 Welcome to Sheboygan County government working for you. My name's Adam Payne. I'm the Sheboygan County Administrative Coordinator and co-host of this program with Chairman Bill Gehring. And today our guest is the Healthcare Center's Director, Dale Pauls. You've certainly heard that name before. Not only has he been on this program talking about the activities of the Healthcare Centers, but you've probably read reports in the paper about a number of initiatives going on with our Healthcare Centers. And that's what we'd like to talk about today. Dale, good to have you with us today. Thank you, Adam. Good to be here. Healthcare Centers, the industry itself, a lot of changes are going on. And, Dale, why don't you give our viewers a flavor of just what's all happening in regards to changes in your industry? It is changing. It's evolved over time, but probably in the most recent years rather rapidly. And I see one of the main things that have occurred to cause this change was when the hospital changed, changes changed to DRGs, diagnostic-related groups, which in other words meant that people were classified in specific areas and they had so much time provided as far as coverage in the hospitals. That was shortened up. Thus, more patients were being discharged quicker to the nursing homes. When this happened, it caused more admissions. It also increased the rehabilitation services that we were providing, Medicare eligible people took advantage of that. It also then increased the number of discharges we had. So the length of stay shortened considerably. So even though we were emitting more people, they were staying less time and that resulted in less beds being utilized. Another factor is as I think we all are learning more and more about is that there are more community-based services available today than ever before. So that it prolongs the admission to the nursing home. I just read a statistic recently that more than 50% of the residents in nursing homes today are over 95 years old. So we know that that definitely is happening. So as a result of that, those changes, we are seeing less utilization of beds in the nursing home. And let's talk about that for a minute. Many of our viewers are probably aware or may recall that the county board had a real difficult decision to make a number of years ago to consolidate from three facilities to two facilities. And in that process, we downsized. We have less beds today that we had two, three years ago. Meanwhile, as you mentioned, market trends continue to change. We're seeing less demand for beds at our nursing homes and the healthcare centers recently took action, I think, to downsize from 319 to 265 or something like that. What's happening there? Why are we seeing less and less demand for our beds? We're very similar to all the other nursing homes for some of the reasons that I just mentioned. People are prolonging their decision to come into the nursing home mainly because there are more alternatives out there. So when you see these kinds of changes in the industry and when the healthcare centers committee makes that decision operationally as the director, what do you have to do? Do the staffing changes occur as a result of the census there or what types of changes do you see? Staffing does fluctuate based on the number of residents that we are caring for. So, yeah, as we've decreased in number of licensed beds and occupied beds, we've accordingly decreased our operations. I know one place that has changed dramatically is the area of your operating budget. And like all of us, I'm sure you're pleased that very recently the county board adopted the 2004 budget but you had a very challenging task ahead of you. Why don't you share with our viewers a little bit just what happened with revenue and what you did to meet your targets? Well, from the revenue side, we all of a sudden lost approximately $2.7 million in intergovernmental transfer dollars that we had been used to having. So we had to look at on the upper of the expense side certainly some definitely some reductions in order to offset that and to meet the goal that had been set for us as a department. Now, I recall from the consolidation when we went from three to two facilities and you were a big part of making that successful. We saved nearly a million dollars in operating costs. We've now lost $2.7 million in revenue. You again had to look at your budget and tighten up where you could. But the bottom line is your levy nearly doubled. Is that not the case? That's correct. It did. Do you anticipate any additional revenue streams or are you optimistic that there might be some relief in the future? Hopefully. Currently, we're awaiting the outcome of some legislation that we can be proud to say that a couple of local legislators had sponsored, primarily represented at Lemahew and then it was co-sponsored by Senator Lybom to increase the amount of IGT dollars, the Intergovernmental Transfer Funds. And if that occurs, it's on the governor's desk to hopefully be signed. It could mean as much as $900,000 or more dollars to Sheboygan County, which would definitely help us. The other part of it that I would mention is that Medicare has come forth with an increase. With the number of Medicare residents we have, that should be helpful to us. Having said that, the largest payer source is our medical assistance program. And that is an area where we aren't fully reimbursed for our services. And that's where the biggest challenge comes in, is making up that deficit. And unless that increases, it does possibly mean more direct tax levy. So with the IGT, and again, it's very encouraging that we may receive up to $1 million of additional revenue for 2004 if this legislation is passed by the governor and if we have successful wire transfers in the future. But it's one time funding, is it not? Yes, it is. And so when you talk about the main source of revenue that we receive, generally speaking, with that income coming in, that revenue coming in, yet the expenses we have to care for the residents, what's the difference? When we're speaking of how much is reimbursed under medical assistance, it can vary anywhere between the two facilities, $45 a day difference in less reimbursement than what our cost is for one facility to over $100 a day. And the other facility. So for every resident we care for, whether we like it or not, we lose anywhere between $40 and $100 per day per resident. That's correct. What it does in order to make that difference of, we rely, of course, more on our private paying residents, unfortunately, to help support us, as well as taxpayers. And that's why I think it's so important with the recent action the county board took and I'll turn the gavel to the chairman. As many of our viewers probably know, the county board at their last meeting approved the appointees to the health care center's task force. And the task force is going to come up with some recommendations regarding the future of our two health care centers. Dale, can you tell us how you will be involved in that when they're first going to meet and how your staff might also assist the task force? I see us as resource people being able to provide the information that pertains to our operations that will be helpful for them to learn what we're doing currently, take a little bit of a look at the historical aspects of our operation, go into educating them in regards to staffing, the ratios there and basically just the types of things that we go through in the operations. Has there been an initial meeting set and do you know how they will operate? Is there going to be some type of outline or work plan? The first meeting of the task force will be next Tuesday, November 25th. And we have prepared a work plan that looks to be able to lead them through the whole process to take a look at the organization, orientate them a little bit as I said before, then start to look at analysis of the critical issues. And that's where we would be looking at looking at regulatory environment, marketing trends, the mission as it is now, what possibly we would be doing as far as maybe changing that. Health and Human Services, services that they provide in the community and how they dovetail, how they may be taking over more services that we currently provide. All these things will, through presentations from Health and Human Services and ourselves and some outside resources, hopefully give them a good background, some working knowledge to then develop some recommendations for the county board. Is there a target date by which those recommendations will be brought forward? The board has asked that they prepare a report and their recommendations by May of 2004. I'm sure that our viewers might be interested in possibly attending some of those meetings. What will be the role of the public in this whole process? Those will be open meetings, just as like our regular county meetings that they will be able to attend. As a part of the work plan, we definitely have some open meetings scheduled where they will be able to provide direct input in the process. Have any other counties that you know use this process or have we come up with a totally new idea? Just on our own? One county that we're familiar with would be Rock that did this a couple of years ago, pretty much following the same format or did this the same way that we are doing it and in talking to officials from Rock County, they felt that it was very beneficial and helped them going forth in their planning. Okay, Dale, I know as administrator, you've taken a lot of steps to keep the public informed about what's happening with our facilities. One of the things was the recent open house. Can you talk a little bit about what you've done in that area? Yes, that certainly is one that, and we felt that was a good opportunity to let the public know what we're doing within Sunny Ridge, some of the refurbishing we did, as well as provide quite a bit of written material for people that may be interested or have to look down the road to utilizing a nursing home. In addition, we've tried to, and we are working on a marketing plan that currently we're implementing some things and will be in the future. One of those things is that we're gonna be advertising. We've got some spots in one of the local news papers that will keep people aware of the services that we are providing. Just in the recent past, we were on a radio program talking about the healthcare centers. We will continue to try to do that. There will be an update from the healthcare centers director and administrators as a newsletter going out. So we're working on those from a communication standpoint but also we've upgraded our logo. We are planning to use that on a number of our types of information that we'll be getting out, brochures that we're upgrading and developing. So it's a combination of all those things that we feel will help keep the people aware of what we're doing. This is a difficult time when we're in the process of going through this study and as much as you try to dispel rumors, they get out there. So with these tools, we're hoping to minimize that. If people would have any questions either about the progress of the task force or about Rocky Knoller's Sunny Ridge, who should they contact? Should they call you or? Certainly, myself. My number is 893-9205 but if there's questions for Sunny Ridge, Jean Stark is the administrator of that facility and certainly could call her at 4537,000. Our assistant administrator, Kaila Renset at Rocky Knoller's available too at 893-9215 would encourage people to call if they have questions because rather than maybe accept rumors, we hopefully would be able to provide them with what is accurate information. Okay, thank you. Let's try to review just a couple of things because we've gone through a lot of information. Many people watching this may be wondering well, how many nursing homes do other counties have? And I know you've shared before and we've discussed at other forums that of 72 counties, I think it's 40 counties that have a nursing home and of those 47 counties have two nursing homes of which Sheboygan County is one of them. And as we mentioned previously, we recently consolidated from three to two and here again, just a couple years later, we're looking at formulating a citizen's task force to once again look at our mission and the types of services that we provide. Although I think it's a little different than the first discussion because that was really a building that was 60-some years old and had some issues with the basic standards and the size of the rooms. What have you? I keep losing my mic here. So with the task force being convened and starting next week as you said and Bill asking you a little bit about the staff involvement and providing information, what have you? What do you envision those first couple of meetings? What do you think's gonna happen? Well, the first ones will be pretty much educational. We planned to tour Sunny Ridge in the first meeting and then the second one would be touring Rocky Knoll. So we're just trying to get them acclimated to the buildings and some of the challenges that we're facing right now and knowing what future services we may or may not want to be providing. So those will be background type meetings. Now with 14 citizen committee members that Bill recently appointed and which was supported by the Full County Board, how are you gonna keep them all from having a balanced discussion? What approach are you gonna take in that regard? There will be a facilitator that is basically supposed to keep all those people on task and move the process through and talking with people that have utilized them before. It does work effectively. So the facilitator along with the chairperson will hopefully keep them on task. And Connie Zigglebauer was selected by Bill to be the chair and I think she'll do an excellent job. I agree. So Connie, the facilitator will keep folks focused, make sure that everyone gets a chance to participate and then Bill asked you about the public getting involved. All of the meetings are gonna be open to the public. All of the minutes will be taken and posted and you said that chances are the ad hoc committee will have a couple of meetings where they open it up for public participation. Though anyone can go to any meeting and listen and observe there may be some meetings where folks can actually interject and provide comments. That's correct. Very good. Well, let's move on to some other exciting developments in the healthcare centers. I know that Sonny Ridge recently just had a very successful open house. I believe it was a nice Sunday afternoon and a lot of folks from the community came out. What happened at Sonny Ridge? We did have an excellent turnout. There were tours that were provided and we had groups of staff that were taking those and visitors around and the response there was a lot of questions. A lot of didn't realize what types of services we provided. We then during a couple of sessions we talked more specifically about the services. We had a rehab director there that concentrated on occupation, physical and speech therapy services that we provide for people particularly that are under Medicare. So all in all I think it was a very educational day for those that attended. And in spite of what some people may be thinking that the board wants to get out of the business if you look at what's happened of the last three or four years the county board put a $10 million new addition at Rocky Knoll and at Sonny Ridge was in the facelift in the amount of about $350,000, $400,000. And what did that all involve? It involved resident rooms, quarters, bathing complexes all refurbishing and making the intent was to try to make it as much as home like as possible. We converted some of our resident rooms to lounges where families could have more privacy. The resident rooms were upgraded so they were more user friendly for the residents and beautified the corridors. So it ended up really presenting a much brighter and warm appearance to our resident rooms and quarters. And Bill, you were there for the open house. What were your impressions? I was very pleased with how home like the facility was. I had been there a number of years ago and my wife's aunt lived there for many years but it really has been upgraded. I was very pleased. Money well spent by the county. And it's encouraging, I think you made an excellent hire decision with Jean Stark. She seems to have been a breath of fresh air and we've had some trouble over the years maintaining an administrator at Sonny Ridge. Some folks have come and gone and she sounds like she's doing well and going to stay with us so. Yes, very pleased to have her on board as a member of the team and she's already made some changes that we're seeing very positive results so we're glad to have her. Oh, if you haven't had an opportunity to get out to Rocky Noel or Sonny Ridge recently, I hope you'll, I hope you do so because as Bill mentioned, great investment has been made in both those facilities and I think we have excellent staff providing top notch service and I credit Dale and his team for the job they do. Speaking of staff and assisting residents, a big part of our success are the volunteers and I know with the holidays right around the corner, you probably see even more involvement from the volunteers and some of the activities at the facilities, what's upcoming? It is a busy time for them, Adam. And I must say, in both facilities, we just have an excellent group of volunteers. Just to mention a couple of unique things that are special things, there's a Christmas tree at Sonny Ridge that is, we call it a giving tree and it's open to families or staff or even visitors in the community to take a residence name and purchase a gift. It gives us then the opportunity to be able to provide presents for those residents for their Christmas. So that's going on. At Rocky Noel, we provide a resident buffet that our staff is involved in, try to make that as a special dining day and so that'll be going on. Number of Christmas programs of course, entertainment, it is a busy time but as busy as they are, we're always looking for more volunteers. There are certain things that maybe don't cover as well as we'd like and would like to see them more involved. So if someone's interested, who do they reach out to? How do they get information? At Sonny Ridge, Lori Trad is the activity director and her number is 453-7067. The volunteer coordinator is Beth Wilkie and her number is 453-7068. So if they're interested in volunteering and they have plenty of ideas for them, they should contact them. And then at Rocky Noel, it's Kim Losey and her number is 893-8552. And if someone's interested in making a donation or giving a gift or distributing cards to some of the residents, are these the individuals that they would contact as well? Yes they are. Very good. And speaking of activities, I know just within the last week or so you had an excellent Veteran Services activity or program there. Talk a little bit about that if you would. At Sonny Ridge, yes. Yes. Last year, they've had those, it's become a tradition there which is just excellent. Where Veteran Services, Jen Riesenberg does a super job in organizing that along with Beth Wilkie, the volunteer coordinator. But last year was the first year that they established what they call a wall of honor. And that's really special because they have each era of Veterans where they have served, they have a picture of them and a brief background of how they served on the wall. So each year they put up new residents that have come out of the facility. And I just think that's very special. And I know everyone truly enjoyed observing and recognizing the service of those residents at Sonny Ridge. Great. Well in the few minutes way of remaining, is there anything else you'd like to touch on or share with our viewers? I guess I would, you know when we talk about the task force, I've been very supportive of that and I'm looking forward because I do feel they are your, meaning you, the public's facilities. And this is a way for them to get involved in. And some major decisions that'll have to be made down the road for our facilities. And so I do encourage those people that are interested to come and observe and then when they do have the opportunity to express their feelings. Very good. And as you said, you'll be having their first meeting next week, Tuesday. November 10th. And then thereafter, how often do you envision they'll be meeting? We would anticipate at least two times a month. Yes, next week November 25th, five o'clock at Sonny Ridge. Very good. Well, thank you Dale for joining us again today. I won't be surprised if you're asked back by Bill and myself in the near future to give us a status report as to how the citizens task force is doing and how our healthcare centers overall are doing. And until then, I hope you'll join us for our next program when Anne Wundergem, the Health and Human Services Director, joins us to speak about many of the programs and activities at the Health and Human Services Department. Very important programs, services being provided, especially around the holidays. And I know we have a lot of wonderful volunteers who reach out and help those folks as well. So thank you for joining us today on behalf of Chairman Bill Gehring, myself Adam Paine, and certainly our guest Dale Pauls. Again, thank you for being with us today.