 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 we're very pleased to have Dale Pauls, the Health Care Center's Director with us. Welcome, Dale. Good to be here. Dale's going to give us an overview of some of the current activities at the Health Care Centers. As you know, this has been one of the major challenges for the county board and county as a whole. There's been discussion for the last four or five years and a fair amount of change that's going on. That's probably the understatement of the day. And we're real pleased to have Dale here today to talk a little bit about what they're currently focusing on and some of the primary objectives of the Health Care Center's committee and his staff. As you may know, and certainly, Dale, you're where the county board last September, September of 2005, made a rather significant decision and that was to support the Health Care Center's committee direction. And specifically that direction was to downsize or a right size, sunny ridge. And there were also other recommendations as part of that report that the Health Care Center's committee forwarded to the county board. Since then, you've been working diligently to begin implementing those recommendations. Please start by sharing with our viewers how did this all come to be? Give us a little background before we get into what we're doing in the future. We go back to, in November of 2003, we established a citizen's task force who were instructed to take a look at what alternatives might be, should be, possibly, pursued for the Health Care Center's. And they convened for approximately seven months, and in June of 2004, they submitted their recommendations to the county board. And just briefly, the recommendations were, first of all, to take a look at renegotiating wages and benefits that might be comparable to the private sector. Secondly, they wanted us to take a look at implementing Gunnerson and Graham recommendations. Gunnerson and Graham were consultants that we had hired to take a look at our operations. Thirdly, they were wanting us to take a look at the county departments, whether they would be willing to work towards some savings overall that would help the Health Care Centers, and fourthly, to analyze possible uses, other uses for the Sunny Ridge facility. Considering all of those, if they were not able to, if we as Health Care Centers were not able to achieve a 75% reduction in the tax levy, then there should be consideration to possibly leasing or selling Sunny Ridge. And that gets me right to the next question. The county board appointed this Health Care Center Citizens Task Force, if I recall correctly. It was about 17 members or thereabouts, and they met a little more. We've had Gunnerson and Graham consultant come in and look at our operational structure and provide recommendations. They worked hand in hand with the Citizens Task Force. But what was the purpose of this? Why did the county board establish the Citizens Task Force to begin with? Over the last several years, since about 2002, our tax levy has gone up tremendously. In just, for example, in 2005, we had to have tax levy of a little over 5 million projected for 2006, it's going to be 6 million. So we knew we had to take a look at ways that we would be able to reduce that tax levy if we continued to operate it or even at a lesser capacity. And very quickly, what was the key reason that the property tax levy had to be increased so much in the past four or five years? That's been somewhat reduction in revenue that we're receiving from the state of Wisconsin. As we know, we received quite a bit of intergovernmental transfer dollars that are being very severely reduced as we go forward. So if my memory serves, I think six years ago, we actually had a flat tax levy for the operations of our health care centers, as did many county-run nursing homes across the state. And then as federal and state revenue has declined, and when I say declined, I mean declined significantly by millions of dollars. As you pointed out, we had a $5 million tax levy in 2005 and for 2006, it's gone up to 6.1 million. So clearly what's driving a lot of the discussion is that reduction in state and federal revenue. So that sets the stage a little bit for why the task force was created and some of the work that you've been doing. What are some of the key objectives now that the health care centers committee has set out to accomplish? As you mentioned a little bit earlier, we have been given direction in September definitely to be looking at downsizing Sonny Ridge. And so that process involves the state of Wisconsin. We just recently filed a downsizing plan with them to reduce somewhere between 100, approximately between 125 and 150 for a licensed capacity at Sonny Ridge. A second piece of that, we'll talk about a little later, it probably is Rocky Noel and that there would be a downsizing plan submitted to for the ICE-FMR. As a part of that downsizing plan, we would create two licensed facilities at Sonny Ridge and we do that again because there's provisions that give us the opportunity to realize some reimbursement advantages in this downsizing plan. I know there's been questions as to why we would want to do that. So those are the main things that we're currently working on with the state of Wisconsin. Now our viewers just heard you say that we're looking to downsize Sonny Ridge to a range of approximately between 125 and 150. What's our current census at Sonny Ridge? Current census is 208. And as we go through this process of reducing our census there, how does that occur? Could you clarify how that occurs? Because as you know occasionally people will read letters to the editor or hear someone say that folks are being kicked out or they're being asked to leave or comments such as that. How does that decrease occur over time? We made a decision as of November 14th that we would freeze admissions and the only we would achieve the downsizing through attrition only. So no, we're not discharging people to other facilities. And when you mentioned earlier a phase down plan and that you forwarded a request to the state of Wisconsin, please explain what is a major phase down? What does that involve? Well the phase down means that you are submitting to them a plan that you want to reduce the number of license beds that you currently have. To the state of Wisconsin? Yes, yes. As a part of that for realizing some reimbursement advantages as you downsize because there are certain fixed costs that continue. In order to meet their criteria for example you have to have 15 percent of your beds that are occupied D license and then for additional reimbursement in our capital such as the building piece you have to have at least 25 percent of all your licenses D license. So those are the things that make up the components of a major downsizing plan. Now as viewers listen to that last response we may have lost a few people because I know it gets complex with the intricacies of the phase down plan itself but the bottom line is we need to work with the state. There has to be agreement and that's part of how we can continue to maintain some funding is by locking in an agreement with them. Probably one of the most important aspects of all this is community relations and making sure that the residents and their family members and guardians know what's going on and why. How have you been communicating to family members and the public at large? Various ways. Internally with our residents there's a resident council meeting every month which the administrator attends and discusses questions and concerns that they have about it. We have had family meetings, relatives, guardians, etc. that were invited to initially we explained exactly what we were going to do and we will be having another one of those very shortly. We try to do that as things start to happen as a part of this downsizing. Of course we've discussed it at our health care centers committee meetings, there's been letters that we've written again to the various parties that are involved. So a variety of communications. If you want to learn more you shouldn't have to work real hard to get the information that's essentially your point is it not? Yes. At the health care committee meetings they're all open to the public and your chairman Mike Van der Steen of the health care centers committee he also provides an update at every county board meeting. That's correct. Yes. Very good. Thank you Dale. Dale we've been talking about a lot of changes that are going to be occurring at Sunny Ridge but things are also happening at Rocky Noel. Could you explain why we're going to be going out of the ICFMR the Woodlake Village business at Rocky Noel? Sure. In 2003 this state passed legislation that restricted admissions to the ICFMR and also required that anyone living in the facility would be reviewed annually as to whether they would meet what they call the definition of the most integrated setting that they can live in and when I say integrated setting mainly we're talking about a person being able to live in the same situation that maybe you and I experience out in the community. So this really narrowed down whether it's appropriate for our residents to be continuing to live in the ICFMR. We knew immediately we weren't going to get any more admissions because of that freeze and we also have seen as they review that there is going to be opportunity to place individuals out in the community in different settings and family homes. So we felt that it would be necessary that we proceed with ultimately closing the facility. What is the actual timeline for the closing and how will that occur? Is there kind of a drop dead date by which we expect everyone maybe move somewhere else and that other place might be another bed in Rocky Noel? The health care committee took action a month ago to indicate that we would be closing no later than December 31st of 2006. So we will be working on toward that goal. It's my understanding that health and human services is very involved in this process. Could you explain how their involvement is taking place? Yes, they are. First of all, they're very involved in the plan when it's reviewed for a resident as to whether they feel that the recommendation would be the place in the community and then further deciding and making available community placement. I think just very recently they've been able to secure going forward some providers that will either renovate or build new complexes in the community to meet the needs of those residents that will be being discharged. We've heard a lot about a concern that some of the residents of the ICFMR may have no place to go. Can you tell us a little bit more about that? My assumption is that there will be some place. Yes, definitely. A couple things. If for some reason or other a person isn't successful, may need to just, you know, need a little more concentrated programming, there are provisions for them to come back to the nursing home or if you still had an ICFMR for anywhere up to 120 days. So hopefully, you know, you would be able to deal with the issues that they have, have them go back to their other setting. If there had to be some permanency and they had to go into an ICFMR, that would mean they may have to go to another county. But I don't really see that happening. I think we will be able to handle their needs within the nursing home. There are some residents currently in our ICFMR that will probably move directly to our nursing home that we know right now have more medical needs than they would have dealing with, you know, other issues and will be able to do that. So, no, I know we will definitely have plans to be able to provide services for these individuals. Some folks have asked, why don't we convert the ICFMR to a CBRF? Has your committee addressed that question? Yes, this was, again, part of the overall planning that has gone into this. We had recommendations from Gunnerson and Graham. They took a look at what the need was for CBRFs in our community versus needs for other kinds of services. Their recommendation definitely was not to go with the CBRF way, but to convert that to skilled nursing beds and then concentrate on rehabilitation services through Medicare. I know backing up a little bit with the ICFMR, converting it to a CBRF for developmentally disabled, there is no funding available. So it was a pretty easy question there, or a pretty easy answer to that question. But even with, for geriatric, funding issues and just not feeling that that would be the best area to be concentrating on for use of that facility in the future. What are the committee's plans for use of that actual physical plant once the ICFMR is closed? Part of our downsizing plan will be to be able to transfer skilled beds to those and convert those 37 beds to skilled. Those as you know are all private rooms. We feel like that gives us a marketing avenue for more and more people when they have to make that decision to come to nursing homes that are looking for private rooms. And secondly, skilled rehabilitation, the therapies is another area that seems to be in demand. And we're even talking about possibly outpatient, where somebody may have had a knee replacement or they had a hip replacement. They need some outpatient therapy. They could come to that unit and receive it there. So we will be working on marketing for those, providing those services. Okay. One final question regarding both the right sizing of Sunny Ridge and what's occurring at Rocky Knoll. I worked in the human services field for 31 years. And it seemed that there was an increasing pressure from both the federal and state government that more and more individuals that in the past had been cared for in a nursing home or institution could be placed somewhere else. Isn't that in Maine what's driving most of this? It's a very good point. It definitely is. As you look at the increasing number of people that are going to need services, skilled facilities can't take care of them, nor is it necessarily that they are the most appropriate setting. So they are restructuring reimbursement to make it more easy to access in community service. And I think it's coming down to that the nursing homes are going to care for really the most needy resident where they may have dementia is certainly an area or short time rehabilitation. I just looked at our statistics for last year and pretty close to 50% of our residents were discharged. So as you say, we're moving more and more to community type placements and using nursing homes only for those most needy. Thank you, Dale. You just spoke a fair amount about the ICFMR and some of our viewers might be wondering, well, what is an ICFMR? Those letters stand for Enemy Care Facility for the mentally retarded. And how many residents are in that unit right now? We have 30 residents. 30 residents. So at Rocking Hill, there's a total of 195. And 30 are in that ICFMR unit. And those are the 30 that when the county board made the decision supporting that or the health care centers committee made the decision to close that based on state law. Those are the 30 individuals that we're seeking to integrate into the community. How many thus far have left the ICFMR and have gone to the community in a more integrated setting? We have three right now since we started to really take a look at discharging. And reports back that they're doing very fine in the community. And we do plan to, as we've had in the past, have meetings with guardians. Health and Human Services has worked very hard to open up community facilities that they're using to allow guardians to see what services are providing out there. And we will be continuing to do that. I think there's always that. And naturally, when they've lived with you for a time, it's their home. The concern about making change. So we're trying to do as much as we can to relieve that. I wanted to take a couple of minutes since we have you here today, Dale. Because again, this continues to be one of the most important pressing matters that the county board and our organization as a whole continues to be challenged with. And I think you've already addressed some of the real key questions as you shared earlier. And as we discussed, state and federal revenue to support our operations, our health care centers, has reduced by five, six, seven million dollars over the last six years. And as those dollars have gone down, our tax levy has gone up. And in fact, our finance director shared with me recently that if you look at our increase in the last six years alone, the tax levy has gone up 480 percent in a six-year period, 480 percent. Those of you watching this, if you think about your bills at home and the cost of fuel and heating your home or filling your gas tank, if we had a 480 percent increase in that short period of time, I think we'd all be pulling our hair out. It's a tremendous challenge. The other thing that Chairman Gehring and I and the county board as a whole and you and Dale, the other 22 department heads know is that we now have a state-imposed levy cap on county government. That provides for no more than a 3 percent increase each year in our property tax levy. Well, a 3 percent increase in our property tax levy is about 1.3 million dollars for all county operations. Last year, the tax levy for the health care centers went up from five million to 6.1 million. One department, that's about a 20 percent increase. All the other departments received less than 3 percent. So certainly it isn't a lack of care or concern about our health care center's operations. It isn't a lack of care or concern about the residents we care for. And our quality of care is second to none. But from a dollar and cents standpoint, right now the county board and as an organization, it just continues to be a tremendous challenge. And I, for one, appreciate the proactive stance by the health care centers and the county board to put together the citizen's task force to hire outside consultants to look at our operations. And the bottom line is today, and many people aren't aware of this, but today, out of 72 counties in the state of Wisconsin, no one owns and operates more beds than Sheboygan County. We're number one. So despite the downsizing that's currently going on or right sizing at Sunny Ridge, despite some of the things that are happening with the ICFMR, despite the financial situation and the incredible increase in the property tax levy to support these facilities, we're number one. No one is providing a broader level of service. And I certainly take some pride in that. And I know you Dale do. And I know Chairman Gehring does. But whether we like it or not, we have to deal with the realities of the situation. And it's difficult. It's challenging. And going back to the reality of the situation, back specifically to Sunny Ridge, which has most of the attention from a standpoint of right sizing and reducing the overall facility operations, how does this impact of the freeze work? You mentioned earlier, we froze admissions, but we have criteria in place that will allow some people to still come to either Sunny Ridge or Rocky Null, some people can't. How does that work? The criteria right now is that if there is no other bed available within county facilities for whatever reason, whether a facility can't take them or there just isn't possible, then Sunny Ridge would take an admission. And as I said earlier, we froze admissions as of November 14. Since that date currently, we have admitted eight residents. So to me, the other facilities are absorbing the admissions. You do go through a period of time, and I think we may be heading into it right now, where there is a higher demand. And we may have to admit some people. But nevertheless, even after eight admissions, as I said, we're at 208, and we started with 242 on November 14. So from a timetable standpoint, we were seeking to reduce our numbers over a two, two and a half year time frame from around what were we at 240 down to, again, somewhere between 125 and 150. And we're already at 208 in a matter of four months. Less, yes. Less. So we may meet that target sooner rather than later. It would indicate. Arthur, you mentioned earlier, and certainly the three of us feel strongly about it. Sheboygan County is going to continue to be the safety net for the neediest of the needy. That's not going to change. How, through this process, do we ensure that that's the situation? For example, what's your vision for Rocky Hill? What's your vision for Sunny Ridge? Once Sunny Ridge gets down to that 125, 150 number? Well, at Sunny Ridge, we're definitely thinking that we will concentrate on dementia and the rehab, as I indicated, even at Rocky Knoll. So those two areas where the greatest demand will be. At Rocky Knoll, as we say, we are not going to probably deal with nearly as large a population of development and disabled. But we may have a few yet that are going to have to need our services. mentally ill will continue to service. And then have a mix of geriatric Alzheimer's. We have a special unit, too. So I do think, yes, going forward, the neediest of the needy will be served. And as I've said earlier many times, we need to be mission driven because of the fiscal constraints that we're faced with. We need to look at what our purpose is going forward. And even after that right sizing, we're still going to be leading the state from a standpoint of the level of service that we provide. We would be number two. We'd be number two out of 72 counties. Just to clarify for our viewers, while there is a freeze on admissions at Sunny Ridge, there is no freeze at Rocky Knoll for the normal nursing home admission. Right if there's a bed available. That's right. There can be an admission. We expect discharge planners to include us as a part of the placement. I know we only have a couple of minutes remaining. Very quickly after this right sizing occurs at Sunny Ridge, the North Building is going to be vacant. And I think many people appreciate that this saga could continue. Financially, we're still seeing the pressures from the state and federal level. We're still going to have to live within a cap. What do you envision happening to that North Building to help us keep two facilities operating? Well, we're very interested in finding out what may be other health related businesses or even other non-health related businesses might be interested in utilizing that for. And we will be within the next week sending out a request for information from a very broad number of companies to see their interests. And hopefully from there, we would be able to pursue engaging in some type of a lease arrangement with interest parties to utilize that North Building. Outstanding. Well, Dale, thank you so much for being our guest today and touching on a lot of information in a short period of time. For those of you who have followed this program today and if you have more questions, suggestions, concerns, don't hesitate. Please don't hesitate to contact Health Care Centers Director Dale Pauls, Health and Human Services Director Ann Watterjim, any of their staff, myself or Chairman Gehring personally. This, again, continues to be an ongoing challenge, a very important issue for Sheboygan County and one that we certainly would appreciate the benefit of your input. Don't hesitate to contact us. Don't hesitate to call if you have questions. We'd rather get the right information out there rather than see incorrect information circulated. So thank you for joining us. And on behalf of the Sheboygan County Board, Chairman Bill Gehring and myself, Adam Payne, it's been a pleasure. MUSIC