 Welcome to Sheboygan County Government, working for you. My name's Adam Payne, Sheboygan County Administrative Coordinator and co-host of this program with Chairman Bill Gehring. And today our guest is Health Care Center's Director Dale Pauls. Dale's going to talk a little bit about the Health Care Center's Citizens Task Force that was appointed by the County Board in November of last year, the work that they did, their charge, timetable, and then focus on what's happened to date, what kind of progress has the County made in dealing with those recommendations and where are we headed. So Dale, thanks for joining us today. Thank you. Why don't you start by giving our viewers a little bit of background as to, again, when the Health Care Center's Citizens Task Force was appointed, their charge, timetable, and then I know we're going to get into a little bit some of their findings and recommendations. Okay. They were appointed early November and were charged with looking at and evaluating the future of the Health Care Center's. They were to complete their work plan by May of 2004. During that time, they had approximately 12, they had 12 meetings and the first six were basically educational. They spent time familiarizing them with our operations as well as county government, the history of the Health Care Center's. We went into the finance and the accounting, our finance director, Tim Finch, explained that operation. And then Health and Human Services, we had a couple meetings and a complete overview of their operation and how it interrelates with the Health Care Center's. A gentleman, the executive director from the Wisconsin Association of Homes and Services, the agent talked about the state and what was happening on that level in regards to nursing homes and benefits, staffing ratios of other nursing homes. As well as touring both of the facilities, and I should have said that earlier, that was the first thing that they did as tour of the buildings. So the first six meetings were background, following that then we had two panel discussions, one with local and area nursing homes that were basically indicating the services they provide, some of their challenges, and what they were going to be doing in the future. The second panel was of three county facilities, each of them having some of the same types of struggles and challenges that we face, and they talked about how they worked through those. For example, one was downsizing and building new, another one decided that the county decided that they would sell their facility. The final four meetings were including a public hearing in which the task force listened to citizens and staff, etc., and their concerns and questions that they had, and the other meetings were to look at what they were going to recommend for the future of the health care centers. So this task force, just to touch on that a little bit more, I mean it was a citizens task force, the county board obviously could have appointed staff internally, the health care centers committee, the county board supervisors, that committee could have run with this themselves, but instead the full county board appointed citizens from this community to look at the problems and challenges that we face and develop these recommendations. How did one become a member of the citizens task force, how are they selected? They, first of all, were allowed the opportunity to submit their own resume and express an interest in becoming a member. And then once the deadline for all the applications were in, the health care centers committee met with the executive committee, that's right, yes, and narrowed it down to who they felt the best choices were for it, and went to Chairman Gehring, who made the final decision on the compliment, and from there it went to the county board for their final authorization. And if I recall correctly, Chairman Gehring took the individual selected by both the health care centers committee and the executive committee and forwarded that onto the full county board for support. Yes, yes. So these citizens, as you said, met for over a seven month period and they looked at a tremendous amount of information. We had other, we had representatives from other counties come in, both the public and private sector, and as you said, we're not alone with this challenge, although we certainly have more beds and provide a higher level of service than many other communities. What in short were the task force key findings as they proceeded? Local areas, census and market trends, they looked at, if you look at Chabuagan County health care centers, at one time they had over 900 beds, decreased now to above, to 460. That's occurring because of what's happening out there in the industry. Much more emphasis on community-based services, people are living healthier lives, they're living longer lives so that they don't not need our services as much as they did in the past or at least for the purposes. It's more and more for sub-acute kinds of services or maybe dementia related. So they saw those trends. And when you say sub-acute, Dale, not everyone may understand what you mean by sub-acute. Well, they would be illnesses or injuries, broken hips, arms, the type of things that require therapies. And high levels of skilled care. Yes, yes. And as a result of looking at this, they found that they weren't the only facilities that, or we weren't the only facilities that were seeing this. Most places were downsizing, either remodeling or possibly building new facilities. When they looked at the other 11 facilities that were in the county, they discovered that they pretty much were operating at full capacity. So if we're going to make major changes, either privatizing, downsizing, or possibly closing, it wasn't going to happen overnight. And I think we've tried to stress that because as the public listened, they began concerned about that people were not going to have a home. And so the task force became very aware that it would be a long-term process. State and federal funding became very evident that that's continued to decrease the intergovernmental transfer monies that we were used to in the past. Over 100% less from one year to the next from 2003 to 2004. Also state and policy changes were occurring. The, there was a Wisconsin Board on Aging 2003 report that places emphasis more and more on community-based services and less and less traditional long-term care. So they can see that the trends are changing. The state is providing incentives to nursing homes to downsize. On the county level, benefits that are provided for our employees, they found in comparison with other health care centers were two to three times higher than the private sector. Our tax levy in 2004 was $5.2 million, which was three times higher in just in the last three years. So we're faced with that. There's a county levy cap that stats totally have to stay within and so there's a number of concerns in regards to the financial part of the operation for the county. Private and non-profit sectors in those panel discussions, they learned that they do care for very similar type residents that we do at the health care centers. They have medical assistance patients just like we do, which, and I think was a misconception out there in the public that maybe those other private sector people did not care for them. But they certainly do, they have to abide by the same federal and state regulations that we do. And again, as I mentioned earlier, the benefits are two to three times less. The process then again was the citizen's task force looking at a number of alternatives, gathered a lot of information, made the findings that you just summarized. But the county board did further work than that. Not only did they have this process going on, but they also, the health care centers committee, the county board supervisors on that committee, hired an outside consultant to come in and also review the operations of our facility and provide some recommendations. What did they come up with and how was that incorporated with the citizen's task force work? Number of recommendations, they took a look at our staffing and as a result of that analysis, they felt that there were approximately 13 positions, both non-bargaining and bargaining unit positions that could be eliminated over time, which would generate $450,000, $460,000 savings. They noticed right away that our part-time full-time ratio of staff was like 60% part-time and 40% full-time, recommending that we basically reverse that and create a savings there. Look at outsourcing certain services that we provide, like laundry and housekeeping and dietary, should explore that. They also wanted us to review our pharmacy and rehabilitation contracts, increasing the number of days that we provide rehabilitation to our residents. In overall recommendations, they felt like we could possibly merge some of our management positions within smaller departments and relocate a manager at one of the buildings. Also identify positions that could be reduced as our census went down. There were a number of recommendations that the task force in their final recommendations brought forth as requesting that we pursue those. What's ironic here is, I know our viewers who are watching this are certainly who have followed this issue, a tremendous important issue for the community. Obviously there's high value for the services we provide at the healthcare centers, but because of some of the findings that you just went through, our bed census going from 900 to 450 and different market trends and financial assistance going down from the state, something had to change. And again, the county board, as an oversight political body, could have made some of these changes or done a number of things internally and quickly if they so choose. But instead, they said let's go out to the community, let's appoint some citizens in this community and see what they come up with. Let's bring an outside consultant with some fresh perspective and experience looking at other facilities and see what they come up with. So now we have a number of recommendations before us and you did a nice job giving a recap of where we've been, I'll turn it over to Bill and he'll talk a little bit and ask some questions about where we're headed. We certainly have a tremendous challenge here before us about what direction to go in. I think that we owe the task force a great debt of gratitude for all the hours and the time that they put in. They certainly brought up a lot of awareness in the community about the whole issue. But Dale, can you talk a little bit about what the actual recommendations of the task force were in regards to the tax levy, wages and benefits, the Gundersen and Graham study recommendations? Their final recommendations in regards to the tax levy was that they charged the health care center's committee to develop a package that would, in the aggregate, the results in the reduction of the tax levy would be 75 percent of the current, which was $5.2 million and that would equate to about $3.8 million savings that they would need to find. Another big piece here, as we mentioned earlier, has to do with wages and benefits. And they were recommending that they renegotiate wages and or benefits to achieve a reduction in wages or benefits closer to the highest labor costs per productive hour for private sector and long-term care employees in Sheboygan County with the highest such cost so that we would be comparable in that area. And then implement the Gundersen and Graham recommendations that I had mentioned previously. Another item was to take a look at the unused space at Sonny Ridge and see if, for example, they would utilize it maybe by another department in the county or an outside source where they could lease them. Now if they were unable to come up with a package that would closely equate to this recommendation, then they indicated that the recommendation would be to continue ownership of both Rocky Knoll and Sonny Ridge, continue county operation of Rocky Knoll, but lease Sonny Ridge to a private sector healthcare center with the priority going to a non-profit operator. That's not achievable, then it would be to again, to operate as a county Rocky Knoll, but sell Sonny Ridge to a private provider with priority to a non-profit. So those were the recommendations that went to the county board. What were the timeline recommendations from the task force? Did they talk about these general ideas should come into play by the end of the year? Yes. Yes, that's correct. By December 31st, the healthcare center's committee should come back with their recommendation based on the task force. Okay. Now when this recommendation came to the county board, what did the county board do? Did they just put it on the shelf or did they send it somewhere? They certainly didn't. When it came to them, I believe it was in June, it was immediately referred to the healthcare centers as well as the finance and health and human services board. But the healthcare center's committee definitely is the committee that is currently working on trying to meet those recommendations by the task force. Now it may take some time to achieve those recommendations. How will the county board and the citizens of the county be kept apprised of progress that's being made towards achieving those goals? They will be reporting back monthly to the county board and the chairperson, Mike Van Erstein, will be doing that to keep them, the board abreast and other avenues, I'm sure we will, as we have in the past, from the healthcare center, send out newsletters to citizens' radio and providers so that they are also in tune to how we're progressing with the recommendations. One of the issues that has come up throughout the whole process is that Sheboygan county provides quality care at their two healthcare facilities. I know these are kind of difficult times for the employees, but it's my understanding that there recently was a state survey at both of the facilities. Could you tell us a little bit about what the state surveyors found about what's happening at the facilities? It's my pleasure to talk about that, really, because as you said, it has been a difficult time for staff with the uncertainty, but I think the results of these surveys really indicate that they are dedicated to providing the services that we know they can to our residents. Sonny Ridge had their survey about a month and a half ago or two months ago, and then Rocky Knoll just completed their survey. State of Wisconsin comes in with probably four to five, at least, staff that are looking at many different aspects of the operation. There are approximately 1,500 different code requirements that at any one time they could find that we may not be operating like we should. For Sonny Ridge, they had an excellent survey. I believe there were only a couple issues, and they really weren't serious as far as quality of care. Rocky Knoll was very fortunate that we did not at Rocky Knoll have any deficiencies this time. And so I truly commend the staff for a job just very well done, particularly during these challenging times. Well, congratulations to you and your staff on succeeding those wonderful. Greatings. And I'll question a team effort. Your staff, as well as your management team and you, Dale, as you said, this hasn't been easy on anyone at any level, and to have those kind of survey results come from the state reflects well on all of you, so compliments. Speaking of change, and that's another thing that's nice to see a perfect survey at Rocky Knoll. It was just two years ago, a little better, that we had our consolidation from comprehensive health care center to Rocky Knoll, nearly a $10 million addition, beautiful facility. I know the residents in particular love it, and it was just what within the last month that you had a pretty important meeting at Rocky Knoll to share with many of the guardians and loved ones of some of the residents in Woodland Village. That change is coming, change being initiated by the state level. What's happening? Woodland Village is our intermediate care facility for the mentally retarded, and as you said, in July we'll, or yeah, actually, yeah, real soon it will be two years that they moved into a brand new 37 bed facility. It's how quickly things can change at the state level. We had that meeting to inform responsible parties and guardians and family members that effective January 1st, 2005, admissions to that facility are going to be very, very restricted. The whole thrust is, again, community placement. They term it placing someone in the most integrated setting, meaning that they have the most involvement with non, with, you know, public, the public as opposed to staff. So that will be impacting them immediately January 1st, and then after May, all the residents on a regular basis throughout the year are reviewed for their protective placement as for why they're there. Well, they'll apply those same guidelines to those individuals over time. So it is going to mean a change at Woodland Village. It may be, I would anticipate it's going to be gradual, but there will be some changes coming. So that was an awareness meeting for those people. So you said in January is when the more restricted criteria will go into place and then by May of 2005, that's when there's going to be what some further assessment done to see whether or not we are able to make some placement in a more integrated setting in the community? So for those residents in May, it would be those that are currently residing. And how many residents right now currently reside at Rocky Knoll? 37. 37. In that unit. So again, to our viewers, this hasn't necessarily been a pleasurable experience for any of us. Dale touched on the fact that IGT funding has gone down significantly and on the horizon it looks like it's going to go down more. If IGT funding, funding coming from the state and federal level, state at the same level it was a few years ago, we may not be talking about Rocky Knoll and Sunny Ridge and whether or not we have to downsize. That certainly has driven it, though the census and all the other things you raised as well. And here two years ago, the county board makes a $10 million investment, beautiful facility and as little as two years later, the state is changing their policies, which is certainly their prerogative in such a way that it could turn out to be a real blessing for those residents that we can place in a more integrated setting. It's not necessarily a bad thing, but it's an example of how things change and impact our facilities. And what will happen here? I know Dale, you've mentioned that if we do place more people in the facility, we may have more beds at Rocky Knoll for skilled care. Do you want to touch on that? That's very possible. What we've done working jointly with Ann Wandergem, the director of the Health and Human Services and her staff, our staff, we've formed a work group to analyze this, the whole process and how it will eventually impact us. With information that we currently have, it would seem that eventually we would definitely phase out the majority of that unit, probably. It is going to be a challenge and over time for the community to be able to capacity build and be able to provide those services, but the thing that has changed here is now whatever the cost is at Rocky Knoll, those dollars will follow the residents of the community because some people say, well, there's no way that you're going to be able to match services out there. They will have the same amount of money to provide those services. It's difficult. It was difficult at this meeting because many families and guardians struggle with that as a change and the unknown. We don't look forward to that, but on the other hand, yes, if we are able to successfully do that, it will provide an opportunity for us. That building was built to skilled nursing facility standards, so that's a positive side to it. So I take you'll continue open communications, reaching out to family members and others and keeping them informed of information as we receive it from the state and as you need to make changes. Yes. Can you continue with meetings and newsletter items to them? We only have a couple of minutes left, and as you said, it's been two years since folks moved from Comprehensive Health Care Center to Rocky Knoll, and in two years, you certainly have had sufficient time to get your own sense of how that's gone. I know that there's growing pains with that, and that was another change, but from your vantage point, how has it gone? Two years later, how are we doing? You mentioned the survey, so that certainly speaks volumes, but how are employees doing, how are residents doing? Right from the beginning with residents, it was a very positive thing for them. They were acclimated very quickly and enjoyed the new surroundings and of course the new building, but even the remodeling in the Southwest, those residents enjoy that setting. We continue to work with the change that occurred for staff that were working at Comprehensive, and I think it's natural. Some of those people will work 25, 30 years in that building, so it can't come easy to relocate and you do things differently with policy sometimes, so you have to work together as a team to eventually reach agreement, and I think each day, each month, it is improving in that respect, and staff are adjusting. Great. Well, thank you so much, Dale, for being our guest today and giving us a snapshot and overview of where we've been the last seven, eight months and where we're headed. For those of you who have never interacted with Dale, if you have questions or concerns or suggestions, I strongly encourage you to contact Dale or certainly County Board Chairman Bill Gehring or myself. We appreciate the input and Dale in particular has really shouldered, as you can anticipate or imagine, a difficult challenge here and has done a tremendous job. If you do have questions, don't hesitate to give him a call or a member of his management team. With that, thank you so much for joining us today at our next program. We're going to be focusing a little bit on something that I know you've heard about as well, and that's the PGA Championship. Dale just mentioned off the air that he's hoping to spend a little time there that week, and it certainly is an exciting time for the community. I know a lot of people are involved with the planning. There's been tremendous teamwork at Sheboygan County between the Sheriff's Department, Health and Human Services, our airport, our highway, and we're ready. We'll see how things go, but a lot of planning and preparation, and hopefully we're going to have beautiful weather and a great event. So next month, during our program, Mike Helmke, Sheriff Helmke's going to be here to talk a little bit about how it went, how did the traffic patterns go, how were we able to move people safely along and get him to and from the event, and what kind of challenges did he have, not only regarding the PGA, but other challenges the Sheriff's Department has to work with every day. So until then, on behalf of Coneyboard Chairman Bill Gearing and myself, Adam Payne, thank you for joining us. Protection, stop the spread of AIDS. The only difference between a grape and a raisin is time spent in the sun. Ever wonder what the sun is doing to you?