 Welcome to Sheboydon County Government, working for you. My name's Adam Payne, County Administrator and co-host of this program with Chairman Roger Distruty. And as you know, every month we strive to focus on a different department and bring a different guest. And today, we are very pleased to have the leader of the five-star facility at Rocky Knoll Administrator, Rochelle Valesky. Welcome. Thank you, Adam. Thanks for having me. Rocky Knoll is one of our 19 departments. It's one of our larger budgets. A lot of very important work going on there. A lot of history associated with Rocky Knoll. And today, we'll give you a little snapshot about some of the roles and responsibilities, but let's start with Rochelle and simply ask, please tell our viewers a little bit about yourself and when you started at Rocky Knoll. Well, last September marked three years that I've been there now. So just a little over three years. And I've been a nursing home administrator for the last 13 years, though, and a registered nurse for a little over 20. All of my work as a nurse and a nursing home administrator have been in the long-term care industry. I took a little hiatus and worked for a hospital setting for Roar Hospital in administration there for about five years just before I came to Rocky Knoll in a role of director of quality. So I was happy to be able to bring some of those skills too. But I have always worked in a nursing home. Even from the time I was in nursing school, I was working as a CNA and then became a nurse. I was a director of nursing for a few years and just kind of grew up in this system. It's been your career? Yeah, it's been my career. Is this where you're going to end it with us at Rocky Knoll? It is, definitely. This is being taped and we'll be put in the vault. Well, very nice. I like the fact that you have that registered nurse background. Roger and I both married registered nurses, so we're very fond of them. And I think it really helps you be successful in your role. Not only do you have the importance of the administration and all the stresses that can go along with that, but you really can relate to the nurses and the importance of quality care to the residents. So I don't know how many nursing administrators, if that's a norm for them necessarily to have a nursing background or not. It's not a norm. What I find is primarily either social workers or folks that have a healthcare administration degree. But there are a few of us. Because we've certainly had a number of administrators over the last 20 years when we had Comprehensive, Sonny Ridge, and of course now just owning Rocky Knoll, but I don't recall an administrator that was a registered nurse. Maybe Linda Martin from 17 years ago, but I'm not even certain of that. I also was a CNA instructor at one point, so I think that really helps me to understand the role that they play too. And that's our biggest body of workers with the nursing assistants and nurses. So I agree with you. It helps to know what they're doing. And of course all the positions are tremendously challenging. Whether you're a CNA or a registered nurse, all of the positions at Rocky Knoll are important, but shed a little light on the challenges or what are some of the most challenging aspects of being a nursing home administrator. I'd say the biggest challenges that I've had since coming to Rocky Knoll have been I'm sad to say, to quality of care. And it's not for lack of people wanting to do a good job and loving the residents, because they certainly do and did. But we had some hurdles to overcome early on where we had some, a couple of bad state surveys that really helped to point out our flaws and show us what we needed to work on. And that took a tremendous amount of effort on everyone's part. And hopefully I was able to bring to the table some of my background in quality and performance improvement to be, I think it was process issues primarily that where we were failing. Again, not that people didn't want to do the right thing, but just being shown a better way perhaps. And it's worked like you said, we're a five star facility and that took quite a bit of effort and time to grow from at what point, or one point was at one star back up to five. So we're very proud of that. We'll have to maintain it. You can't let your guard down for a moment, but always looking to improve your quality is certainly the biggest challenge I think. And it's the most important aspect of running a nursing home. Obviously quality of care is critical. I agree, the people deserve it. It was an eye opener I think for Roger and I and members of the board that we've always taken pride in our facilities. We know there's been a lot of appreciation for the county owned and operated facilities. We know we have a lot of wonderful staff, a lot of very senior or seasoned staff with tremendous experience. So I don't think quality was ever on the mind to us. There was just kind of a strong assumption that's got to be good. Then for a number of years the focus was all on the bottom line and how are we going to continue to own and operate these facilities with the tax levy going up as high as it did. And of course I think as many of our viewers know over time we went from three facilities to two facilities to one. And then of course when we had the pleasure of hiring you and you focused more on that quality it was disturbing to see that jeez you go online and you saw we only had one or two stars and thank goodness you and your management team and everyone involved stepped up and you turned that into a five star which is as good as it gets. Thank you for that. Certainly the reporting is more transparent so it's not unusual for folks to say oh I didn't realize where we were at because it wasn't as well reported as it is these days and I think that's a good thing that people need to know when they're making comparisons and making choices of where to live or place their loved ones that they're able to see what's going on there. Right. So in addition to quality care and maybe you want to focus more on that but what have been some of the key enhancements that have been made during your short tenure of three years? Quality food satisfaction has been a big one. You and I have talked about that before but food's important to everyone but I think particularly when you live in a setting that can be somewhat institutional and you look forward to that next meal and check on the menu and what's on there and we were getting some reports that the quality of the food, the taste of the food, the temperature of the food just a variety of things was not really where it needed to be and I really took that to heart and so did the folks in the kitchen and we made some great efforts on improving that quality bringing in menu changes, fresher food, even the way we serve the food, the way the food's prepared, from top to bottom there's been a complete change over and the food satisfaction is just off the chart now. You can just see the survey results have really gone up. It just makes me feel good that people like the food and they comment so much on it now. I guess in addition to that would be aesthetically the place just looks nicer. It was starting to get a little institutional and older looking a lot of beige color and just you know really needed to be spruced up and I think intentionally the effort for a little while was to focus on the short term rehab unit that's called Woodland Village so that area is beautiful but the rest of the building in comparison was really kind of drab and we have worked very hard over the years to do things that low cost but great return on our investment and it just looks so homey and nice and everybody's really appreciative of everything that's gone on there. I would agree I'm not there every day like you but every time you go there the landscaping on the outside looks very attractive and on the inside it's a market difference. It's very very nice. You also made an improvement or enhancement for our employees. Exactly. Their work environment is greatly improved. What I'm thinking of is that employee break room. I mean that's the nicest break room that we have in county government of all 19 departments and of course that was a generous donation but it improves the work environment in morale does it not? Absolutely. It's a beautiful space with massage equipment and nice place to heat or cook their food. It just feels good. You take a break and you really truly can refresh and relax and be ready to go back at it. At the county board meeting this week there was a focus about you know we've got 4,000 maybe I'm exaggerating 2,000 or 4,000 jobs available in the county what was the number? 2,400. 2,400 okay there's the two numbers 2,400 jobs available and not enough people to fill them and so of course we're looking to attract people to our area. County government needs to fill key positions as well whether they're CNAs or nurses or what have you and when you have a facility as attractive as Rocky Knoll providing outstanding quality care, great meals and a nice work environment not a bad place to start a career or end a career. I agree. What about future enhancements? Anything on the radar that you're looking to continue to improve or further improve? A few things we're working on for this year. One of them is to expand our memory care unit or the dementia unit. It's currently 19 bed and we'd like to expand it. There's kind of a simple way to do that to add on another wing or another hallway to make it 28 beds. We're finding that that unit stays full so there's definitely a need in the community for more dementia beds so that'll be one is to expand that unit. Outside of bed another thing we want to do is to take and create hospice suites. So we have some rooms in the building that are a little smaller in size and they're connected by a shared bathroom. Some people call them like a Jack and Jill bathroom so the bathroom's in the middle to these two smaller rooms. We want to create one suite out of that. I think it'll work really well for hospice because then you can have the person who's in the end stage of life have their bedroom setting in one of those rooms and have an area for visiting family members who maybe want to spend the night or just spend time to be able to relax and take an app watch television or whatever the case may be and still be right there very close to their loved one. And what that'll allow us to do is to de-license eight beds because we're still looking to bring the total number of the beds at Rocky Null down a little bit. So that would allow eight de-license beds and create these terrific suites. So we budgeted for that this year and I'm really looking forward to that and our healthcare committee, the county board supervisors are in full support of that. They agree that that would be a really good way to utilize those rooms. And if any of our viewers are wondering why would we want to de-license or reduce our bed count, why don't you just give a little explanation on that. It's been kind of the trend throughout all skilled nursing facilities or nursing homes is just to have less and less of a need of so many beds in the county or the state or the nation quite honestly because there's so many options available to people. So coming to a nursing home isn't the only alternative. People stay in their homes longer. People go to group homes or assisted living. There's just such a wide complex of services that are available, home health care etc. Which is a good thing. It is a wonderful thing absolutely. You know there's still going to be a need for long-term care because the acuity level, we have 24 hour nursing staff on board so it sets us apart in that regard and some people still need that level of care just not to the extent that it had been in the past. Don't need a lot of empty rooms and the state also charges a tax associated with those empty rooms so you're almost penalized for holding onto that space. That's correct. So great one we can diversify. I love the hospice room idea. Just to also one final clarification, I'll turn it over to Roger. All the rooms right now at Rockino are private rooms. They are private. So every room is private but in the situation that you described it would add kind of a suite or a wing to a private room so when family members visit there's a little more privacy for all involved. That's correct and the rooms that I was talking about are the only ones that are designed like I said. The other ones are private and they're large and they're really really nice rooms but these particular eight of them, they're 16 but they would become eight are the ones that we would be looking to make that change. Excellent. Over to you Roger. Thank you and great to have you with us today Richelle and your staff and you do some fine work at Rockino. It's much appreciated by the county citizens. And as you know that not a lot of county owned facilities in this state we're, I'm not sure, 10 or 15 of the counties in the state have facilities something in that order but we do have a lot of people that go there and much appreciated but what is the tax levy that in 2016 that goes toward supporting Rockino and compare that with a few years ago or even as much as 10 years ago how much does it compare 10 years ago we still had two facilities. Correct. So this year for 2016 it's about $828,000 for tax levy for Rockino and that represents just under 2% of the whole for the entire county and if you look back in the last three years it's been running just under 2% so it's been kind of at a plateau in that regard but if you back up a few years behind that like you say when there were two facilities saving the year 2006 I believe it was it was over $6 million for tax levy. So it's definitely been going the right direction and it's certainly something that's important to not only the community but to me as well and we continue to need those dollars for some of the great enhancements that we were talking about and it's always my aim to continue to go on a downward progression with that and do what we can to reduce or eliminate our need for tax levy and the other county homes that you mentioned in the state of Wisconsin I don't know the exact number but I know it's in the 30s and we have a networking group amongst those county homes and we talk quite a bit so I had challenged the group in asking who's been successful in reducing their dependency on tax levy and what has been successful for you and able to do that some are even at zero but very few and what I've heard back just a resounding number is people who are able to offer a continuum of care on their campus meaning not only the nursing home setting that we have but an assisted living or senior apartment so it's something where you can follow kind of the trajectory of life's course as people and they have less needs more needs you know through there to capture that so in some regard we're a little bit stilted that way because regulation will not allow us to convert to any portion of Rocky Knowles existing structure to an assisted living which was something that we had hoped to do but we're just prevented by regulation to do that but that would certainly help so it just means that we need to always be watching our expenses and look for other revenue opportunities and what different kinds of services do you offer and how do we compare with other homes in our county okay well Rocky Knowles is of course one facility but it's much like having five different nursing homes under one roof because there's five really different culturally different population different units in Rocky Knowles so one of them is the short term rehab unit which is primarily folks who are coming to say on an average of four weeks they're coming to us directly from the hospital generally they've either had overwhelming illness or a recent surgery and they come to us and they just need to be built up again and go through therapy and get stronger and those people tend to leave us then and go back to their homes or whatever setting they came to us from so that's that's that unit there is another unit that is for behavioral health and that unit houses people with chronic mental illness typically you know around 60 plus years age are the folks that are living on that unit quite stable but have been institutionalized for a greater part of their life we have quite a few veterans there who've suffered from post-traumatic stress syndrome or we have people with diagnoses of bipolar or schizophrenia just a variety of things that brought people to that place but that makes us unique from the other places in the county to have that behavioral health unit we have a unit that is strictly geared for folks with dementia any gamut of the Alzheimer's umbrella they call it but that's a secure unit so the people on there aren't at risk of getting out of the building or eloping and that's the unit I was talking about earlier we want to expand the services because there's a greater need than what we have beds for on that unit and then the two remaining units are similar to some degree probably more what you would consider a traditional nursing home long-term care people with chronic illnesses and they're probably going to stay with us for the rest of their lives but of one of those units it's a little higher acuity where we're able to take people who have needs for tracheotomies or they have IVs running or respiratory issues we have one room on that unit which really sets us apart from our competitors in that it's a negative pressure room or reverse isolation so we can take active TV cases or we can take people with a respiratory illness that's highly contagious because we're able to keep them and our staff and everyone else safe in that room so that's really something that's a standout for us and what are some of the advantages and disadvantages that Rocky Noel has compared to our competitors? I would say not only the diverse population that we can serve but our staff their tenure has been terrific when I first started the average tenure was 25 years we've had some retirement since then so I haven't asked HR to run that for me I'd be curious but it's still pretty high people who have been working there for years and remain dedicated and there's something to be said for that they know their stuff and they want to be there to continue to come after all those years the setting where Rocky Noel is is beautiful and that really is an attribute as far as disadvantages I would say sometimes that setting can be a blessing and a curse because it's a little bit further away so for someone who might want to stay in an area that's close to either their spouse or their family or their friends being at Rocky Noel and away from them you know we have lost a few admissions based on that because it's a little difficult because typically we'll take an aged person and their spouse is aged as well so it might be difficult to make the haul out there other disadvantage is probably the age of the building we're competing right now with some nursing homes who have built brand new facilities and some people like sparkly pretty new things our care is outstanding and once we get there we win them over but to get them in the door there are always going to be certain people who want to go to the new place so that's one the other disadvantage I could think of would be not having that assisted living option because as people come to us and they have rehabilitated and they're in the nursing home maybe they haven't quite gotten to the state that they were at before where they could go back home and now they need an assisted living so they've improved but not to the point of complete independence we don't have that option available for them and many people have said I wish you had assisted living I would like to stay here and how many beds do we have at Rocky Knoll and what's our current census there's a total of 154 beds again they're all private today's census is 136 and the rehab unit that particular unit is 37 beds and right now there's 32 people living there we've got three more coming this week and we're going to be really close to full there which is a nice problem to have but an unusual one because we tend to run in the 20s there so we've really had quite an uptick there in that rehab area and it seems like word of mouth has been just so much more positive about Rocky Knoll we've discussed this before and I've just heard from different people throughout the community that you know right now Rocky Knoll has an excellent reputation and I've got to believe that's why our census is higher than you projected as budget and higher in the rehab area just fantastic I'm so glad to hear that we right we had budgeted for 128 residents for the year that was the same as last year and we had done a prospectus looking back several years and it looked like that was right on target but we have gratefully been running into the high 30s 130s towards the tail end of the year it dove down a little bit and sadly we lost some of our long term people who had expired and it takes a while to recover from that we're used to a revolving door in the rehab unit it fills up and it empties out and it fills up and it empties out and that's typical that's just the name of the game there but to lose some of those long term care people that have lived there for so long it not only hurts your heart but it's tough to replace but we've done it we're back up there so in the long term care portion there's 117 beds and now we're at 103 for occupancy and that's pretty good and how many people, how many staff do we have at Rocking Hole to provide that service the last number I got from the human resource department we're at 190 we do have a few open positions so we generally run right around 200 employees at Rocking Hole and of that 190 there's 83 part time people in 107 83 full time 107 part time employees Thank you again for you and your staff doing great work out there Thank you. You touched on earlier the budget and that our tax levy now is under a million, it's been under a million for a while when Chairman Distruti and I were working with our advisory committee that was looking at the health care centers years ago and the $6 million tax levy associated with subsidizing it we've got to downsize, we need to right size and at that time the goal they laid out there was if we can keep that tax levy and a million dollars or less I mean that's fantastic and of course that's been accomplished but as Rochelle knows better than any of us we don't have a lot of control over the funding sources necessarily you rely on federal and state funding Medicare, Medicaid could you give a little snapshot of what those funding sources are and why we don't necessarily can control how much we're going to receive I sure can. The largest percentage of people that live at Rocky Knoll are being paid through medical assistance or Medicaid and that figure bounces around but typically runs about $160 a day reimbursement and that's determined by that $150 a day who makes that decision what they're going to pay is that state the feds? Unfortunately I don't get to decide that. Yeah we don't. Right. It's decided at a state level and the average cost of us providing care for a resident a day is closer to $280 so we lose money on those folks and you hope to recoup it on the other payer sources which ranges from Medicare, Medicare Advantage programs managed care organizations, family care, private pay we are also contracted with the Veterans Administration so we've got them as a payer source as well and quite a few veterans live at Rocky Knoll so there's a variety of payer sources but again Medicaid tends to be our primary one so we run a little deficit there to make up with the others. Yeah so it makes it challenging. It does. And if you just think of your staffing $160 a day if you have to have staff there 24-7 it doesn't take long to do the math and recognize there's not a lot to spread around there though obviously the more residents we have and then the more diverse the payer sources the better we do unfortunately we've been doing our right so as you think about the budget today and you said you talked to some of your peers with other county owned and operated facilities what do you think is the best means to continue to achieve that objective of reducing property taxes or if not reducing them at least holding the line for as long as we can it all goes back to quality of care in my mind you know if you continue to do a good job and your reputation is high and people want to come to your facility you'll be able to make up for those dollars particularly in the short term rehab stay which is the highest reimbursement that we have through Medicare and people come and they have good results and they're able to get back out the door quickly then it's a win all around yeah I'm with you 100% and that's why we both are so proud we're also proud that we've got five stars and that anyone going on the internet can see we're right up there with quality of care you have the word of mouth you have the doctors and people living in this community knowing the quality of care is good and as you said though our facility may be a little older if I have a choice of going to a brand new facility it just looks beautiful but doesn't necessarily have the same quality of care reputation or doesn't have the longevity with staff with you know they just don't have the same experience that we have you want your loved one to be where they're going to get the best care and so I really appreciate the work that you and your staff do speaking of good work you also have a rocky no foundation and here's some volunteers that come together and they raise funds to do some beneficial projects for the facility could you give an example or touch on a little bit what they do here that's a terrific committee of really dedicated people who just love rocky no there's eight members they meet monthly they focus on receiving donations and also doing fundraising and every dollar that they spend has to go towards a resident to enhance their quality of life and they look to things that are not operationalized but would be just an enhancement above and beyond they've done so many things we just recently did a look back over the past five years to $140,000 buying just fabulous things for the residents between the outdoor grill area they call the bistro I know you've seen it that's fantastic right now they're looking towards this year of creating a scholarship program for staff members who want to continue their education to purchasing blanket warmers the hospitals have them they're so nice lazy boy chairs they do something with quite a few recliners they just yes really nice stereo systems big screen televisions just I could go on and on with the things that they have done for the residents really really good we could go on and on but unfortunately our time is up that was a very quick 30 minutes and I hope it gave you just a nice snapshot of one of our most important departments providing outstanding quality care to residents in this community so if you want to learn more about Rocky Null don't hesitate to contact Rochelle or one of her staff don't hesitate to stop out at Rocky Null and check out the facility we welcome your interest and we certainly appreciate your support Rochelle thank you so much for being here today we appreciate your time and the good information and thank you for joining us next month Laura Henning Lorenz our county treasurer is going to be here to talk about gathering those property taxes and how she administers that the important work she does so until then stay warm and thanks for joining us