 Welcome to Sheboygan County Government, working for you. My name is Adam Payne, Sheboygan County Administrator and co-host of this program with Chairman Roger Distrudi. And as you know, every month we strive to bring a different department or department head to the program to talk about critical roles and responsibilities. And one of the really interesting departments of our 19 in Sheboygan County is our health care centers, Rocky Knoll. Today we have Rochelle Valesky with us. One of our newer department heads, she's been here since September 2012, welcome Rochelle. Thank you very much. Please begin by sharing a little bit about your background and why you love being an administrator of a nursing home. I do love being an administrator of a nursing home. Well, let's see. I'm a registered nurse and I'm certified in gerontological nursing. I've just always been very interested in elder services and I've worked in health care for a little over 20 years now and became a nursing home administrator, goodness, 11 years ago. Really liked the balance between nursing and administrative work. I think it helps me to understand nursing being the biggest department that we have in a nursing home. And you've worked at a number of nursing homes now, have you? Quite a few of them. Most of them were owned by the same owner, so I don't want it to sound like I jumped around. You've been at from one nursing home to another. I'm pretty committed once I start working somewhere, but yes, my previous employer owned 18 nursing homes in Wisconsin at that time and I had been in all of them at some point or rather doing corporate work for them, so yes, I've been in a lot of nursing homes. And I know that was attractive to us when we interviewed you and ultimately hired you because you had that breadth of experience and having gone into a number of nursing homes, you knew what worked and what perhaps didn't work so well. And of course, we were very fortunate to bring you aboard at Rocky Knoll. So that nursing background really I think is helpful if you're an administrator because you can relate better with your staff and certainly your focus is on resident care. That is true. Well, it's good to have you here today. Let's set the stage a little bit. Tell us a little bit about Rocky Knoll. How many employees do you have? Just set the stage for our viewers who may not have been to Rocky Knoll and seen what a beautiful facility it is. Okay. Well, Rocky Knoll currently has 127 residents living there and just over 200 employees providing care for them. So the different departments of Rocky Knoll include not only nursing, which would be nursing assistants, registered nurses, LPNs. We have nurse managers. We have a dietary department, an activity department, maintenance department, medical records. Housekeeping. There's a lot of departments going on there to make it all work for the care of the residents. And to be a Rocky Knoll administrator overseeing all of that, it has to be very challenging. What do you find are some of the more challenging aspects of being an administrator? Well, the changes over time, I would say current time the most challenges they're seeing are related to a changing market. Long-term care industry in and of itself is changing where people are having a lot more options available to themselves as far as housing or care needs. So you'll see a lot of people being able to stay in their homes longer and having services provide there or having more options in the community before they ultimately make a decision to come to a long-term care facility. So what that does for us is decreases our census and decreases our market share, if you will, of being able to provide health care services in later stage of life. So decreasing census has been a challenge for us and all nursing homes as I talked to my peers, it's pretty prevalent throughout health care. Another challenge is decreasing reimbursement. So always looking at funding and how people can pay for nursing home care, which really is quite expensive. And coupled with that would be increasing demands regularly. So it becomes a little bit more challenging to do more with less. And just having 200 staff, of course, the vast majority of them are good people and hard working with good hearts, but every now and then personal matters do rise and they end up landing in the lap of the administrator. That's true and I'm always welcome to, you know, meet those challenges head on because you want quality staff to take care of the residents who live there. What are some of the key changes or enhancements you've made during your tenure? And again, it's only been a year and a half that Rochelle's been here, but let me tell you, she hit the ground running. You know, what do you think about it as some of the key changes you've made already? I'd say one of them is decreasing our bed size. When I first came on board, Rocky Noel had a total bed capacity of 165. And today it is 157. So over time we've been decreasing the bed size just because that's what the community is demanding, that we just don't have the need for those. So rather than pay a bed license fee for empty beds, you know, it made sense financially to do that. And the nice side of that is, has been that we're able to offer all private rooms. So that's bad. Every single room at Rocky Noel is private. With the exception of one room that's still double occupied and that'll be changing soon. Very good. And that will be private, which I do think is preferable, certainly. Other changes that come to mind? Another change that comes to mind is the dining services. Food is such an important aspect of the residents' lives. And we've really been paying a lot of attention to the quality of the food, the taste of the food, the temperature of the food, offering more choices, just really responding to what the resident feedback has been and in making a lot of improvements with the food service that we've been delivering. That's one of the things that really impressed me right away about your management style is you're really focused in on those resident evaluations. And of course, that's where they're giving direct feedback about the quality of care and the food. And right away, you notice, though, we were providing nice meals, they could be better and could be more homemade. And I've heard good feedback with that change. That's great. Yeah, I think we fell into a little bit of maybe serving institutional food where it needed a change to be a little more home-like. And those changes have been made. And I really appreciate the feedback that we've gotten from residents and family members who helped us to realize that that's what was happening. Any other changes you wanted to touch on or that stand out? One of the more recent changes I'm pretty excited about is a new team that we have that's comprised of a lot of frontline workers. And it's called the Morale Boosters Team. And it's really been positive since day one in just coming up with ideas about how to improve morale. There's been a lot of changes since I've been there. And before I got there with new team members and just different faces. So sometimes you just need to pull together as a team and learn how to appreciate each other more. And they come up with some great ideas. And since the ideas are coming from them, very well supported. And it can be as simple as a potluck. Valentine's Day, we had a big potluck for all three of the shifts. And the participation was fabulous. So just things, that little things that are making a big difference. And you truly need to build a team, especially for those of you who have followed county government or health care centers over the years. At one point we had three facilities, the Comprehensive Health Care Center in Sunny Ridge and of course Comprehensive was ultimately closed. An old facility, a new addition put on at Rocky Knoll. And then Sunny Ridge was privatized. And so we had a number of staff that would either bump other lesser senior employees or move to Rocky Knoll. So we really have a mix from three different facilities. And some of them, we were Team Comp or Team Sunny Ridge. And now of course they're Team Rocky Knoll. And that takes time. And I believe we've gotten there. But when I first even came, which is just a little over a year ago, people still referred to themselves of the facility they came from. Like we're from Comp or they're from Sunny Ridge, et cetera. But now it's a really strong team. I feel good about it. The other thing I've noticed is you've really started to build your own management team. The longer we're around as managers, obviously, we start new faces come aboard, we get to hire new people. And I know in the 15 years I've been here there's a much different look to our department heads today than there was 15 years ago. Most of them I've had the opportunity to hire now. And that's starting to happen with your management team as well. How do you feel about your management team and how have they been with embracing these new changes that you've implemented? I'm glad that you alluded to that because we have some new faces on our management team, myself being one of them. And then we have some people who've been around for a long time. So it's just a really nice mix of people who know the history behind Rocky Knoll and why certain decisions were made. And then enough fresh faces to bring forth new ideas and maybe some things that have worked at other places and they can bring forward. But the team works very cohesively together. We've gotten to a really good place where there's trust and there's respect. And people are comfortable bringing forward ideas and sharing and just working really well together. And there's a common thread throughout all the managers where we hold each other accountable. And in addition to that, holding our staff accountable. So really just raising the bar. And I appreciate that support. So it's not just me hammering. It's everybody wants good quality and to really have a stellar place for the residents to live. And one of the things I really believe in and management has picked up and supported it and not fought it at all and really gotten some benefits out of it is visibility. So I have an expectation that the managers are out on the floor every day, every unit really being visible to staff and residents and the positive feedback that's come from that from all angles, from staff really appreciating seeing management but the residents getting to know people behind the scenes. So it's been very positive. Last question before I turn it over to Roger. You come with such good credentials. You've worked in a number of nursing homes or seen a number of nursing homes. And obviously there's the private sector, there's the public sector where a county owned and operated nursing home. What were some of the differences you first observed now working for a county owned and operated versus a private sector previously? Private homes, how do I say this? I would say have prioritization of quality of care and then cost effectiveness. And what I noticed right away from public sector is quality of care is still of utmost concern but behind that is more of the people making sure that the staff are cared for. Less so I would say with my experiences in private. And when I worked for private homes I worked for both for-profit and not-for-profit. So there were differences in that too. So what's been really advantageous is to pull all of that together. So quality of care still remains number one. We gotta take care of our people but we also have to be really cost conscious and always looking towards waste reduction and how we could run an efficient organization. So pulling all of those together has really been something that I gained over years and different experiences and able to pull those together. Very good. Thank you, Rachelle. I'm Roger. Good to have you with us today, Rachelle. As you know there's several, a lot of counties that don't operate a nursing home, some that do. Could you tell us some of the advantages of a county or public owned one rather than a private and what are some of the disadvantages? I will. One of the advantages I see on an almost daily basis is the support from the community. I think because the taxpayers have a vested interest in the success of Rocky Knoll, they're really supportive of what we do there. So whether that's that they volunteer, we have a terrific volunteer base or support fundraisers or just have a presence at Rocky Knoll. That's really been something that has been new and different to me that I noticed at Rocky Knoll. Something else being county owned that I would consider an advantage definitely is being one of many departments. And so the co-mingling of support and services has been terrifically advantageous. So whether I'm leaning on finance department for sub-guidance or IT department, HR, et cetera. So really being able to pull those services together and work in that brother and sisterhood has been a fabulous support. Outside of that, perhaps a disadvantage might be that the employees recognize very clearly that the county does not have to be in the healthcare industry. And so there's a sense of a looming threat of are we gonna be privatized? So I hear that a lot with staff. So I'm always trying to allay fears and remind them that if we run a quality organization and we maintain our fiscal responsibility that that's not being talked about. But there's kind of just that unsettling that the staff definitely carry with them and that's part of being a county home. I looked recently and in the state of Wisconsin right now there are 34 counties that are still in the healthcare industry. And of those counties, then there's 44 nursing homes. So that's definitely been decreased over time. Another disadvantage I guess I would say is that there's a sense in the community that because we're a county home that will take any resident that might need care, might need to be placed in a long-term care residency. Where I think that that was probably the history, that if there was somebody who's really difficult to place because of behaviors or other situations, then you would say, well, maybe that person can be at the county. But the problem with that is that we are not treated any differently from a regulatory aspect than any other nursing home. So we fall under the same guidelines and whether it's that we're monitored for the number of anti-psychotics that we give or how you manage behavior management, et cetera. So we're not any different than any other nursing home. So we need to really be cautious when we look at potential admissions. And yet balancing that too with always wanting to meet the needs of people in the community who need housing and who need care. So there's just that misconception that we deal with a little bit. What is the tax levy budgeted for 2014 for Rocking Oil? And how does it compare with other years? For 2014, it's just under $760,000 for this year. And when you think back over the years, like even as long ago, say 2006, when it was three and a half million, it's been a huge effort towards reducing that, to the tune of in that period of time, 2.7 million dollar reduction or close to 80%. So really, really good, strong effort that will continue in always trying to decrease that. How many beds do you have at Rocking Oil and what is your current census? Today, the bed capacity is 157. Very soon, it'll be 154. We had three remaining rooms that were semi-private. Now there's just the one. So it'll just be a matter of letting the state know we wanna de-license. So that'll be at 154. And today's census is 127 residents. And I had just last week did a review with all the other nursing homes in Sheboygan County, asking them to share what their census is. And I learned some really interesting things. There's one smaller home that's just under 50 bed and that one is at 100% capacity. Outside of the exception of that one home, Rocking Oil has the highest percentage of occupancy. We're at 81% occupancy and the county average is 72%. So even though I'm not thrilled with our census and wish it was higher, it was comforting to know that we're still doing very good. And I'm proud to know that we're a leader in Sheboygan County as far as being able to keep that occupancy rate high. It shows that people trust us and still want to have residents live at Rocking Oil. So that was really comforting to see. And what kind of different services do you provide and how do we compare with other institutions? Rocking Oil is a pretty big campus kind of sprawling. So what it has is five different units, each with its own nurses station and really kind of its own culture. And of those five units, one of them is the short-term rehab. So the people who come to live there, their intent is not to stay long just to recuperate from something acute, whether it's a surgery or a recent illness, a stroke, pneumonia, something along that line where we tend to meet their needs a real short fashion. They get therapy and they pretty much have a discharge plan started from the first day of admission and an average stay might be three or four weeks. So that's fast turnover in that unit. Outside of that, we have a unit that is geared specifically for behavioral health residents who have an underlying mental illness diagnosis. And then we have a dementia care or Alzheimer's unit. So those are three. The remaining two are very similar in nature and they are what you would consider to be more traditional long-term care setting where the people who live there tend to have chronic disease processes on board in place where they're gonna probably live with us for the remainder of their life. And what are some of the advantages and disadvantages that you see in Rocking Oil compared to its competitors? I think one of the advantages is its setting. It's in a really beautiful setting up on a hill, wooded, lots of nature. Other nursing homes tend to be right in the heart of the city in residential areas. That has a lot of appeal to people to be able to get outside and take a walk and be amongst the trees and have a bonfire, et cetera. So the setting is definitely an advantage for us. Another one would be the longevity of the staff, as Adam was talking about earlier with the other two county homes no longer being in operation. We do have the most senior staff. So along with that comes a long-term commitment to working in a nursing home and working with the elders and they know what they're doing. They're seasoned and they've been doing this a long time. So that's something that sets us apart and makes us different. The other thing that goes along with that is the history, the support from the community. Having been a county home, the reputation has been ongoing for a long time and the community is very well aware of the status of Rocking Oil as being a provider of quality care for its existence. And people share that with me and it makes me proud to hear that, that what we're trying to achieve now has really been going on for a long time. Well, thank you for the great work that you and your staff do for the citizens of Sheboygan County and I'll turn it back to Adam. Thank you and it's my pleasure. Tremendous history there. You know, as you're talking about the longevity of the facility, it made me think about my grandfather who used to be at Rocking Oil when it was a TV center back in the day. And most recently, as you know, during your tenure, my mother was there for rehab for a double knee surgery. And of course, that gave me a different perspective going to the facility and visiting her and hearing her talk about the quality of care and the staff and it was very heartwarming to hear her talk about how good the staff were and how caring they were and that the food overall was very good and it's only gotten better, I know, since then. But I know that she wrote a note to many of the staff there, thanking them for the quality of care. And you know, when you go through rehab like that and you're in discomfort, it sure is nice when people are attentive and take good care of you and they took care of my mom and that means a lot to me and certainly meant a lot to her so I thank you for that. Things are always changing and that's one of the fascinating things about your job and those of us who have to work with nursing homes. I mean, it's one of 19 departments here. It's a very important one but we rely on state and federal funding and anyone who follows Medicare and Medicaid and it's always in the news that, you know, funds are depleting or whether or not there'll be any increase of any kind and that's a lifeline to being able to continue to provide service for us. I know none of us, you certainly don't have a crystal ball but what do you see heading our way? If you could envision rock, you know, five years from now, you know, what do you see changing and how we provide nursing home care? I think we need to change, first of all. If we continue doing what we've always done, I don't believe we'll be successful in a changing market. We need to be nimble and respond to the ever-changing healthcare market and you're right, I wish I knew what finance was gonna bring for us. I just don't know what the payer sources of the future are necessarily going to be but so many healthcare facilities have approached provision of healthcare for seniors by offering a continuum of care on their campus so it's not unusual to see these sprawling campuses that have independent living apartments and then from there as their care needs increase maybe going to an assisted living campus and then from there to a long-term care campus and from there the end of life services where right now Rocky Null doesn't offer a continuum of care. We have the long-term care setting and then the short-term rehab. I really think that what we need to be looking to do is to expand our services and offer something that is a little bit less restrictive of an environment, a more affordable option for people who really don't require that 24-hour nursing provision of care so along the lines of a CBRF or assisted living option makes a lot of sense for our future. Just recently there was a beautiful article in the Sheboygan Press front page of the press about I think two people that had been married for 60, 70 years. I'm sure I'm gonna get the facts wrong but it was just such a tender photo of the two of them and one woman needed skilled care was in a nursing home and the husband wasn't at that stage yet. He could come and go and of course if we can provide a situation where a married couple could come to Rocky Knoll and one needs skilled care and the other can get by with assisted living which is a much different situation that would allow them to be together and to support one another and of course that all speaks to the quality of life and happiness and that's something that you're currently exploring, are you not? I am, that would be a wonderful scenario that you just described to be able to meet the needs of a couple just like that, absolutely. So I'm looking to, I'm doing my homework right now on what it would take to create an assisted living option at Rocky Knoll, create a proposal and then bring that forward through all the appropriate channels and the board for their decision making. And we may have the space within our existing campus because as you said, it's somewhat sprawling that we perhaps can do so, I mean we may need a new entrance and some things like that but this is feasible, it's something that can be seriously considered. Without a great deal of change or construction. Yeah, I think that's fantastic. So stay tuned for that and where I'd like to end is where you started a little bit, that there's so much support for Rocky Knoll and there's a lot of pride in the community for Rocky Knoll and we have a foundation. I'm trying to think of, there are a number of good people on it but the chair of it, Bernie, Bernie? The chair is Charlie Conrardi. Oh, it's Charlie Conrardi now. Okay, who previously was chair? He's been there since I've been there. I'm sorry, I don't recall. I'm thinking of someone else. Okay. The foundation obviously is open to taking donations and have helped purchase what lazy boy chairs and just make improvements. I think one of the latest ones was working with Sargeno on the Bistro where folks can go out and enjoy a grill out or a bonfire. Talk a little bit about the value of the foundation and how it's helped Rocky Knoll. The foundation does wonderful things through private donation and everything is to enhance the life of the residents. So above and beyond what's already provided for them by living at Rocky Knoll. So you're right, the Bistro has been set up. That's an outdoor patio with a grill and encourages families to come, particularly during the summertime and just experience the outdoors in the beautiful setting and be able to cook with their loved one. And the recliners is definitely one. Our upcoming foundation project that they're working on is something called Susie Q Karts. And it's just a rolling mobile cart that will serve food in the dining rooms to the residents at the table side. So this rolling cart has a plate warmer on it and then all the steam wells where the food is so the residents can see what they want to eat. Sometimes looking at a menu item, it's not very explanatory what is that or what does it look like or do I really want it? It's like we all wanna check out the buffet before we decide to take it. Wonderful, Bernie Nowicki. Bernie Nowicki. I'm getting older too, so I'm starting to forget. He's a member of the foundation has been very active. And again, there's a number of them that bless their hearts have done good things. Well, beautiful overview. A lot of wonderful things going on at Rocky Null. Roger and I can't thank you enough for your leadership. You've really brought some new vibrant leadership to the facility. I know you're developing a management team that you're very proud of. And we take so much pride in the quality of care that's provided at Rocky Null. They're taking care of our parents and grandparents and loved ones in this community. And we appreciate the good work that you and all of our staff do. So thank you, Rochelle. Thanks for saying that, right? I really like being there. Yeah, thank you. Well, thank you and thank you for joining us. We appreciate your time. If you have any questions or suggestions or feedback regarding this presentation today or how we can do a better job at Rocky Null, don't hesitate to contact Rochelle. I know she'd love to hear from you. Next month, we're going to have another department head here, our building services director, Jim DeBeest. And let me tell you, those building services employees have been working very hard as well, dealing with the snow and everything else. So we look forward to learning more from Jim. But until then, thanks for joining us.