 Welcome to Sheboygan County government working for you. My name is Adam Payne, Sheboygan County Administrative Coordinator and co-host of this program with Chairman Bill Gehring. And today our guest is Dale Pauls, the Health Care Center's Director. As many of you may be aware, the Health Care Center's committee recently submitted a report to the full county board for action that was submitted last month and last night. The county board acted on that report and today Dale's going to share with us some of the challenges that the health care centers continue to face as well as some of the plans for the future to overcome them. So Dale, thanks for joining us today. You're welcome. Thank you. Why don't you start by sharing with our viewers just what some of these challenges are that the health care center's committee and you and your staff continue to be faced with. I was thinking about a little bit about challenges and before I talk about some of the challenges I would like to say that despite working on some financial challenges, we continue to be able to provide excellent care to our citizens of Sheboygan County and in fact, Sonny Rich just completed a survey and had excellent results as far as the health care piece. So it's hats off to our employees as they continue to meet those challenges. However, we do have some fiscal challenges that continue to be in front of us. The biggest challenge is with reimbursement. The medical assistance program for years has not been able to fully fund the costs of care and we have over 70% of our staff that are residents that are in that program. Now we've had supplementation through the intergovernmental transfer program to help that but as many of us know that program also is decreasing and they're phasing out the electronic transfer program. When you say they meaning the federal government. So those two as well as there's more and more community based services being provided. So our census tends is starting to decrease as a result of that. When we have those funding sources not providing what they should, it then has to fall back to the local taxpayers and as we also know that has been increasing and a major concern. You know in the last couple of years it's been five million. The projections now by 2008 it could be eight million or more. So we have to be taking a look at how we're going to meet those challenges in the future. So we've seen a reduction in state and federal dollars. We've seen more of a reliance on the local property taxpayer and we also see a lot more opportunities for people to go to when they need that type of critical care. When you said opportunities, can you expand on that a little bit? Opportunities either in home or community based service. I think from both the state and federal level they're realizing that the medical assistance program is just not going to be able to continue to operate at the levels that they have been and they're looking to be able to provide more services in the community that some of our residents will be able to have their needs met. So more and more dollars are being shifted to the communities to do that. And as you well know, Dale, because of your leadership, the county board a year and a half or so ago appointed a citizen's task force to look at some of these pressing challenges that were faced with and develop some thoughtful recommendations. That committee was appointed by the county board as a whole. The health care center's committee, the executive committee both played a role in selecting folks but the board as a whole appointed them. Can you please share a little bit about what did they come up with? What were the recommendations of that task force? In summary, they were recommending the board to be looked at as substantial savings toward the tax levy. In fact, approximately 75% they were saying that we should try to reduce and do that through looking at reducing the costs of employee salaries and benefits, looking at opportunities for utilization of the north building or unused space in Sunny Ridge and maybe taking a look at other employees seeing if they could assist as other, I mean other county employees in savings. So those were in really summary form the recommendations. For 2004, that would have met approximately a $3.9 million savings. So the report after six, seven months of work I think they met about a dozen times was forwarded by the county board to the health care center's committee, the liaison committee that you work with for consideration and moving forward. What's happened since? The, as we've moved forward, Chairman Gehringer had requested that the committee report on a monthly basis which our chairperson Van der Sneen has done to update the board on progress. And we have made progress. There's been a number of areas that we have. First of all, in negotiating contracts through our human resources committee, we've reduced, we're able to garner substantial savings. We also instituted the Gunnerson and Graham report or portions of that as you know, the committee had requested that they come in and take a look at our operations. Through them, we reduced nine full time equivalents. The administration also took further looks at where we might garner savings and we're able to reduce another approximately nine employees. So the combination of those almost 18 full time equivalents, we generated substantial savings. Now to put that in perspective, you have about 550 employees there. So 18 of 550 to some people may not seem like a real large amount but from a standpoint of the savings that were realized as well as the employees providing more toward the cost of their health insurance and some of the other operational adjustments you made, you came up with a pretty significant total savings thus far. Why don't you touch on that? The other piece of the savings I just wanted to mention was the fact that at Sunny Ridge we had more people that were paying their own way than had been anticipated. So there was another piece added to that savings. So the net savings was approximately $1.33 million toward that goal. That was set out by the task force. Outstanding, well with that I'll turn it over to Bill. Certainly this was a very rigorous challenge given to the county board and the health care centers committee to reduce expenses by 75%. But I think everybody understands that the status just cannot continue. What other things might the committee be looking at? What might they be thinking about that would get us beyond that 1.3 million savings that we've already achieved? A number of areas, first of all in the area of employees and some of these things have been pursued in the first six months but we're going to continue to work and see if there's opportunities. Outsourcing of a couple of the departments, laundering housekeeping, are potential hopefully areas that we could do so. Having employees contribute to actually pay for their portion of the pension. And when I talk about that, I'm talking about all employees and not just bargaining your employees. Three days paid time off reduce those days by three days again for all employees. Reducing the capacity of Sonny Ridge down to 125, which is a significant decline right now we have more license for 265. But if we were to do that, it would free up the North Building and we would be looking for potential use of that building. And that would be twofold. We'd be able to realize revenue there but also hopefully the utilization would be some continue of care, alternate types that would lead to maintaining the census in the nursing home. So those items that I've mentioned, even the total savings there, we still would fall approximately $221,000 short of the goal that had been set forth by the task force. But we do think that definitely there is potential to do that with these. As I said earlier, I think we need to continue to dialogue with our employees and be able to explain to them the concerns, what issues we're faced with. And hopefully, they be amenable to working with us and making some changes. We've talked about outsourcing, housekeeping and laundry. Have other nursing homes done it? Has it worked there? Any thoughts? It has. I have had several colleagues, particularly in county homes that have negotiated that or instituted it. And reports that I get back, they have been satisfied with that. One of the things we have to keep in mind there is that, as Adam mentioned, we have over 500 employees doing something like that. I'm not saying that it isn't going to impact people, but the total number would be approximately 34 people that would be affected by that if we were to do it. We know that there are opportunities for those people too in our buildings. So even though it wouldn't mean a change, it is not significant in the overall employee package. I just wanted to comment too on this bill, if I could. Obviously, Dale nor I relish, nor I think any county board supervisor relishes, the challenges we're up against. No one enjoys having to talk to employees about perhaps giving more toward their health insurance or changing some positions or downsizing or eliminating positions because of savings that need to be achieved. But when we had those citizen task force meetings and the public hearings, there was a tremendous amount of input about maintaining two facilities, the county owning and operating two facilities. And if we're going to be able to achieve that, Dale knows this as well as anyone, if we're going to be able to achieve that, we're going to have to make some changes in how we operate. And if you have 550 employees and could subcontract for 34, and the majority of those 34 could find positions in other areas, and we could save $500,000, $600,000, those are steps we absolutely have to take. Right now, another item of perspective. Right now, Sheboygan County, as Dale well knows, we own and operate more beds than any county in the state. Even by reducing at Sunny Ridge from 250 to 125, we're still going to be a state leader in this area. And I think many people need to really think about what level of service should we be providing, what level of service can we afford to provide. So I really appreciate the job Dale and his staff have done, and I know this is an emotional issue. But if we're going to continue to own and operate two facilities, as many people in this county want us to do, then they're going to have to embrace change, and our employees are going to have to help us achieve some of the cost savings that we're looking for to continue. Absolutely. Let's then talk a little bit more about the potential reduction to 125 beds at Sunny Ridge. Well, that's really a significant reduction. There's some reason behind coming up with that number, isn't there? Yes, absolutely. First of all, as a part of the Gunnerson and Graham Report, they took a look at different capacities in operation for Sunny Ridge. And then we had several. But the 125 was where we could probably operate the most efficiently, both economically and with the building. What would happen there is that we would be able to then free up the North Building for other utilization, as I mentioned earlier. And the 125 would be strictly in the South Building. Since their recommendation, I think that number is becoming even more realistic because of what's happening both on the federal and the state level, as we've talked about a little bit earlier, in their emphasis toward more placement in the community. The governor's proposal in his budget indicates that in eight years, he would like to see 25% of the nursing home population in the community. We just got some very preliminary figures from the state what that would mean to us. And there would be a number of people that they're saying have potential for the community. So I think people have to realize that those initiatives are going on. And I think Adam alluded to it earlier. We have to look at our mission. Our mission can't be anymore to be a provider for everybody for all services. And I always talk about what counties originally homes were created for. And they were to take care of the neediest of the needy, or to be the safety net. And I think we need to realize that due to the various things that are going on within long-term care, we're probably having to come back to being that provider, which is an important part to the community. But it also provides us the opportunity to continue to operate and be able to not be a tremendous tax burden to our citizens. I suppose, too, depending upon what care might be delivered in the future in the North Building, it might even be considered community care if it were done through an outside firm leasing our building or something like that. It certainly could be. Yes. And in that building, we would be talking about maybe community-based residential facility, assisted living, where outside sources are very interested in doing that today. Thank you. So to recap somewhat for our viewers, two or three years ago, we consolidated from three facilities to two. We got out of an outdated building and comprehensive that no longer met state codes. And we provided an addition at Rocky and we know that it's just a beautiful facility for the residents that we're caring for there. We garnered about $1 million in savings by consolidating from three to two operationally and improved the environment for the people we're caring for. Meanwhile, in the last two or three years, our levies gone from zero to 2.7 million to over 5 million. And for 2005, we were able to hold the line right about 5 million. But if anyone thinks about that just for a moment or two, if every department countywide had their levy go from 1 million to 5 million to 10 million, I don't know if we'd have anyone living in Sheboygan County. So this has put a tremendous strain and pressure on all our other departments. We don't like it. We know we have to do something about it. You touched on some of the changes in state and federal revenue and how that's declining, how people have more options. So last night, the county board supports the health care center's report, the recommendations. It was strong support. It was 28 to four, strong support. Where do we go from here? We have a number of things, as I mentioned earlier, that we need to look at. And first of all, I think we have to look at the avenues we have available to us as being able to reach the 125 as far as the census. And we begin with talking with state officials. The Bureau of Health Care Financing would be the people that we'll begin with to see what's advantageous for us as far as increments of going down. We know in the past, we've had a downsizing agreement with them. We would hope we would be able to do that because it works to our advantage. So we'll be looking at that. Secondly, we'll be looking, obviously, to see what the interest is in the North Building, whether it be strictly for health care or other potential use. If we don't have outside sources interested, and our recommendations have indicated we want to look at it from our own standpoint, is there a feasibility for us to operate an assisted living? Maybe a debenture-related community-based residential facility. We know we've done some preliminary looking at other county offices, possibly occupying space there. So we'll definitely be looking at how we can maintain the North Building as well as what we would do in the South Building if we get to 125. We wanna be able to provide subacute care there where we feel if we can do that, our pair mix changes a bit, and from preliminary indications, it would be more financially operable than the current operation. And to make sure everyone's hearing this very clearly, that in order to get to 125 at Sunny Ridge, we're looking at that being accomplished over two to three years through attrition. No one is gonna be asked to leave the facility or find another place to live that'll be through attrition. That's correct, yes. No ideas of ever doing anything differently, and as you say, it will take time, but we want to make it as smooth as possible. And if we're able to find someone from an outside provider or someone who's interested in leasing that North Building, assisted living, a CBRF, some type of additional continuum of care, that in fact could make Sunny Ridge, put Sunny Ridge in a better position to operate, to continue to operate if we can bring in new revenue sources and improve the overall continuum of care at that campus. That's our hope. I think it definitely is what we feel is a good way to be able to still be able to operate two buildings if at all possible and meet the needs of the residents. Well, we only have a few more minutes, but I'd like to turn our attention real quickly to Rocky Null. Once again, the rules of the game have changed. Part of that $10 million addition and renovations at Rocky Null included a 37-bed addition for the ICFMR unit. Could you briefly touch on what that is and what's happened in just the last two years? The residents are there developmentally disabled, and that was, again, a part of that consolidation. We brought those residents from the Comprehensive Health Care Center. Recent legislation that someone has become effective January 1st and more as of April 1st impact those residents and potential residents. It's going back to the philosophy of placing people as appropriately as possible in the community. And with those residents, each one of them will be reviewed as of April 1st when their annual reviews come up to see what is the most integrated setting. And if it happens to be the community, there's a community plan that's developed by Health and Human Services, they will be placed in the community. And that's done through the CART system. The CART system makes that decision. Any future admissions would have to be authorized again through Health and Human Services, and it'd have to be the most integrated setting according to their analysis of it. So we see that population decreasing. It's a little, you know, I think we have to give it time. We don't know how fast people will be placed in the community. There has to be capacity building out there in order to meet those needs. So it isn't something that tomorrow I'm gonna come and announce that there's gonna be a closing of that facility, it's gonna take time, over time. And we still don't know for sure what other uses or similar uses that we will have for the building. And to your credit, you've been holding a number of meetings with the guardians and family members of our residents to keep them informed as to state policy changes and what that means here, is that correct? That's right. And joining with Health and Human Services staff, we've met several times and brought in outside speakers to educate our guardians and families because it's a difficult, really a difficult time for them. They're satisfied with services. There's a lot of education to make them better understand why we're gonna do this. And Health and Human Services staff have done a wonderful job in trying to educate them what the bail resources are out there and what the process will be. So again, to recap a little bit, how many total beds then do we have in Sheboygan County today, both at Rockingill and Sunny Ridge? We have what, 265 at Sunny Ridge and 195, I believe that's 460, 460 beds totally. And over the course of the next two to three years, when we downsize at Sunny Ridge to 125 to free up that North Building, we're still going to be leading the state with the number of county-owned and operated beds. We will be, like you said, a leader. I think if we're not first, we're certainly, we would be second in total number of beds. And at this point, if we see more residents at Rockingill and that 37-bed wing that will be placed in the community, and as you said, that's gonna take time and we're gonna have to develop the capacity in the community, what do you envision happening to that area? A couple of things that just very preliminarily have potential is that we can convert that to a skilled nursing facility. When it was built, it was built to those standards. So that can just, depending on our need, we could convert it to that. We need to also look at what in the area is needed for maybe community-based residential facilities. A less or assisted living kind of complex. So those are a couple of things that we're considering right now that we'll be exploring. Any final thoughts that you'd like to share with our viewers? Well, as you said, I was very pleased with the outcome of the meeting last night to support the board to allow us this next six months to be able to explore the recommendations we have and I'm positive about believing that there are opportunities there and in six months we'll be able to come back with a positive report that shows that we've made even more progress toward reducing future tax levies. Very good. Well, as you can see, if you haven't met Mr. Paul's previously, he is a very down-to-earth personable, thoughtful director of our healthcare centers and if you have any questions or concerns, I strongly encourage you to contact Dale or any member of his staff. He started off by complimenting his team and he's got a good one in place, not only an excellent management team, but we have outstanding employees at our two facilities that are providing top-notch care and we share Dale's pride in that and are proud of the services that they provide. Next month, we're going to have our health, I'm sorry, our planning and resources director here, Shannon Hayden and you may have been hearing more about the development of the park or trail system in Sheboydon County, the possibility of a bike trail extension from the southern part of our county border with the Ozaki up through the Usberg area and Shannon Hayden's gonna be here to talk a little bit about what's in the development stages there and some of the other very exciting ongoing initiatives from the Planning and Resources Department. There's a lot of good work being done there and certainly Shannon will be able to touch on that as well. So on behalf of Chairman Bill Gehring, the Sheboydon County Board, my name's Adam Payne, we're very glad to have you with us today and we hope to see you next month.