Travis County Commissioners Court
December 27, 2005
Item 4
Now, number 4 is to consider and take appropriate action in response to recommendations regarding Travis County indigent burial services. And dana, in my view this would take 15 minutes to 30 minutes. And the question is whether you need to come over on item 36 so that members of the public can hear your explanation of 36-a, b and c. And if not, the court will do it. We believe you can do it a whole lot better. I beg your pardon?
>> [inaudible - no mic].
>> okay, thank you. Number 4.
>> good morning, sherri fleming, executive manager for Travis County health and human services and veteran service. On November 17th the department came to work session with the court to discuss revisions to the indigent burial assistance policies. The last revision was 10 years ago. There have been various interpretations of the policies by county staff throughout that time period. Our proposed changes were to reconcile a lot of those practice interpretations of the policy, actually ends the policy, which included an attempt to align indigent burial policies with regard to residency with our emergency assistance policies and also to bring forward for your discussion various issues that we have had over the years with burial in terms of things like viewing and additional resources being added to burials. And then also to bring forward for your discussion the idea of potentially having cremation be a part of your policy and procedures. So today this is our first opportunity to bring forward to discussion to a voting session. There are a couple of options that the department has e-mailed to you. The first being direction from you to move forward with the policies, which would in effect cause us to have a public hearing set because it has been your practice to have public hearings when you are about to change your policies. You would also have the option to hold these policies until the cremation language has been drafted. We do not have that language as of yet. It does not exist in our policy, so legal will have to create it for you. Another option that we would see you having is to go forward with approving the rate increase. I think you heard from the funeral directors during work session that we have not increased these fees over many, many years, and our current contracts with our current vendors have a provision that would allow you to increase the fees that they receive for these services after a proper notice period. And I think legal can speak to that provision if you would like more information on that. So these are the options the department wishes to lay out for you. Certainly any of the options that the court would have we are happy to report.
>> the last increase is when?
>> the best of my knowledge when the policies were revised 10 years ago, the fee schedule was put in place, we will have no record of any fee increase since then. So that would have been in 1995.
>> in the work session the discussion with the funeral directors, part of the discussion that led to having indigent services, having a chapel type setting where some funeral homes have that aspect. They have a chapel there and of course persons that would like to have a burial with the chapel aspect of it could have that. Does this new policy still allow that service to still be embraced by indigent parties that would like to have that chapel service?
>> yes, sir, Commissioner Davis, there was discussion in the work session about the definition of viewing. Originally in the first draft that you all received from staff, we were asking the court to consider no service as a part of the policy. I think what you heard from one of the funeral home vendors is they have been allowing families to have service in their area, in a particular space within their funeral home. You also heard from other vendors that they have separate facilities in that there's a viewing space and a much larger space that requires more resources in order to have a service. So our compromise, if you will, on that policy, has been added to include language that would encourage those funeral homes that were to allow a service, that they allow that service for every -- at least offer it up to every indigent burial that they were to host. So that's the compromise. Viewing is -- a service is not required, your policy says that. Viewing is what we asked for as a part of our service, but for those funeral homes who want to provide or have an option for a certain that they -- service, that they offer is to everyone who might be coming to them under our program.
>> so the offer is still there.
>> that's correct.
>> I wanted to make sure because that was a touchy subject and as we go forward, I wanted to make sure that that service of going through that is something that would be available to those families that would like to not only view, but also have church service or something else within the chapel of the funeral home.
>> the policies with the revisions that resulted from discussion at the work session were posted on the Travis County website. The revisions were e-mailed in fact to all of our contractor funeral home directors. As of December 24th those policies have been posted for 30 days. So far staff has not received any comment on those policies. I think it's important to note, though, that our posting of these policies commenced with the onset of thanksgiving and christmas, so you may want to consider whether or not you want an additional comment period in light of the fact that most of the comment period has been during the holiday season.
>> I would feel comfortable with additional time.
>> just to make sure so that we don't have a reaction that I was busy with the holidays and I would be comfortable with more additional time.
>> did we find out if any other large counties had language with regard to cremation, because they are doing it, and if so can that language be shared with the funeral home directors because they were the ones that were wanting to be careful about liability, not only theirs, but ours as well. And so it seems like they would be a very good sounding block for that kind of language. And it just raises the question how is it that other larger counties are able to do it and we can't? Certainly there's got to be a thread the needle thing here to understand what the risks are and perhaps look at those other large urban counties who have many more decedents than we have to deal with and how they've dealt with that question of liability. An executive session question I知 sure.
>> we have requested from some of the counties who have the most experience with cremation copies of their policies. One in particular that I won't mention has declined to provide that to us, and so we are -- we will be in consultation as to whether we can make a public information request.
>> can you say open records request?
>> yes. To receive that. But yes, we have been in contact and will be making formal requests because apparently a phone call takes a little bit more than a phone call to get those because we haven't received them yet.
>> you might also make the phone call to the county judge or a county Commissioner from that county to bypass all of that because I certainly know if I got that kind of request from another county that one of my departments was not turning over what is public information, we would try to be helpful.
>> thank you, Commissioner. We certainly will do that.
>> I know there's a rotating list, we understand that, but what if the family has a preference and it's not the funeral home that is up on the list?
>> none of the funeral homes have expressed concern about the rotating list. The rotation list is primarily used by hospitals and hospice type facilities when they have no next of kin to contact and need some guidance in terms of how to select a funeral home to release the body to. Most often if there is a family member available, then they have an opportunity to determine which funeral home they would like the body released to. There are a few funeral homes, however, who are not part of our contracted vendor list, and so -- and of course at that point the family may not have any idea of the cost or -- you know, so at the point that a decision would be made about a funeral home, it is not likely that the discussion about whether or not they're able to afford the burial has occurred yet. So there are sometimes transfers from funeral homes into our contracted vendor list, but we try not to have those services provided by funeral homes who are not contracted. It was also our desire once we are further along in the policy process and as a part of this new fee increase is to open our request for services along with purchasing so that if there are funeral home vendors who want to become a part of that list, they do have an opportunity. Because we have also not opened that list for new vendors in the last 10 years.
>> based on these policies, if a cadaver ends up as a funeral home, and a funeral home basically asks us if the funeral home qualifies -- if the person qualifies, that funeral home does the services. We don't go through the rotating list -- issue
>> because of purchasing rules, we have to work with vendors who are on our contracted lists, who actually have contracts with the contract. County.
>> I知 assuming this person is one of the contracting funeral homes.
>> oh, yes.
>> but the policies would allow that funeral home to go ahead and do the business.
>> absolutely.
>> and if no funeral home, then we go to the rotating list based on these policies. I think that's in here somewhere.
>> that's correct, yes.
>> I do have several specific things. Has legal read the proposed policies here?
>> I looked at an earlier draft. I have not reviewed the latest draft in detail.
>> there's a whole lot of stuff here, and there are eight or nine things that I want to mention. I will share this copy with legal because I do have some word smithing, some style stuff. We referred to informal and common-law marriage. My recommendation is to use both. Legally there's just common-law marriage, right? Why don't we just thereafter refer to it as common-law marriage? Do you see what I知 saying? We say informal, then we say common-law marriage, either or. Let's just say common-law marriage, it makes sense to me.
>> we ought to use a legally defined --
>> just define that. And if we want to define common-law marriage as sometimes called informal, that seems to make sense to. Within a household, those individuals sharing the residence housing unit. And sharing I guess is one that -- do we mean individuals residing in the applicant's housing unit, chas a little bit different? And then for how long? I was sharing my sister's home this past weekend for christmas, but actually not residing there. I知 just visiting.
>> that is not a test that comifts if your emergency assistance policies in terms of the length of time that people revied together.
>> the question is should we. But the -- we siding there is what we really mean, right?
>> I think so.
>> I do have here how long. And then-- on 417 we refer to a casket industry. The last part down there. And should we add, as determined by the funeral home and not the family? What we're saying is we want the funeral home to determine the appropriate size of the casket.
>> that's correct.
>> and we say meeting standards of casket industry. I知 just saying we add the language, as determined by the funeral home and not the family, which is our point is we don't want the family determining what the appropriate size would be, we want the funeral home to do that because we're paying for that, right?
>> that's correct.
>> you pick up the bill, then we let you determine the appropriate size for the family. Now, do we have a description of a temporary marker? Is there like a standard temporary marker that we use?
>> I知 not -- I don't know the answer to that, judge. I would have to check into that.
>> every funeral home is required to provide a temporary marker. My question was whether the county has approved a temporary marker that funeral homes have, know about, etcetera?
>> mr. Wheeless from tnr?
>> judge, the funeral homes have always provided the -- basically a little name tag, and I assume that that is an accepted practice because all of the funeral homes do the same thing, it's just a little standard metal plate with a stake on it that has the name or some description of the deceased, and that's what they provide and we put at the graves.
>> and judge, what you're asking for is a description of that marker to be included in the policy?
>> well, we require the funeral home to provide a temporary marker. Now, on the ones that are there right now, apparently whatever they've been doing has been sufficient. But if we open this up and get two new funeral homes, will they know what the temporary marker is? I知 not saying let's make additional work for ourselves, but I did raise that question.
>> okay.
>> now, we say here that a copy of the death certificate is available through the Texas department of health. Is that the easiest place to get it?
>> yes. Funeral homes routinely charge for getting copies of death certificates for family members, and I guess the idea behind the policy is that there would be no exchange of resources between the family and the funeral home if they are qualified for an indigent burial.
>> okay. We say funeralhomes will not gie applicant, da da da, a copy of the death certificate. Why would we care if they give the family one?
>> they don't give one.
>> why is that our business I guess is my question? If we continue to do that, that's fine. I知 just wondering if we're not overreaching. If they have these things, what do we care anyway? If our point is we don't want the family paying the funeral home for one, we ought to say that. Funeral homes that contract with the county are disallowed from providing certificates of doath the family of the deceased for a fee. So we at least are narrowing that to the ones that contract with us, and I assume that makes sense. Some of this other language I guess I値l get to, mayor mar yet ta. We refer to emancipated minor. Is that defined by state law?
>> yes. I believe that's the section where we have added the language directly from the health and safety code into the policy with regard to -- and there's a whole section there of new language.
>> I値l simply say when we say emancipated minor, we need to say, under Texas law. ... Signed by the decedent needs to be clarified in some way. We seem to be saying that if you have something signed by the decedent, we'll accept that. And normally -- the law requires a little bit more than that.
>> here again in this section, I believe this is also section that we have lifted from the health and safety code.
>> I can almost guarantee you that if they accept a written instrument, they qualify or define it somewhere. Written instrument is just too general. Now, we refer to verification of this, verification of that. What's the difference between proof and verification? Proof of kin ship, proof of age, proof of this is what I知 used to seeing. Verification is a slightly different connotation. We want to verify something when you give us something and we really don't believe you. Then we ask for verification. But proof of residency, proof of age, you pull out your driver's license, that's proof of that. It's not verification of age, it's proof of age. If there's a reason that we do verification -- but I was left with that impression. Moving on, toward the end there we say that if you do not accept the decedent, when you come up on the rotation list you will be subject to sanctions. I think we need to add in there somewhere, without good cause. If you look on page 16, if you don't accept the decedent when you're up on rotation without good cause, then you are subject to sanctions. And then the question needs to be, subject so sanctions outlined in the contract, but the contract doesn't outline sanctions, does it?
>> I would have to verify with legal.
>> where are the sanctions? We need to see those and sign off on them.
>> it's my understanding also from legal that this is a 10-year-old contract, and so the current contract --
>> we're going to redo.
>> may list sanctions and it may not follow through in the existing contract. So we'll make sure that language is approved.
>> I know the funeral homes will want to see what the sanctions are, especially if we're thinking about imposing them. But I would qualify that by saying without good cause. You could have good reason. If you already have more cadavers than you can handle, kind of like our medical examiner's office from time to time, then in some circumstances the best thing to do is not to accept another responsibility. Do you understand what I知 saying?
>> yes, sir.
>> so in that case we would want you to say I知 overworked right now, I can't do you a good job, catch me next time. On these fees what we're doing is increasing everything 200 bucks.
>> that was the staff recommendation.
>> that's what I have.
>> mr. Wheeler is also here because there were questions during the work session about the availability of space at the international cemetery. And so he's here to speak to that if these questions still exist.
>> I do think we need to agendaize and either we need more space, in case there is ajay isn't land now that is not built on that I guess we could acquire either without condemnation or not. It doesn't make sense if we need more land and have to get it at some point soon, it makes sense to me to go out and get it before it's built on because later the value would be much, much greater. And what don said in one of his e-mails is we've got three or four years left based on the amount of burials. If cremations allow us to reduce that, three or four may become six or seven. But even that is not a long time if you are getting ready for the inevitable. And last time I was out there, there's a sort of structure on one end, city park on the other, but land across the street, right? I think if we need to get more acreage for the burials, then we just go ahead and move on it. That needs to be posted separately, though. I don't know if that's --
>> there was a tax sale item as well -- we had multiple options out there, but we need to land someplace.
>> if we need to expand, it would make sense to expand on to contiguous property. It would serm make maintenance a whole lot easier than if we got a separate tract of land at another location, but we ought to put that on the agenda.
>> yes, sir.
>> now, do we need all of these policies, our recommendation to be to try to look at them and figure out if there is a way to cat gore eyes them in such a way that we don't end up with 18 or 19 pages of single spaced policies. But at least more for staff and funeral directors than for anybody else?
>> yes. We have kind of a summary of the program that we can provide to the general public, so these are the specific work plan of staff and the funeral directors in terms of how we -- what our policy direction for the program is.
>> where are we trying to land in terms of being able to bless these documents? Because I知 a little concerned at least related to the price increases. And one of the biggest ones that was in there that I noticed was updating what the mileage fee was, which we all know has just changed dramatically over the last six to eight months. I知 wondering if there are pieces of this that we can move on related to existing fees that we can update and refresh because I am beyond convinced that those numbers are appropriate as opposed to having to wait until it's all finally said and done. And I know that marietta has a couple of economic development things out there and four social service contracts that were extended today. So we don't have claims that are needed to get done and there are multi-million-dollar contracts that need to get done in the next three weeks.
>> it's my understanding that the rate increase that the court has the ability, if you so desire, to enact the right increase because the current contract requires us to give 30 days' notice. Now, that notice, as you can probably figure, is if we're reducing their fee in some way, that would be the -- they would have the option to say if they wanted to continue to provide the service, but in this case the 30-day notice would be that we were increasing their fee. So if you were to enact a rate increase today, then I believe, and marietta hopefully will correct me, we will be able to provide notice and the increase could go into effect by February 1st.
>> if the court wants to go ahead and approve the rate increase for the funeral homes, we can get that taken care of just with a notice letter to them and it will take affect 30 days from the date of the notice letter. And then we'll go ahead and use that fee in the new contract when it's developed that you could go ahead and give that pay increase instituted within 30 days.
>> more like 11.
>> these are very, very modest compared to the going rate in the marketplace.
>> two points. The first is the 200-dollar rate increase, the department can absorb that within its existing budgets, so there wouldn't be any resources needed in this fiscal year to accomplish that. The second thing is that the mileage that Commissioner Sonleitner mentioned, however, that language does not exist in current policy. So you're handling of that may be different. Marietta may have to speak to that.
>> can can we increase the mileage?
>> we don't have mileage now, so you don't have anything to increase.
>> can we adopt this mileage then?
>> if the court wants to approve the mileage right with the direction that we bring back an implementation plan, then let me look at it and see how we need to do that. I don't know if you will need to amend contracts. I don't know since we're going from nothing to having something in place, then we may need to do a contract amendment.
>> I would be looking at something like with that same February 1 implementation date to hopefully get all that rolled in appropriately in a new contract. But we're talking about treating those folks the same way that we treat our own employees and that is the mileage reimbursement which is absolutely what the i.r.s. Says is the current number. So you don't put a number in it, it just gets refreshed, and jose sends us an e-mail sailing here's the new number. So you don't have to have a contract amendment every time he does it.
>> it's on both of those if the court wants to approve those today with direction for us to move forward with appropriate implementation, that will take care of t we'll bring back something if there's something that needs to be brought back, if not, the department will go ahead.
>> move approval of exhibit a regarding the proposed fee increases and mileage reimbursement with the understanding that we see an implementation schedule. Our goal would be to try to get both of those in place by February 1.
>> judge, I値l second that.
>> '06.
>> any more discussion of that? All in favor? That passes by unanimous vote. On the other hand, we really need a revised policy that incorporates changes in our legal looking at this. Our residency requirement varies from residency for voting. Right?
>> the issue with residency in the existing policy is that according to the health and safety code you are required to bury folks who not only live in Travis County, who are residents of Travis County, but who also die in Travis County. And our policy didn't reflect that previously. It merely said that they were residents, but that was not aligned with the health and safety code. And so that's the primary change in residency. But we also asked you to consider, there are instances where we have folks who are residing in nursing homes outside of Travis County, they have been in those nursing homes for less than 90 days, they are in those nursing homes because of an insurance requirement or some other payer requirement, and that person is deceased, everything that they have proves residency in Travis County. They were in the nursing home less than 90 days and so for those -- under those conditions we were asking that the court consider --
>> where did the 90 days come from is my question?
>> it's a standard test.
>> can we ensure that the 90 day requirement in our definition of residency comport with the state law? We use 60 days in some cases, 90 days in others. 60 days comes from our emergency assistance policy.
>> yes.
>> we need to make sure they don't run afoul of state law is what I知 lightly concerned about.
>> and we have been trying to align in places where we can the two. So if the court is more amenable a 60 day test, then we could -- that would align with the emergency assistance policy.
>> the judge is ameanable to whatever complies with state law. If what we're doing complies with state law makes sense to me. But I hadn't thought of the specific time lines until reviewing the policy. When I reviewed the policy, my first question was this other provision of state law that I知 familiar with has this, with the intention to remain indefinitely. Which with the evacuees, if you have left new orleans and come here and you decide 15 days later I知 living here permanently, my guess is that you meet the voting residency requirement. If 45 days later you make the same determination as to state law on voting, I assume you meet that. So my question is is there a similar state requirement. And if we want to make sure we don't run afoul of state law. If what we're doing seems if not consistent with it, but it doesn't violate it, then I知 happy with it.
>> okay.
>> so when are we looking at having this back on?
>> three weeks?
>> two weeks?
>> how long do you think it would take --
>> well, because there's the possibility of if you want a public hearing, if you want -- and so how complete does it need to be to bring it back. Do you want to have a public hearing to take public comment with the understanding that we are still working, you can go ahead and schedule the public hearing, they would have a draft, which is already out there, with the understanding that that draft might have changes. We could go ahead and take public hearing comments say in two weeks to roll that into what we're working on. Or if you want to wait and have a public hearing when what you have is complete in our minds, then I would say three weeks would be a good idea.
>> the 17th.
>> but if you want to go ahead and have a public hearing on the draft that is out there with --
>> I think I would revise the draft before having a public hearing.
>> before? Then I would say three weeks would be good.
>> does that conflict with -- when is mlk day this year?
>> the 16th.
>> is there an issue having the public hearing a day after mlk?
>> I値l have it back for the us to approve a revised draft and then the public hearing later.
>> the 17th.
>> okay?
>> all right.
>> 17th is fine with me. Ms. Brown?
>> and hopefully we can have an appropriate item if there are real estate issues that need to be brought to our attention in the next four weeks.
>> thank you.
>> thank you.
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Last Modified:
Wednesday, December 28, 2005 8:56 AM