855 am, 337.4131 351.0200 351.5672 pm Dstals. License cun.nn cuneni current current mount in procros Ito. of Children Issossim . M'7,T-27, TTh-21 iB . _ .. _- 30 20 26'session _ _ 2630. (_&hone Age Renge 2ta-5 yrs 3.5 Y's - _9:00.11:30 3.5 yrs _ - 4yrs by Rnpt. 15 _-_•11 yrs, 3.5 via 513Yrs all ages Nature Open 90611:30 am 9.11:30 am am 9.0011.20 am 7:30 am -5:30 am 9:001100 am 8:30 am -5:00 Pm varlea - 1:00360 pm 12:30,10pm coop 1:003:30 pm Oeya peqn WF M -F MWF, TTh groups MTh 8!•F FA -F MT _ ver es 3-. Month Open .-!lwmay Scpt.May 9 9 12, Supt MaV-_____• 9: summer season vanes Arrangements: full-time; TTh; MWF UNT'485yrs yesyes yeslyns yeslyes full time to 3 30 Pm .port OsyllVeek TTh 384 yrs _. ... __... .. eat. to 5.00 opt. EIIgiDIIl1y lald•tmtned, lulnt trtdnod, tdlet-Ira'ld, lice in Tttla l school totettrained. Ioi1d•hamed, all welcome up to can fa filling at ' Policy. medical form medical form mrdicnl lam neighaahood medical lam medical lam quota homes -' • - Food Seton drinks at snack time am snack nutritious snncks . _ breakfast, noon ....... . snack _.___....... _.._.__ - meal, arrepm snack FealChlld 3251mo 2 -day 3162,scm. 3 -day 3250sessim no lou S10mino wok Vhfine 3 -day 31.103lchd S35'mo 3 -day $ 1081som. 2 -day; 545lmo3hrwmJJwk $2350'mo2-day $100 ervoll. leo 161 3571mo 5day coop: 3251mo 6 hr wcrWwk 326.501mo 3 -day yr :... 370,uam. 2 -day coop $117;sem:3-daY __--. --.--parent .. _ Required Work . _ _._.._. ` snacks on totaling coop only assist in Involvement s -:o loo'child Pm coop casslon occaslmal help---__—_ Pwent basis srhud encro,aged .. only askod Requlrad 7112e4:61anoslsam, 64 n1t.'sem Required— btmontMy • monthly moutinga Other mcc!irgs, furnish ... I —�... smnak • Required Time .. vadas I -Immunization required Int an children ova 18 months attending school or canter. I' co ��: ..�: �i .�1 �r '.�� ._.�.. ,_�. ..�, ...marl r.�1 er•rmd L!� � r: MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1'I0I11ES APPENDIX B CHILD CARE SURVEY QUESTIONNAIRES Family Day Care Homes, Group A 1. How do parents usually learn about your services? Newspaper Department of Social Services Other Parents Friends Other (Please specify) 4 C's (Community Coordinated Child Care) 2. What criteria do you use in accepting or rejecting children? 3. Please check below to indicate the age group(s) you serve. '2 years old or younger 3 years old 4'years old 5years old and older 4. How many single parent families do you serve? # a. Of these, how many parents are students? # b. Of these, how many parents are working? # 5. How many two-parent families do you serve? # a. Of these families, in how many are both parents students? # b. Of these families, in how many are both parents working? # C. Of these families, in how many does one parent work and the other attend school? # 6. Please indicate the number of families who pay be each of the following means: Parent fees # Donations # Title XX # Other (Please specify, if known) Sponsorship # MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES IIOINES 2) Day Care Questionnaire 7. Please indicate the amount you charge for each of these catagories: Private Title XX Other Per hour Per day Per week Per month 8. About how much time is spent each day in: organized Activity (e.g., story time, group games, are, skill development) hrs. per day Free play hrs. per day 9. Hours of operation: (be sure to circle a.m. or p.m. for each line, for example: Sun. 9 a.m./p.m. to 2 a.m./p.m. Sun. a.m./p.m. to a.m./p.m. Mon. a.m./p.m. to a.m./p.m. Tue. a.m./p.m. to a.m./p.m. Wed. a.m./p.m. to a.m./p.m. Thur. a.m./p.m. to a.m./p.m. Fri. a.m./p.m. to a.m./p.m. Sat. a.m./p.m. to a.m./p.m. 10. How do you provide back-up supervision in case of an emergency (e.g., bing ill yourself, a child needing emergency assistance, etc.)? 11. What do you do if a child becomes ill while in your care? What problems have you had contacting parents in emergencies? (Please specify) i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MINES 40. h.! ■ 41. 3) Day Care Questionnaire 12. Have you participated in any job related training programs? Yes No If yes, when? ____19_ Month Year What was the subject of the training? Do you think you would benefit by more training? If yes, in what areas? Yes No 13. Please check the items which are included in your daily nutrition program: Milk Bread or cereal Fruit or juice Vegetable Meat or other protein food Butter ormargerine 14. Are you insured against incidents involving your day care service? Yes No If yes, please describe the limits of the policy. 15. Would be interested in organizing with other day care providers to... Exchange information Yes No Discuss methods of providing service. Yes No Other Yes No If yes, please describe. 16. Do you receive requests for services that you do not provide, e.g., ex- tended hours, weekend services, emergency care for sick children, finan- cial support? Yes No If yes, please specify the type of request. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MONIES 4) Day Care Questionnaire 42. 17. What are your most pressing problems or needs as a day care provider (e.g., liability insurance, fee collecting, play equipment, emergency relief)? 18. Do you consider yourself a day care provider or a baby sitter? Day Care Baby sitter 19. Why? 20. Is your service registered with the Johnson County Department of Social Services? Yes .. No 21. If no, have you considered registering? ... ,. ..Yes .. No 22., If, no, why? Thank you again for. your time and effort in helping us address day care needs. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401NES 1 A u N .n -fl B U g 4) Day Care Questionnaire 42. 17. What are your most pressing problems or needs as a day care provider (e.g., liability insurance, fee collecting, play equipment, emergency relief)? 18. Do you consider yourself a day care provider or a baby sitter? Day Care Baby sitter 19. Why? 20. Is your service registered with the Johnson County Department of Social Services? Yes .. No 21. If no, have you considered registering? ... ,. ..Yes .. No 22., If, no, why? Thank you again for. your time and effort in helping us address day care needs. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401NES 1 t. 43. CHILD CARE HOMES QUESTIONNAIRE, GROUP B NAME OF AGENCY 1. PLEASE CHECK THE FOLLOWING DAY CARE MIPONENIS YOUR PROGRAM PROVIDES: DIRECT INDIRECT Developmental Education (i.e. dealing with stages of dev- elopment) Physical Health (nursing, dental, nutrition) Special Therapies (e.g. speech and hearing) Social (social services for the family) Mental Health Career Development (specialized job training for adults) 2.. IS YOUR PROGRAM CONTEMPLATING EXPANDING ANY OF THE FOLLOWING: services (see question R1 for services) yes no hours — — capacity IF YES ON ANY OF THE ABOVE, IN WHAT WAYS AND TO WHAT EXTENT? 3. WHAT REQUESTS FOR SERVICE DOES YOUR PROGRAM FREQUENTLY RECEIVE BUT DOES NOT PROVIDE (e.g. extended hours, weekend services, before and after school ser- vices, emergency care for sick children, applications for Title XX families) 4. DO YOU HAVE A TITLE XX CONTRACT? yes _ no IF YOU DO NOT HAVE A TITLE XX CONTRACT ARE YOU CONTBIPLATING APPLYING FOR ONE? yes _ no _ Approximately when? 5. HAVE YOU HAD TO REFER TITLE XX ELIGIBLE FAMILIES TO OTHER PROGRAMS? yes —no IF YES, APPROXIMATELY HOW MANY AND/OR FOR WHAT REASONS? 6. WHAT PROBLM DO YOU SEE WITH TITLE XX DAY CARE PROVISIONS IN JOHNSON COUNTY (e.g. transportation, fees, location of day care centers with Title XX con- tracts or problems in the Title XX contract itself)? MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 7. WHAT LICENSING AND REVIEW PROCEDURES ARE DOES THE REVIEW AFFECT THE QUALITY OF YOUREQUIRED FOR YOUR PROGRAhf7 HOW R PROGRAM? S. DO YOU THINK THE REVIEW IS USEFUL? yes no =i PLEASE ELABORATE (e.g. how would you change full) the re ieiv to make it more use- " v i 9. APPROXIMATELY WHAT PERCENTAGE OF YOUR CLIENTS FALL WITHIN THE FOLL01VING CATEGORIES (If data is not available, or if a reasonable accurate estimate cannot be made, Please indicate)? Source of information (Please check) estimate A. AGE case records 0-2 _ 2-3 _ 3-4 _ 4-S _ 5-12 _ B. TOTAL FAMILY INCOME Under $3,000 _ $3,000-$5,000 _ $5,000-$10,000 _ $10,000-$15,000 $15,000 $ over _ Don't Know _ (not required) C. APPROXIMATELY WHAT PERCENTAGE OF YOUR CLIENTS RESIDE IN THE FOLLOWING LOCATIONS? 1. Iowa City _ 2. Coralville _ 3. University Heights _ 4. Small Cities (e.g. Hills, Oxford, Solon, Lone Tree, Swis North Liberty, act.) 5. Rural non -city her, 2 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 44. 9 `1 "I P4 ni r� 45. ba 0 � ,cu 1 9-'19 0 4) O N 0 A N xu o F j I. N o a�ooZ ,Cl 1�.� p oM� O o O 0 U U ' a N Lr7 0 2 Q w >1 = .IG0 N )y H M •--i Va 1 va 1 O O Ca V7 9" O w H N N N w F O O O O F 0 cd F v 0 ri •el 6 41G O O O 0 0 0 d d o 1 1 i 1 1 E .. .. In W ,>; W O OH CJ � Q W PQ j tu 4�.{1 cFy O j W *Mia G1 +Hia VY PQ f H A U N Ij 4J a9 0 a� K F ¢cdrq r Ni 45. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES M 1 O 0 o F j I. N ,Cl 1�.� O o O 0 U U Lr7 0 = .IG0 N M M tla Va 1 va 1 O O Ca V7 9" C W w H N N M V m N H F O O O O F 0 F F �(y� O F •H N ri •el N O O O 0 0 0 d d F N 1 1 i 1 1 E 10 In W ,>; W OH > PQ j tu 4�.{1 cFy O N M v IA W *Mia via +Hia VY PQ f m 6 U MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES M RETAKE OF PRECEDING DOCUMENT JORM MICROLAB TARGET SERIES MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES 110INES 0 10. PLEASE CHECK YOUR IDIPRESSIONS OF THE DEGREE OF AVAILABILITY OF DAY CARE FOR THE FOLLOWING GROUPS. YOUR IMPRESSIONS OF THE CMUNITY Variables Ages Approximate nwnber Available to of people not being all who need Available to Available only served who need the it most Don't Know to some Not Available service 0-2 2-3 3-4 4-5 5 -12 Family Income Under $3,000 $3,000-$5,000 $5,000-$10,000 $10,000-$15,000 $15,000 $ over Before and After School Day Care Before School After School Care of Sick Children 3 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES NOINES 46. 11. WHAT KIND OF SERVICES IVOULD YOU LIKE TO HAVE AVAILABLE IN THE CO,MIUNITY THAT WOULD IMPROVE THE SERVICES YOU PROVIDE? 12. DOES YOUR PROGRAM HAVE A SLIDING FEE SCALE? 13. a) HOW MANY CHILDREN WERE SERVED BY YOUR PROGRAM THE LAST FISCAL YEAR? b) HOW MANY CHILDREN CAN YOUR PROGRAM SERVE. AT ONE TIME? c) ARE THERE CHILDREN STILL WAITING TO ENROLL IN YOUR PROGRAM? ..........IF'YES; HOW MANY ? 14. IF CLIENTS NEED REFERRAL, TO WHAT PROGRAMS DO YOU ROUTINELY REFER:IHiM: 15. FROM WFUI DO YOU ROUTINELY RECEIVE REFERRALS? 16. PLEASE CCRAENT ON: a) trends in service delivery b) problems you have in delivering services to clients needing them in child care programs and gaps in service delivery (e.g. a need for more compre- hensive day care centers, more Title XX contracts to programs, transporting kindergardeners to and from school, etc.) MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES APPENDIX C DESCRIPTION OF TITLE XX PROGRAM AND LIMIT OF SIX CHILDREN FOR CHILD CARE PROVIDER Local social service representatives say they will continue to follow the limit Of six ruling in Day Care Homes in the wake of an Iowa Attornev General's opinion modifying that requirement. That 1 six children may be in a home when the provider's pr( not counted as part of the six. This runs counter tc social service requirements that all registered and r care homes may not have more than six children of prc government requirements include the provider's pre-sc total. Title XX is a federally funded social services through the U. S. Department of Health, Education and allocates Title XX funds to the states, usually based Title XX money is matched with local government fundi money from the private sector such as United Way fund According to the State of Iowa's Title XX plan June 30, 1979, Iowa receives 33.5 million in federal 2.7 million from the federal government's 100 percent The range for Iowa Department of Social Service, child care is from $4.65 to $9.00. Most Title XX homy rather than a weekly rate. A possible reason why som higher than those for private fee payers is that Titl, for services that are not rendered. For example, whet is taken care of in a provider's home with Title XX fl misses that payment as part of his or her child care i payers are obligated to pay for those days missed by 1 or any other reason. Accordingly, Title XX fees are perhaps a little days the child will be absent, but also enable the pre budgetary and operational cost needs without severe fl FIICROFILMED BY JORM MICROLE CEDAR RAPIDS -DES 140111 47. , 48. 94 w About $90,000 in Title XX child care funds for both homes and centers will be available to Johnson County, estimate local social service officials. w This amount will be met with a 25 percent match in funds from United Way and county government contributions, bringing the total of child care funds for w the county to $112,500. Currently, two Aid to Families with Dependent Children (AFDC) recipients are employed at local child care centers. Salaries for these personnel are paid with WIN (Work Incentive Funds). A child care worker's position is one of the jobs funded through WIN monies for low income persons. A participant ' in the WIN program can select the job of child care worker as one in which ; he/she desires training. Participation in Title XX funded programs, including child care, is based on a family's income. A sliding scale fee payment is used for families •- whose income is above poverty level, but still below minimum income standards. For example, in Iowa a family of four must have a gross monthly income below i $957 for eligibility in Title XX funded child care services. Family day care homes and licensed centers registered with Social Ser- vices are eligible to participate in publicly funded child care services if meeting the following criteria: families are public assistance recipients or whose gross monthly income qualifies within Title XX guidelines; parents are in training or employed; child is mentally or physically handicapped and par- ents are unable to provide adequate care; care is needed as part of a protec- tive services plan to reduce family stress and a need exists because mother r... or caring adult is absent from home due to hospitalization, desertion, illness _ or death. Family day care homes receiving federal fund payments through purchase of service contracts with local Social Service Departments must also adhere to the following federal stipulations: 1. "Infancy through six years. No more than two children under the age of two and no more than five in total, including family day care provider's own children under 14 years old." ^- 2. "Three through 14 years. No more than six children, including family day care mother's children under 14 years old." i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MONIES 49. APPENDIX D DESCRIPTION OF REGULATIONS AND PROGRAMS FOR FAMILY DAY CARE HOMES A child care or babysitter's home may be listed by the local Social Services Department as part of a child care referral process. These homes may or may not receive federal funds tc cover payment of child care services. A Certificate of Registration is issued by the local Social Services Department to homes which apply for one. A self-evaluation form is completed by the child care provider for registration. This pro- cess is an optional one for child care providers, although it does enable the provider to be placed on a referral list for persons needing child care services. . According to the Iowa Department of Social Services, family day care homes are the most frequently utilized method of child care in the state In many communities, and especially in rural areas, family day care may be the only type of child care available. A family day care home or child care home is considered to be an optimal environment for infants, toddlers, and sibling groups in a neighborhood -based arrangement. A family day care home is evaluated in seven areas by Social Services in determining eligibility for certification. Certified homes are then able to participate in subsidized child care services offered through Title XX. Areas of operation for which each home is evaluated include: qualifications, safety, program activity, number of children, discipline, nutrition and record keeping. In issuing a Registration Certificate, the State is publicly stating that the provider has certified in writing that minimum requirements are and will be complied with in all areas of family day care home operation. (Information from: Iowa Department of Social Services manual Title XII, "Family Day Care Home Registration.") OPERATIONAL REQUIREMENTS BY IOWA DEPARTMENT OF SOCIAL SERVICES FOR LICENSING OF FAMILY DAY CARE HOMES* Safety 1. Telephone have posted emergency numbers nearby. All medicines and cleaners and available first aid supplies stored safely. 2. All electrical outlets capped, cords properly used and maintained, and safe storing of combustible materials from furnaces and stoves. I j *Summarized from Iowa Department of Social Services Registration Requirements for Family Day Care Homes. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES IIOINES 3. Install safety barriers at stairways for pre-school children and have a safe outdoor play area. 4. Have an evacuation plan in case of fire or natural disaster and regularly practiced fire drills. Provider 1. Must be at least 18 years old, likes children, gives careful supervision and is capable of handling emergencies. 2. Frequently exchanges information with child's parent(s) and has not been convicted by any law in any state of acts involving lasciviousness, abuse, or neglect of children. Activity 1. An activity program should include active and quiet play; activities for large and small muscle development and available, safe play equipment for both indoor and outdoor use. Number of Children 1. No more than six children shall be under a provider's care. The provider's children not regularly in school full days shall be counted in that total, however the provider's school-age children shall not be included in the total 2. A provider cannot care for more than four children under two years of age at any one time. Discipline 1. Discipline is not to be used which is physically or emotionally harmful to a child. Nutrition 1. Regular meals are to be provided which are well-balanced, nourishing and in appropriate amounts including the major nutrition groups. 2. A mid-morning and mid-afternoon snack shall be served which are nutritious and appealing. Records. 1. A file on each child should be kept including his or her name, birthdate, sibling names, parent(s) name and workplace number and special needs. 2. Emergency information on each child should include doctor's name, tele- phone number and back-up adult if parent(s) can't be reached. 3. A signed medical consent from parent(s) authorizing emergency treatment. 4. Signed report from child's physician on child's health and immunization record. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES I4O1NES Z er r•1 V 51. APPENDIX E DESCRIPTION OF IOWA REGULATIONS AND PROGRAMS FOR CHILD CARE CENTERS Under the Iowa State code, the licensing of child care centers is under the purview of the Iowa Department of Social Services (DSS). Accord- ing to the state code, a license is issued when a license application or renewal is filed with the appropriate social services department and when the center making application meets state health and fire requirements and complies with minimum requirements of the DSS regulations. The Iowa DSS defines group care as a specialized form of child care in which an overall service to children requiring daytime care away from their homes is provided in an organized program which protects and promotes the development of the child as an individual and as a member of a group. A center is defined as a facility providing child day care to seven or more children. Child care centers are considered to be important resources for child care for children who must be separated from their families for a part of the day.. It is emphasized that child care is in no way a substitute for the home nor does it supersede parental rights, responsibilities and rela- tionships. Rather, it is an effort to assist the parent in fulfilling his or.her responsibilities for protecting the child and providing opportunities for .his/her development. The DSS defines child day care as the care, supervision or guidance of a child by a person other than the parent, guardian or custodian for periods of two hours or more and less than 24 hours per day per child on a regular basis in a place other than the child's home. Child day care does not include short-term classes between school terms, a church -related instructional pro- gram of not more than one day per week, or programs administered by a public or non-public school system. The Iowa DSS lists seven areas of program operation which are evaluated to determine if the child care center meets minimum requirements for issuance of a license. Those areas are: administration, records, health and safety, personnel, physical facility, food service, program activity, and parental participation. A child care center is licensed by Social Services after the department has received the center's application and the facility meets the department's minimum operation requirements and fire safety regulations MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES 101UES I 52. issued by the State Fire Marshal. The fire inspection of a child care center is to be performed by the local paid fire department of the State Fire Mar- shal. A child care center's application may be denied, receive provisional approval or full licensure, according to the DSS. Under penalty of law in Iowa, a child care center serving seven or more children may not operate unless it is licensed by the DSS. Legal ramifications may also apply to centers whose license has been denied, suspended or revoked. Centers operating under any of the above conditions shall be guilty of a misdemeanor with each continuing day of violation after conviction or notice from Social Services counted as a separate offense. OPERATIONAL REQUIREMENTS FOR LICENSING OF CHILD CARE CENTERS BY IOWA DEPARTMENT OF SOCIAL SERVICES Administrative 1. An incorporated child care center must file incorporation papers, articles, bylaws and ammendments with the DSS. 2. An unincorporated child care center must submit a written program plan outlining objectives and purposes with Social Services. 3. Anon -profit child care center shall have a governing board to determine rules and policies within the center's objectives. 4'. A fee -policy must be established by the child care centers. 5. A child care center's preschool program should be appropriate to its clients' developmental level and not duplicate the elementary school curriculum. 6. A child care center shall have an ongoing staff training and development plan. Records 1. Personnel records of a child care center's employees should contain the worker's employment application, age, education, previous work history, physical examination report or religious exemption waiver and salary/ benefits records. 2. Records on children cared for by the center should include a health record, emergency phone number, next of kin, who has permission to pick up the child, necessary information on child's doctor and health care provider, an emergency care plan for the child, accident and incident reports and signed permission to secure emergency care. 3. A bookkeeping system shall be maintained, including necessary fiscal files. i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 1 J 53. child, necessary information on child's doctor and health care provider, an emergency care plan for the child, accident and incident reports and signed permission to secure emergency care. 3. A bookkeeping system shall be maintained, including necessary fiscal files. Health and Safety 1. Each child must submit a physical examination report signed by a licensed physician or clinic designee upon admission. Report should include immuni•• zation record. 2. The written physical health report must include past health history, cur- rent health status and when applicable, recommendations for continued care. 3. A clinic employee will be designated to administer all medications to children when appropriate with proper mention in the child's record. 4. All medications must be kept in a locked cabinet. 5. Staff members are to watch for apparent illness, communicable disease, or unusual condition or behavior in each child. 6. The center should provide a quiet area for ill or injured children with parents or designated person notified of the child's condition. 7. Each center should .have a safety and escape plan developed and practiced in case of natural disaster. Personnel 1. A center's director should be at least 18 years old, completed high school or an equivalent program and have two years administrative or program ex- perience in a child care center. 2. No person is to be employed as a staff member who has a prior conviction in the areas of lascivious acts, neglect or abuse of children. 3. Staff should demonstrate competence in working independently with children and be at least 16 years of age. 4. At least one staff member shall have a valid certificate in standard first aid training. 5. Staff ratios should be as follows: . Me of Children Minimum Staff Ratio to Children Two weeks to two years One to every four children Two years One to every six children Three years One to every eight children Four years One to every twelve children Five to ten years One to every fifteen children Ten years and over One to every twenty children MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOVIES t MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140114E5 54. 6. Adult should be present in any child -occupied program or nap room. g4 7. All child care center personnel shall have a pre-employment physical. Physical Facility . 1. Theminimum program room size shall be eight square feet. e;4 %1 2. A center should have 35 square feet per child in the indoor area and 75 square feet q per child in the outdoor recreation area. Kitchens, bath- rooms and hall may not be counted in the square footage per child. s 3. All stairways used.by children shall have handrails. "^ 4. Outdoor play premises shall be maintained throughout the year and kept free of rubbish and flammable materials at all times. S. Area used by infants shall be safely equipped and free from intrusion by older children. 6. One toilet and one lavatory for each 15 children shall be provided. Food Service 1. All children at a center during standard meal times shall receive a full, balanced meal meeting at least one-third of the child's daily nutritive requirements. 2. Menus should be planned at least one week in advance with a variety in i �^! tastes, textures and colors emphasized. 3. Noon and evening meals should include a bread or cereal, a meat or sub - stitute, a vegetable, a salad and milk with a midmorning and midafternoon n, ; snack for children remaining at the center longer than two hours. A. Children under six months of age are to be held while fed. Bottles are ' not to be propped for children of any age. 5. Special formulas or meals are to be available for children with special dietary requirements. �•.,. Activity Program 1. Programs to promote a child's emotional, social and intellectual growth should be provided with an emphasis on gross and fine motor development. 2. Active and quiet learning experiences should be offered for the develop- ment of skills, social competence, self-esteem and creative expression. 3. A sufficient amount of equipment for both indoor and outdoor play should be available and kept in good, safe condition. 4. A nap or quiet time should be offered for all preschool children at the center for five or more hours. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140114E5 1, 3 ! 8 55. 5. Children from the ages of two weeks to two years must be provided an environment free of physical harm, but one where the infant is stimu- lated through rocking, playing and general human interaction on a regular basis. 6. Infants shall have their own crib, matresses and playpens. Parental Participation 1. A child care center will provide parents with an opportunity to observe their children at the center and when possible, work with the center's program. 2. A policy advisory committee comprised of at least 50 percent parent repre- sentation will be formed at non-profit child care centers serving forty or more children. Summarized from Iowa Department of Social Services "Child Care Center operations Manual". MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES NOIRES J 56 APPENDIX F 4C's REPORT ON SICK CHILD CARE NEEDS A recent information gathering project on the need for sick and conva- lescent child care was conducted by 4 -C's (Community Coordinated Child Care) Committee of Johnson County. The agency had heard recurring comments from health and teaching professionals in Iowa City about situations confronting families and schools when a child was ill. Consequently, an informal explor- ation was made. This was to determine two things: first, whether schools had problems with parents picking up their children when the children became ill at school and second, what kinds of problems faced parents when their child was ill and the parents worked or went to school. For six weeks in the fall of 1977, records were kept in a local elementary school and a local pre-school on the problems relating to children's illnesses and injuries occurring at school. Most of those were handled by the school nurse. This informal investigation indicated that when parents or another responsible adult needed to be contacted about a child's illness or injury, someone usually responded to the call and the child was picked -up if that was necessary. For six weeks in the spring of 1978, information was gathered about exist- ing problems in providing sick child care in families where both parents worked or went to school when an ill child had to remain home. Staff persons in two local pre-schools and two elementary schools called a child's home after he/she had been absent from school for three days and asked whether having to care for the child at home during school hours was creating a problem for the parent. Parents experiencing the most problems, ranging from inconvenient to severe, were for the most part in families where the mother was employed or attended school. In the majority of homes contacted, the mother stayed home from her job or class with the sick child. The father remained home in a few instances. Sev- eral of the mothers contacted said their employers permitted them to use their sick leave to stay home with the sick child. Concern over loss of pay and loss of job was expressed by some par-nts. This informal observation indicated that although there are an appreciable number of cases where children's illness caused difficulties for families, this is not a widespread problem. There were a few families that suffered MICROFILMEO BY JORM MICROLAB CEDAR RAPIDS -DES MOVIES 57 anxiety or loss of wages by the necessity of caring for the sick child. It should be noted that 4 -C's information gathering project did not include infants and the large number of pre-school children who are cared for outside of the home and not at a center. The report encouraged health professionals and home service agencies to address this need. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES U t 58. PPENDIS O POSSIBLE BARRIERS TO A SICK CHILD FACILITY* The notion of a facility to care for sick children has been discussed among child care providers, health providers, teachers, parents, and in- terested community persons. A myriad of problems and logistics confront this complex issue. Among them are the following: Predicting utilization of a sick children facility would be dif- ficult. The variability of numbers of sick children and types of illnesses requiring care would make staffing a facility dif- ficult and expensive according to need. For example, A cross -contagion factor would be considerable. children with a fever or pneumonia would be cared for in the with infectious diseases such as chicken same place as children pox or impetigo. Putting a child who is already ill in an unfamiliar setting (such as a sick child facility) might impede or slow down recovery. There would be a double cost factor for many parents already com- mitted to pay for child care, along with paying for sick child ildren would require attention care. Care needs of low-income sick ch and funding. The areas of liability and cost would be numerous. An agency or de- partment would have to assume responsibilitlevel of efor the facility S et ployees in case of medical emergency. would be needed for staffing of such a center as it relates to a client's medical needs is difficult to ascertain. A possible change might occur in several local pediatricians' policies of not tunnecessarily hospitalizing ahchild, when it is assumed the child i A sick child care facility could defeat the concept of low-cost, accessible child care. *Interview with local pediatricians group. Z - MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140114ES nursing homes This Is the tenth in a series of hdman services studies prepared by Johnson County Regional Planning Commission Iowa City, Iowa I MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 21129 i + r» I HUMAN SERVICES STUDY Report on NURSING HOMES December, 1978 Prepared by: Family and Individual Life Services Subcommittee A Kathleen Kelly, Chair Katherine Kruse Benny Leonard Tim McCue Russell Proffitt Marjorie Strait Mike Townsend Jeannie Williams Human Services Staff Bernice Weinberger Pamela Ramser Larry Allen Human Services Project Johnson County Regional Planning Commission 22� South Dubuque Street Iowa City, Iowa 52240 r — MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES 140VIES The preparation of this report would not have been possible without the involvement and support of the Family and Indi- vidual Life Services Subcommittee members. The talent, time, and energy contributed by them were invaluable to the success of the project. Appreciation is also due to the many human service agencies, organizations, and concerned individuals in Johnson County who contributed their knowledge and time to the project and supported us in our planning effort. Finally, we thank the Regional Planning staff for effort and support above and beyond the call of duty, which enabled us to complete the report you are about to read. STAFF PARTICIPANTS Emil Brandt Executive Director Pamela Ramser Project Director Marianne Salcetti Planning Assistant Bernice Weinberger Planning Assistant Larry Allen Planning Assistant David Chancey Research Assistant Frances Blommers Secretary Ellen Mills Secretary Judith Waterman Graphics This study was prcparad by the Johnson County Regional Planning Commission for the City of Iowa City's Comprehensive Planning Program. It was funded in part through a contract with Iowa City from the City's Com- munity Block Grant allocation. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES JOHNSON COUNTY REGIONAL PLANNING COMMISSION COMMISSION MEMBERSHIP City of Hills (1) Larry Culver City of North Liberty (1) David Roberts City of Oxford (1) Donald Saxton City of Shueyville (1) Jerry Cisar City of Solon (1) Harry Kral City of Swisher (1) Ron Saddoris City of University Heights (1) James Stehbens Universitv of Iowa (1) Richard Gibson Citizens Advisory Committee (1) Herbert Jordan Johnson County (5) John Dane JJJ Charles Duffy Joseph Marak Doris Bridgeman Donald Schr �7 J. Patrick White !i4 City of Iowa City (9) Katherine Kruse 661 Carol deProsse ('dr01 FYdCdSElnl Dorothy Douglass �y James Harris I p� Letha Lovelace Nicholas J. Karagan Mary Neuhauser Jeanette Carter David Perret David Schutt Glenn Roberts Rex Honey Isabel Turner Alan Vestal Lori. springer Florence Spaine City of Coralville (3) Kathy Kelly f I James Cole William Stewart Benny Leonard Lee Strottmann City of Hills (1) Larry Culver City of North Liberty (1) David Roberts City of Oxford (1) Donald Saxton City of Shueyville (1) Jerry Cisar City of Solon (1) Harry Kral City of Swisher (1) Ron Saddoris City of University Heights (1) James Stehbens Universitv of Iowa (1) Richard Gibson Citizens Advisory Committee (1) Herbert Jordan FICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIIIES 1 .. HUMAN SERVICES COMMITTEE Carol Spaziani, Chair Doris Bridgeman Jeannie Williams Russell Profitt Betty Bunge Gladys Benz Katherine Kruse Rodger Darnell ('dr01 FYdCdSElnl David Schuldt William Eckhardt Faith Knowler R Nicholas J. Karagan Paul Sandia Jeanette Carter James Harris David Schutt Mike Townsend Rex Honey Lorada Cilek Margaret Stephenson Lori. springer Florence Spaine Susan Simon Kathy Kelly Nancy Warner Benny Leonard Mnrdi Cooper Roald Rolfson Andy Anderson Al Colston Andy Burton Verne Kelley Michael Rose ti! Lee Graham Dameron 7 1, FICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIIIES 1 TABLE OF CONTENTS Page PREFACE............................................................. 1-v GOAL................................................................ 1 SERVICE AREA DESCRIPTION ............................................ 1 PROBLEMDESCRIPTION ................................................. 1 Comparison of Nursing Home Residents With U.S. Population Age 65 and Over .............................. 4 Prior Living Arrangements .................................... 4 Characteristics of the Elderly in Iowa andJohnson County ........................................... 5 Medicare and Medicaid ........................................ 5 Certificate of Need .......................................... 6 SERVICES PROVIDED/POPULATION SERVED ................................. 11 UNMET NEEDS/PROBLEMS IN SERVICE DELIVERY ............................ Assessment of Bed Need ....................................... Admission Procedures ......................................... 14 DischargePlanning ........................................... 14 Appropriate Level of Placement ............................... 15 Availability of Beds ......................................... 15 Care Review Committee, Medical Review Team (Department of Social Services) and Consultation and Licensing Division (State Department of Health).......... 16 GENERAL RECOMMENDATIONS ............................................. 17 RECOMMENDATIONS..................................................... 20 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140INES LIST OF TABLES Page TABLE 1 - Long -Term Care Facilities in Iowa City .................... 13 Location of Long -Term Care Facilities InJohnson County ......................................... 13a LIST OF FIGURES FIGURE 1 - Nursing Home Project Bed Need Based on CurrentFormula .......................................... 7 FIGURE 2 - Projections for Iowa Population Aged 65 and Over ........ APPENDIX APPENDIX - Review Teams ............................................. 24 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOIIIES i Preface I. BACKGROUND OF THE PROGRAM The Johnson County Regional Planning Commission, at the request of Iowa City, as well as other interested groups in the area, has undertaken a county- wide human services planning program. The program will provide input into the Iowa City Comprehensive Plan in the human service area and will provide guid- ance to other policy-making groups in the community on future directions of social services. Up to 75 percent of the financial support for the planning effort comes from Iowa City Community Development funds via a specific con- tract with the City of Iowa City. The balance of the funding is being pro- vided by the Regional Planning Commission. A Steering Committee was appointed by the Commission in early September, 1976 to develop a preliminary work program and to determine priorities for program directions. The committee met on a weekly basis into December when it submitted recommendations to the Commission. Steering Committee members were: Carol Spaziani, representing citizens; Florence Stockman, representing Johnson County; Neal Berlin, Dennis Kraft and Linda Schreiber, representing the Iowa city Administration; Doris Bridgeman, appointed by Iowa City; Faith Knowler, repre- senting United Way of Johnson County; Emil Brandt and Isabel Turner, represent- ing theJohnsonCounty Regional Planning Commission. Staff assistance was provided by Emil Brandt, Regional Planning Commission Executive Director, and Mary McCue, Research Assistant. After the work program was adopted in January, Constance Echternach was hired as the Human Services Project Director and Pamela Ramser as Assistant Planner. Ms. Echternach resigned in December, 1977, and Sally Baldus served as Project Director from January through July of 1978. Pamela Ramser replaced her in August, 1978 and is the current director of the program. At the recommendation of the Steering Committee, a Human Services Committee of the Regional Planning Commission was created to provide overall policy advice for the study. This committee, composed of approximately 35 members, includes 1) representatives of local funding bodies, (i.e., Iowa City, Johnson County, and the United Way); 2) human service board members; 3) staff from public and private human service agencies; 4) consumers of services and informed citizens; and 5) representatives of the University of Iowa. -i- MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOIMES II. GOAL AND OBJECTIVES OF THE PROGRAM The goal and objectives of the human service planning program, as recommended by the Steering Committee and adopted by the Regional Planning Commission, are: Goal: To make the planning and implementation of human services in Johnson County as efficient and effective as possible by providing policy makers with the information necessary to make sound decisions about needs and resources for programs such as health, recreation, social services, economic opportunity, education/information and transportation. Objectives: 1. To supply data about existing programs and agencies. a. To provide for meaningful organization of existing data. b. To gather new data as needed to supplement or to fill gaps in existing data. 2. To identify the human needs of the residents of Johnson County and to determine the extent to which these needs are being met. 3. To analyze and correlate the information on human needs in order to make it useful for decision makers in formulating programs and allocating resources. 4. To establish a mechanism for ongoing planning and coordination of human services, to include a way for keeping information on services and needs current and available. Because the area of human services encompasses a variety of resources, priority areas needed to be set. The Steering Committee used the following criteria in selecting the priority areas for the first two years of the pro- ject: 1) the programs in each area would have some degree of local funding (i.e., from Iowa City, Johnson County, or United Way), thus assuring some local program leverage; 2) there was a feeling on the part of the Steering Committee that substantial unmet needs and other related concerns existed in the program area; and 3) the study of the service systems could be accomplished within the time frame of the project. The Steering Committee which organized the planning effort was disbanded after formation of the Human Services Committee. The members of the newly formed Human Services Committee were each assigned to one of the four subcommittees established to deal with the four major areas under study. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES II0111E5 III. ORGANIZATION OF THE PROGRAM ORGANIZATIONAL CHART Iowa City (1) Johnson County Regional Planning Commission (2) I Human Services Planning Staff (3) 1 Human Services Committee (4) Steering committee (5) i -� Family & Individual [Emergency -� Life Services (6a) ssistance (6c) _l Mental Health/ Public Protection & I Chemical Dependency (6b) Justice (6d) Program Development (6e) 1) Iowa City: Contracts with the Regional Planning Commission for Human Service Planning. They receive reports, conclusions and recommendations and regarding programm- ing and funding for human services and can act or not act upon them. 2) Johnson County Regional Planning Commission _I Is responsible for fulfillment of the terms of the contract. It has over - allresponsibility for the results of the study and recommendations made by it. RPC delegates responsibility for carrying out the plan to the i Human Service staff and committee. 3) Human Services Planning Staff: Guides and directs the study, prepares materials for committees, conducts research and data analysis, prepares reports, arranges meetings and carried out reporting requirements. u -iii- MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES 1 4) Human Services Committee: �~ ( Has overall responsibility for guiding the study, approving actions and recommendations made by the subcommittees and the assimilation of data Yt into a unified plan. The Human Services Committee delegates responsibility ;i for plan development in specific service areas to subcommittees. 3 5) Steering Committee: •I Coordinates the work of the subcommittees, consolidates subcommittee re- ports, recommends joint efforts between subcommittees when appropriate, and has primary responsibility for A-95 review. s'. 6) Human Service Subcommittees: (' Prepare work plans for individual service areas, provides information on data r that is available, data that is needed, and appropriate ways of collecting data. Identify existing resources, provide information on how the service delivery system works, and identify knowledgeable people to be brought into'the study. ^' They recommend how data should be organized and prepare conslusions and recom- a mendations for service areas. Those subcommittees which published reports in 1977 (see below) have also worked to help inplement some of the recommendations .made in those reports. ..a 6a) Family and Individual Life Services: Includes such programs as child care, in-home support services, adult day care, rehabilitation, home management/functional education, family plann- ing, and alternative living arrangements. Has been divided into two groups (A and B) for the second year of the program. Group A has studied the areas of Disabilities, Nursing Homes, and In -Home Support Services; Group B has studied the areas of Child Care, Neglected/Displaced Children, and Family 7 Planning. Reports to be issued between December, 1978 and March, 1979. 6b) Mental Health/Chemical Dependency: Includes mental health, substance abuse and family, individual, and group counseling programs. Issued reports on Counseling, Mental Health, and i 1 Substance Abuse in November, 1977. 6c) a Emergency Assistance: , i Includes short term assistance with food, shelter, transportation, medical care and jobs for transients and permanent residents in crisis situations. ' Issued reports on Emergency Assistance to Residents and Emergency Assistance ' y 3 to Transients in November, 1977. j 6d) Public Protection and Justice: Includes juvenile justice services, adult community-based corrections, and -' protection of the elderly from abuse, neglect, and exploitation. Issued reports on Juvenile Justice, Adult Corrections, and Protection of the Elderly I in November, 1977. .� «i MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 6101IES 6e) Program Development: Includes development of a program proposal for a hu.;nan services support network to begin in July, 1979 (after the termination of this phase of the Human Services Planning Program), study of information and referral services, and other activities to make the delivery of services in John- son County more efficient and effective. I NOTE: The Steering Committee dealt with in this chart is composed of the iChairpersons of the five sub -committees and should not be confused ,) with the Steering Committee used to develop the Human Services Project initially. i IV. DATA COLLECTION AND PRIORITIES OF PROGRAM AREAS Data on human services and unmet needs was collected from a variety of local i resources through questionnaires, personal interviews, and group meetings. An -� effort was made to use data included in previous studies and surveys, both within --i and outside of Johnson County. The agencies and individuals contacted and the methods used are too numerous to recount here. This information is available through materials on file at the Johnson County Regional Planning Commission. The data which was collected has been compiled into fourteen service area �. profiles, the major sections of which are: Goal, Service Area Description, Problem Description, Service Population, Services Provided, and Unmet Needs. -� Recommendations were developed from the information contained in the Unmet Needs portion of the profiles. The profiles were then sent to relevant agencies for their review. Corrections submitted by the agencies were incorporated into the profiles. 1. Counseling I 2. Mental Health '1 3. Substance Abuse 4. Emergency Assistance to Residents 5. Emergency Assistance to Transients 6. Juvenile Justice 7. Adult Corrections 8. Protection of the Elderly 9. Child Care } 10. Nursing Homes 11. Developmental and Acquired Disabilities 12. Neglected/Displaced Children ;-� 13. In -Home Support Services 14. Family Planning Recommendations made for each individual service area have been assigned priorities by the Human Services Committee, Steering Committee, and Subcommittees. several general recommendations, relating to all service areas, have also been developed; these are reprinted in each of the profiles. There has been no formal -v_ IIICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES tIOINES ranking of individual service areas against each other. However, of the eight service areas studied during 1977, the area of Emergency Assistance to Transients was informally given first priority. of the six service areas studied during 1978, the areas of In -Home Support Services and Child Care were seen to be of high priority, while the areas of Disabilities and Foster Care developed as low priority. -vi- MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES GOAL The goal of this service area is to maintain and improve the physical status and functioning of the aged and chronically ill for whom independent living is not feasible and hospital care is not required but temporary or long term permanent care is needed. SERVICE AREA DESCRPITION The services in this area are A:r:igned to provide short-term and long- term care on a 24 hour a day basis to individuals who are unable to maintain independent living arrangements because of physical and/or emotional disabil- ity and for whom substitute arrangements are not feasible. SERVICE ELEMENTS Room and Board in a congregate setting; nursing services (professional and practical) under medical supervision; physical and occupational therapy; family and individual counseling; recreational activities; religious services; rehabilitation services; and informal education. This program differs from in-patient medical care in that medical treatment is less intensive and there is a lower patient/staff ratio. PROBLEM DESCRIPTION Nursing homes in the United States apply some form of supervised care for medical and medically related problems; the term generally embraces those facilities that offer skilled nursing care, intermediate levels of nursing care, and residential (personal) care. The function of the nursing home is to provide restorative care for convalescing patients and continuing care for the aged. A few nursing homes are limited to caring for convalescent children or providing special services for mentally disturbed patients. However, the U.S. Public Health Service estimated in 1969 that 88% of the residents in nursing homes and related facilities were at least 65 years of age.' The State Department of Health's regulations for the care of children are different than those for adults, and, therefore, none of the local facil- ities are licensed for the care of anyone under the age of eighteen. There are no known facilities in Johnson County that will provide long term care for those under the age of 18 with medical problems. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 140MES -2 - Under Iowa Law there are three levels of long term care facilities: residential care facility, intermediate nursing facility and skilled nursing facility.2 The Iowa State Department of Health defines the three levels of care as follows: 1. Residential Care Facility means any institution, place, building, or agency providing for a period exceeding 24 consecutive hours accomodation, board, personal assistance and other essential daily living activities to three or more individuals, who, by reason of illness, disease, or physical or mental infirmity are unable to sufficiently or properly care for themselves but who do not re- quire the services of a registered or licensed practical nurse except on a emergency basis. 2. Intermediate Care Faciltiy means any institution, place, building, or agency providing for a period exceeding 24 consecutive hours accommodation, board, and nursing services, the need for which is certified by a physician, to three or more individuals who, by reason of illness, disease or physical or mental infirmity require nursing services which can be provided only under the direction of a registered nurse or a licensed practical nurse. 3. Skilled Nursing Facility means any institution, place, building, or agency providing for a period exceeding 24 consecutive hours accomodation, board, and nursing services, the need for which is certified by a physician, to three or more individuals who, by reason of illness, disease, or physical or mental infirmity re- quire continuous nursing care services and related medical services, but do not require hospital care. The nursing care services pro- vided must be under the direction of a registered nurse on a 24 hour per day basis. The State Department of Health, the Department Social Services, the Care Review committees and the State Fire Marshall's offff ice monitor each facil- ity. Information on these organizations is taken from the Care Review committee Manual published by the Iowa Commission on Aging. (See Appendix 1) Data from the 1973-74 National Nursing Home Survey conducted by the Department of Health, Education and Welfare estimated that there were MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES -3- approximately one million persons who were residents of nursing homes* in the United States in 1973-74. They resided in about 15,700 facilities providing some level of nursing care. The data collected by this survey showed the preponderance of women in nursing homes - about 708 of all residents were women. This fact was related to the greater longevity of women and to the dis- proprotionate representation of elderly women in nursing facilities as compared to elderly men. Nursing residents were found to be an elderly population with 899 being 65 years of age and 388 bein, 95 years of age and older. The mean age for residents was 79.3 A follow-up national nursing home survey was conducted in 1977 which included those facilities surveyed in 1973-74. Since this was a subsample of the facilities surveyed earlier, the estimates are considered provisional. The earlier survey excluded facilities providing only personal care or dom- iciliary care but the 1977 survey included these facilities. However, the impact of including these additional facilities was considered to be minimal since they included only 29 of all nursing homes in the 1973-74 survey. For the period May to December 1977, the provisional estimates indi- cated some 18,300 nursing homes with a total of 1,383,600 beds serving 1,287,400 residents. Proprietary ownership continued to dominate the nursing home segment of the health care delivery system with an estimated 749 of the facilities operated for profit. Non-profit and government nursing homes comprised about 269 of the facilities but had a greater bed capacity compared to proprietary facilities. About 34 percent of all residents were served by nursing homes operated under non-profit or government auspices. About 75 percent of the nursing homes in the 1977 survey were certified as skilled nursing home facilities (SNF'S), intermediate care nursing home facilities (ICF's), or both. The largest share of the certified facilities (459) were certified only as ICFs. Nursing homes certified as SNF's had a shorter median duration of stay (39 days) than did nursing homes certified only as ICF's (181 days). In addition, nursing homes certified as SNF's had about 133 admissions and 116 discharges per 100 beds, while nursing homes certified only as ICF's had about 59 admissions and 54 discharges per 100 beds. These differences thus indicate that patients in ICF's have longer lengths of stay. 4 *Excluded facilities providing only personal or domiciliary care. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES -4 - Another characteristic of nursing home residents found in the survey is that a greater proportion of the residents were widowed than were married, divorced, separated, or never married. When marital status of male and female residents was compared, 734 of the women were widowed compared to only 424 of the men. Only 84 of the women, but 224 of the men, had a liv- ing spouse who could presumably visit or be responsible for them while away from the facility. Data from the 1973-74 National Nursing Home Survey showed that the mean length of stay was 2.6 years and the median was 1.5 years. About 704 of the residents lived in proprietary facilities and about 304 lived in non-profit or government facilities.5 COMPARISON OF NURSING HOME RESIDENTS WITH U.S. POPULATION AGED 65 AND OVER It has generally been accepted that about 54 of the U.S. population 65 years of age and over reside in nursing homes and only 254 of those 85 years of age and over. Although females exceed males in the population of those over 65 years, the difference is far more pronounced among the nursing home population.6 The difference which occurs in the distribution of marital status in the two groups (non -institutionalized population and nursing home population) is significant. This is reflected by the fact that while 544 of the non - institutionalized population aged 65 years and over were married, only 124 of the nursing home population were in this category. About 374 of the non - institutionalized population 65 years and over have never been married, com- pared to 154 of the nursing home population. Another pronounced difference .between the nursing home population 65 years of age and over and the non - institutionalized population is in the age distribution. Whereas 834 of the nursing home population were 75 years of age and over, only 374 of the .non -institutionalized population were in that category. 7 PRIOR LIVING ARRANGEMENTS The National Nursing Home Survey of 1973-74 found that 594 of the residents were transferred from some type of institution and 374 moved from a MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MORIES a 71 I _1 J -5- private residence. Thirty-five percent moved to the nursing home from a gener- al or short -stay hospital. In comparison, a similar 1964 survey found that 126 moved to a nursing home facility from a general or short -stay hospital. The shift toward prior instituti:nalization is reflected in the fact that in 1964, 696 of nursing r•-; personal care home residents lived in private accom- modations prior to admissions. The increase in nursing home residents trans- ferred from hospitals is likely due to the introduction of Medicare and Medicaid in the mid 1960's.8 CHARACTERISTICS OF THE ELDERLY IN IOWA AND JOHNSON COUNTY In 1970, 12.49 of the population in Iowa was 65 years of age and over compared to 7.09 in Johnson County. The state population in 1970 was 2,824,376 and the Johnson County population was 72,127. The over 65 population in Johnson County at that time was 5,013; of this number 1,986 were male and 3,027 were female. Of the total state population in 1970, 28.39 of those aged 65 and over were below the poverty level compared to 9.49 under the age of 64. Poverty households in Johnson County included 8,530 persons or 12.79 of the total pop- ulation. Of the total number below the poverty level 12.79 or 1,083 were over age 65.9 MEDICARE AND MEDICAID The passage of the Social Security Amendment in 1965 established Medi- nr' I, caid and Medicare. Medicare (Title XVIII) is the federal hospitalization (Part A) and medical insurance (Part B) programs for the aged and disabled. Medicaid (Title XIX) is a joint federal -state program covering health care for the indigent. While Medicare is administered entirely by the federal govern- ment (in Iowa, Blue Cross/Blue Shield Plans are the intermediary for Medicare Parts A and B), Medicaid is administered by the states under broad federal guidelines. In Iowa, Medicaid is administered by the Department of Social Services. Skilled Nursing Care Facilities are the only type of nursing homes eli- gible for reimbursement under the Medicare program. Medicare will reimburse on a "reasonable cost" basis for skilled nursing care. The Medicaid program in Iowa presently reimburses up to a maximum of $21.00 per day for nursing homes providing intermediate nursing care. There is also provision for care in a skilled nursing care facility for patients eligible for Medicaid who have exhausted their Medicare benefits or who cannot meet the coinsurance payments of Medicare. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1d0 RIES -6- W Because of the restrictive definition of "skilled nursing care" in the _ regulations and because of limits on the length of stay (100 days), Medicare covers only a small percentage of the total number of people in long-term ra care facilities. On any given day, only 78 of all persons in nursing homes �I '+ nationally have their care paid for by Medicare. " Under Medicaid, states do not impose limitations on length of stay in , nursing homes. Because of less restrictive eligibility requirements, Medicaid covers many more persons in long-term care facilities than does Medicare. Med- K� i .� icaid pays approximately 606 of the nation's total nursing home bill. In f Iowa for the year July 1976 to June 1977, of the total nursing home bill, "'• e Medicaid paid 46.88 (93.2 million) and Medicare paid 1.58 (3.1 million); private pay amounted to about 51.78 ($103 million). 10 o -.l CERTIFICATE OF NEED I Since July 1, 1978, a certificate of need program has been in effect. w i S Therefore, any plan to either add or delete any one of the three levels of i ' nursing home beds, intermediate skilled and residential, must be approved by I Ijj the Health Systems Agency and the Iowa State Department of Health. At present no onein the county has submitted an application for a certificate of need. The certificate of need program uses a formula adopted by the State j Department of Health to determine long term bed need. This formula is also used by the Iowa Health Systems Agency. The formula is based on past utili- u zation of long-term beds in Iowa,and it is likely that there will be revisions in the future. At present there are no federal guidelines in determining bed need such as those which exist for acute care institutions. 1 I There are two variations of the formula, one for rural counties and " the other for urban (SIISL) counties.* The rural formula in used for Johnson County, and determination of bed need is based on population projections of the office for Planning and Programming. (Figure 1) _ I *Rural Counties: - .09 (65+) + .0015 (64-) x 1108 = ltc bed need 1 Nursing (snf = icf) = 2/3 (ltc) Residential (rcf) = 1/3 (ltc) Urban Counties: r. .07 (65+) + ,0015 (64-) x 1108 = ltc bed need Nursing (snf + icf) = 2/3 (ltc)or(4/5 ltc) I Residential (rcf) = 1/3 (ltc)or(1/5 ltc) -� MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1d0 RIES i I I 1 j 1 FIGURE 1: NURSING HOME PROJECTED FACILITY NEED BASED ON PRESENT FORMULA ADOPTED BY IOWA H, ALTH SYSTEMS AGENCY, USING POPULATION PROJECTIONS OF TIIE STATE DEMOGRAPHIC OFFICE OF PLANNING AND PROGRAMMING. (FOR JOHNSON COUNTY) *SNF - SKILLED NURSING FACILITY �----� �• -�• *ICF - INTERMEDIATE CARE FACILITY n ----a RCF* *RCF - RESIDENTIAL CARE FACILITY MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES ?I01NES 1400 1200 0 w z �. 1000 ez w s 0 wm 800 ( w 0 z w 600 m f --- ---- _ _ 439 RREN SNF & ICF B DS - 0 900 w t - U O w 200 K -----114 CURRENT RCF BrDS--- -----i- 19701980 1990 2009 2010 2020 YEAR *SNF - SKILLED NURSING FACILITY �----� �• -�• *ICF - INTERMEDIATE CARE FACILITY n ----a RCF* *RCF - RESIDENTIAL CARE FACILITY MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES ?I01NES The present formula for determining the need for nursing care beds w can be interpreted in the following manner, 12 i Skilled Nursing Care Beds 66.0 beds per 1,000 population age 65 and over in non -SMSA counties. 51.3 beds per 1,000 population age 64 and over in SMSA Coun- ties, plus 1.5 beds per 1,000 population under age 65. w,u Residential Care Beds 33 beds per 1,000 population age 65 and over in non -SMSA counties. 25.67 beds per 1,000 population age 65 and over in SMSA counties, plus 0.55 beds per 1,000 population under age 65. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES IIOINES In addition to the formula components, there are several variables; which could affect final bed need determination. The following variables would justify a change in bed need according to Iowa Code 203.13 ♦ 1. Ratio of nursing beds to residential beds may go to an upper limit of four nursing beds to one residential with the appropriate justification. Justification for such a change may include current utilization,status of day care, etc. 2. The number of persons served as special clientele which has not �?! previously been calculated in the formula. 3. The finding that less costly, more efficient or more appropriate . alternatives to such in-patient care are not available and the de- -. velopment of such alternatives has been studied and found not practicable, (a.g., in-home health services, community nursing services, adult day care, congregate meals, etc.) 4. Additional bed need for patient care may be added to a county's �- bed need. That is, out -of -county residents may increase the bed need if it is determined that the county of origin from which the out -of -county residents are coming have an unmet bed need. By using the present bed formula and the population projections from the office for Planning and Programming, there is a need for additional nursing home beds in Johnson County. Population projections show an accelerating number of persons age 65 and over with a projected.three fold increase'by the year 2020. (Figure 2) MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES IIOINES %\�_ -.,Z... FIGURE 2: PF 16000 12000 w m w 8000 CD 0 z 0 ., F- d J d O a 4000 1970 1 YEAR 1 -10- Additional Formulas for Determining Long-term Care Bed Need According to the Iowa Health Systems Agency, there are five approaches used by planning agencies to calculate the need for long-term inpatient ser- W vices. None are considered ideal and all have deficiences. The Iowa Health Systems Agency believes that all bed need formulas should attempt to esti- mate the need for services, regardless of the prasent utilization of services or the present availability. After the numbers and types of services have been determined, they must be compared with what exists in order to measure the type and amount of change that will be necessary .14 Five common and general methods of determining bed need being studied by the Iowa Health Systems Agency are as follows. 1. The Hill Burton Formula Patient Days (base year) Population, 65 yrs. + (base year) x Projected Populat16n + 10=PBN* 365 .9 This formula has several weaknesses which are as follows: • It is based on current utilization. ,. • Only those 65 years and over are covered. • It:.will yield an estimated number of beds greater than what is needed, since it ignores other methods of car- ing for persons who require long-term care. • An automatic 906 occupancy rate is built in. 2. Ratio of beds to Population 65 years and over. This formula includes the weaknesses of the Hill Burton formula, as well as several others. Currently used ratios range from 35 to 80 beds per 1,000 age 65 and over for SNF's, and 15 to 40 beds per 1,000 age 65 and over for ICFs. These target ratios are set on national utilization patterns, which assume that present utiliza- tion is appropriate and does not take into account reqional vari- ations. 3. Use of average occupancy rate as a basis for estimation after a Long-term care facilities projects are approved until the occu- pancy rate in local facilities drops below the "desired" level. This method has all the weaknesses of the two previous methods. *PBN = Projucted Bed Need MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES ?10111ES MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401RES -11- j 4. Estimate of need by number of patients on waiting lists. J This method is a poor indicator of need or demand due to several ifactors. Some of these are: Many persons are on waiting lists for several facilities; names may remain on lists long after the in - .7 dividual has died or no longer requires that level of care; it is j difficult to prove that patients on the waiting lists have been certified as needing the level of care for which they are waiting. 5. Patient surveys. This method, if properly constructed may be the most valid, but I there are difficulties involved in such a methodology. Some of J ' these are: • A clean cut and precisely worded defination of all levels of care (e.g., ICF vs. SNF) is necessary. i i� • It is expensive and time consuming. • It requires cooperation and assistance from the medical profession. • It cannot be repeated and updated as other methodologies. This means that collected data will tend to lay behind needed changes. I - • Surveys often yield good bed need estimates, but tend to be deficient in estimating need for non -institutional services due to problems with definitions of levels of care and perceptual pro- . _ blems on the part of the individuals being interviewed. SERVICES PROVIDED/POPULATION SERVED In 1970 the total population of Iowa was 2,824,376 with 12.4 percent -� .. being over 65 years of age. The over 65 population of Johnson County was 5,013 or 7.0 percent of the total population in 1970. In 1970 it was esti- - - mated that the county had experienced an increase of 500 people in the over J 65 population 15 It was further estimated 10.6 percent of the 1976 Johnson •' County population is over 65. Nationally, it has been estimated that 59 of Jthe elderly are in long-term institutions. If this percentage rate were -i applied to the 1976 estimated population of those over 65, there would be 'I .J approximately 275 Johnson County residents in nursing homes. Since there _. are 553 nursing home beds available in the County, it is possible that the number of Johnson County residents in nursing homes exceeds the national average. The number of non -Johnson County residents in local nursing homes - i is not known. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401RES 9 -12- There are a total of seven nursing homes in Johnson County. Of these, five are licensed by the State Department of Health as intermediate care facilities, one is licensed as both an intermediate care and skilled care facility, and one is licensed as a residential care facility. (Table 1) UNMET NEEDS/PROBLEMS IN SERVICE DELIVERY Unmet needs and problem areas were determined by the results of a sur- vey using a questionnaire directed to nursing home admisistrators. In addition, a number of unmet needs emerged from committee meetings which have included meetings with nursing home providers and representatives of community agencies providing services related to nursing homes. ASSESSMENT OF BED NEED Most nursing home administrators did not feel that additional inter- mediate nursing home beds were needed. Only one nursing home indicated a need for additional beds at this level of care on the basis that they maintained a waiting list. one home had an average annual occupancy rate of 834 while the others maintained average annual occupancy rates of over 904. From the infor- mation available in the questionnaire it was not possible to determine why one home was underutilized while one maintained a waiting list. It is possible that a nearby retirement apartment complex increased the demand for this particular facility. The need for additional skilled nursing home beds was not documented by the questionnaire. Some nursing homes believe that their care is comprehen- sive enough to eliminate the need for additional skilled nursing beds. It is evident that there are various interpretations as to what constitutes skilled nursing care. The facility licensed for skilled nursing care maintained a waiting list and was aware of patients being placed out of county because of the un- availability of beds. University Hospital, Mercy Hospital and the Department of Social Services often place patients requiring skilled nursing care out of the county,with Cedar Rapids being cited as a frequent place of referral. To meet the need for skilled nursing home care for a hospitalized patient, Medicare coverage is extended to permit a patient to remain in the hospital, but only if they live in Iowa City. This alleviates the problem of inadequate MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES tIOIIIES "1 I M; �-r w, .i F:a ) ICS TABLE 1: LONG-TERM CARE FACILITIES IN JOHNSON COUNTY FACILITY LOCATION, OWNERSHIP BED CAPACITY LICENSE CERTIFICATION COMMENTS MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES j Beverly Manor 605 Greenwood Convalescent Iowa City, IA. Proprietary 89 ICF Medicaid Quota of 35 Medicaid II Center patients. Preference to I private pay residents. i i Lantern Park 914 N. 20th Ave. Proprietary 100 ICF Medicaid No quota for Medicaid j Care Center Coralville, IA. but preference topri- vate pay residents. Solon Nursing 523 E. 5th St. Proprietary 67 ICF Medicaid Limited number of Med- Care Center Solon, IA. (Community •. icaid residents ac- j Corporation) cepted. Preference giv- en to Solon residents.: -Iowa City • Rochester Rd.. Proprietary 89 ICF Medicaid No quota for Medicaid Care Center and Scott Blvd. and Medicare. Physical. Iowa. City, IA. therapist available who can be reimbursed by Medicare and Medicaid. Lone Tree Pioneer Road Proprietary 46 ICF Medicaid Unspecified number of Health Center Lone,Tree;.IA. (Community Medicaid residents 'ac-- Corporation) cepted. Preference ..:j given to Lone Tree res- idents and other John- son County residents. 'Johnson �. R. R. # 1 Johnson County 114 RCF N/A Provides custodial care County Care Iowa City, IA. to residents. Facility *Oaknoll Re- 701 Oaknoll Dr. Non-profit 16 - ICF Medicaid Only 8 ICF tirement'. % Iowa City, IA. corporation 32 - SNF Medicare beds utilizied. Residence *This is an apartment complex which maintains a separate nursing home facility. To assure the availability of beds to its own residents due to the terms of living arrangements, preference is given to Oaknoll residents. Non-residents can be admitted to the facility if they require short-term care. Non-residents can be admitted to .. the skilled facility but cannot be admitted directly to the intermediate facility. There is an intermediate . nursing bed capacity for only 8 patients since the rooms are used as single accomodations. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES -13a - MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIt1ES -14- skilled nursing home beds but contributes to higher costs. At least two of the homes in the survey indicated that they could qual- ify as skilled facilities but did not desire this certification because of the burden of meeting stringent regulations and as a result of reports of retro- active denial of Medicare benefits. However, the latter situation is felt to be less of a problem at the current time. In addition, a need for residential nursing home beds was not documented by the questionnaire. The need for this type of facility will be discussed in the section, Appropriate Level of Place- ment. The Iowa Health Systems Agency has determined that there is a need for additional nursing home beds. As a basis for estimating need they use a State Health Department formula. There are two variations of this formula, one for rural counties and the other for (SMSA) counties.* The rural formula is used for Johnson County and determination of bed need is placed on population pro- jections from the Office for Planning and Programming. ADMISSION PROCEDURES Admission procedures vary.widely with emphasis often being placed on the physical problems rather than overall social and medical needs. The diversity of procedures indicated a need to develop a uniform admissions procedure so that residents will receive comprehensive care. There is a need for a thorough assessment of a resident's needs to be completed before admission followed by a review of this assessment by the nursing home to determine whether they can meet these needs. DISCHARGE PLANNING Some patients discharged from nursing homes are not referred to com- munity sources that can provide needed ongoing services. The nursing home questionnaire revealed that some nursing homes do not take responsibility for discharge planning leaving that to other sources such as family members and the Department of Social Services. .There was little indication that referrals are initiated by the homes themselves. The questionnaire indicated that there was a lack of knowledge about the availability of community resources to nursing home residents. Some ser- vices were felt to be accessible when in fact they do not exist or do exist on a limited basis. *See page 5 under Certificate of: Need MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES I MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES n0 RIES APPROPRIATE LEVEL OF PLACEMENT As a whole, most nursing homes did not believe that patients were in- appropriately placed as a result of utilization reveiws. Inasmuch as many studies indicate that nursing home residents could use lower levels of care, ' it is likely that utilization reviews are not sufficiently sensitive to patients needs. Agencies involved with nursing home placements are aware of individ- uals who do not need nursing services or need them only to a limited extent who could be placed in a residential (personal care) facility. 1� Only one licensed residential faciltiy exists in Johnson County and it is used for developmentally and psychiatrically disabled individuals. The lack W' of other residential facilities has been attributed to the problem of licensing t� this type of facility. Since many of the requirements for licensure are the same as that used,fcr-skilled and intermediate type facilities, the cost of i operating a personal care facility discourages their development. AVAILABILITY OF BEDS �:{ (- Although one of the most commonly expressed needs is for the patient to be placed in close geographic proximity to his/her residence there is indi- cation from health and social service agencies that patients under the Medicare and Medicaid program are often placed in nursing homes outside Johnson County.. The reason for out of county placement differs depending upon which of the e:1 two programs is involved. A reasonably sufficient number of beds presently exist for providing , intermediate nursing c are but Medicaid patients do not have the same access to these beds as private pay patients. Nursing home providers often set quotas on Medicaid admissions because they feel that the actual costs of care exceed Title XIX reimbursement. In order to compensate for losses, private pay rates are increased resulting in financial hardship for those patients who must bear the increased costs of care. of the total number of nursing home beds available in Johnson County - only 32 beds in one facility are certified to provide skilled nursing care ��- under the Medicare program. Out of county placements, often to Cedar Rapids are frequently made because the existing facility cannot accommodate all requests for care. 'I M MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES n0 RIES -16- CARE REVIEW COMMITTEE, MEDICAL REVIEW TEAM (DEPARTMENT OF SOCIAL SERVICES) AND CONSULTATION AND LICENSING DIVISION (STATE HEALTH DEPARTMENT) Nursing homes were most dissatisfied with the reviews of the Care Re- view Committees and the State Department of Health. There was indication from the questionnaire that the Care Review Committee does not fulfill its role of patient advocacy. In addition, it was learned that there is insufficient training of members who are volunteers. At this time it is likely that mem- bers of the Care Review Committee are chosen by nursing home administrators, so that their position of advocate is questionable. Care Review Committees do not have access to medical records and it is generally felt that they do not provide in-depth reviews. The State Health Department and Medical Review Team (Department of Social Services) were viawed by virtually all the nursing homes as.contribut- ing to increasing "paper work" and increasing costs. The existence of three different review teams may contribute to the disatisfaction expressed by the nursing homes. Some of the problems could possibly be eliminated by coordi- nating activities of the three monitoring bodies. r - MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES I401NES MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOVIES i-_ FOOTNOTES i 1 U.S. Department of Health, Education and Welfare, Characteristics of Residents in Nursing and Personal Care Homes (February, 1973), p. 2. 2Iowa State Department of Health, Rules and Regulations Setting Minimum ''- Standards for Health Care Facilities, Code of Iowa (1977), p. 5. w i, 3U.S. Department of Health, Education and Welfare, Utilization of Nursing, i) (July, 1977), pp. 1-9. r' 4U.S. Department of Health, Education and Welfare, An Overview of Nursing t 9 Home Characteristics, (September 6, 1978). ry , �( 5 Ibid. 0.1 r.: )i ] 6Fact Book on Aging A Profile of America's Older Population, The National w ;. M, Council on Aging, Inc., (February, 1978). 7Ibid. yy� i- U.S. Department of Health, Education and Welfare, Utilization of Nursing r Homes (July, 1977), pp. 1-9.' 9U.S. Bureau of the Census, Department of Commerce, (1970). i1I ; 7 Y 10Draftreleased by by Iowa Health Systems Agency, (July 17, 1976). f. '- llState Health Department, Certificate of Need Program, Code of Iowa. c. 12Draft released by Iowa Health Systems Agency (July 17, 1978). ` 13StateHealth Department, Certificate of Need Program, Code of Iowa. 98 14Draft released by Iowa Health Systems Agency, (July 17, 1978). i.l i' 15 U.S. Bureau of the Census, Department of Commerce, (1970). RI vi rH MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOVIES Priority Problem GENERAL RECOMMENDATIONS Agencies Recommendation Affected Possible Funding Sources The following problems and recommendations relate to all of the service areas studied during the first and second years of the Human Services Planning Project. Because they relate to all areas, they will not be tailored to each individual area. However, their importance to each of the service areas should not be diminished due to this manner of presentation. COMMUNICATION, COORDINATION, INFORMATION Inadequate communication and coor- dination among agencies providing service results in inconsistencies, particularly in the way clients with multiple problems are handled. Delays in the provision of service and misunderstandings or disagree-, ments regarding service provision may occur when two or more agencies are involved with the same client. Regular meetings among agencies have been attempted but have been less than successful. Organizing and convening such meetings re- quires staff time and effort not available from any one agency. Inadequate knowledge on the part of service providers concerning the functions and programs of agencies can result in inapprop- riate referrals or lack of referral to a needed resource. In addition to clients getting lost in the system and not finding the Agency directors and staff pro- viding similar programs or ser- vices to similar client groups should meet together on a regu- lar basis to: 1) Share information about programs. 2) Explore solutions to common problems. 3) Acquaint them with the staff of other agencies to facili- tate the referral process and increase trust levels. 4) Share information on clients within the confines of confi- dentiality. Human Service planning staff may be assigned the responsibility for calling and'organizing such programs in order for them to succeed. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES M01NES All public Johnson and private County He - providers gional Plan - serving John- ning Commis - son County sion; State clients. and federal sources of funding should be explored. GENERAL RECOMMENDATIONS (Continued) Priority Problem appropriate services, service pro- vision is often carried out without consulting other agencies which pro- vide similar or complementary ser- vices. The result is that services are delivered with less than optimal efficiency and effectiveness. DATA ON CLIENT CHARACTERISTICS Information on client character- istics (e.g., age, race, sex, in- come, residence and problems pre- sented) is not available at the present time through many agencies As a consequence, it is difficult to assess portions of the popu- lation which may be inadequately served and for which programs should be developed. Agencies Recommendation Affected These agency sessions might be used to address many of the spe- cific recommendations found in each of the profiles. Assessment of data requirements All public is needed by 1) agencies to and private assess existing programs and not -for -pro - 2) funding bodies to make allo- fit agencies cation decisions based on commun- providing ity need. A common data collec- service to tion and retrieval system should Johnson Coun- be developed which would place ty, United minimum demands on agency staff Way time and be economical. Funding agencies should make inquiries into systems of evaluation used for services. Accountability should be emphasized. The Human Services planning staff should be available to coordinate the de- velopment of this effort. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES Possible Funding Sources Johnson County Re- gional Plan- ning Commis- sion, City, m County, United Way; State and federal fund- ing sources should also be explored. GENERAL RECOMMENDATIONS (Continued) Possible Agencies Funding Priority Problem Recommendation Affected Sources FUNDING General revenue sharing funds should ha considered as a possible funding source for many of the recommendations. Wherever possible, recommendations should be met by agencies already in existence. This may involve coordination of existing services, addition of a new program or program component to ! an existing agency, or shifting the focus of a current program to meet an identified need. It is recommended that a new agency be established in response to an unmet need only when the efforts of existing agencies have failed or when it has been satisfactorily determined that it is not feasible for an identified need to be met through such efforts alone. This approach will help ensure that additional costs are minimized and fragmentation of services avoided. HUMAN SERVICES SUPPORT NETWORK A continuing program to provide support and assistance to local human service agencies has been proposed by the Program Development Subcommittee of this project (December, 1978). This program would assist in the areas of coordination of agency services and data collection (see preceding Recommendations in this section). It would also provide for joint program and budget review by local funders of human service programs. (See Proposed Program for Implementation of a Human Services Support Network for further detail.) It is recommended that local funding bodies share the cost of providing this support network and that they require participation in this process by human service agencies applying for funding locally. MICROFILMED BY JORM MICROLAB CEDAR RAPIOS•DES 140114ES Priority Problem 1. DISCHARGE PLANNING RECOMMENDATIONS Patients are often discharged without referral to community agencies which can provide ongoing supportive care. There is evidence that nursing homes are minimally involved in planning for discharge. If there is no com- munity agency such as the Department of Social Services or Veterans Admin- istration involved with discharge planning then the nursing home resi- dent may not be receiving needed com- munity care. Nursing homes do not always take an active involvement in discharge referrals because they are not oriented to providing care beyond the confines of their facility. They also lack knowledge of community agencies providing supportive serv- ices. Inappropriate Placements It is not known how many residents are inappropriately placed. Studies have shown that many nursing home residents require lower levels of care than they are receiving. Nurs- ing homes do not have a means of assessing the appropriateness of placement which contributes to the problem of residents remaining in nursing homes longer than necessary. Often nursing homes are unaware of inappropirate placements because they do not have adequate means of eval- uation. Recommendation Discharge planning needs to be implemented on admission. Nurs- ing homes should assume more re- sponsibility for discharge plan- ning and be knowledgeable about community resources which can be utilized by their residents upon discharge. Nursing homes and community pro- viders need to meet regularly for joint problem solving and sharing infc.-mation. The development of a liason sys- tem should be explored to assure continuity of care as an indi- vidual moving from one level of care to another. An assessment tool should be de- veloped which will assist the provider in determining place- ment in the appropriate setting and to determine the appropriate level of care required at any given time. Community based services need to be developed for those need- ing minimal amounts of nursing care. The present licensing procedure of the State Depart- ment of Health discourages development of I- - MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 14011JES Agencies Affected Hospitals, Visiting Nurse Ass'n., Dept. of Social Services. Hospitals, Dept. of Social Services, Visiting Nurse Association. Possible Funding Sources Include in budget of Nursing Homes and referral agencies. Expansion of funds from State Health Dept. to be administered through the local health department. State Dept. of Health, City, County, United Way. Priority 2. 3 L RECOMMENDATIONS Problem Inappropriate Placements (cont'd) Third party payments for residen- tial care do not exist thereby encouraging use of higher levels of care than may be necessary. ASSESSMENT OF BED NEED The accelerating increase in the elderly population will result in an ever increasing demand for nurs- ing home beds unless there is an expansion of in-home services com- bined with the development of a system for assessing intermittent and short term care. DATA There is no data collection system to determine how many Johnson Countyresidentsmust leave the county to seek nursing home care because of problems involved in securing care within the county. There exists a need for more skilled nursing home beds but the extent of this need is not known since there is no mechanism to collect data on Johnson County residents placed out of the county. F� Recommendation alternatives to nursing homes. Modifications of rules and reg- ulations to encourage development of more residential care facili- ties to assist individuals no longer needing continuous nursing services to move into non-medical settings. Expansion of third party payments to include residential care would encourage use of lower levels of care when it is appropriate. Unsing existing facilities by ex- panding the role of nursing homes to offer other services such as day care to avoid removing large numbers of individuals from the community. - Statewide survey of nursing homes to determine residents' county of origin and reason for leaving the county as a mFans of determining the need for skilled nursing care in the county. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES IIORIES Agencies Affected Nursing homes and all agencies serving the aged in Johnson County All Iowa nursing homes. Possible Funding Sources Health Systems Agency University of Iowa, State Dept. of Health State Dept. of Social Services, Iowa Gerontology Project K RECOMMENDATIONS Priority Problem q, ADMISSION PROCEDURES Nursing homes vary widely in their admission procedures often empha- sizing chronic and long-term med- ical problems, excluding social and psychological needs. 5. REVIEW MECHANISMS The review mechanisms which have been established to monitor the care of the residents in nursing homes are not always effective. Three separate mechanisms have been established to monitor the care of patients: the Medical Care Review Team from the Agencies Recommendation affected A standardized admissions proced- Hospitals ure should be adopted. A method and other of assessment should be developed referral prior to admission to assure ap- agencies. propriate placement. Nursing homes should be able to determine whether they can meet an individ- uals needs based on this assess- ment. Implementation of a multidisci- plinary team approach to deter- mine the need for nursing home placement or an alternative plan for those individuals who only need intermittent care and whose needs can be met by utilizing community services. One person or agency should be designated as coordinator of continuing care. Liasion and coordination among Dept. of the three independent monitoring Social bodies to provide a comprehensive Services, review of all residents. Improv- State Dep - ed training of revier: teams with artment of emphasis on developing rapport Health, with nursing home staff and nurs- Iowa Com- ing home residents. Reviews mission on Possible Funding Sources State Dept. of Health Older Ameri- cans Act, Dept. of Social Ser- vices, State Dept. of Health, Iowa Commission on 6:,:..4 1.. 1,...4 ., . 1,..,-4 ....0.---1 1'-4 i,.i P.", P-W.N pwwd WMI Now W=d ...... Iow.,.,.. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES NOIRES Priority a ■ RECOMMENDATIONS Problem REVIEW MECHANISMS (cont'd Department of Social Services, De- partment of Health Consultation and Licensing Division of the State Department of Health, and the Care Review Committees at each facility. The latter are volunteers who act as patient advocates and are chosen by nursing home administrators. These three monitoring bodies act independently and it is questionable whether there is adequate follow-up to correct identified problems. MEDICAID Individuals who qualify for Medi- caid do not have the same access to nursing home beds as those able to finance their own care. A suf- ficent number of beds does not guarantee that there will be beds available for Medicaid residents. Nursing homes are charging higher rates to private pay residents to be able to accept Medicaid res- idents. This results in financial hardship for those not qualifying for Medicaid. Recommendation Possible Agencies Funding Affected Sources should emphasize quality of care Aging, Nurs the Aging, and appropriateness of placement. ing Homes. Private Duplication of reviews should be Foundations eliminated. with inter - Care Review Committees (ombudsman est in the Aged. program) should be strengthened by adequate training of volunteers. Responsibility for volunteer se- lection should be assumed by soinc method other than nursing home administration to assure advocacy. Resident councils need to be de- veloped to work together with Care Review Committees. Prompt and equitable reimbursement Johnson Co. Dept. of So- to encourage nursing homes to Regional cial Services, accept Medicaid residents. Planning Health Care Commission, Financing Study methods used by other deliv- Nursing Homes Administration ery systems for cost determination Dep. of So- (HEW), State and cost containment. cial Services Dept. of Health State Dept. of Nursing home administrators, hos- Health pital staff involved with long-term care, and other providers of serv- ices reimbursed by Medicaid should meet on a regular basis to share information and for joint problem solving. (See Communication, Co- ordination, Information under General Recommendations.) MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 110PIES -24 - APPENDIX REVIEW TEAMS DEPARTMENT OF HEALTH Annual unannounced licensure inspections of health care facilities are to be carried out by the nurse consultant of the Consultation and Licensing Division of the Department of Health. During such inspections, all records (dietary, personnel, etc.) are open to the nurse consultants. Attempts are also made to talk with some of the residents to gain their input as to the facility's condition. Upon inspection, if the nurse consultant finds the facility to be in violation of the state law and/or regulations, a conditional license may be issued. Along with this a grace period of thirty days, sixty days or one year depending on the severity or extent of the violation is extended to the licensee to remedy the conditions. On -sight follow-ups are done to see if violations have been corrected. While consultation and education are viable and important ways to help bring health care facilities into compliance with state rules and regulations, they are not always sufficient to enforce compliance. In 1975 the Iowa General Assembly passed legislation, effective July 1, 1976, implementing a fining and citation system for health care facilities. The system classifies violations of department rules and regulations into three classes depending on severity, duration, intent and recurrence of the condition. Facilities are fined accordingly. Facilities have the right to judicial review of any _i citation and fine levied which they feel there was not just cause. `i The maximum time allowed for the correction of violation is one year; _ a health care facility may operate under a conditional license for no more than one year. If, at the end of that time, the violation still exists, the inspector is to recommend revocation of the license. In some instances �- waivers may be issued to a home failing to meet a particular standard provid- ing that it does not hamper patient care or the delivery of services. Re- vocation of license may be recommended upon an inspection if conditions in the home are so poor that the physical plant and/or patient care is jeopardize the health and safety of the residents. The nurse consultant is in the pos- ition to recommend rather than act on a revocation of a license; the ultimate power to revoke a license lies with the Commission of Public Health. If this process is carried out, the Commissioner of the Iowa Department of Social I " Services becomes involved and must withdraw Medicaid -Title XIX funding from that home. i If the revocation of a license is made, a notice of same is sent to the licensee, listing the deficiencies in the home. It notifies the licensee of the right to appeal the action and allows 30 days for a hearing at which time evidence may be presented on both sides, as to why the license should or should not be revoked. The hearing officer who presides over the appeal is appointed by the Commissioner of Health. If the licensee chooses not to appeal the decision, the license is revoked on the date stated on -- the revocation notice and Medicaid funds are withdrawn. However, if an MICUFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 1401RES -25- 1 MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 110114ES d�Appendix 1 con'td. appeal is requested, the facility remains open unless the repeal results in a for which revocation decision for closure. If an appeal is sought, all reasons to disclosure, however, if the Com- have been recommended are subject public in home present a danger to its residents, missioner believes the conditions a Committee go into the home and survey he may ask that the local Care Review he may close the facility the situation, and if the committee recommends, He also has the power to close a home of his I prior to the appeal process. such expedient action must be taken to pro- own accord if he is of the opinion tect the residents. R'1 In addition to the annual inspection, special investigation and in- Health ( regarding specific complaints received by the Division of The wa spections out by the Consultation and Licensing tDivision. Facility are carried of the party complaints received. The identiissuing Division investigates all be disclosed to the facility's administrator the complaint is not to be acknowledged. The department prefers unless the complaintant wishes to form with as much documentation as the complaint to be submitted in written '1 possible. Health has a contract with the Department of Social m� The Department of latter's ICF (Intermediate Care Facility)•surveys " Services to perform the to accept Title XIX - Medicaid patients. required for home to be certified federally funded, limiting its inspection to nursing Mq The ICF program is ICF rules were written in accordance with federal homes and hospitals. State guidelines. DEPARTMENT OF SOCIAL SERVICES The annual review of Title XIX (Medicaid) patients is carried on, Social Services. r1', according to federal guidelines, by the State Department of Social Services has The Division of Long -Term Care in the Department of in April of 1973. The function of review teams that went into operation skilled and intermediate care facility in Iowa " the teams is to visit every interview all residents receiving Title XIX assist- '1 that has Title XIX and to findings,theg reviewionsmforaespecificndations heir nursinesult toce. mli Each of the review teams consists of a registered nurse and social training .a worker. Each has available a consulting physician. The teams' basic regulations, pro- consists if an orientation during which they study work theories and attitudes cedural guidelines for conducting a survey, social on aging. ,., the nursing home involves a separate interview with each The survey on is public assistance. The interview is .« resident of the home who receiving the human needs of these people are being met; geared toward whether or not is and the resident situation is dis- a review of the medical records made of the home's physical condition cussed with the administrator. A review is made to determinean and its programs is made. An attempt the home that team her individual is appropriaresoutely rceseforntheimprovement of the home. From find and use community to the administrator in terms the findings, the team makes recommendations the situation of the particular patient. of what can be done to improve 1rt MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 110114ES _2A_ Appendix 1 cont'd. These written recommendations to the administrator are also given to the County Department of Social Services. Reviews noting deficiencies require response by the administrator to the review team. If a particular home is found to be providing inadequate care and is in gross violation of health care standards, the Director of Long -Term Care may contact the Department of Health about that home and request a survey to determine if Medicaid (Title XIX) funding should be withdrawn. Medicaid funding must be withdrawn whenever a facility's license is revoked by the Department of Health. Federal law requires at least one yearly review of each Medicaid resident and facil- ity by a review team. No advance notice is required for team visits. In some cases, an unannounced follow-up visit is made in order to see if the recommendations made upon the first visit have been acted upon. Any changes in the facility, its programs, and numbers of staff are also noted at that time. CARE REVIEW COMMITTEES (CRC) Each health care facility is required to have a CRC periodically re- view the needs of each resident of the facility. Members of the CRC are appointed by the Commissioner of the State Department of Health. If the Commissioner fails to act within 30 days after notification of a vacancy by the administrator of a facility, the facility administrator may make the appointment. A CRC found to be functioning unsatisfactorily by the State Department of Health may be required to place such membership by new appointments. The Care Review Committee (CRC) should act as consumer advocates for the residents and made recommendations for the improvement of care and services on his behalf. They should be a liaison of the residents of the health care facility, the facility administrator, and the community. Any person, pro- vided no conflict of interest exists, with an interest in health care ser- vices in the protection of dependent persons may be appointed to serve. The members of the CRC shall not have ownership in the facility, be employed or related to an employee or the licensee, nor a public employee involved with sponsoring the placement of residents, or who inspects or other- wise evaluates the health care facility or residents. All residents of the facility are to be reviewed annually by members of the CRC. An evaluation form shall be filed with the administrator of the facility. The committee is to be concerned with the physical, spiritual, personal and social needs of the individual resident and to determine whether the facility is fulfilling the contract of services and programs for care as agreed upon in the resume of care. The CRC members may recommend a resident be transferred due to inability or failure of the facility to provide ser- vices by the resident. FIRE MARSHALL The State Fire Marshall's Office along with local fire marshalls in Iowa's larger cities, conduct annual .inspections of health care facilities, including federal inspections for Title XIX certification. These inspectors are also responsible for a variety of other fire -safety inspections, e.g. in public schools, hospitals, etc. Facilities that are found to be in MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 110RIES I J _1 _2A_ Appendix 1 cont'd. These written recommendations to the administrator are also given to the County Department of Social Services. Reviews noting deficiencies require response by the administrator to the review team. If a particular home is found to be providing inadequate care and is in gross violation of health care standards, the Director of Long -Term Care may contact the Department of Health about that home and request a survey to determine if Medicaid (Title XIX) funding should be withdrawn. Medicaid funding must be withdrawn whenever a facility's license is revoked by the Department of Health. Federal law requires at least one yearly review of each Medicaid resident and facil- ity by a review team. No advance notice is required for team visits. In some cases, an unannounced follow-up visit is made in order to see if the recommendations made upon the first visit have been acted upon. Any changes in the facility, its programs, and numbers of staff are also noted at that time. CARE REVIEW COMMITTEES (CRC) Each health care facility is required to have a CRC periodically re- view the needs of each resident of the facility. Members of the CRC are appointed by the Commissioner of the State Department of Health. If the Commissioner fails to act within 30 days after notification of a vacancy by the administrator of a facility, the facility administrator may make the appointment. A CRC found to be functioning unsatisfactorily by the State Department of Health may be required to place such membership by new appointments. The Care Review Committee (CRC) should act as consumer advocates for the residents and made recommendations for the improvement of care and services on his behalf. They should be a liaison of the residents of the health care facility, the facility administrator, and the community. Any person, pro- vided no conflict of interest exists, with an interest in health care ser- vices in the protection of dependent persons may be appointed to serve. The members of the CRC shall not have ownership in the facility, be employed or related to an employee or the licensee, nor a public employee involved with sponsoring the placement of residents, or who inspects or other- wise evaluates the health care facility or residents. All residents of the facility are to be reviewed annually by members of the CRC. An evaluation form shall be filed with the administrator of the facility. The committee is to be concerned with the physical, spiritual, personal and social needs of the individual resident and to determine whether the facility is fulfilling the contract of services and programs for care as agreed upon in the resume of care. The CRC members may recommend a resident be transferred due to inability or failure of the facility to provide ser- vices by the resident. FIRE MARSHALL The State Fire Marshall's Office along with local fire marshalls in Iowa's larger cities, conduct annual .inspections of health care facilities, including federal inspections for Title XIX certification. These inspectors are also responsible for a variety of other fire -safety inspections, e.g. in public schools, hospitals, etc. Facilities that are found to be in MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES 110RIES Appendix 1 cont'd. violation of the state fire -safety rules and regulations are given provisional certificates and a written list of specified time periods to come into com- pliance. Facilities must come into compliance or obtain a waiver within a year in order to maintain their fire -safety certification and their state license. The State Fire Marshall's office has two methods of bringing a home into compliance with the laws and regulations. The methods of enforcement used in nearly all cases is that of threaten- ing to deny a fire -safety certificate to a home that refuses or is unable to come into compliance with the fire -safety laws and regulations. A home that does not have a current fire -safety certificate cannot be licensed by the State Department of Health. The second method of enforcement available to the Fire Marshall is a fire misdemeanor law, under which homes can be fined if they violate the fire safety laws and regulations. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIRES MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOINES MICROFILMED BY JORM MICROLAB CEDAR RAPIDS•DES MOIRES MICROFILMED BY JORM MICROLAB LFnnn RAPIV,•ar,-1o1its, J 1/29/79 To: City Council Members, Mike Kucharzak From: Jon Graham, Vice-chairman Housin; Commission Re: Inspection checklist amendment to Housing Occupancy and Maintenance Code I regret not being able to attend your informal session on 1/29, but scheduling conflicts prohibit it. The Housing Commission, in a meeting on 1/25, voted 5 to 1 to recommend to the council that you not accept this amendment. It was generally agreed that the checklist is a fine idea. This is an instrument that I believe should be used to promote under- standing and clarity between the landlord and tenant. However, as was expressed in the motion the commission adopted, we do not believe the Housing Code is the broper medium. As I understand it, the purpose of the Housing Code is to establish standards to protect the safety and welfare of the ci- tizenry, not to regulate financial interactions between tenant and landlord. The primary impetus for this amendment is the use of the damage deposit by landlords and the equitable transfer of this deposit between landlord and tenant. Since this is not a direct concern for the safety or welfare of the public, I believe it is beyond the scope and intent of this ordinance. I also share Mr. Kucharzak's Cl-nrarns about practical enfor- cement problems and the detrimental effects such an amendment may have on the entire code. I hope the council has given proper con- cern to these problems. Who will mediate disputes? and who will interpret what is a prover checklist? are just two of the questions that will need to be answered. What my arguments point to is the commission's belief that the Housing Code is not the appropriate place for a checklist. Such an amendment will be detrimental to the code because it goes beyond the code's purpose and in t!e process creates the potential for a great many unnecessary problems. What constructive comments can I offer? As I stated earlier, most members of the commission agree that the checklist is a good idea, but that its proper place is as part of a model lease. This is in fact what a checklist is. It is part of the rental agreement. If the council believes that rental agreements need to be regu- lated, I believe it should be done on a straight forward and con- sistent basis. Perhaps the council believes there are certain items t -at should be present in all leases. In any case, I urge that if the council feels this type of legislation is necessary, that it be drafted as an ordinance seperate from the Housing Code, with its own enforcement procedures and its own properly defined purpose. I will make every effort to be in attendance at the formal session Tuesday night. If any member of the council has questions or desires discussion, I will be pleased to cooperate. As a member of the Housing Commission, it is my desire to see Iowa City enact and enforce sound, consistent and reasonable housing ordinances. We currently have a good minimum housing code. Let us not wreck it with patchwork additions destroying its con- tinuity and purpose. Thank -you for ,your consideration. R speclly,submitted, on Graham. ova City Housing Ccmmission MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES t1M A n a at in mc. _ _ - 5o �LC7o 13,7&3 pall 17.753 11.893 $y Zoo / :5-/S RIP# Victim Advocacy 91515 6,003 &71126,567 Salvation Ary _ I fyw Agency Request ,1 l..00 School Children's Aid - Funding Rraaldoen ,30,nc ,o L'. P. Y. 30.000 27.327 :"o 559 6,000 FY80 City FY79 City fYBO Cc FY79 Co 1979 United Z0• Will reel Mel9hborhood Center 5,616 6,000 Funding Rey Funding Req funding Req Funding Rep Way Fund 17y @`rqw/! L • Aid i Attornative for �ee0 Youth Mort 8.000 8,000 9,9i70 19,150 United Way Way - Violet Of SPyeee Abuse 13.356 '/ q Sr JCRPC68 195 Tdl.1 740;737 6S 897 Tyt: p r6Z6ff 71 810 sm;x/s American Red :roe, 29,609 •Reserve W Y�N !ands ""sfsf3� Sr� w,"Infonutlon Cor IY80 avoil(ale4Pi2066 F' i�p00 7,700 12 -Babe Ruth League 2,500 1,200 - - 12- 91 Boy, Baseball 1,100 1,200 Bey Scout, - - - - 12,000 Caapfire Girls 1,500 Conualty, Coord. Child Care - / C's 7,500 Crisis Center Transient Progress 5,000 2.2001 - ;�, V3�� 10.000 1],000 ,ono 3,000 _ 2,000• 0 dao Free Medical Clinic - - /uQ'p0 11,650 27.000 I�U• Friends of Children "I �, Mueeu. 10,000 2,000 Girl Scouts _ 9,600 L /28,.r cirt't :ortbal a 3./80 1.200 GYodvll) • - 26,000 Headstart - - - - 12,000 '4 -� Mara 1.500 Jova Children L Fla. i Sm. 1.200 p ' Johnson County Council )9 0'00 i on Aging 13r;g6. 18,550 IOYdOo 1500 S.000 /J000 t J.L. Assoc. for Or'.,. Jed Clticens _ _ 1.500 Libraries (Oxford, Solon f --•� !wa City, Coralvi)le) - J // o 12,956 Lutheran Soc. Serv, x3,13% Mayor'sYouth 23,133 21.271 - /700 1 .� MECCA 35,000 - 38,000 122,833 - /7000 Menbl Mealt^ Cantor Me I - - 795,JI/0 176.050 (i ryq re -A n a at in mc. _ _ - 5o �LC7o 13,7&3 pall 17.753 11.893 $y Zoo / :5-/S RIP# Victim Advocacy 91515 6,003 &71126,567 Salvation Ary _ _ _ - l..00 School Children's Aid - 1,700 ,30,nc ,o L'. P. Y. 30.000 27.327 :"o 559 6,000 Y.Y.A. $lifa� 01.300 35.500 Will reel Mel9hborhood Center 5,616 6,000 6�00 • 9,000 �ee0 Youth Mort 8.000 8,000 9,9i70 19,150 United Way Way - 41,000 Sr JCRPC68 195 Tdl.1 740;737 6S 897 Tyt: p r6Z6ff 71 810 sm;x/s rts,7aa •Reserve W Y�N !ands ""sfsf3� Sr� w,"Infonutlon Cor IY80 avoil(ale4Pi2066 F' 7, a"a e J T9 / 3 /UY LG" MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOINES /F 000 /P x30 /A mo BASIC ELEMENTS THAT ;MOULD BE PROVIDED BY UNITED FLAY - Package'El i - Regular updating and distribution of Johnson County Services Index.'° - Spin-off directories for Special Population Groups could be provided (if costs wore picked -up) - Coordination of joint hearings on human services program funding requests - Assistance in proper use of budget forms - Assistance in priority development and use - Provision of information on program services and needs - As'sistance to agencies via workshops in effective management - Management by ohjective (MO) workshop - Workshop on completing budget forms properly - Workshop on provision of grant information - Development of criteria to be used in assesing social impact of planned developments in county - Provision of grant information and assistance to human service agencies as relevant to specific grants * If the Service Index would be updated y.^ar y but on y printed an distributed every other year a $500 savings would be experienced. A simple sheet of additions and/or corrections could be distributed to each agency yearly. MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES MOIRES BUDGET - Package #1 4+ $5600 '. ..Y :'J.:...:-'.:4iiYt'«SS�.'.'s+Oi�ll6--Y.: _ .�.�. �'+�avOus�Yoa'..�,r.ru•:. r. ELEMENTS THAT WOULD BE PROVIDED BY UNITED WAY - Package X12 Coordinative meetings between providers of like or complementary services for sharing of information on services and problem -solving (regular agency directors luncheons are currently being held) Impact statement prepared annually on: Improvement of service delivery Current and projected problems in the areas Funding pattern for human services locally Unmet needs Relevant legal, demographic, economic and institutional changes (practicum student) Staff and/or'representatives will attend meetings of multi -county funding agencies l Title XX IHeritage Agency On aging Hawkeye Area Community Area Program LEAA HSA Plus all items listed in Package #1 ++ United flay is giving approximately $13,000 in hind MICROFILMED BY JORM MICROLAB CEDAR RAPIDS -DES ttOIRES 11—`. BUDGET - Package�p2 nc Iu ing �'1) TOTAL - $7100 ® johnson county regional planning commission ® /2 south dubuque street, Iowa city. Iowo 52240 (319)351-8556 Isobel Turner tron�e"on Emil L. Brandt 1/24/79 BASIC ELEMENTS WHICH WOULD BE PROVIDED BY HUMAN SERVICE SUPPORT PROGRAM (if housed in Johnson County Regional Planning Commission) The three program packages below have been developed from the longer "Pro- posal for a Human Services Support Network - FY '80 and Ongoing, which you received for review in December, 1978. The Program Development Subcommittee of the Human Services Project feels that all of the components outlined in the three packages should be pro- vided in order to assure adequate support and planning for the human ser- vice system in Johnson County. The total amount of support which we would need in order to provide these components is $26,400. We hope that this cost could be shared between Iowa City and Johnson County. I However, we realize that the Council and Board of Supervisors may not be �. willing or abletoprovide this full amount of support. Therefore, we f have chosen to present the program in these three packages. i Packages A and B would allow for provision of assistance in the areas of management, evaluation, and coordination. Their aim is primarily to achieve implementation of the products of the first and second years of I the human services planning effort. Package A is what we consider to be a minimum program level and would provide fora half-time project director. Package B (which includes the components in Package A in addition to those listed).would provide a more complete program and enable the employment of a full-time project director. Package C would expand the services in Packages A and B to include addi- tional planning assessment and grant assistance. This package represents the total program level which we would like to see funded. It would al- low for the employment of a half-time planning assistant in addition to a full-time project director. The cost and components of each.package..are shown below. Package A $10,000 - '$7,800 Project Director Salary 1,200 Fringe Benefits (F' -CA, IPERS, Health Ins. Life Ins., Merit Inc. Reserve) 1,000 Printing and Mailing MICROFILMED BY JORM MICROLAB c IDAR nnr IDS - X ', MD 1 t1Cs Packa e A (cont'"�} 2. Components: I. Annual Update and Distribution of ,Johnson County Services Index 2. Spin-off Directories Excerpted Annually for Youth Elderly Law Enforcement Officers 3. Coordination of Joint Hearings on Human Service Funding Requests 4. Assistance in Use Of Joint Budget Form 2 Workshops: 1 for Funding Bodies 1 for Agencies 5. Evaluation of Human Service Funding Requests Which Require Local A-95 Review 6. Attendance at Meetings Regarding Multi -County Programs to Keep Up -to -Date on Programming and Funding Changes and to Advocate for Relevant Needs in Johnson County Health Systems Agency (HSA) HACAP Heritage Agency on Aging Title XX Iowa Department of Substance Abuse (IDSA) Package $20,000 - $15,600 Project Director Salary 2,400 Fringe..Benefits (FICA, IPERS, Health Ins., Life Ins., Merit Inc. Reserve) 2,000 Printing and Mailing Components: 1. All Components in Package A 2. Coordination of Workshops to Assist Agencies in Effective Management of Services 4 Workshops: Goal and Objective Setting Data Collection and Use Grant Resources Peraonnel Management 3. Individual Assiscance Provided to Agencies as Fol- lowup to Workshops Upon Request By Agencies 4. Coordinative Meetings Between Providers of Like br Complementary Services for Sharing of Information on Services and for Problem -solving 3 Provider Groups, each having quarterly meetings 5. Assistance to Funding Bodies in Development and Use Of Priorities to be Used in Funding 6. Development of Criteria for Use in Social Impact Statements (to be uned together with assessment of environmental and economic impacts) MICROFILMED BY JORM MICROLAB CEDAR RAPIDs•DE5 !10PIL5 3. Package C $26,400 - $15,600 Project Director Salary (Full-time) 2,400 Fringe Benefits (FICA,IPERS, Health Ins., Life Ins., Merit Inc. Reserve 5,600 Planning Assistant Salary (Half-time) 400 Assistant Fringe Benefits 2,400 Printing and Mailing Components: 1. All Components in Packages A and B 2. Annual Report Assessing Human Service System.and Needs, to Include: Changes in Services and Service Needs Current Funding Patterns for Human Services Locally (All funding coming into Iowa City/ Johnson County for Human Services) Relevant Legal, Demographic, Institutional, Economic Changes Current and Projected Problems in the Area of Human Services Current and Specific Information on Services Provided,.Client Characteristics, Gaps and Fragmentation in Service Provision 3. Provision of Current Information on Available Grants to Relevant Agencies in an Effort to Meet Identified Needs; Assistance with Documentation of Need and Pro- gram.Planning MICROFILMED BV JORM MICROLAB CEDAR IMPIDS•DES '101tirS