[Editor's Note: The Grant County Commission work session on Sept. 6 and the regular meeting on Sept. 8, were both long meetings, so this series of articles will be numerous. Part 2 gets into the discussion of a county Health and Human Resources Department. The previous article is linked at the bottom of this article.]

By Mary Alice Murphy

A discussion at the Grant County Commission work session on Sept. 6, 2022, focused on the potential creation of a county Health and Human Resources Department.

County-contracted Attorney Ben Young of Mynatt, Martinez and Springer PC out of Las Cruces said the item was the result of conversations with (District 3) Commissioner Alicia Edwards in an effort to address matters of concern in the county. "We have discussed creating a new department through resolution. It would allow the county to address specific needs. I spoke with the Dona Ana County Health and Human Resources Department head. She said she wouldn't name it that again, because they get calls from folks who think they are the state or federal Health and Human Resources department."

Edwards said: "We've been talking about some sort of department funded through Health and Human Resources coordinated with ARPA (American Rescue Plan Act) money. It has become obvious that the county should be taking the lead on facilitating work around behavioral health, the health council, senior services and others. But the county will not be providing services. In Rio Arriba County, they started an HHR department and now it has 28 positions. I don't see that in Grant County, but it has to be self-sustaining. I would like to see the county take the lead around health and wellness. We have one of the highest youth suicide rates; our poverty rate is high. We can partner with other agencies. Having one person (a health coordinator, who recently quit to take another job) coordinating meetings and in charge of the local rollout of 988 (the mental health phone line) has helped us. What the county is charged with doing is taking care of its residents, with roads and parks. There will be a lot of funding for such a department. We could use the opioid settlement funding. I think we can increase the budget with other sources of funding."

District 5 Commissioner Harry Browne said: "I'm wondering if there is some way to put on paper what the department would do. I would ask who's doing it now? You suggest that it can be funded through other sources than through our General Fund. It strikes me that such a department will have an impact."

Edwards clarified that what she meant by senior services was not what HMS (Hidalgo Medical Services) is doing with providing meals and transportation for seniors. "Once upon a time there were many other services available to seniors. I'm guessing the funding has changed. We had programs where housekeeping was provided. How can we partner with other organizations to provide those services? It's part of what I'm thinking about. Every organization is stretched thin because of funding issues. My vision is that the county would take the lead in facilitating all the work. I want to hear from all of you [she said to the commissioners]. We are not ready to pass a resolution. I can provide data on what we know from the health coordinator that has happened over the past seven months. She got more done in seven months than many of us working together, and more quickly, because it was that person's job."

Dan Otero, HMS chief executive officer, said: "I want to support what Commissioner Edwards is proposing. The 'Great Resignation' has hit health care positions. We have talked about a community triage center. But it's getting difficult to fill positions. Ms. (Cassandra) Hartley (the health coordinator) got all of us around the table. She asked: 'Why can't we do this?' We began to understand each other's issues. She was neutral. I saw great value with that. She was taking the lead in a direction where the community needs to go. I liked what Dr. Shepard said [in part 1] that he is doing what is needed."

Browne said the community used to have an interagency alliance. "It was awesome. It was collaboration among community groups without county involvement."

Edwards said she remembered it, too. "I got involved when it was dying. One thing that is different now, is we have lost a lot of people from the hospital who participated and the health council which worked hard. Before Mary Stoecker (former NM DOH liaison) retired she worked with Michelle Giese. When Giese took over the spot, she was spread too thin and only did half the work. It took more than a year to replace Giese's position after she retired."

"I think the name of the department is everything," Edwards said. "It might be something similar to interagency alliance. We are seen as neutral, so yes, it would be similar."

Browne said the Grant County Community Health Council comes to mind, because it did similar work.

Edwards agreed and said: "We had a great Health Council, but then the state yanked the funding. I don't want to rely on the state to fund this department. Yes, the state can be a partner, but we need to take charge."

Otero said he had recently attended a conference in Chicago that talked about health equity and social determinants. "We have to make sure we on focused on getting funding for these things and focused on managing, as well as on what are things not being supported. We want to help."

He noted that for the senior centers, two of which have not reopened since the pandemic, "we can't get staff. The state gives money for seniors to get to services, but we don't have the staff. Having a conversation in a collaborative way would be beneficial."

Edwards reiterated that the county as a neutral party could facilitate. "In the seven months of meetings we've had in talks with HMS, Gila Regional Medical Center, and with law enforcement, we have found out some of the needs."

Browne said: "If Miss Hartley did such a good job, while she was here, maybe we need a coordinator instead of a department."

Edwards said compensation was an issue. "What we're proposing is a big pile of work and money. We will need administrative staff. We have a tremendous need here for health, wellness and well-being that we have to do. We have a tendency to go low. If we want to be successful, we have seven months of experience to call on. I think it will take a department with a person with administrative capacity and the ability to herd a lot of cats."

Otero said it's the key to legislative priority and infrastructure.

District 4 Commissioner Billy Billings asked where Rio Arriba County gets its funding.

Edwards replied that Rio Arriba started by using indigent funding. "We would need a strategic plan. We have ARPA dollars allocated, and we have budgeted dollars, as well as the opioid settlement. That's enough to fund two or three years without going into the General Fund. We have to make it self-sustaining. Someone in the department must write grants. I think we can get it off the ground."

"How would legislation work with or to take the place of the Health Council?" Billings asked.

"I don't see why the Health Council wouldn't be a partner," Edwards said.

Billings asked about the report from the health coordinator, and Edwards said she has all that, with what she was doing.

Interim County Manager Randy Villa said: "We're in discovery right now and figuring out where we need to be and what our incoming county manager wants to do."

Browne said: "If we are going to create a department, that's a different conversation."

"If we're going to hire someone, it would essentially be a different position," Edwards said.

Browne said a department would be broader than a coordinator and would be more supervisory.

Ponce said it would be a different person with different qualifications. "I don't know the history about why we went with HMS on senior services. Why was it contracted? Right now, it has the support of HMS."

Edwards replied: "We've lost a lot of services over the years. We lost many of those services when the Grant County Senior Services closed. When we lost the resources that were holding it together, it went away."

Billings said he thinks it is a big undertaking. "Maybe we should start slowly. I would like to see the successes of the coordinator and how to make a department successful. It's a huge undertaking, and we need to be careful not to duplicate services."

"I'm not suggesting the county provide services," Edwards said.

"What you're suggesting is what I pictured the coordinator could do, so that it wouldn't just benefit a specific organization," Billings said.

Browne said he was trying to see the difference between a coordinator and a department. "To me, a department provides services, but what services should be provided? I need a list of things and what would make sense for the county to provide."

Edwards noted that when senior services failed, no one in the county wanted to take it over. "If all fairness, the county completely wasn't prepared to take it over."

Villa said: "When it happened, the county only owned two of the centers, but the county took over all four centers. We had no choice, it was a challenge from the get go. In the long term, all services were available when the county was over it, housekeeping, transportation, meals, etc."

Edwards said she was at The Volunteer Center, and "there was a lot of discussion about TVC taking it over, but we were too small to wait for reimbursements, which took 90 -100 days. It was a one-size fits all. The state made it impossible. Deming had one of the most successful senior services programs, but they had a lot more money than from the state."

Otero noted that a lot has changed. "We were approached in 2016, because it was more appropriate for a health organization to take over things like dental care, health care and behavioral health. It was working well, but then March 2020 hit. We worked hard to provide meals. We have had to put in $80,000 of our own money to cover senior services. We could maybe break even in some years. The congregate meals, the delivered meals and transportation are what we are under contract to provide."

Villa said even when the county was doing the services, "it was hard to get staff. It's always been a challenge."

Otero said that now that the state is raising the minimum wage it will get more expensive. "No one can make a living working part-time, but we do offer benefits."

Edwards said what HMS is dealing with is not enough workforce in Cliff and Mimbres for their senior centers, and it's hard to commute.

Ponce said what he needed is a point of discussion on whether the county can start with the indigent fund. "Where it comes from, where it goes, and any left over. This department of whatever, I'm afraid if we put in a department going in so many different directions, we would have to be careful with the responsibilities."

Detention Center Administration Joseph Andazola said Hartley had been instrumental when the jail took over the RISE program, "and she helped with the Stepping Up program, too. We were meeting with HMS and with Gila Regional. It was all very helpful."

Edwards noted that the Detention Center is one-third of the county budget. "It's all interconnected with behavioral health. I think this proposal would lower recidivism."

Andazola agreed and said Harley was also helping a lot with homelessness.

The next article will get into the county reports.

For the previous article, please visit: https://www.grantcountybeat.com/news/news-articles/74190-grant-county-commission-holds-work-session-090622-part-1 .