 Welcome to Sheboygan County Government, working for you. My name is Adam Payne, County Administrator and co-host of this program with Chairman Mike Van der Steen. And as you know, every month we try to bring you a different department head, a different program to learn more about your county government. And this month we're very pleased to have our Rocky Noel Administrator with us, Mike Tobinheim. Welcome, Mike. Good afternoon. How are you guys? We're doing good and we're pleased to have you with us. Mike's been with Sheboygan County now for going on his third year. So three years as the administrator at Rocky Noel. And let me tell you, it has been a very successful track record. So we're pleased to have Mike here today to talk a little bit about Rocky Noel and what's changed over the last three years and the good things that have happened. Mike, please start by sharing a little bit about yourself, your background. Sure. I've been in healthcare about 33 years. I'm sure there's a point in time which you stop acknowledging it, but about 33 years. All of it in the long-term care industry. Most of it, though, in the private sector. So this is, while not my first experience working with a government-owned or operated center, it is the first as the administrator of such a center. And healthcare is kind of in your family genes, it seems like. It is. Yes, my wife is a nurse and a vice president for a competitor of ours. I can't give them credit. And then my daughter is a licensed nurse as well, an RN. And my son is a paramedic, although he's not currently practicing in the field. And when you say 33 years, public sector, private sector, where have you gained most of your experience? Most of it was in the private sector. I worked for, back in the 80s, what would have been the 800-pound gorilla in the industry, Beverly Enterprises, back then when we owned and operated over 1,100 centers. So I was a corporate director for them. And again, three years ago, started at Rocky Knoll. Yeah, three years ago, August in 2007. And what's been your greatest challenges since you became the administrator? Probably working with the staff to get them to understand that we could be successful, that the center could reduce the tax levy, that we could be owned and operated successfully as a county entity, and that we could compete in the private sector. And I think as a number of our viewers know, particularly if you've lived in Sheboygan, Sheboygan County for the last decade or longer, that at one point Sheboygan County had three facilities, Rocky Knoll, Comprehensive Health Care Center in Sunny Ridge. The Sheboygan County Board closed Comprehensive Health Care Center. That was actually around 2001, 2002. We put on a $9, $10 million addition at Rocky Knoll to consolidate, as well as tremendously improve the conditions, the environment that our residents lived in. And then in 2007, May of 2007, the county board privatized Sunny Ridge. So Mike came in on the heels of all that, going from three facilities to one, and staff transition, and some working with the private sector, some staying with Rocky Knoll, bumping other, less senior employees out. So it was a very trying time, I think, in the history of Sheboygan County, difficult decisions by the county board. But again, Mike comes in with a very strong background, a business sense, and as you said, have forward some good working relationships with your management team and staff. What were some of the key enhancements or changes you made right away when you became administrator? Well, I think probably the biggest single change was to get everybody to understand that it wasn't a mentality about cutting and just reducing and eliminating. It was about going out and generating revenue. We're one of the few county departments that has that capability to actually generate its own revenue streams. And one of the biggest challenges was teaching them how to do that and how we could compete and be successful, generate the revenues that we needed to enhance our overall operations and keep things going. And then secondly, was to convince everybody that Rocky Knoll wasn't next. I mean, we weren't just going to close it or sell it or, you know, abandon it or that. And then to get everybody to function together as one team. As you mentioned, you took three separate buildings and while they're in the same industry, they each have a life of their own and they each have different ways of doing things and all of a sudden you had to combine three workforces and teach them how to work as one. And how do you think you've succeeded thus far? How's your management team been reacting to this new approach? I think the management team has done very well. They were skeptical, of course. Most of them had 20 plus years of seniority in the county system. So a lot of what I brought to them was a different way of looking at things. And once they started to see some success, I knew they would begin to embrace it and they did. And they have now become accustomed to being successful. So it's not hard to motivate them to continue to be successful. You've got a great team there. And as you said, we really needed to operate more like a business, generate revenue. And as you know, and certainly Mike knows, that was one of the key challenges the county board had. We had three facilities, more beds than we needed, more beds than demand. And at one point, our tax levy was about 6.1 million to support these facilities. That was reduced significantly when we consolidated comprehensive with Rocky Knoe and we privatized Sunny Ridge. But when you started May, I think the tax levy was still about 3.5 million or so. It was. What's happened since? Well, since that time, I'm very pleased to report that we've been able to cut our tax levy with the adoption of the 2011 budget if it is adopted by 62%. So we will have a tax levy of less than 1.4 million going forward with very distinct possibilities of continuing to reduce that over the next two years. Which should be a close up shot of Chairman Bannerstein and I just smiling really large. Because it's just a tremendous success story. It's a tremendous success story. One that we certainly had some trials and tribulations along the way. But your leadership, your management team, all of your employees there, it's just been wonderful. And I know the quality of service is outstanding as well. Yes. We have over 260 employees actually. I think it fluctuates between about 265 to 270. And a lot of them with a high degree of seniority. I think our average seniority there is about 19 plus years. So they take a great pride in doing the work that they're doing. Number one, they're dedicated caregivers. And number two, I believe they're beginning to believe that Rocky Knoll can be successful, will be successful and can continue to be part of the county's overall delivery system for health care in the years to come. So I've got a great staff. Last question before I turn it over to Mike. So 33 years of experience in this industry, most of it in the private sector, what do you see as the key differences or what was your perception then entering a county owned and operated facility? Obviously, I think for me as a manager looking at it that way, the first thing would be the decision making and the timetable involved in the private sector. It's not unusual to have a meeting about an issue on Monday and a decision, you know, Tuesday afternoon or Wednesday, a strategy mapped out and implementation starting yet that week. As you know, in government, things don't move that quickly. So as somebody who likes to identify a problem, identify a possible solution and then go to implement, that took a little getting used to. But I have to compliment you and Chairman Van der Steen and the county board supervisors who have been extremely supportive of me and our team out there and have allowed us to be more flexible in making decisions and moving forward when things are on a time sensitive nature. And I think it's become a good blend. That was probably the biggest thing, just the hurdles of the process. And I just a follow up question on that. What about the facility itself? I know you've made a number of improvements or the county board through your leadership has made a number of improvements, but what was your impression of rocking all as a facility compared to some of the private sector facilities you worked in? As a facility, it was very well equipped. It's a big campus. In the private sector, typically you wouldn't have campuses that big or sprawling, but taking into consideration the age and the design. I think the county did a great job in it. When I saw it, I saw nothing but potential. And I still do. Very good. Thank you. I guess, you know, fewer and fewer counties are operating nursing homes. A lot of them are selling them or privatizing them. What's the advantage for Sheboygan County to own and operate a nursing homeless such as we do at Rocking All? I think given County, Sheboygan County's long tradition of really caring for its residents and looking out for the well-being of everybody that lives in the county. There's always going to be a need for this level of care to be provided by the county in one way, shape, form or another, whether it's outright pain for a resident that is indigent and has no means of covering themselves but requires the care. Or as a supplement to other agencies such as the Department of Health and Human Services, and the vast clientele that they serve, we support that department on a routine basis. In fact, there's typically about 36, 38 of our residents that are, for lack of better term customers of health and human services. Whereas if Sheboygan County had to pay for that, an out placement would be substantially more expensive in the long run. So given the trends and the aging, the aging population is going to crest about 2030, 2035, where roughly 60% of the residents in the state of Wisconsin are going to be 55 years old or older, there's going to be continued demand. Those counties that have lost the capability of providing that level of care are going to end up having to outsource that. And I think in the long run it is substantially more costly premise than what Sheboygan County will be since we can operate Rocky Knoll and generate independent revenue to help offset the outright costs. That's great. Now as we look at Rocky Knoll, how many licensed beds do we have there? And what's our current census with relationship to the total number of people we could handle? Sure. Our current census is about 165, 167. Our licensed capacity is 195 beds, but you have to keep in mind that a large number of those are in semi-private rooms, which in today's world is almost a no-no. The consumers today are really looking for private accommodations and given changes in medical conditions or that some of our rooms were not able to put another resident in. So our realistic capacity is probably about 175, 180, and we're running about 165, 168, which is fairly good given the current economic conditions because the healthcare industry, like all industries, has been hit as well. I know our hospitals or both of our local hospitals have had layoffs, staff reductions, closed units, even closed them on a temporary basis because even they can't maintain a census level. Mike, what kind of services do we offer at Rocky Knoll and especially the services that maybe set us apart from some of the other facilities in Sheboygan County? Sure. Good question. We offer a vast majority, a wide majority of programs and services. Short-term rehab for both inpatient and outpatient, which isn't all that unusual in the industry. That's where the industry has gone. But we also provide extensive room care programming. We have an all-heimer dementia program, which we're in the process of finalizing and formalizing. We have an acute behavioral health or life skills unit, which is unique to Sheboygan County. There's nothing else like it in Sheboygan County, and that allows us to deal with some of the more challenging clients that are out there that need our services, but there are no other alternatives for them. I know you mentioned it before, but to what extent can we really compete with the other facilities in the county? Well, the fact that I haven't received a single Christmas card from any of my competitors in the three years that I've been here, I think speaks well for our ability to compete with them. They would just as soon like Rocky Knoll to be a place of last resort rather than a premier health care center like we are. We are aggressive in the way we market our center. We're aggressive in the way that we work with our physicians, build relationships, and are currently in discussions with one of our local hospitals in looking at other areas that we can create some synergies and partnerships. What are the disadvantages and advantages that you see and how we compare with those other facilities? From an advantage standpoint, I think our campus, our location is very much a plus for us. Our stability of our workforce and the skill level of our workforce is very much a plus. I think probably the average length of seniority in most of the centers around is probably less than five years. And as I mentioned earlier, we're 19 and a half years and that makes it that our staff can perform their jobs without question. They know what's expected. They know how to do it and they've done it successfully for years. The drawbacks to us being a county owned center, we have our labor contracts over the past. We have a high benefit cost, high cost to our staff that we're constantly working with the two collective bargaining agreements to bring that more in line. But I would say that that would probably be the single biggest disadvantage for us is that our workforce is more expensive. But as I said, it's much more experienced and seasoned as well. So there are tradeoffs. Okay. And as you brought changes to rocking all, what's been your experience with those labor unions that represent the majority of the staff that you have out at Rocking All? We spent the first year, I spent the first year kind of being grilled as to whether or not I was there to sell it or buy it or close it. And once we got past that, I think we've been able to establish a relatively good working relationship. I'm working very aggressively with our largest union AFSCME and their local leadership to create a real partnership, a real synergy, a joint effort to allow us to continue to make Rocking All successful. They've seen the success. They like it. They're looking for job security and continued employment like anybody in today's world. And in contrast to that, I'm looking for being able to the ability to compete successfully, which is to control our costs, one of which is labor. Labor represents roughly 59% of the total cost. So that's obviously a component we have to see about trying to manage as well as we can. So we've been able to develop some joint agreements outside of the annual or semi-annual contract negotiations that have led to some significant cost savings without forcing any layoffs, adjustments, or for the most part. Any significant reduction in the wages or benefits that our existing staff receive? That's great. I know you've really worked hard to make them a partner with you and many of the decisions that have to be made out there, and that's to be commended. And you can see some real great results from that. Thanks. We've all had a lot of fun watching those billboards go up, something about getting your umphaback and then the men of Rocking All standing on the beach. Tell us a little bit about your marketing campaign and how you've come up with some of those ideas. Sure. Thanks. That's one of those fun questions to ask. That's one of the more enjoyable parts of my job is to sit down and get to be creative with my staff. All of the ads have been created by the staff ourselves, and then we take those concepts and ideas to our advertisers who then bring them to life. But one of the things, I really had two messages I wanted to get across. First of all, that Rocking All is a first class top rate healthcare center, and that we deliver quality service day in, day out. The second is that I wanted people to understand that you don't come to a center like ours just to sit in the chair and gradually fade away and pass. When you come to continue your life, you just need some additional support in doing it. So that's where the Keep Living campaign came from as you alluded to. The men of Rocking All has probably been the most successful billboard ad that we've had soliciting calls from passerbys that called the center to say they had nothing to do with the center. But they saw the billboard and just had to call to compliment us on it, and it brings about name recognition. And that's really what I'm looking for. I think everybody understands for the most part what we do. I just want them to remember that we're out there doing it. Well, you're doing a great job, Mike. Keep it up. Thanks. I'll turn it back to Adam. Thank you, Mike. The industry keeps changing. I don't know if it's you or a former administrator who said it's more complex than nuclear energy or rules or regulations. It just continues to change, and every year you establish a budget, and then the state or federal level of government changes the rules of the game. And it's a difficult environment to work within. As you look ahead, as we not only prepare for 2011 but the next five years, how do you envision us responding to those state and federal changes? And in most cases, as you know, reducing the revenue that we have to work with in order to keep afloat. Great question. Who knows exactly what's going to end up shaking out of everything? But the direction that everything is moving, if you look at the aging population, as I mentioned by 2030, the numbers are just astronomical. The healthcare system and the sources that pay for it, Medicare and Medicaid are no way going to be able to keep up with it under its current form. So we need to keep looking for other ways. You're going to hear new terminologies such as bundling and capitated payments and things of that nature as we start to roll forward. Hence my discussions with the area hospital administrators, because these changes are affecting them as well, forcing us to work closer and closer together. Rehospitalization is going to be a big no-no going forward. There will be penalties not only for the hospitals initially but shortly thereafter to the skilled care centers like us. So we need to be more effective, more cost effective and more efficient in our delivery of care and work together more seamlessly. So that's probably going to be the biggest change. You're going to see more partnerships for a lack of better term. And last night, and if you follow both this program and our county board meetings, that the good person behind the camera here also films for us. Mike Taubenheim was one of the key speakers last night and gave a nice overview of what's happened with Rocky and all the last three years. And I encourage you to look for that program if you get an opportunity. And during that meeting last night, Mike, you mentioned that we've had a great track record with reducing the pressure on the property tax levy. But it's your goal to continue reducing our reliance on the property tax levy in order to be successful. What do you envision in the next year or two ahead? Well, I have two targets that I'm aiming for 2012. As I said, 2013, excuse me, 11 is already set at 1.3. I'm looking to be under a million dollars next year in 2012's budget and at one half million or less for 2013. Ambitious goals, but I think doable. And of course, the reason I ask you again is because you are on camera and of course we will have now two forms that we've heard you say this publicly. No turning back now. Well, we look forward to working with you to see that happen because again, it's just been a tremendous run. And it's so helpful to all the other departments that need that tax levy and can't generate any other revenue, whether it's the sheriff's department or health and human services or planning or you name it. So it's just been a remarkable and tremendous leadership on your part. Final question before we wrap up here. Looking five years down the road, where do you see, how do you see Rocky Null? I think the key ingredient there is going to be our continued working relationship with both of our bargaining units. I think there's no doubt that we will consider you to pursue revenue sources and look for ways to generate revenue. But controlling our costs going forward is going to be a key. And they're going to play an instrumental role in that process. As I said, the whole industry, as you mentioned as well, the whole industry is changing, the way we have to do business is changing. And I think the way we conduct our labor negotiations and our working relationship with our labor organizations, it's going to have to be that same partnership and synergy if Rocky Null is going to continue to be successful for the county. I believe that with the steps that have been taken so far that the future really looks bright for Rocky Null. And that continued reduction of the tax levy will just be another one of the added value services that Rocky Null can add to its resume. Well, very good. Very nice overview. A lot of information. If you have questions or suggestions, please don't hesitate to contact Mike Tobinheim or a member of his staff. Please, if you haven't gotten out to Rocky Null, whether you're looking for that type of service at this point in your life or not, swing on in and take a look at that facility. A lot of improvements have been made. Beautiful facility. And it's your facility, so I encourage you to take a look at it. And it's not just Rocky Null that's doing well. I think the future looks bright for Sheboygan County government as a whole. And that's a real tribute to Mike and Chairman Van Der Stien and everyone who's been involved. We're just about wrapping up our 2011 budget. It wasn't easy, but an effective process. And of course, we continue to have to work as a team, whether it's labor, reducing expenditures, or looking at alternative revenue streams. It's all of the above. There isn't just one answer. So Mike, thank you for being here today and talking about Rocky Null and the good things happening there. It was my pleasure. Thank you both. And again, would like to echo Adam's invitation. Wednesday is the best day in the afternoon. We have on the rocks the bar that is open for our family, guests, and residents. It's a fun time. Mike, what's the website for Rocky Null? Rocky Null's website is MyRockyNull.com. Thanks. All right. MyRockyNull.com. Until next month, when we'll have another department head joining us from the Health and Human Services Department, an important partner to Rocky Null, Tom Eggebrecht will be here to talk about Health and Human Services, their programs, and some of the special things that happen over the holidays. And they're going to shortly be upon us. So until then, on behalf of the County Board, Chairman Mike Van Der Stien, thanks for joining us.