 Welcome to Sheboygan County Government. Working for you, my name's 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 to you to talk about the roles and responsibilities of county government. And we have a new face before us today. I'm very pleased to introduce Rachelle Valesky. Welcome, Rachelle. Thank you very much, Adam. Thank you for having me. Rachelle is our Rocky Knoll Administrator. I think it's been two, three months now. It has. I so quickly lose track of time. Oh, two and a half. Two and a half months. She's been doing a wonderful job. And of course, today you're going to get a chance to get to know Rachelle a little bit better and learn about her background and the very important work being done at Rocky Knoll. So again, it's wonderful to have you with us. Let's start with the obvious. Please tell us a little bit about yourself and your background in the healthcare arena. Okay. Wow. I'm a registered nurse and I have been working in long-term care for, gosh, since the early 90s, I would say. And primarily I worked at one nursing home for over 12 years and just kind of grew up through the ranks there. Had a mind for business and was recognized in that capacity and became the administrator at that home in the year, I think, 2000 it was. And then I ended up working for the corporate office and traveling to all of their other nursing homes in Wisconsin and they have a total of 18 of them. So it was a really great experience to see a lot of different homes and work as interim administrators at many of those homes that were either in trouble or newly acquired and also doing mock surveys there. But more recently, for the last five years, I've been working at a hospital in acute care and really felt the draw to get back into long-term care and realize what I was missing. So I'm just so grateful to be at Rocky Knoll. I'll work. Glad to have you. So 12 years at a nursing home previously then with a hospital for five, six years? Five years there. Five years there and then back in the nursing home arena. Fantastic. Well what's your impression thus far of Rocky Knoll? How does it rank compared to the nursing homes you've worked with in the past? I honestly feel so blessed to be there. I really do. I had known of Rocky Knoll in the past and had been there a couple of times to the campus but never inside. And each and every day as I drive to work it's just, it's so majestic driving out 67 and up that hill and the first thing you see is that water tower says Rocky Knoll on it and it's such a beautiful setting and beautiful building and it's so impressive. And then you get to the building and it's huge and expansive and the land is gorgeous. So you know just exterior impressions, amazing. And then you walk in the door and the staff are just out of this world. They really are. And so welcoming and I feel even though it's only been a couple of months that I've been there forever, it's just a very comfortable setting and I'm getting to know more and more people there and the residents it's just been really wonderful. It is a beautiful setting. It is. We take it for granted I think a little bit but it's just gorgeous there. I love how they kept some of the old architecture with the, I don't know if you call arches or towers. Right. I'm so glad that was preserved with the years because that really adds a lot to the character. So a beautiful building, a beautiful setting and as you said the staff have been very welcoming which is great to hear. Not a surprise. I know we have a lot of wonderful staff and what about your management team? I know you have a pretty experience management team. How has that helped with the transition and getting acclimated? It's helped greatly. They are a committed group of professionals. Just amazing. And you're right about the tenure. The years of longevity there is just amazing. But it's really helpful for me because I can tap into their history. So any decisions that have been made I can ask what's the rationale that was behind that or what's the history there and someone's inevitably got the answer there. So it really helps me in my acclimation here and we just work really well together. I feel a mutual respect and appreciation and just a terrific team. Yeah. Well fantastic. Yeah. So as you've gotten acclimated, getting to know your staff, the strengths and weaknesses and just all the resources available to you, I know that some good things have happened already in your short tenure but what do you see as some of the key challenges that were before you in the last two and a half months? I'd say challenges I could sum up in two terms. Building and rebuilding. Really. Building in the actual building itself. As beautiful as it is, it's older and there's a lot of structural and maintenance type of projects that are going on now that are big projects and costly projects but necessary. So we're working through some of that. Also related to building would be the older sections of the building are in need of updating. Just to spruce them up and make them look more appealing. A lot of focus was put on the Woodland Village part which is more short term rehab and that was necessary at that time. So now I'm looking forward to spreading some of that beauty over into the older parts and have the interior of the building just really shine. So those would be the two building. Rebuilding really relates to the culture and the team. There's been a lot of challenges in this past year at Rocky Knoe related to, you know, either budgetary issues or loss of personnel or turnover and that just creates some turmoil and a little bit of fear and mistrust in people. So we're really working on rebuilding that. Very good. And then as you look ahead as you think of the next year or so and goals that you've identified opportunities for improvement, what are some things you're aspiring to achieve in the year ahead? Certainly maintaining the course we're on. I think Rocky Knoe really has a lot of great things in place. I'm not looking to change a lot of what they're currently doing. The services that are being provided there are very inclusive of, you know, a large gamut of folks who would need care coming to Rocky Knoe. So I think they're right on the mark with that. So I wouldn't really be looking to change that. Certainly getting a little bit more cemented in the things like I was talking about with team building and such. But in addition to that I would like to see more opportunities explored as far as efficiencies. I've been trained in Lean and Six Sigma and I'd really like to and have so far done some but even more just to streamline what we're doing and to fine tune some of the processes and systems that are in place which would help to make us more efficient and create more time for people to do their jobs. Outstanding. Thank you. Roger. Rachelle, as you know most of the counties of our state own and operate a nursing home what are some of the advantages and disadvantages of Sheboygan County owning and operating a nursing home? I think advantages are very clear in my mind as I'm acclimating because of the amount of resources that are available. So I can reach out to my brothers and sisters within the county organizations and certainly have done so. So the assistance that's provided say whether it's finance or IT or purchasing you know that you just have those other departments that you can reach out to and hopefully we support each other in many ways and that's not something you would see in another environment. Disadvantages would probably be related to processes being slowed down a bit so if you have an idea or something that you want to move forward there's just layers of approval and processes it just slows it down a little bit. Coming from the private sector as you do please describe your impressions of working in the county government environment. I guess you spoke a little bit of that already. You know what was surprising to me is I think there are more similarities than there are differences particularly in healthcare industry and the reason I say that is because of the amount of regulation that comes from state and federal government compared to all nursing homes across the board so we're not any different in that regard so we must still maintain all of those regulations but as far as differences I would say a level of oversight and accountability which is a real positive thing so you've got that in the county government where you are accountable and ultimately accountable to the taxpayers as well so that adds certainly a lot to your conscience and I think that's one of the good decisions each and every day. And do you think the county can compete with the private sector? I know they can. If I base that by one thing alone would be resident census Rocky Noles census right now has been running in the 90s to low to high 90s where if you look at our competitors in the market they're struggling with census really that the community really recognizes the county run facility as being a place where they want their loved ones to go. What's been your experience with bringing changes to facility and labor organizations which represents a majority of the staff? It does. There's two bargaining units at Rocky Noles, one of them is the nurses and my experience with them has been so positive I think they appreciate the fact that I'm a nurse and have walked in their shoes and that probably paved the way to a real nice welcoming and a lot of mutual respect there so I've been getting along swimmingly with the nurses the other group there, the local 2427 is a really large group of folks at Rocky Noles and they have new leadership there they have a new union president and some stewards that have changed it's been so nice it's been a location that's been taking place with that group where they feel completely comfortable walking into my office and chatting about issues and we just have a real good camaraderie so I feel very positive with the unions both of them and the unions are relatively new to me my past background I had mixing, not mixing interactions I should say with unions at a couple of the facilities that I was at for short terms so it was new for me and I just really appreciate how educational and how welcoming they have all been so I don't anticipate problems we've had labor management meetings and we chat and we work through problems and we certainly celebrate successes it's just been really positive and what's the total number of staff that you have out at Rocky Noles and what kinds of services are provided? The staff is over 200 I believe it's 205 when I last looked at a roster related to the United Way campaign so then the services that we offer are many and varied from the short term rehab which really is a big focus for us we still have traditional long term care offered for folks who come there towards the end of their life we specialize in dementia care and we also specialize in psychiatric care and then the services that are provided for those people are therapy both in-house and outpatient therapy we have a really active activity department or life enrichment department that keeps people having lots of things to do throughout the day those are a terrific group of people we offer hospice service for end of life care there's a chaplain in the building daily visits from a nurse practitioner so there's a lot of opportunities to see a medical provider on a daily basis if need be those are the ones that are occurring to me right now Thank you This discussion reminds me a little bit of a discussion I just had with my dad just this week I have a 96 year old grandmother that lives in assisted living and she's at a point now where I think she's going to need a higher level of care so we were just discussing this week well when do they as her children make that decision and they're going to be visiting with their doctor early next week to of course get some counsel on that but in your experience, Rochelle you know for folks watching this program that have loved ones in assisted living and of course there's many alternatives many people want to keep their loved ones at home as long as possible for obvious reasons but if you're in assisted living and like my grandmother at 96, now needing more care what generally are the signs or indicators that you may need a higher level of care such as Rocky Null? Well safety certainly comes into my primary whether there's a fall risk or that she's feeling apprehensive being alone at night or not having licensed staff available 24-7 a lot of the enroads that can be made earlier on with people in assisted living is to get them out and about and into the nursing homes to see them it takes away that fear factor so what we try to do is to have opportunities for the community to come and be on site at Rocky Null for various functions and meetings and it gets people in the door what it looks like and what it smells like and it's not quite so frightening years ago we would tell our parents I'll never put you in a nursing home but then when it comes time that you have no choice now you feel like you've betrayed them where it's really not a bad thing I tell my own mother who very likely will be in a nursing home at some point yes you are going to a nursing home but it's going to be a great thing you're going to be able to have built-in socialization you're going to have all your care needs met you will no longer have to manage your home take your garbage out, wash your dishes go to the grocery store all those things that don't really add to the fun part of life the quality of life but the things that do add to quality of life is all you really have to manage so that's getting a good night's rest and knowing that you're safe and comfortable and having someone else manage your meds and your doctor will come right to you and comforts are there so safety of course and you just touched on some very important areas there what about eating habits and assisted living you don't have the number of staff as you touched on and I know that in some points in people's lives they're just not eating enough or getting enough nutrition what would be the difference in an assisted living environment in that regard a skilled care environment primarily a nursing home will have a dietitian who reviews each and every person's nutritional status and that would be their lab work, their weights and their height so their body mass index comparisons to what their diagnoses are what disease processes might be in place what medications they're taking and really evaluating what kind of a diet would be most advantageous to them so it might be a low salt low sodium no concentrated sweets, whatever the case might be that is best for that person and we can institute a meal plan based on that now we also don't force people to eat that diet so it's recommended it's prepared and it's available to them but if a diabetic person sees the Boston Cream Pie and says I want a piece of that they're going to get it and it's so structured that they can't still have those things that are desirous to them but we can offer the education and make recommendations gee the Boston Cream Pie probably isn't in your best interest we have some jello, would you care for that no I still want the pie, okay I wish I would have had Rochelle at the table this week those who have been helpful I emphasize we'll see what the doctor says an objective opinion but that time comes that difficult decision that goes back to the next question or trends in nursing home and skilled care I've been here 14 years now you've been here two and a half months and Roger's been on the county board I think for over 30 years 29 sorry to age you there my friend nearly 30 years so Roger's really seen the dynamics and the changes in nursing home care we have three facilities I started here comprehensive health care center which was a grand old facility was closed now it's I think it was 2002 when that occurred we put a $10 million addition on it at Rocky Knoll to accommodate those residents though many of them actually went to more home like settings rather than a nursing home facility but for those that did come to Rocky Knoll they loved it because it was such a wonderful improvement and much better environment Sunny Ridge nursing home which obviously continues to provide service in this community was county owned and operated in 2007 we privatized that facility and so we remain with Rocky Knoll and I know the three of us all take tremendous pride in the service and the level of care and the excellent work our team does at Rocky Knoll but as you mentioned earlier it's not the norm for a county to own an operated nursing home my personal hope is Rocky Knoll is going to be providing service as a county owned and operated facility for a long time to come but when we look at the trends you know the trends we've dealt with in the last decade is in Chaboyton County we were over bedded I think there's still some concern in that regard there's so many nursing homes that there may be more beds than we need but also people are looking for different alternatives to a traditional nursing home longer going to assisted living and then ultimately a nursing home what do you see here you're closer to it than I this has been your line of work what have you seen in trends the last 5, 10 years and then what do you see as you if you had a crystal ball as we go forward how are the dynamics of this industry changed well you've nailed it that people are staying in their homes longer there's some terms being kicked around called aging in place which really allows for people to be in the comfort of their own home and have more services provided there up until that doesn't meet their safety needs any longer so then as your grandmothers in an assisted living you've got different layers of healthcare that are available to most people I say most people because a lot of assisted livings can accept Medicaid or other finances which tends to be the largest population base of most nursing homes so those people do still fall through the cracks in our current environment so they tend to come to nursing homes maybe sooner than other folks but ultimately people tend to need to come to a nursing home at some point so what we're seeing is we get them later stage later stage in that they're pretty darn depleted by the time we get them so their care needs are higher they've been holding on and I understand that and I respect that a lot but I feel like if they had come sooner we could have done so much with them in their final years and they probably would have had a better quality of life but that's a very independent decision and most people don't make that early they make it when they have to so in some cases though maybe you want to stay home but who doesn't think that I want to be in my home my own home as long as possible as independent as long as possible but there are points where the quality of your life how many visitors do you have are your children near are your friends and family near and obviously at Rocky Knoll what I appreciate each time I go there whether it's to visit you or my mother as you know who's currently getting rehab there and loves it there's community at Rocky Knoll you can see the care between the staff and the residents how they get to know each other all on first name basis and the activities as you mentioned there are so many neat activities that go on we have on the rocks where you can get a drink with your loved one if they stop by and it's a warm community where I think the quality of life in some cases perhaps in most cases is better than it might be if you're at home and didn't have any of that going on I believe that completely in my previous role I went out to people's homes and apartments and assisted living to assess them and talk to them about the need to come to a nursing home and there was such sadness in that because I would see them in the environment that they were living in whether it was a really tiny little cluttered apartment with lots of safety hazards looking in the refrigerator hardly any food there or if they had meals on wheels or some other way of getting food it was old that they didn't clear it out and weren't eating it well and they would basically just wake up sit in a chair have the television on sometimes not even the television and just sit in the chair pretty much all day until it was time to go to bed and all alone just that isn't living I had one of the sweetest little ladies at a nursing home tell me I didn't come here to die I came here to live and then she went on and explained all the great things that were happening in her life on a daily basis like I love bingo and I love going to church and so and so is my friend at my table she just really carried on I would love to have had her on camera because she really really did a good job of saying how she came there to live and it was so truthful of many people so when I see the folks living in their own homes and you want to support that up to a certain point but I know if they could just come on and we could help them we only have a few minutes left but with the very important vital role that nursing homes provide the excellent service at Rocky Knoll or many of the other wonderful nursing homes we have in Sheboygan County but they're so important to our circle of life why is it then struggling financially why is it that so many nursing homes across the nation have gone out of business they're closed what's your read there why are nursing homes struggling to continue to provide the important service that they do cost of care is just so high cost of medications is high many physicians still order what I would consider to be unnecessary diagnostics and labs just adds the cost go up up up up and the nursing homes are only given a flat rate so they receive a flat rate and yet they are having to cover all the expenditure that is required for that resident so if we can control costs of taking care of that resident I think we'd be fine which has been one of our key challenges certainly at Rocky Knoll controlling costs I think we've made progress over the years and of course you're going to be more successful operating one than three facilities in Sheboygan County so hopefully we're positioned for long-term success but Medicaid generally isn't sufficient to cover the cost of that care in many instances is that not the case that can be the case that can definitely be the case Medicare we receive more funding generally for those patients more lucrative from a standpoint of making sure we're covering the costs and it's short term so Medicare goes away pretty quickly we also have to be really cognizant of each patient we take in under Medicare as to what their needs are going to cost as well because that's a flat rate as well so as you look forward this is some heavy things to consider and hopefully this has been valuable because we're all at some point if we're fortunate to have this type of care if we've lived a long life or we have family members that are certainly going to be there it's just so important as you look forward with Rocky and Olin you mentioned some of the good things that are in play already but where do you see us five years from now the trends changing any predictions there's so many unknowns with healthcare reform I think at this point we need to stay the course with managing our expenditure and certainly as you say we get a flat rate so let's try to live within those means and be frugal and yet always have a mind for doing the right thing for the residents and if folks want to volunteer their time I know we have a number of wonderful volunteers throughout the county organization whether it's health and human services but certainly at Rocky Knoll and whether it's helping people with meal time or to and from or walks you know better than I but how can folks get involved if they want to come and brighten a residents day the best way to get involved is just to offer their time they don't have to have a specialized program or come in with a fancy idea residents are just looking for time they love to visit the best part of my day is when I seek out a resident in their bed and just chat for a few minutes and I get more out of it than they do but you know you can see the change it's if they truly want to become a volunteer there's a process but just to spend time with an elder makes a huge difference in their lives right and I know we have a foundation that's active at Rocky Knoll and they do some good work so if folks are looking to make a donation to brighten up a residents day or do something that benefits the organization as a whole there certainly isn't avenue there as well definitely well very good well thank you for joining us I hope you got a better appreciation for the very very important work being done at our Rocky Knoll Healthcare Center Rochelle Valesky I know would be happy to talk to you if you had any questions about Rocky Knoll or services we provide or suggestions for improvement but as you can see we're we're truly tickled to have someone like Rochelle and our team and I know that as I've interacted with staff there's just a real good feeling in that facility so again thank you for joining us next month our Health and Human Services Director Tom Eggerbrecht is going to be here to talk about the very important work that department does we have the holidays approaching us and I wish you all the best so on behalf of Chairman Roger Distruty and the County Board thank you for joining us