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Bladen County Commissioners discuss deaths, births, and challenges of CAP Program

By Charlotte Smith

Bladen County Health Department Director, Terri Duncan gave a review to the commissioners of the 2018 Vital Statistics Report during the Bladen County Board of Commissioners meeting held on Monday evening. The annual report listed Bladen County with 162 births and 228 deaths in 2018. The report only gives data on the births and deaths which occurred in county.

Other counties or states are not included in the statistic report, but Ms. Duncan said there were 227 births and 219 deaths of Bladen County resident outside of the county.

Mr. Peterson pointed out there were 45 more deaths than births in 2016 according to the report. “This is probably part of the reason we are shrinking population wise,” Peterson said.

Commissioner Arthur Bullock asked, “If someone died due to a communicable disease outside the county, is the county notified?” Ms. Duncan confirmed all Bladen County residents’ deaths outside the county due to diseases are reported to the Bladen County Health Department.

In October of 2018 there were only three births in the county and no births in the months of November and December due to damages the Bladen County hospital received from the hurricane, according to Ms. Duncan. In January 2019, Cape Fear Valley made a business decision not to re-open the Obstetric and Gynecologic care unit. Now, births in Bladen County will be in-home births or in the emergency department if a transfer is not an option, according to Ms. Duncan.

Commissioner Michael Cogdell asked about the steps a woman in labor should take since the hospital no longer offers maternity services. “If someone is in labor they should go to their prenatal care provider,” Ms. Duncan answered.

The percentage of children not being vaccinated was brought up by Commissioner David Gooden. Ms. Duncan said she would estimate the children receiving care at the health department are 97% vaccinated, however she could not estimate the amount of vaccinated children not receiving primary care at the health department.

“Children who have not been vaccinated have been contacted to come in and be vaccinated,” Ms. Duncan said.

Commissioners Ray Britt and Dr. Opheila Munn-Goins discussed recent reports of chickenpox in the county. Mr. Britt reported the child had received the vaccination and then came down with the chickenpox.  Dr. Munn-Goins echoed what Mr. Britt stated in her report about chickenpox in the East Arcadia area. She said, “They are treated, they had their vaccination.”

Ms. Duncan also reported challenges with the county’s Community Alternatives Program (CAP). CAP is a special Medicaid program that provides in-home services as an alternative to nursing facility or institutional placement.  The program targets disabled adults (CAP/DA) and children (CAP/C) who would be forced to choose nursing home or institutional placement over home care due to their medical condition.

Currently there are 117 CAP-D patients and seven (7) CAP-C patients in the county according to Ducan’s report. Bladen County’s appropriation for the program is up to 25% with an average of 19% over the last seven years.

The program is down to only two employees, Registered Nurse and Social Worker, according to Ms. Duncan. There has been no applications submitted for the Supervisor and the social worker positions since posted last month.

The state of North Carolina has offered assistance, but no time line has been given, Duncan stated. If new employees were to be hired it would be at least six months before optimal performance in the positions could be accepted.

This year was a break even, according to Duncan and she and the current staff could handle the coverage until more staffing or assistance is received with the CAP program.

“The state has encouraged us to maintain the program,” Duncan said.

At this time there is not a recommendation from the BHS Advisory Board to maintain the program or to dismiss the program. The plan at this point is to maintain the program until decisions are made to move forward, Duncan reported.

“What is the appropriation the state gives for the program? What is the percentage the state pays,” asked Commissioner Cogdell.

“It’s not here,” Commissioner Peterson stated. “No sir,” Ms. Duncan replied.

Commissioner Ashley Trivette asked if Ms. Duncan felt like the program was necessary. “These clients can be served by other agencies,” Ms. Duncan replied.

“What affect could it have if we didn’t have it,” Mr. Cogdell asked.

“The state CAP supervisor is looking into a three entities to help us manage the program interim or long term to vest the program,” Ms. Duncan said.

“What are you plans moving forward,” asked Mr. Peterson. “What are your recommendations,” asked Trivette.

“We are planning to move forward if it is budgeted,” Ms. Duncan announced.

“I’m not for moving forward,” Mr. Peterson said.

“What effect would it have on the clients of the program,” Mr. Cogdell asked.

Ms. Duncan explained, the children would take it pretty easy, the parents would receive a letter and they would choose an entity and then go. It would take six months with a minimum of sixty days for the adults to find assistance. 

“Do you see this program making a profit in the future,” Commissioner Arthur Bullock asked.

It would be six months before the county could tell if a profit could be made with the program according to Ms. Duncan’s estimations.

“Historical data shows it may not be,” Ms. Duncan said about the profit.

The CAP item was not an action item according to Mr. Peterson. No vote was made on the matter.

Citizens wishing to address the commissioners about the new fiscal year budget may do so soon. Chairman of the Bladen County Board of Commissioners released a public notice on Wednesday stating, “The proposed FY 2019-20 Bladen County Operating Budget has been submitted to the Board of County Commissioners for consideration. A copy of the proposed budget is available for public inspection in the County Manager’s Office, Administrative Building, 201 East King Street, and in the Bladen County Library, Elizabethtown, NC. You may also access it from the County’s website: The Board of Commissioners will hold a public hearing on Monday, June 3, 2019 at 6:30pm to receive comments regarding the proposed budget.”


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