 Welcome to Sheboygan County Government, working for you. My name's Adam Payne. I'm the Sheboygan County Administrative Coordinator and with me is County Board Chairman and co-host of this program, Bill Gehring. And today our guest is Dale Pauls. He's the Healthcare Centers Director. Many of you may recall it was a year ago this month that we consolidated from three Healthcare Centers to two, a major decision by the County Board and certainly one that was controversial during the course of discussions, but all in all, things came together very nice and Dale's here today to discuss a little bit about the consolidation and how things have worked the last year as well as upcoming issues and challenges with our Healthcare Centers. Dale, why don't you start by telling our viewers a little bit about yourself and your roles and responsibilities as Healthcare Centers Director. As the Healthcare Centers Director, I have the overall coordination and the management of both Sunny Ridge and Rocking Oil. I work closely with the Healthcare Committee in regards to implementing policies and procedures. Another duty there is to promote the facilities through marketing, through advertising and hopefully that enhances the image of the facilities and helps us with our admissions. There is another administrator at Sunny Ridge who of course I assist and work with on issues. Hopefully I am able to find time to make rounds in each of the buildings to learn the residents and more about staffs and staff issues that we do and also work closely with the Human Resources Director to develop recruitment tools and hopefully then end with retention of employees. As the administrator for Rocking Oil, basically the overall day-to-day management of that operation but I would say there is an assistant there that certainly does help and assist in all facets of the operation. The budget, the implementation, preparing all that is a major task, personnel issues, hiring, day-to-day functions. Probably one of the biggest ones is just making sure that we stay in compliance with all rules and regulations that are part of our operation. Now you were administrator for a number of years at Rocking Oil before being promoted to the Healthcare Center's Director overall but you still are wearing both hats. How long have you been in both positions? Well, I became administrator in 1994 and then two years ago took the position as the Director of the Healthcare Center. And you've been in the thick of it through all the discussions about the consolidation going from three nursing homes to two and the planning and implementation of that. You had a lead role in that. What are some of the changes you've seen over the course of the last couple of years involving the consolidation? The biggest change when we talked about consolidation was closing the comprehensive building and then we were moving the residents basically to Rocking Oil. So once we were able to do that, we have a number of services that are consolidated on that campus. We now have the chronically mentally ill residents residing there. We have 59 beds for those individuals. We have 37 beds for the developmentally disabled or the ICFMR unit for them. And then we have 99 other beds that are for basically geriatric residents. Within that 99 bed complement, we have a 16 bed dementia unit. So in all total, we have 195 residents. And at Sunny Ridge, we have 319 beds. That whole project, we reduced a total of 202 beds from when we started out. So it was a major undertaking. The residents really adjusted very quickly. New rooms, same faces basically for staff and of course fellow residents. But they adjusted real, real well. And how about the employees? Are they going to go from a different location, from comprehensive to Rocking Oil? And in some cases, some residents were moved to Sunny Ridge. How have personnel adjusted to that change? That has been gradual. As you said, new building, new surroundings, some new supervisors, changes maybe a little bit in how policies and procedures, particular procedures, were done in one building versus another. But it's gradually coming together. And I think after almost a year now, those people are feeling like this is where I should be going to work. And we're melding together as one building. I know last year around this time, you had a grand opening with Rocking Oil and invited the public. I think we had well over 100, 200 people there. And certainly it was encouraging to get the feedback from folks who got to see the new rooms and the new living quarters and the residents. That was the bottom line for me. They seemed to really appreciate the new and updated living conditions that they had. Yes. And as I mentioned, it will be one year, July 17th. So we are going to observe that with some activities that will involve residents as well as staff. And I think families, yes, very pleased. Resident issues are a lot, I believe, less than they were because of the type of being able to have private rooms. And overall, with the consolidation and refresh my memory, but I recall operationally, we saved almost $1 million of Sheboygan County Taxpayer assistance to operate the nursing homes. It was around $800,000 to $1 million. And we went from how many beds? Was it around 700 to about 500 or whereabouts? Yes, we went from 717 down to 514. So it was a pretty significant change in operations. Do you envision any more building or remodeling here on the horizon? Certainly we're hopeful that after completing a major project such as that, that it would be sad to school for a while. But in our industry, it just doesn't remain that way. And I don't foresee at Rocky Null immediate changes within the year. However, maybe down the road with some new legislation that may be passed, we may be looking at some other types of services. At Sunny Ridge, yes. I think we're definitely in the process of looking at how we can deliver different services. The amount of community-based services continue to increase. Thus, there is tend to be a decline in census in all long-term care facilities. And that's what we're experiencing right now at Sunny Ridge. Very good deal. Many of our viewers probably know that Sheboygan County has a huge deficit in next year's budget, roughly $4 million. One of the things that's impacting us is the cost of operating the health care centers. And we're going to be losing state and federal dollars through IGT. Can you explain a little more about how that impacts the county and your budget? Yes. We were a transferring county under the Intergovernmental Transport Program for the past three years. As a result, as you know, we're participating in that we realize a large number of state and federal dollars. In last year's budget, we had over $5.4 million that went toward our operation. Because that program is being severely reduced, that's going to cut us in half. We'll only have approximately $2.7 million of IGT funding, which means it will require more tax levy because we don't have the additional revenues to offset that. So it will impact. Rather than approximately $2.7 million levy last year, we're looking at $5.5 in the coming year. I understand that currently your committee and you are considering reducing the number of licensed beds. What's happening there and what will your recommendations be regarding that? One of the things that comes into play with doing this is recent legislation for nursing homes in order for them to receive state medical assistant dollars, they're imposing a bed tax. And they're going to impose that on all licensed beds. In our situation, when we have a large number of unoccupied beds, we certainly don't want to have to be paying for those. And knowing that probably with the trends, we'd be more realistic to reduce the number of licensed beds. So it works in our favor in that aspect to downsize. A second piece of this is if you reduce 50 or more beds, it's called a major downsizing. And again, as we had in our previous consolidation, some agreements with the state that we weren't penalized for bedhold when people left the facility. We got reimbursement for that. And occupancy penalties that would have been imposed. So it's kind of twofold that it would work to our advantage to reduce. And the primary reason, of course, is we don't feel there is a need for some of those unoccupied beds anymore. That's really kind of an interesting phenomenon with the aging of America that really we don't need as many nursing home beds any longer. What's really going on in their deal? I know that's perplexing to people because you read all about the baby boomers and how that large group is going to demand services in geriatrics. If you look at statistics, whoops, it's hard to say here, statistics over years, 5% of the population, 65 years and older, that's the maximum that I've ever been in long-term care. Seems like there's a lot more, but really, it's been basically holding at 5%. Part of that is to do with more and more community-based services that are available to elderly so that they no longer have to come in the nursing home. Or if they do, rehabilitation is a center focus for us, the short-term stay. We probably see more admissions, but a lot less links of stay. So these community-based services are coming into play and again, legislation at the state level right now is promoting more dollars for those services. The baby boomers, again, getting back to them, they don't project a high usage of long-term care, whether it's community or facility, until 2015 to 18. So we're kind of going through a period here now where demand is just pretty much stay out of school or tending to decline a little bit based on the services that are being provided through the community. I understand that you and your committee are looking at various ways to enhance your revenue. What types of things are you looking at in that area? We've looked at the building at Sunny Ridge and we want to maintain what our mission has always been, to take care of those that maybe are not taking care in other facilities, meaning basically like the dementia or behavioral type of residents. So we would have maintained those units in the building, but also look at some alternative services that would help maintain a continuum of care. Oftentimes you see that on campuses of long-term care facilities where they have assisted living for people that aren't quite ready for the nursing home, but they can move into an apartment, have services available to them. So we're looking at that type of service. Community-based residential facility is another step just above assisted living, that someone is not quite ready for the nursing home, wants to remain independent in their own room. So we're looking at a unit, a possibility of a unit for those type of residents. As well as, as I mentioned earlier, rehab is a major focus for long-term care. We want to possibly develop a special 15-bed unit that would be like for hip fractures or knee replacements or those types of not so lengthy rehab, but certainly subacute kinds of rehab. Maintained an area for geriatrics too, but that would be just a part of all these types of services that we're considering. Okay, are there any changes coming down the road for Rocky Knoll or because we recently reconstructed that and changed it, we're pretty well set at Rocky Knoll? We're pleased with the census right now. We're maintaining at about 95% occupancy. And so I don't foresee right in the immediate future that there'll be changes. Earlier, I mentioned earlier that there will be more emphasis to place developmentally disabled in the community as well as chronically mentally ill in the future, but that is in the future, so not right now. Okay, I know that you're having a consultant come in and talk to your committee and also the full board next week. Have you any idea when your recommendations for changes that Sunny Ridge might be formulated or brought back to the full board? My desire would be certainly to be able to include this within the 2004 budgeting cycle. This fall, I'm very hopeful that we'll be able to bring to you a recommendation for the future use for Sunny Ridge. Okay, we look forward to a recommendation, thank you. And let me take a minute to put this in perspective for our viewers because on the one hand, viewers may be listening to this and think to themselves, my goodness, we just went through a major consolidation, three facilities to two. We put on a $10 million addition at Rocky Knoll. We have approximately 200 beds at Rocky Knoll and about 320 beds at Sunny Ridge. Rocky Knoll's just about full, is it not Dale? And at Sunny Ridge, I think the census out of 319, 20 beds is around 255. They're considering further de-licensing beds for savings and because of the lack of demand and because of trends in the industry. You know, what's happening here? Now we're talking about additional changes perhaps at Sunny Ridge. The bottom line is, as the chairman mentioned earlier, we're looking at a four to $6 million revenue gap for 2004. And when I say we, I mean Sheboygan County. Well, where is this revenue gap coming from? Well, you've probably heard a lot about reductions in state-shared revenue. That's certainly contributing to it. But not a great deal. It's around 600,000 or so. So where's the rest of it? Well, as Dale mentioned earlier, because of the loss of federal and state dollars, IGT funds, as you may recall, we're losing $2.7 million for 2004 alone. And in fact, in the last two years, that figure's closer to a $4 million reduction. So what does that mean for Sheboygan County taxpayers? What does that mean for you and I? That means that we're gonna be paying more in property taxes to maintain our healthcare centers. And not only does it mean that, but in order to maintain the tax rate as the County Board and certainly Chairman Gehring is looking to achieve, every department is gonna have to reduce expenditures to address that $4 to $6 million revenue gap. So for healthcare centers, Mr. Paul's right now has a $1.2 million reduction that he needs to make at the healthcare centers. Health and Human Services, he mentions he works closely with that department. They're looking at a $1.5 million reduction. Highway, 500,000, Sheriff's Department, 500,000. Every department is being asked to address this revenue shortfall. And long-term, how are we gonna continue as a community to operate with these reductions in revenue, especially when the key area that is driving these reductions are the healthcare centers. A $2.7 million reduction again for 2004 alone and we anticipate revenue reductions in the future. We've got to change the way we're operating and that is the challenge of Mr. Paul's and the healthcare centers as well as the County Board as a whole. And you're probably gonna start hearing more and more about once again, how is Sheboygan County gonna operate its nursing homes as cost-efficiently as possible as well as what our priorities. And clearly the County Board has some very difficult, challenging decisions to make in the future to say nothing of the decision they made a few years ago to consolidate. Well, that's probably enough about budget. Let's move on to something that I know is very, very important to you, Dale, and that's the quality of care that you provide at the healthcare centers. I know you feel so strongly about your staff and the fine job they do, but another group of on-sung heroes that you don't often hear a lot about are the volunteers. Why don't you touch a little bit on the volunteers and what their role is at the healthcare centers? It's a pleasure to do so because they are a very key part of it and sometimes overlooked. And they do many, many different things for us and annually we do have a volunteer banquet to recognize them both at Sunny Ridge and Rocking All and it's amazing the number of hours they keep track of that they provide different types of services whether it's taking people to church two and three times a week or participating in certain kinds of activities that our activities department does but needs support, taking people to the beauty shop and the barber, taking them outside. Just any number of things that they do is so valuable to us and we don't always get that opportunity to say thank you to them. So I appreciate the opportunity to say thank you to many people that probably are listening that do help in healthcare centers and they bring smiles to residents' faces because of them just sharing a little time with them. That's another thing. That's a lot of one-to-one kinds of volunteerism that goes on. They're a valuable resource for us. You have any idea how many volunteers you have? We, I know at Rocking All there's around 200 and I think it's pretty similar at Sunny Ridge. I'll be direct. And you mentioned some of the activities that they help out with. Can you expand on that a little bit, if you would please? Some of the one-on-one time with the residents to taking them out to get their hair done or what are some of the things the volunteers do? Well, they try to match them up to a certain extent with residents and their needs. You know, there may be people that have always enjoyed reading all their life but due to vision problems, they can't. So a volunteer will just come in regularly to read to them this is a good time of year where they get them outside and just around the grounds. There might be a person that's a gardener that truly enjoys being able to see the grounds. I have to mention that we have a real special volunteer called his name is Chance. And it's a dog that comes about only two and three times a week just to be in the facility. We have a resident that takes him out for walks. Excellent volunteer that every resident or a lot of them probably have had a dog in there or a cat and truly enjoy that. So if we have any viewers today that are interested in volunteering or if their dogs are presently tapping them on the knee, who might they contact to help us out? At Rocky Knoll, Kim Losey is the activity director. So they can call her. And at Sunny Ridge, it's Beth Wilkie. She's the volunteer coordinator or Lori Tread, the activity director. And I know we only have a few minutes remaining but another relatively newer area with our healthcare centers was the development of a foundation. And you've put together a board of directors. It's an opportunity is it not to do again some good things for the residents that we're serving? Could you touch on that quickly? Yes, that was established three years ago with the idea in mind, not to be supporting the direct operation but to foster quality of life for our residents, doing things that would help enhance their lives. And we are still working on filling a couple of those positions. So I'm very interested in anybody that would maybe like to serve in that type of capacity. We had a community relations director a year ago and cheaper and he much was directly involved with that piece because of having to make some decisions in our budgetary process. We no longer have that position. I am getting more involved and intend to in the future to promote that foundation. And if anyone has a loved one or a family member or friend that may be interested in checking out one of our healthcare centers whether it's Rocky Knoll or Sunny Ridge, how would they go about looking into it? They just, they need to call either one of the facilities and ask for the social services directors in either building. So they would then provide any kinds of information they might need. And certainly Dale, you'd be willing to show them around the campus and there have been a lot of improvements. Absolutely, yeah, I think that's probably the best suggestion is for them to come, get a tour and as they get a tour they would be able to answer their questions. Very good. Well, whether you're interested in taking a look at one of the healthcare centers, again because it may be time for a loved one or a family member or a friend to perhaps need that types of service, certainly Dale Pauls is an excellent person to contact. We have two beautiful campuses. The county board has made a number of improvements over the last couple of years. Whether you're interested in volunteering or participating with the foundation, certainly feel free and you're encouraged to contact Dale or a member of his staff and we wanna thank you Dale for being here today. Thank you. Our next program, we're gonna have Highway Commissioner Roger Lanning in. You may have been driving around the county and seeing different county roads being worked on or town roads being maintained and the state right now is working on Highway 23 and Roger's gonna help pull that together for us and talk a little bit about the roles and responsibilities of the Highway Department. So until next time, thank you for joining us today.