 Welcome to Sheboygan County government working for you. In fact, welcome to our 100th program of Sheboygan County government working for you. Pleased to have you with us today and also pleased to have Mike Tabenheim, our administrator of Rocky Knoll. It's been a year since he's taken the reins over there and Chairman Mike Van der Steen and I are looking forward to discussing with him what's all happened the last year. Mike, why don't you start by sharing a little bit about yourself and how it's been going the last year? Sure. First of all, thanks for inviting me and it's a real pleasure to find out that it's the 100th show, so I get to hit the centennial. I've been in the healthcare industry some 35 years now. When I started out, I joked routinely that I would never live to be 30, much less, you know, be in the business 35 years. So it's been an interesting experience so far. And you're back to your roots here in Sheboygan County. I am, I'm originally from Sheboygan. I was born and raised, went to urban and north high and then off on a wild tour of the United States. Well, it's good to have you back and good to have you on your program. In fact, 100th program, we thought we really had to bring on one of our most successful department heads and it was a tough discussion, Mike and I went through because we've got a number of good folks but you made the cut. Well, thank you, I'm honored. I'm honored, I'll collect the plaque later. Later, off the year. Okay. Mike, tell us a little bit about some of the greatest challenges you had coming to Rocking Hill right out of the gate. I know you had to take on some big challenges. Yeah, I did. It's been an exciting year but there have been some significant challenges. Probably one of the biggest was I came on board right on the heels of the transition as Sunny Ridge was privatized and a lot of the staff from Sunny Ridge as with County Comp Pryor were now at Rocking Hole. So basically, I would say that was probably one of the largest challenges that I had was to create a new team out of these three separate workforces and I remember a lot of staff introducing themselves, hi, I'm Jim, I'm from Sunny Ridge or hi, I'm Bill, I'm from County Comp kind of thing and trying to remind everybody there from Rocking Hole. So it's taken quite a bit to get the staff to acclimate and join as one and focus on their new home or home now as Rocking Hole. So that was probably one of the biggest, the other was a concern as to what would happen to Rocking Hole. Would it be privatized? Would it be closed, sold? What would happen to it? And so as we worked with the staff, getting to know the staff, that was probably the second big issue that I'd noticed and had to work with. And then of course just getting your hands around the operation itself, what we were doing, how we were doing it, what was working, what wasn't working and figuring out where to go. So a year ago, August, you walk into this building with staff from essentially three facilities, Rocking Hole, Sunny Ridge, Comprehensive, all have come together, we just went through the difficult bumping process associated with privatizing Sunny Ridge. What were your impressions? What were your first impressions of the facility and of the staff? The facility, first of all, was a gorgeous facility. I mean it's a very big campus and that's probably the best way to phrase it, comprised of three distinct buildings. Original building of the current configuration was built in 1972, another in 1992 and then the latest addition, our Woodlands unit short-term rehab in 2002. So it was a good building out in the country. So from a location, location, location kind of thing, you had the location in terms of the beautiful scenery, the secluded environment, but you were away from most of the activity. We're probably one of the furthest facilities away from any of the area hospitals, which are your main feeder sources and that. So while it had its pluses, there were some minuses that you would have to deal with and overcome. The staff was just impressed, just blown away by the seniority, by the experience level of the staff there and while there was a lot of challenges trying to get them to grow to be a single family, you certainly had the wealth of experience and skill to work from. Probably by far the most seniority and experience that I've ever had in one building in my 35-year career. And when you're talking about quality of care, of course some more senior experience staff, that's gonna bode well for the residents they care for. How about your management team? Of course you've been working very closely with them, what was your impression there? Equally as impressed, very devoted individuals, with again a lot of seniority, some of these department heads have been in the county system for over 25, 30 years and very impressive skill levels. Of course I threw a new wrinkle into the way we were gonna do business and the way we were gonna grow and build our organization. But they brought all the basic sound foundation tools that you would need to move forward. Very dedicated and very interested in being successful and making Rocky Hill successful. Well as you know, the county board struggled for years with the size and scope of healthcare centers that we had and from a standpoint of the property tax levy continuing to go up to subsidize, owning and operating at 1.3 facilities and then two. And you came right on the heels of privatizing Sunny Ridge. And Dale Paul, your predecessor, he did a nice job with that transition. He was a good person, employees were comfortable going to him, but when he retired and we had the opportunity to hire a new individual, of course we were looking for someone who could take on the incredible challenge that you took on and with your background and ability we certainly were blessed with the right person. What have you done in the last year to help reduce the pressure on the property taxes associated with subsidizing Rocky Hill? Well as I started to look at the operation, it became clear to me very early on that this county owned facility suffered from a lot of the same concerns or problems that most county homes that I've dealt with over the years was facing. And that is while they were good at trying to control their cost and rein it in, their cost base started out much higher than the normal privately owned and operated facility from the private sector because of the benefits that county employment offers. And with that, even controlling costs, you're never gonna be able to compete face to face with the private sector. So what we needed to do was look at the revenue side. And as was my experience in the past, while we had a decent size population in the facility, the facility was doing very little to optimize its revenue streams and that became my main focus. I knew again early on that by cutting costs I was not gonna be able to achieve the goals that the county has set out for me which was to maintain that facility in county ownership and keep it a viable entity without continuing to drain the resources of the county to try to do that. And so we had to focus on building revenue and that has been our primary focus going forward. The next question we have is how would you rate your success the past year and let me quickly answer that for you. Okay. Outstanding. Oh, well thank you. Please tell our viewers why. Well, I'm hoping that it's because of some of the achievements that our staff and management team have made out there. So far this year we are running $1.2 million ahead of the revenue streams generated the same time last year. We've converted that into bottom line dollars or in this case savings to the county just over $300,000 so far this year. As compared to last year, we're operating almost three quarters of the million dollars ahead of last year. So we're doing pretty good in moving forward and my only warning is we're just starting. We're just getting going. Kind of warning we like to hear. Our last question before I turn it over to Mike Banderstein. As you think about or reflect down what you've been able to accomplish in the last year which we all know how quickly a year goes by, what are you envisioning or what do you anticipate doing in the year ahead? Continuing a lot of the same successes we've already started hopefully. The management team continues to gel and get better and better at what they've done and what they're doing. I've introduced some financial management type programs to help them understand the cash flow, the way the money moves throughout the organization and give them a real time ability to manage and steer those funds the appropriate way. We're continuing to educate the staff to make them more involved in this entire process. I've been teaching reimbursement to nurse aides since the mid 80s and I don't wanna change that trend. I wanna continue to go that way because I fully believe that the more my staff understands how this business works and moves forward, the better job they will do to help us get there because they're interested not only in providing quality care but interested in sustaining the facility. Very good, thanks Mike. Mike, in the state of Wisconsin about half of the counties don't operate nursing homes. What are some of the advantages and disadvantages you see for Sheboygan County because we do have a nursing home? The advantages or disadvantages sometimes become much more evident than the advantages but the advantages quite honestly are much more profound. The disadvantages are you have a large workforce and with the county's costs and benefits and programs, it's a costly operation to keep going if it's not aggressively run like a business. The advantages though clearly outweigh the disadvantages. The advantages, it gives the county internal resources to deal with the public health issues and county resident health issues that it in a lot of cases is mandated by law or regulation to deal with provides a resource to the county to utilize at a much lower cost than paying outside private resources to provide or other counties to provide. Behavioral health is an easy one that comes to mind that is beginning to be more and more a topic of discussion as the needs become more evident to the county and to the community. There's got to be a place that you can work with these individuals and help them and give them the proper care and that is just one of the voids that we can help fill. Okay, coming from the private sectors you have, why are your early impressions of working for county government comparison? It was an interesting transition and my initial impressions, I'm not sure what my initial impressions were gonna be. I envisioned myself raising a question and a year later still working to try to achieve an answer and quite honestly I have to say that I've been very pleasantly surprised. We've kind of mapped out a strategy with our liaison committee and I've had the pleasure of strong support from both Adam, Bill Gehring before you and now yourself in the chairman's position helping and recognizing what we need to do to make Rocky Noel successful. So I've been very pleased, our liaison committees, both the current one and the previous session committees have just been extremely supportive. We're focusing on the big picture and what we need to do to be successful as a group and they've been extremely supportive and from what I understand from feedback from Adam and some of the other department heads, very liberal in allowing me to move things forward at the rate that we need to move them to be successful and not time things up over long debates. That's great to hear. After being here for a year, do you think that Rocky Noel's getting the support that it needs to be successful? I don't like we change the advertising budget to give you more money to promote the facility and things in that area. Absolutely, I've again been extremely pleased. Any thing that I've been able to present not only to Adam, yourself, our liaison committee or the county board, I've been, as long as I'm able to explain why we need it and make it make common sense to these individuals, they've supported the process. So I have to say, yeah, we really are getting that support. And I know even some of the county board supervisors who've might have been more critical in the past have recognized the improvements that we're making and have extended their hand in offering support and help. So no, I really believe we're getting what we need. Great, I know you touched on this before, but to what extent do you believe the county can really be effective in competing with the private sector in the nursing home area? I think the biggest hurdle the county had to make as an entity was to understand that they were operating a business, a true all no holds barred business. It wasn't just a service that was being provided to the taxpayers, it was a business that they were operating. And while they had structured it appropriately, setting it up in what they refer to in government circles as an enterprise account, it had not necessarily been looked at as a business and a lot of times looked at just a service. So in going forward and realizing that it was a business, we do need to compete. We do need the advertising dollars. We do need to go out and market. We do need to go compete with the private sector. Once that realization was made, the support then was there and I think that's the biggest hurdle that needed to be made was just changing that mindset. Now it's a question of us going out and doing our jobs and being successful. And I'm judging from some of the feedback that I'm getting from individuals attending association meetings and that were being successful because they're wondering how we're able to do what we're doing when some of our counterparts in the private sector or in the non-for-private sector are struggling. What do you see as some of our advantages or disadvantages in competing with the private sector? The advantages are clear on the onset, which I had nothing to do with and it's all back to you guys, is the reputation. The facility has us had a good strong reputation while mostly unknown out there. It was a well-known facility but the people that did know it had positive experiences with it. So that was a definite advantage to start out with. Going forward, the resource, the support of the county is certainly an advantage to us moving forward and it allows us to take some of the more riskier steps in building a business or strengthening our business because we have that foundation that's very strong and not the whole county is funded by this one-payer source or two-payer sources like the private sector is. Change in Medicare quickly cripples the private sector where in our case doesn't necessarily cripple us while it impacts us. We still have the wherewithal to continue to compete. Move forward, so. Excellent. Mike, you made a number of changes already. We know that you're looking to make others to make us successful for the future. How has your experience been with the labor unions who represent the majority of the employees at Rocking All? Remarkably good overall. We're representing, our staff out there is represented by two different locals. One for the professionals, the RNs and the other for what in the industry is referred to as service employees which would cover our LPNs, nurse aides, dietary housekeeping, laundry maintenance staffs. The service industry staff and the union that represents them, AFSCME, 24, 27 has been extremely supportive while leery as any management relationship is typically with labor started out very leery. We have developed a rapport and we're communicating well, I believe, and they understand the need that we have to make some changes if we're gonna keep Rocking All a viable entity and make it successful going forward and that we have to work together to be that way and to be successful and they've embraced it and I want to very much compliment them on that. Our professional group, which is a much smaller unit, is having more of a struggle in making that transition and going forward. They understand that they need to but it's tough. It's a smaller group, less diverse, more focused on certain issues but I too believe there we can and continue to develop a decent line of communication and be successful with them because ultimately the goal is the same. We both, all three of us want to deliver quality care to the people that are in our charge and we also want to maintain and keep the entity known as Rocking All around and successful. Well, thank you for all your efforts in doing that, Mike. Sure. Turn it over to back to Adam. You know, it's probably one of the more pleasurable interviews that we've had regarding our healthcare centers. When I look back 10 years, our 100th program, during the last 10 years, you know, we looked at downsizing from three to two facilities and close comprehensive healthcare center and that was difficult. That had an emotional strain in the community and though it was badly needed because the building was so old and outdated, it was still difficult. Then we looked at privatizing Sunny Ridge and even more of emotional charge throughout the community. People concerned about the residents and what will that mean for the area. And a little over a year and a half ago, the county board made that decision, was perhaps one of the most significant decisions the board's made for our overall financial health as a county. There are 10 nursing homes throughout Sheboygan County so counties certainly don't have to be in the business but we got through that and now we have a level of service that I think we can support. And Mike, as you know, as you both know, you often say in management, you're only as good as the people around you. But you clearly have brought a level of expertise and leadership and energy and can do attitude that we badly, badly needed in this organization. And I'm just so proud of the work that you're doing at Rocky Knoll. One of the things of late that is resonating a little bit in the community, I think from a journal sentinel article about two months ago was some focus on Sunny Ridge and nursing homes throughout the state that have had some incidents. Whenever you have nursing homes and elderly people to care for, accidents happen as they happen as home. And you and I talked about that a little bit and you gave me a perspective that, this can happen at any nursing home. I think our viewers, perhaps by the time they see this program are gonna see an article or focus on this further coming from our own Sheboygan Press. And my understanding is they're gonna take a good look at the nursing homes just in Sheboygan County and touch on what's happening there. Please offer our viewers some perspective, Mike, as to what types of incidents can occur or why does it occur, give them a sense of that. It isn't, frankly, it's not unusual to have from time to time an accident that happens. And then when that does happen, what the response is from the state? Who's keeping an eye on things? Sure, after 35 years in this industry and working with it, obviously, I've seen a lot of change. But to operate a healthcare center like we're operating, probably the best analogy to give the public would be, you're running an ice skating rink but the expectation is nobody ever falls down. Whether they get hurt on the ice or just fall on their butt. It's clearly unrealistic to assume that you can care for so many people that the only reason they're there is because they require a high level of care and intervention that something may not happen. Accidents will happen. The mistake or the problem comes in is when the facility doesn't respond correctly to that accident. While you can't anticipate anything, when a problem does occur, you need to investigate it, look at it, and then take the necessary precautions that are reasonable to try to prevent that type of thing from happening again. And it is in that circumstance where I would have a problem with a healthcare facility if they've experienced problems and they have the same problems over and over again. That's clearly a lapse in management. The dynamics that you have going on is obviously it makes for headlines and headlines then generate pressure on politicians. Politicians generate the pressure on the regulatory agencies. And the agencies quite honestly look at, the feds will look at a state like Wisconsin and go. We're not seeing the degree of deficiencies or citations that we are seeing in certain other areas. We don't think you're looking hard enough. Step it up and the pressure comes on. And sometimes things will start to be cited that weren't cited in the past. Clearly when an injury or an incident happens concerning a resident, steps need to be taken to safeguard not only that resident from it happening again, but other residents from experiencing that same type of problem. And the difference between a good facility and maybe a not so good facility is the fact that a good facility will respond, will take steps, will move forward. But again, that never gives you a guarantee that it cannot or will not happen. All you can do is take reasonable and prudent approaches to preventing and safeguarding these issues. You're dealing with a lot of people. And as you know, no two people are alike. And my interpretation of what's acceptable versus somebody else is different. Personally, I think it's good when the press raises some attention to this because it hopefully makes all nursing homes perhaps even be a little, even more guarded to the important role they play. And when people weigh in and raise a concern about one facility or another, again, if that raises awareness and leads to better care, that's a good thing. But as you said, these can happen at any time, at any nursing home. And frankly, I'm real proud of the quality of care that I think our nursing homes throughout Sheboygan County provide. We have some good nursing homes. I certainly want Rocky Knoll to be number one and our reputation has been strong. But when we went through that privatization of Sunny Ridge, we had significant bumping and that changes staffing patterns and people are in new areas. And I know at Rocky Knoll we had to work through that. And frankly, I think at Sunny Ridge they still are working through that a little bit. They're relying on more pool help than I know they'd like to. But I just raised that because I know there's been a little bit of attention to it. It's very, very important. And I think we're fortunate that in Sheboygan County we have a lot of good people with wonderful hearts and intentions working in all 10 nursing homes throughout Sheboygan County. We only have a minute. I've got to wrap it up. Mike, I just want to say thank you for the leadership you've provided, the work you've done on the budget with your management team, your staff. It's been fantastic. It's so good to have you as part of our organization. So thanks for joining us today. Thanks. Pleasure to be here. On behalf of Chairman Mike Van der Steen and the County Board, my name's Adam Payne. Again, it was good to have you. And next month our guest will be Rebecca Persek, the Family Court Commissioner. So until then, be well.