 Welcome to Sheboygan County government working for you. My name's Adam Payne, Sheboygan County Administrator and co-host of this program with Chairman Bill Gehring. And take a look at this set. You may think we've lost weight, but that's not the case. We're in chairs twice the size and far more comfortable than before. So we're considering extending this program another 30 minutes today. No, we won't do that, but it's good to be with you. Thanks for joining us and I'm pleased today to introduce a new face to county government. As you know, there's been a lot of discussion about our healthcare centers. Over the last six, seven years, we've transitioned from three facilities to one. And very recently, in fact, on August 29th, we hired a brand new administrator for Rocky Knoll and I am very pleased to introduce Michael Tobbenheim. Mike, thanks for joining us today. Sure, my pleasure. Mike's been with us now almost a full three weeks and certainly has jumped right in, hit the ground running. And Mike, please start by sharing a little bit about your background and letting our viewers know a little bit about yourself. Be delighted to. I've been in the healthcare industry for just shy of 30 years now. Worked my way up in the industry like most of the guys who I've started with. I started in the maintenance field years ago, then completed my coursework and tested and became an administrator over time. Then an area manager, regional manager all the way up into a corporate director position for a major healthcare company where I spent probably the bulk of my career, about 15 years. Now, one of the reasons we hired you was an outstanding track record of going into facilities and making improvements and really a real financial focus. But I also want our viewers to appreciate that you're no stranger to Sheboygan. Actually not. I was born and raised in Sheboygan. Actually by the old, for the older folks, the old licky store in Sheboygan. I was born and raised in that area around Main Street. And then my parents built a new home back in 1963 on what was the very edge of town back then, 26th Street which now seems to be the middle of town. So I spent my early years here, graduated from North Eye and then started my trek across the country. Well, good to have you come back home. Thanks, it's great to be back. So as I said, three weeks on the job, it's you're just getting a lay of the land. What are your initial impressions of Rocky Knoll and the people you're working with? Very pleased, not surprised, I guess because I remembered the way Sheboygan was in my mind. You had a mindset of the hardworking, dedicated, friendly folks that I had come to know as a young guy. And that's what I'm finding again here. The facility, the physical plant, the skill of our labor force at the center and just the attitude all says that there's no reason we can't be successful in going forward. Again, I know it's been a short tenure and certainly some of our viewers have heard us talk about this on this program before but please give just a little background as to what's transpired of late. Sunny Ridge has been sold to a private operator and there's been some transition period. Set the stage for us. Sure, most of that had all transpired just before I came on board but a fair amount of our workforce that is currently at Rocky Knoll has come from the other two centers that the county used to operate, both Comp and Sunny Ridge. We have melded that workforce together and they are beginning to form their own family now that is centered around Rocky Knoll. Obviously there is some trepidation on the amount of staff and residents alike as to what might happen in the long run and that but overall everybody's settling in and things are really beginning to move forward. Rocky Knoll has taken off on its operation as a privately held company now and I understand is doing fairly well. Sunny Ridge rather. Sunny Ridge, I'm sorry. That's a good segue into my next question because as you can appreciate after consolidating from three to two and we put nearly a $10 million addition on it, Rocky Knoll about five, six years ago and then the sale of Sunny Ridge to a private operator which as you said is really working well. It's really working well and we're collectively all pleased about that and there are our staff at Rocky Knoll for good reason, anxious, well what's gonna happen to Rocky Knoll and there's new administrators gonna be coming into place and certainly we've had discussions about this but for the benefit of for our viewers, what's your take? What's the message been? What have you been communicating to staff about the future of Rocky Knoll? Well, as you recall, part of our conversation in my decision making process to join your efforts here at Sheboygan County has been what was the county's bottom line? Where did they want to be and where did they want to go and you had both of you gentlemen have reinforced me on numerous occasions your dedication to trying to maintain a county operated center to service the residents of Sheboygan County and quite honestly it was that dedication to that cause which was one of the primary reasons I wanted to join and come on board because it was clear that you were dedicated to it and I did not want to be a part of a quick turnaround to sell or close or anything like that. I've had the opportunities to do that many times in my career in the private sector and I know how traumatic it is but that's not what I wanted to do with my career now and so I've been clearly communicating to the staff and the residents there that's basically been the number one question what's gonna happen to us? Are they planning to close us and after I've been able to convince them that no that is not the direction they wanna go then the next question is can we make it? Chairman Gehring and I both were involved at the interview process we had some very good candidates and you were the shining star and I appreciate how you summarize that because I don't want anyone watching this program or anyone in this community have any doubt that it's our we're doing everything we can to maintain Rockinol as an effective healthcare center facility and in my opinion it's the shining star in this community because we have it a very experienced workforce we have a beautiful facility and I think we have excellent staff in place to provide that quality care so I'm as optimistic as I've been in some time about the future and again so pleased to have you on board Mike with your background and experience and getting to that background and experience what are some of the steps you intend to take to help Rockinol be more competitive to essentially stop the pressure that's occurring on the property taxpayer to hold that line and in fact start to reduce the pressure on folks paying property taxes. Actually one of the first things that I'm doing is one of the things that I've outlined with you gentlemen when I was talking to you initially and that is to seize the opportunity to generate revenues that that center has. The revenue potential in that center has just not been realized and there's significant opportunities both in improving the census and the overall number of residents that we care for on a daily basis but also maximizing the reimbursement that is out there already on the residents that we currently have in place through educating and working with the staff that is there to help provide the necessary data and information so that we can bill appropriately and be reimbursed the way other centers in the private sector are. I enjoyed it as if you've heard me mention a couple of times to us our management team I enjoyed during our interview where you mentioned when you were working for the private sector you used to eat county or government run facilities for lunch and you were alluding to the marketing. What did you mean by that? Well basically the mindset of the county centers is typically one of maintenance and the mindset in the private sector is of growth. So you're always looking for new avenues you're always looking at new directions providing new services and creating new markets and not waiting for them to be created working with the acute healthcare delivery system your hospitals in developing either new transitional care and ancillary support mechanisms for that hospital or for the community as a whole. So it's more of mindset than anything else but then you act on it and create your market. So you anticipate being far more effective or proactive in marketing in those areas. Yeah there's a lot of our competition here in the city that I would like to be taken off of the Christmas card list as we're going forward. Final question before I turn it over to Bill. When do you anticipate people or the community as a whole starting to see some of these changes take effect? I think if you were to visit the center today already not that I've done anything dramatically other than working with the department heads and working with the staff that I've come into contact so far convincing them that there is opportunity there is the chance to be successful and we're gonna seize on it and move forward. I think you'll see a slight improvement in the morale and the focus but I think you're also going to see people looking at the operation of the center as a business as well and not just purely an organization that is just there and being supported. I think you're looking at them looking at it in ways to generate new opportunities for the center. Admissions have significantly picked up already. Very good, thank you. Mike, you know the county invested a significant amount of dollars in the last couple of years in Rocky Knoll and one of the things that we did was build Woodland Village which used to be the ICFMR. Yes. What is that beautiful facility being used for at this point in time? Well today that is going to be and in the future that is going to be the crown jewel of Rocky Knoll. That particular building while not intentionally designed originally for the purpose that we're going to be utilizing it for is actually perfectly designed for the purpose that we're going to be using it. And that is to build a strong rehabilitation and transitional care center with the private rooms, private baths, TV, telephone set up in a pod concept where the staffing is consolidated with smaller groups of room so you have more one-to-one service. That would allow us to take more acutely ill individuals, Medicare residents for shorter periods of time exposing them to an intensive rehab and rehabilitation program and getting them back into their homes or the community settings they came from. So the center is really the envy of even the private sector. That is what they would love to see their centers having and in a lot of cases don't have the money or the opportunity to expand and build it. So it fits perfectly into the plan moving forward. That kind of leads into my next question. How does Rocky Knoll in general compare to some of the facilities you work with across the nation? Across the nation, as an entity, as a facility, the physical plant, the people and that it's right near the top. I mean, it really is. It has the material resources over the years of it being utilized wisely and put together in a thoughtful plan where you have today just an outstanding physical plant and center. Anything dates a little bit as you move forward. So you kind of keep updating it but the basic is there. The staff with the tenure, I've never experienced it before. Maybe a small little 60 bed center in the South somewhere but short of that, you don't have that kind of tenure and experience in a workforce which means they know their job, they know what to do, they know how to do it and they're there for a reason and that's because they care. So sort of the business aspect, all the ingredients are there and it would rank right up to the top. Okay, my background is having been worked in government for 31 years before becoming the County Board Chair, not in the nursing home industry but do you think government can really compete in the nursing home business? I really believe they can if they understand it as a business. You're delivering a service but you're delivering it in the concept of a business and you have to think like the business, like the rest of the business world does, take advantage of the opportunities that are presented, look at progressive movements, taking the chance. There's a little bit of risk taking there that has to happen. But if you have a solid plan and you believe in it, there's absolutely no reason why Sheboygan County couldn't compete with anybody. I'm very pleased to hear that. Are there any areas that you can think of where Rocky Knoll compares favorably or unfavorably with our competition in the area? Well, the biggest thing in terms of favorably comparing, you're looking again at the physical plant setting, just the amenities that that complex has, offer us options and business opportunities that our competitors clearly don't have with the cookie cutter style centers that a lot of these are. The Woodlands Edition is clearly a step above, I believe most anything. Now I'm not familiar with every center yet in town but of the ones I've seen, clearly head and shoulders above there. The stability of the workforce is obviously clearly a plus. On the downside a little bit, costs have been a little high due to the nature of the organization and the way it was structured. But I think there are opportunities without doing anything drastic that bring them in line. Part of them is the economies of scale too. As you build the business, the costs that we currently have can be supported the way they normally would have been anyway. Marketing seems to be key as we've talked. What should the first steps be in marketing the facility that we have? The first steps I think we're already trying to take there, those are the quiet ones you don't hear much about and that is putting together the organization and the product you're gonna be marketing. So we are quietly working on the woodland area, making minor little modifications for ease of operation there. Also putting together the staff skill and expertise that we will need to deal with it. The admission process, which is more the paperwork end of the process, but it's also the part that will drive the reimbursement in the long run if it's done right. So we've been working with that for the last two weeks. I've put together a committee that has gone through the process. We're working with the IT department in automating that process to allow us to move the residents in and out as quickly as they possibly would like to come. So the next step is then to put together the collateral material, the advertising and that, the theme that we will be working off of and we've got a little contest going now at the center to develop a theme that would focus on Rocky Noel and try to take that 80 year history of quality and utilize that. How will all these changes benefit the community in general? I think two major ways it will do it, and possibly a third, depending on how you'd like to split it out. The two major ones, number one, it will give the community and the residents of Sheboygan County a high class quality healthcare facility to service the elderly population in the community and to be able to deal with all aspects of their care from all levels. Secondly, the tax burden that the county currently is experiencing. I hope to significantly reduce the current tax levy that is assigned to Rocky Noel over the next two years. So that that tax benefit would be a clear impact on the county taxpayers. Okay, thank you. I'm glad you're on board with us. Thanks. And that question is a good segue to what I anticipate some viewers might be thinking about. Well, why stay in the business at all? You know, we've made it clear where we want to, we're going to, we're going to do everything we can to be more effective and reduce the pressure on the property tax payer yet provide a good service. But we've gone from three facilities to two. Most our viewers, I think, may recall that when we sold comprehensive and put an addition on Rocky Noel, it was because we had a very old antiquated facility. The codes had changed, standards have changed. We needed to make those adjustments. Having two facilities such as Sunny Ridge and Rocky Noel, we couldn't afford it. Our scope and breadth of responsibility was too great and we just simply couldn't afford it. But now we're down to one. And what would you say to our viewers? Why is it important for Sheboyin County to maintain a nursing home? Well, I think that the county has an obligation to deliver care to all of its residents and to provide the type of resources to the community that the private sector isn't willing to get into valve in. And that would be your more acute individuals, your more chronic individuals. The private sector is really in it, strictly for the money. While they want to deliver a quality care, and I'm not trying to suggest to anybody they don't, it is a bottom line operation. It is a business for them and they'll run it that way. I think with what we can do at Rocky Noel with just the tremendous tools that we have available to us, if we can reduce or possibly even someday eliminate the tax levy by operating it the way it needs to be operated and competing the way we need to compete, it will also be able to continue to reduce or hold costs or check costs in line in these other areas in dealing with the chronic or severe mental disorder diagnoses that are currently having to be placed elsewhere at much greater cost to the county as a whole. So I'm looking at direct and indirect effects as we go forward and I see nothing but potential positives for the county. Let me ask you a loaded question, especially with my boss sitting next to me here. Okay. There has been just tremendous change in the healthcare industry and policy changes at the federal level, at the state level, movement for people to reside more at their homes or not in traditional nursing homes. So there's just been tremendous change in the last five years that not only Sheboygan County is experienced, but nationally. And as you mentioned earlier, the private sector needs to be able to respond quickly and adapt and be thinking to where the puck's gonna be, essentially. What is it that the county board can do, needs to do to help you and your team be successful? It's a great question because it's a really, it's a very important issue that plays into my thought process as I move forward. Again, coming from the private sector, you're used to being able to sit around a conference table, have a frank and open discussion, and then you walk out with a decision and you move forward. And it's a dynamic process. And I think going forward, what I hope to develop with the county board and the oversight committees is that type of dynamic management style where we're not so much just looking at single little line items, we're looking at big picture, looking at plans and investing our energies into where we want to go, not just where we've been in the past. And I'm very encouraged by working with the chairman and the chairman of our oversight committee, Mike Manderstein, and the rest of the committee members, I've just been very, very excited that I believe that opportunity is there. So the board, as they look at things, if they keep the big picture in mind and the direction that we're going, obviously have the right to demand some success and some movement. And I believe that if we can show them some of the movement, we can continue to develop that relationship and achieve the goals that we're after. It was nice when we first toured the facility together three weeks ago, your first day on the job. And Linda Berry, your director of nursing, took us around. And I was so pleased with how you interacted with staff and just went out of your way. If they didn't come to you to say hello, you went to them to say hello. And I know you're out there and getting to know your staff. And as you said earlier, it's only been a few weeks, but I sense as well that cloud of uncertainty and anxiety has began to move out and that there's more optimism. And I wanted to hear from you directly, what are you sensing? Is morale improving? Do you feel things are turning in the organization? I think it is. It's obviously very early, but I'm really not gonna let anything stand still. So I've still chased people down the hall to say hi to them and that. And I think I'm being successful because now I get phone calls and messages left on my phone saying, hi, my name is such and such. You've met all the other ones, but I haven't met you yet. And I get the message and I go up to the floor and hunt them down and go right back into the med room or wherever they may be and say hi. And sometimes I'll stand behind them for a minute as they're having a conversation. And the person who they're talking to is going, you know, one of those things. But I think that there is some optimism starting to show there. But the big question is, you know, we've kind of heard it before, maybe not your message, but it's just never materialized. Is it really gonna work? And so it's really a situation where I have to produce for them. Once I think that starts to happen, I don't think there'll be any stopping it. Well, we only have two minutes left. And again, as I mentioned earlier, I'm so optimistic about the future. I'm pleased with the job that Sunny Ridge has done with their operator. And I'm particularly pleased with how things have sorted out for staff. We had a number of staff who either transitioned to Rocky Knoll or had to take a different change and shift and that's hard on people. And a number of those folks I've since talked to and they're very happy at Rocky Knoll or they've made that adjustment at Sunny Ridge. And though I'm certain there are folks who still have concerns, but generally speaking, it's been a lot of positive feedback. How do you, and again, we only have a minute remaining, but how do you envision Rocky Knoll looking five years from now? I think it will be the centerpiece of a community-based healthcare organization where you're gonna see it playing a vital part in adult daycare programming, community support programming, working with health and human services. It will just be part of that overall delivery system that the county will have for its residents. Fantastic. Well, Mike, thank you so much for being our guest today. That 30 minutes flew by very quickly and these chairs are still very comfortable. I'm certain we could continue the discussion. And we'll certainly have Mr. Tobinheim back again in the future to give us a status report. Next month, our guest will be finance director Tim Finch. We're in the meat of the budget process right now. The county board will be adopting that budget first week in November. The state has yet to adopt their budget, so there are a lot of things in play, but a lot of good work being done by department heads and others to pull that together. So look forward to giving you a status report on that. And again, on behalf of Chairman Gehring, the full county board and thank you, Mike Tobinheim. Thank you for joining us. See you next month.