 Welcome to Sheboygan County government working for you. I'm Dan Lemieux, County Board Chairman, and I'm co-host of this program along with Adam Payne, our administrative coordinator. And this month, we're bringing you a program concerning our healthcare facilities in Sheboygan County. This is an issue that has been in front of the County Board for many years. I've been on the County Board for 12 years and all those years we've been discussing our healthcare facilities and what size they should be and everything pertaining to these healthcare facilities. Recently, we have voted a resolution to downsize our healthcare facilities and it was unanimous vote. All 34 members of the County Board supported this. And in our program today, we have with us Gene Larabee, our director of healthcare facilities. And he is going to discuss with us some of the aspects of this downsizing program and the future of our healthcare facilities in Sheboygan County. Gene, maybe as we start this program, you could just tell us a little bit about your background and what you were doing before you came to Sheboygan County. Well, first of all, Chairman Lemieux, I'd like to thank you very much for the opportunity to be with you today. Prior to my coming to Sheboygan County, immediately prior to that, I had my own private consulting business for five and a half years. I served as a consultant to the long-term care industry and I specialized in assisting facilities that were having problems with regulatory compliance. And then prior to that, I served as a facility administrator and CEO in different settings including both the for-profit and non-profit sector of the long-term care industry. And with that background, what gave you an interest to come to Sheboygan County? When I was afforded the opportunity to meet with representatives from Sheboygan County and learn about this position, one of the things that excited me more than anything was the fact that the dedication was truly here to build a system of healthcare facilities that were truly geared toward providing the best quality care to the people we serve. And done so in an atmosphere where as many disagreements as there might be about other issues, it seems that there's a unanimity of agreement on that particular issue. We want to do the best we possibly can for those of who we serve. And that is probably what attracted me here more than anything. Good. Gene, as you know, during my first year as administrative coordinator, the healthcare center's consolidation was the primary issue in the community and for county government and is with great pride that we were able to pull together a consensus and get the unanimous vote in April and also with great pride that you were the first director that I had the opportunity to hire and certainly we're pleased to have someone with your credentials here in Sheboygan County. Could you touch on the present location and use of the healthcare centers today? Sure. We have three facilities currently at them. The largest of our three facilities is Sunny Ridge, which is located, of course, in the city limits of Sheboygan. It's a 341-bed facility, a skilled nursing facility for primarily the geriatric elderly population. Our other skilled nursing facility is Rocky Knoll, which is located in the Plymouth area in the northwestern part of the county on a really lovely campus in that part of the county, currently licensed for 208 beds and also servicing the geriatric elderly population. And then finally the COMP Center, Comprehensive Care Center, which is located in the southwestern part of the county in Sheboygan Falls, and is a 168-bed facility currently servicing a psychiatric mentally ill, mentally retarded and developmentally disabled population. The primary intent today is to discuss the consolidation plan. Our viewers clearly would like to get an overview of what the consolidation plan entails. Would you please touch on that? Sure. One of the things that we were faced with as far as a challenge is what to do and still best meet the needs of the residents of Sheboygan County. Not only meet the needs, but also try to meet as many concerns as the citizenry had regarding this extremely significant project that has a substantial impact, not only now, but in the future for the care of our citizens. The final plan that we arrived at was one which will actually close the Comprehensive Center and create a second facility on the Rocky Knoll campus, which will result in two separate operating entities at Rocky Knoll. And I think perhaps the best way to show that is to go to the architect rendering that I brought with us today, and so people can get an idea of just what currently exists at Rocky Knoll and what will exist there. The part of the drawing, which is here in the two different tones of red, indicates that part of the building, which will in essence remain Rocky Knoll. It will be a downsized facility for skilled nursing, for the geriatric and elderly population. The lighter red right here is that part of the building which was constructed in 1992, and that will remain as the part of the building which will render services for the elderly. The darker red is a new addition to that part of the building being built in order to provide adequate activity space and office area for that particular entity which will become the Rocky Knoll facility. In this part of the drawing, this dark beige color indicates the part of Rocky Knoll which currently exists, which was constructed in 1972. That will become a 59-bed facility which will be dedicated to the care of those with mental diseases currently served at the COMP Center. And then this cream color addition here is a brand new 37-bed addition which is going to be constructed for the care of our intermediate care facility residents who fall into the categories of care and developmentally disabled. This will be a totally new complex really built in a state-of-the-art way. And then if you look right over here, once again, another light cream color area indicates a new dining area that will be built to service the population of what will be the Replacement Comprehensive Center so that when we are completed, we will have one facility indicated here as I move the laser light in this area which will be a total capacity of 96 beds and will replace, essentially, the current Comprehensive Center. And then we will have a second facility which will be in this area which will have a total capacity of 99 beds that will take the place of the current Rocky Knoll operation. And we're very excited about this consolidation plan and also as part of the consolidation plan not only our Rocky Knoll and COMP Center but we're also putting substantial renovation dollars into the Sunny Ridge location to ensure that there are a lot of cosmetic changes to bring that facility up-to-date, modernize it and provide a nicer atmosphere and environment for the residents we serve. Now you started your position in February? February 28th. And when you started, it was really a hotbed in terms of the issue of the consolidation project and the plan to date. And supervisors, the health care centers clearly were working very hard to develop a consensus and listening to the public. And again, I think everyone, including the chairman Lehmann-U, is very pleased that we were able to give you unanimous support and develop this consolidation plan. What do you see as the primary benefits to the consolidation project? Well, I think Adam, there are a lot of benefits to this particular project. First and foremost, the care that we are able to render our residents is going to be able to be delivered at a higher quality, if for no other reason than the people we serve are going to be living in a better environment. Some of the things, for example, that our current population at Comp Center does not have. We don't have adequate space in our resident rooms. They're too small. They don't really provide the square footage area that they should. Our residents in the Comp Center now because of the fact that the building is old, it was built before current codes, has community bathrooms, for example, which is certainly a significant impairment to resident privacy. In the new replacement facility, all rooms will be private for that particular population. A significant number of rooms will also be private in the Rocky Knoll part of the building. So we're increasing our number of private rooms. All the residents will have, for example, access to their own bathroom. We will have new modernized activity space. We're going to have a dedicated workshop in our ICFMR, a new addition that can be exclusively used for resident programming for our population. We'll be building new activity space in Rocky Knoll. So all in all, I think that the biggest advantage that we're going to accrue from the consolidation plan is that we're going to be able to really, truly improve the quality of life for the people we serve. Another issue that's been very important is the bargaining units that we work with and the number of employees that work at the healthcare centers. One of the questions that continues to come up is, is there a possibility we may lose positions as a result of the consolidation plan? I don't anticipate at this juncture that any one of our current employees would be faced with losing a job as a result of the consolidation plan. How much is this project going to cost the taxpayers of Sheboyton County? Well, right now the approximate budget for the construction project, including the Sunny Ridge renovations, is just a little over $8.9 million. And the people in the county finance department tell me what that translates to is about $200 for the person who owns an average $100,000 home, that $200 being over a 10-year period. So the taxpayer who lives and owns in a $100,000 home in Sheboyton County will be paying about $20 a year to subsidize this project. And my understanding is the $8.9 million, does that... I don't believe that includes furniture, furnishings. That's just the construction cost at this point, yes. We anticipate additional costs to the project for furniture and equipment and so on to ensure that the buildings are furnished as they should be. And all probability that that number will come in somewhere between $300,000 and $400,000. And what's the status of the consolidation plan to date in terms of working with the architect? Right now, as far as the public is concerned, it may appear that we're dormant and we're not doing much because, obviously, the visual eye is much more receptive to activity and there are no steam rollers and cranes and shovels that the Rocky Hill Camp is doing anything. And the reason for that is because right now what truly is in the hands of the architects. They have begun the design phase of the architectural drawings, which means that they begin to draw the building in accordance with what we are going to need, what it needs to be included in the building for our own requirements, as far as patient programming is concerned. They then have to run these drawings past the state officials in Madison who license and certify long-term care facilities. Once those kinds of approvals are met, then they go to work on actually putting the construction drawings in place. So, for the next three to four months, from the public perspective, it's going to be a pretty quiet time as the architects finish their work. So, when is Chairman Lemming you going to be able to put his hard hat on and grab a shovel and get out there and break ground for the first time? Well, we hope to provide the chairman with a gold shovel sometime around the 1st of December. Sometime before the frost gets in the ground? Yes, so you can... And I don't have to jam it in. What I thought about before Jean was the impact on the employees if there would be employees laid off because of the downsizing. What about the residents? I think one of the concerns in the community is because we're downsizing into two facilities from three, are we going to be sending a lot of residents to either nursing homes or what is going to happen to our residents that we have in our facilities right now? Well, one thing I want to clarify is that we are downsizing actually and I think possibly that's a misconception in the public generally that they see that we are eliminating the facility and going to two locations and therefore we will only have two facilities but in essence we will have three facilities in two locations, two being on the rocking old campus. So, the downsizing does not really occur in the number of facilities we intend to operate but in the number of beds we intend to operate. And right now if we do an overview of the health care center system we would find that we have a significant number of empty beds currently. The state of Wisconsin generally speaking is an over bedded state in this industry and Treboygan County is no exception to the rule in the state of Wisconsin. And one of the things that we tried to do when putting together the consolidation plan was to anticipate the future needs of the county. Right now if we took the whole resident population that are in our three facilities and we subtracted from that number those people who were ready for community placement the net total would actually be less than the total number of beds we're going to have in the consolidation project. So we certainly anticipate that we will be able to meet the needs. As far as residents being displaced are concerned we don't anticipate that there will be any movement from building to building but while some of the renovation projects occur within a particular building chances are people might have to move a room for a few days while their room is painted or retiled or that kind of thing. Okay. You touched on the over bedding that we have in Treboygan County certainly the cost of running three facilities at three different locations has been an issue another has just been the physical plant at comprehensive health care. Would you touch on or provide an overview of some of the concerns about the comprehensive health care center physical plant? Well I brought along some photographs today Adam that kind of depict and show comprehensive care center and there's no question that when comprehensive care center was built back around 1940 it was a state of the art facility and if people drive by the building it's a very impressive structure it sits out in the country it's beautifully landscaped it's built like a fortress as a matter of fact you might expect the king to come out of his throne while you're out there visiting because that's kind of what the place looks like. It's like a castle. But it's an old building and although it looks good from the outside when you begin to take into consideration some of the things that are on the interior of the building you can see that to renovate that building or to replace that building would be a cost that would be extremely prohibited certainly not in the best interest of the Sheboygan County taxpayer. Some of the examples the building does not have central air conditioning the building has the old fashioned radiator steam heat kind of systems that need replacement and for the past few years we've been keeping them together with patch work and that kind of thing and I want to assure people that we've certainly not created an environment where resident safety or employee safety is ever a question of the best the expenditure that would go into that kind of thing normally has not been made to anticipate the future as what would happen. You can look at some of the plumbing problems in the building for example. Here's a photograph that shows on the right side you can see new replacement piping that has been installed in some of the plumbing areas and on the left side you can see how the pipes are deteriorating over time. This kind of expense comes into the thousands of dollars every year to replace those kinds of systems because of the kind of construction the comprehensive center is in that it's a masonry building, it's built with plaster walls just to get to some of those areas to replace them and work on them is an extremely expensive process because there's no easy access to things like the plumbing and electrical fixtures in the building. I understand as well that there's some concerns with just mobility of the residents in the facilities such as the elevator access as well as some of the problems associated with the sewer system. The building is there's no question the building is old for example windows need to be replaced and those kinds of things we have elevators in our building that are truly interesting but they're relics. We have elevators that I can remember as before your times I can remember the child going to the department store and the elevator operator would open the gate and tell you it was third floor laundry and the bell would go off but unfortunately those aren't very practical in a facility like ours however we still have elevators like that in our building. So I think people can begin to readily see that to renovate Comp Center in its current location is very practical because it would be so extremely cost prohibitive. You also mentioned our sewage plant that's probably perhaps the easiest identifiable single expense that we would be facing if we stayed there just to replace that bring it up to current code would cost over a million dollars. I know in some of the studies that I reviewed prior to the consolidation plan being endorsed they were looking at anywhere from 11 to 12 million dollars completely address all of the issues some of which you've touched on. The final question I have for you Gene before I turn it back over to Chairman Lemming you would be the issue of moving residents to Rocky Knoll and having two different types of populations at one location. What are your concerns or views on that? I think actually it's going to work out in a quite positive way. If I can refer us back one more time to the architectural rendering that we have although there will be two populations at the building. Right here where the colors are different there will be a physical division between the buildings in order to keep the population segregated. We are also going to provide for the residents outdoor courtyards which will be separate and distinct for each population. As you can see up here there's a courtyard designated for the SNF population with a walk path for Alzheimer's residents. There's another courtyard here adjacent to the skilled nursing facility that will be designated for the skilled nursing facility residents and then we're planning two courtyards which will be specifically for the COMP population here for the IMD population and then another over here for the ICFMR population. I think that it's going to provide us the ability in addition to that to have some shared services in which the residents will really benefit. We can begin to look at more sophisticated programings shared between our populations with things like therapy and activities and pastoral care. Those kinds of things by putting them in one location will allow us to better utilize our staff and eventually be able to provide more sophisticated programming to our resident population. Gene this is the consolidation program is a two-year project or better with most of the two years in front of us yet. Correct. So during the rest of the year 2000 and 2001 as we go through this project how will you as a healthcare facility and as the director get the community informed as to the progress of the project and what's going on? Well you're absolutely right Chairman Lemme who that this is at least a two-year project and more probably a two-and-a-half year project from where we sit today. One of the concerns that we have within the healthcare centers is that we want to make absolutely sure whatever information is conveyed to the public is accurate information. This is a critically important project it's a project that a lot of people are going to be monitoring in the community and they should they should do that because it's a significant expense to the taxpayer and so we've got an obligation I feel to ensure that we do as much as we can to get the information into the public's hands so that they can understand and comprehend just what we are doing. We've got different mechanisms by which we do that just prior to my arrival a newsletter was started which we mail out to a number of different people in the community and by the way if anybody wants one of those newsletters I just need to call my office and I'll put them on the mailing list it comes out every other month and it's a report of our progress. I have made the statement in several different venues and I'm certainly willing to go meet with any group that would like to have me present or address any group about the consolidation plan. One of the mandates of Resolution 38 when the county board unanimously passed the consolidation project was to ensure that we consider including a public relations and marketing component of the plan that would include people from the public and we have begun to put out some guidelines and looking for people will be looking for people this fall to join with us in helping a public relations and marketing campaign to ensure that the accurate information gets into the public. We'll also then do discussions such as press releases meeting with people on a one-to-one basis and finally we're very lucky to have the good auspices of television 8 that we can perhaps occasionally have these kinds of broadcasts to get the word out. I think we will probably schedule you again more than once during the course of this project. Just because you're so busy with this project you're busy with the architects and the building committee the field of health care is in standing still. That's correct. And we can't ignore everything else we're doing at the health care facilities while we're doing this project. What do you see Jean as the future of our health care facilities in Cheboygan County? Both with this project and beyond. Well I see a lot of exciting potential that's the first thing I see. I think that we are in a position I hate to sound grandiose but occasionally you're in the right exactly the right place and exactly the right time in history to do some real neat stuff and I think we happen to be in that place right now. We've got potential to really create something special in our health care facility system but at the same time we also have to face reality that the dynamics of the health care industry are now the kind of dynamic where change is the status quo and the status quo no longer exists. We're one of the most regulated industries in the country. The regulatory requirements under which we operate are constantly changing and if they don't change the interpretations of the regulations certainly are constantly changing and one of the biggest challenges that we're going to meet in the future is in the area of our ability to get good qualified staff. The fact of the matter is on a national basis there is a crisis in health care staffing especially in the area of nursing people in the nursing profession just don't exist one of the primary reasons is a practical one 30 years ago when a girl graduated high school she could be a teacher and nurse a secretary or a wife needless to say today the choices are a bit higher for the people graduating school and I don't mean to convey that nursing is a female dominated profession but nevertheless traditionally it has been and as a consequence nursing schools across the country are closing the number of people in those professions is getting smaller and our real need our real ability to meet the needs of our residents in the future I think is going to be more dependent upon our ability to recruit qualified staff than it is on the number of beds we have in our buildings. We have just a few minutes left yet you maybe if we could look at that at that architects drawing one more time true just so that it's clear to the viewers how much of this facility is already there and how much is going to be new construction we talk about the two areas that are going to in the future house the residents from the comprehensive health center but how much of that is already there and how much of that is going to be new construction currently at the Rocky Mill campus the kind of cocoa colored here part of the building in this lighter red part of the building those two parts of the building exist as well as this annex building which is shown north of the main complex the annex building primarily now is used for storage delivery maintenance repair and those kinds of things and that building will stay the cocoa colored part of the building right here is that part of the Rocky Mill structure which is currently which was built in 1972 this part of the building the lighter red part of the building is that part of the building which also was currently there which was constructed in 1992 so if we just kind of run a straight line with laser light here from that building through and over to this building it's this part of Rocky Mill that currently exists the cream color addition over here is the 37-bed ICFMR addition that will be new this cream color portion right here indicates a new dining area for the comp center population that will be new and this dark red area here indicates new activity and office office and therapy space for what will be the Rocky Mill population and that will be new very good we actually did it we got through this program we got all this information in if any of the viewers would like to ask any questions in the future his office is in the conference of health center and Gene I'm sure you'd be happy to answer any calls and talk to people as the questions come in over the next couple of years and beyond next month on Sheboygan County government working for you we would like to talk about our budget process with Sheboygan County as many of you have probably heard and read we are looking at a tough budget year this year we're looking at asking department for some decreases in their budgets and we'd just like to talk to you the viewers about a little bit about the budget process our goals and how that process is working we'd like to have with us that Tim Finch our finance director and Connie Ziegelbauer the chairman of the finance committee and discuss those issues at that time as a last thought we asked last month if anybody had a better name for our program Sheboygan County government working for you it's a long name but if you have any suggestions we have not heard from anybody with suggestions we're still waiting for those if another month or two goes by we'll have to just make our sign with that name on so if you do have any suggestions for a new name either call myself or Adam Payne at the administrative coordinator's office and we'll be happy to take your suggestions for a name thank you