 Welcome to Sheboygan County Government, working for you. My name is Adam Payne. I'm the Sheboygan County Administrative Coordinator, the Co-Chairman and County Board Chairman of Sheboygan County. Could not be with us today, but our guest is Dale Pauls, the Director of the Health Care Centers. And today we're going to be talking a little bit about the progress at the health care centers. We recently completed our consolidation and there's been a lot of activity and good news in regards to our health care centers. So again, our guest is Dale Pauls and Dale, why don't you start by telling us a little bit about some of the recent activities that's been associated with the consolidation? Well, two of the probably more important ones that led up to the consolidation, of course, were the dedication and open house and also the closing ceremony at Comprehensive Health Care Center. On the 23rd of June, we had the dedication and open house, which was a beautiful day. We had a lot of attendance and a very nice program that included a tribute to Dr. Shaw, the psychiatrist that passed away recently. And as I said, we probably had four to five hundred people attend and tour and were very impressed with the facilities. To put closure to moving from Comprehensive Health Care Center, we also had a ceremony on July 19th in which we had a program. John Vandermel, a former administrator, really did a nice job in reflecting on the history of the Comprehensive Health Care Center. And then they opened up the cornerstone, looked at some of the items that were put in that back in 1938, which was very interesting. And it was a tribute also to the staff that had worked there many years, a lot of people over 30 years, and they truly enjoyed that. So those were two real important events that occurred just before we consolidated. I had the opportunity, as you know, to participate at both those activities. And you and your staff did a tremendous job planning and organizing, and we had good weather for both days. Kind of warm, I recall. Yes, yes. I got to emcee the open house, and I had a blue suit on that day and just about melted. But everyone else did real well. And it was very positive, a lot of compliments about the layout, and you sort of had tours and refreshments, and you got a lot of positive feedback, didn't you? Yes, we did. It was real exciting to see people observing and making comments about what they saw. The closing ceremony at Comprehensive, that was emotional for a number of staff. You've got a 30-year club with some long-time, real dedicated, conscientious employees, and just a lot of sentimental feelings, I think, in the air that day. Why don't you talk about that a little bit? Well, what really surprised me was that there were a lot of former employees that came great distances, even, to just be able to tour the facility and to reflect, and there was a lot of camaraderie with former and existing staff, sharing moments of joy and the experiences that they had while working there. And I really think it did help the staff, because that was a major change for them moving to a new building and dealing with that. But being able to say goodbye to the building that they had served so well for many years was excellent. And John VanderMail, as you mentioned earlier, he did a real nice job giving some of the history, and he knows the employees by name and referenced some stories, and I thought he said a nice tone, and then opening the cornerstone. What did you find in there? Well, some very interesting newspaper articles from the time period. What was going on? There were some coins there, I believe. Not really knowing exactly why they were there, but some interesting pieces of information for the times. Great. So we've mentioned our open house and the dedication. We've talked about the closing of comprehensive. What day specifically did the consolidation of Rocky Knoll take place? It occurred on two days, on July 16th and 17th. The first day we moved 34 residents from the ICEFMR, and then on the second day we moved the remaining 54 residents from the IMD section. So how many employees were moved, and how was this accomplished? We probably had over 100 employees that moved along with the residents. Well, it goes back to probably a year before where we started planning this, but the coordination of that involved making sure that we had not only our own vehicles, but other vehicles who was going to be driving those, which residents would be coming. We moved like two times during the day. We wanted to make sure that we had staff already assigned on the other at Rocky Knoll who were there to receive the residents when they came. Once they got there, there was the plan as far as entertainment was concerned. While we were continuing to move residents in, the whole process of eating, and a lot of work went into those details to ensure that they had a very easy transition that day or those days. And it happened. And I think I misspoke with my earlier question. I said how many employees were moved? How many residents moved? The employees at Comprehensive, for the most part, if it could be facilitated, went with the residents. Did they not? But how many, again, how many residents were actually moved within those? Excuse me. 84. 84 residents. And in general, what was the reaction of the residents and their family members? You know, I had the opportunity to be right there when the vehicles pulled up. And it was very interesting to see those residents and their reactions. A little bit of bewilderment when they first got there, but once they got in the building, they were just really pleased, smiles, and, well, I love my room and my surroundings. Families I think had toured earlier and, you know, were very pleased with where their relatives were going to be living. Employees, again, they were a little bit, you know, even though they had had some orientation. Those first couple of days for, like, where am I? Where do I go for this? So they were feeling their way. But again, very positive about the move. And you touched on that earlier, a lot of planning, a lot of preparation. Talk a little bit more about some of the steps that were taken to familiarize the residents and their families with their new environment. Well, I would say at least two months prior to the consolidation, some of the staff at Comprehensive were scheduling tours of the building, both for families and the residents. And even going back further, as the construction was occurring, they would bring van loads over and they would ride around the building and, you know, say, this is where your new home is going to be. So they were continually familiarizing them with the surroundings. And then followed it up with actually touring the facilities. I sat in on your, I think, one of your first department head meetings when you had all the staff together. And after, again, a couple of years of discussions and planning and implementation, I was very pleased to hear all the positive comments around the table that employees are, you know, getting to know one another and they were welcomed by the employees that were already at Rocky Knoll. And I think one of the staff provided an update that the residents the first evening, some of them may have been a little anxious, but very quickly we're getting comfortable. What have been some of the, any time you have a new move like this, there's going to be some, some loose ends that need to be taken care of. What are you hearing from your staff? What are you working on? Most of those things have to do with the physical plant. Things that may have gotten missed in the construction or once the water is on there, you know, maybe it's not working just like it should be or, you know, doors aren't closing quite properly or the bathing complex isn't, you know, just exactly the way they want it. So it was more that and equipment kinds of concerns that we had to deal with. Any concerns from the residents on regards to the facility, anything that they've raised that you're making some adjustments on? I don't think so Adam, really. Some of the, some of the residents as far as where we would like have them go outside, we had to kind of acclimate them to that and, but what I hear from resident council meetings that we've had just recently, not any real major concerns being expressed. And you mentioned that's a good segue, resident council meetings, that the importance of that communication and you've taken proactive efforts to make sure the community is aware of what's happening. You're here in May providing an update on TV8 and you have a newsletter. What are some of the steps that you've taken in the past and that you're going to continue to do to keep the community and public aware of the steps that are going on out there? As you mentioned the newsletter called the connection, that or at least a form of that will continue to make people in the community aware of what the ongoing things are happening at the healthcare centers. We have in the past visited some of the service clubs and I would plan to continue to do that in any other types of community meetings that we can make them aware. Resident council, family council, I think we want to work on that a little bit where family members are certainly aware of what's happening with the residents. So the consolidation on one hand people may say is done, but on the other hand there's a lot of work ahead of us. Give our viewers a sense of what is ahead of us. Let me back up. How much was the consolidation? How much did the project cost? It was approximately 8.9 million. 8.9 million and where are we at with the budget overall? We came in right around 800,000 under budget. From this point forward what do you see as some of the challenges with acclimating the residents and working with staff? What's ahead of us? I think we have to look at it still having to consolidate rock and roll staff with comprehensive on a number of projects because we've got departments that came over separately like the activities department and like social services. So we'll be working on merging those together so that the staff have a better idea of their assignments as a consolidated staff. Looking at the table of organization, are you seeing areas for adjustments? As you said, folks that move from comprehensive to rock and roll are comprehensive to Sunny Ridge. Are you making any changes in that area? Yes. Obviously there are positions that you don't need two of, you don't need two directors of nurses, you don't need two food service supervisors. A number of those positions which we have consolidated into one and as far as the direct care staff, we're looking at areas there as far as how we can be more efficient and utilize them in the best as we can. And speaking of efficiencies, some of our viewers may be wondering well after it's all said and done, we're consolidated, what kind of savings have we picked up in operations? Dale and I just met this morning to review the budget, the preliminary budget for the health care centers. What are you seeing at this point? Well, it looks like we will be very close to a million dollars in savings and operations as far as the consolidation. And I guess I would say that I feel like that this is still going to be ongoing. During the next year, we will be continuing to evaluate and I think we will see probably more changes forthcoming. And comprehensive, that grand old building. What's happening with comprehensive? Right now, we're in the process of advertising that through remax. Bill Cain, the realtor, has been engaged to do that, to advertise it nationwide. We're also getting rid of furniture equipment within the building either through our own departments or the county departments and hopefully we'll open it up to municipalities and other non-profit organizations to see if there are items that they're interested in. So if any of our viewers are watching this and interested in what happens with the property or possibility of picking up some furniture for a town hall or a non-profit, who would they contact? Bernie Romer, who is a purchasing agent for Schwoing County. Okay, very good. When we were in the midst of discussing the consolidation and prior to the county board making a decision on just how far we can go, we had too many open beds that was a concern and a concern from the community is do we have enough beds? How many licensed beds do we now have between Rocky Knoll and Sunny Ridge? We have 514 total beds. When we started this whole downsizing we had 717. So we've reduced by 203 beds. At Rocky Knoll we'll have 195 total beds and then at Sunny Ridge we have 319. We're not at capacity at either of the buildings right now and I really feel that we're very close to the capacity that we need. There may be situations where Rocky Knoll might not have a bed but Sunny Ridge would and I think we have to realize that that can occur and it may only be for a short time if a person vice versa would like to be in the other facility but as far as the total beds for our operations I think we're very close to the need now and going forward in the future. More and more alternate types of care are being provided out there that help to minimize the concern about the number of people that are going to need nursing home care in the future. So I think it stabilizes and I'm comfortable with the number that we have at the Health Care Centers. So you said 514 licensed beds and in both Rocky Knoll and Sunny Ridge we're not at capacity at present. Yes that's correct. Now of course at Rocky Knoll we've got different types of clients and in some parts we may be at capacity. What was originally in the Rocky Knoll side has 99 beds and we're virtually full there. 99 for skilled care. And since you raised that what are the other areas of Rocky Knoll there's been comments made on a regular basis that it's now one of the state of the art facilities in the nation and you've got to be proud of that fact. What types of care can be provided there? As well as the skilled nursing facility residents as you mentioned the intermediate care facility for the mentally retarded 37 beds to provide services for them and then for the mentally ill another 59 beds and with that those beds I had mentioned that those are all private rooms which we've found already to be advantageous for them. And at Sunny Ridge that's primarily a skilled care facility though you do have one wing for dementia Alzheimer? Yes, yes and I should have mentioned for Rocky Knoll we now have a 16 bed dedicated unit strictly for dementia. So that's a service that we hadn't provided in that way before. At Sunny Ridge we have one floor that isn't at this point being utilized at all isn't the sixth floor there vacant? So when we talk about the future you mentioned that we feel that our capacity right now is very manageable that we have room for growth. What is your sense about the long term care needs for residents in Sheboygan County? Well when we talk long term it all depends so the way things happen in health care today you can't go out probably more than five years in that you call that long term and I guess I'm saying that really with the number of beds we have currently I think we're within the needs as far as meeting the needs. We will look for other alternative uses for that sixth floor. I haven't been able to really delve into that as much as I hope to but we will be in the near future if you look beyond five years maybe there will be a need and they're there and we could who knows the freeze on license beds may be lifted and then we would be able to increase licensure if we needed to. So if we did see a spike that wasn't anticipated we have an entire floor that's open and vacant and we have some flexibility. Let's talk a little bit about the funding health care centers in general across not only the state but the nation have been struggling and people I'm sure our viewers have read from time to time reports about how nursing homes are closing are really struggling. How is the Sheboygan County health care center doing and what are some of the revenue sources? We have a number of revenue sources. The largest revenue source comes from medical assistance which is for those that cannot pay their own way we have probably about seventy five percent of our resident population then we have a Medicare population that's between two and five percent that would be people that are in the hospital that need once they come out of the hospital they need some types of therapies and that's a revolving population because and it's a positive one because we rehabilitate and they're able to go back to the community along with that then we would have a small smattering of hospice veterans administration and I guess I did didn't mention those people that are able to pay for their for their care and that makes up about twenty percent. Now when we talk about the medical assistance patients currently what we receive for their levels of care doesn't meet our costs and so we're participating in a intergovernmental transfer program that allows additional monies to make up the difference between what they're paying and what is costing. Now let me stop you there because some of our viewers are once we get into the financial matters it can be tough to follow this intergovernmental transfer program. Number of our viewers may have read in the paper that the county's been participating in a wire transfer and in fact we're looking at doing our fourth wire transfer and this is a means of getting additional financial dollars from the federal level of government to the state which is passed on to the county and other nursing homes. There hasn't been a lot of comfort level with the mechanism but it certainly has helped Sheboygan County and nursing homes across the state and offset what we'd be otherwise paying in property taxes. Why don't you explain a little bit just how helpful that has been. It has basically covered the losses that we would have incurred and what we're concerned about is what the future of that will be. There are projections that is no longer going to be in existence after so many years and so that's why we have to at this point be looking at what other avenues we have to offset those differences. But in the past it's been able to cover like 100% of what may be the different in our nursing care as far as what's costing us and what we're being reimbursed. We were always receiving some Medicaid dollars but by participating in the intergovernmental transfer program I believe we picked up about 2.7 million additional dollars. We have budgeted about 5.5 for this year and as you said we're hearing from the federal government, the state government that that may start dropping significantly and if that happens once again we're going to really be challenged with how we come up with new revenue sources to cover that reduction of federal or state aid. Have you considered what we might do Dale, what are some of the thoughts that you've had in that regards? Well obviously we have to operate as efficiently as we possibly can as long as the mission is to care for the current population and the two buildings that we have. We have to be as fiscally responsible as we can. We also maybe have to look at what other revenue sources possibly can be out there. I do think that the Medicare segment we hope to be able to increase that activity and in turn increase the number of residents we have and that be a larger revenue source for us. So when we talk about reimbursement and maintaining revenue streams what do you see as the biggest challenge in the future for operating our healthcare centers? Well it definitely is where are we going to receive the dollars to pay for the services but in addition to that staffing is a concern for the future. As we look at healthcare workers and I think the audience would have seen a number of articles about shortages of RNs and LPNs and certified nursing assistants we need to be very concerned about that going forward so that we have adequate staff to care for our people. Do you have any plans in place or strategies that you're considering with your management team to address those issues? We've utilized a number of things in the past. We do have like tuition reimbursement program available to those who may want to move from a CNA to an RN or an LPN program. We have people participating in that and in fact we've had a couple of staff that have completed their program so they've been able to come back and help us with the shortages there. We're currently involved with the LTC's program in regards to CNA, a number of classes going on so that we have available people that may want to work for us. We're a part of a consortium of healthcare providers that are working on recruitment techniques, working on educating and getting people interested in the healthcare field. So there's a number of things in that area that we're working on. Good. Good. Well, Dale, I want to thank you for being our guest today and giving our viewers an update on what's happening at Rocky Knoll and Sunny Ridge and the closing of the Comprehensive Healthcare Center. Certainly appreciate your efforts and those of your staff. It's been a real roller coaster ride the last few years on this issue, not only for those of us working for the county but the public and it's really heartwarming that as things have come together it's been so positive based on, again, reports directly from the residents that we serve and their family members. So I thank you and I thank your staff. Thank you. Next month our guest will be Shannon Hayden. She is the new planning director for our planning and resources department and we're looking forward to hearing from Shannon and about a number of the programs in our planning and resources department that's about a $1.3 million department. There's some new initiatives as many viewers know with stewardship and natural resource protection as well as ongoing initiatives with, through the legislature on code and rule updates on septic systems, what have you. So we're going to have Shannon as our guest and look forward to talking to her about our planning and resources department. So on behalf of County Board Chairman Dan Lemieux, on behalf of the County Board, thank you for joining us today.