 Welcome to Sheboygan County government working for you. My name is Adam Payne, County Administrator and co-host of this program with Chairman Tom Wagner and you know I think we've been bringing this program to the good people of Sheboygan County for nearly 20 years and every month we strive to focus on the different department, different programs and services and this month we are so pleased that Kayla Clinton is with us our new or relatively new Rocky Hill Administrator. Welcome. Thank you. Thank you for having me. Kayla started in September, had a brief transition with our former Rocky Hill Administrator Rochelle Valesky and hit the ground running. We are just so pleased that Kayla's here. Good things are happening at Rocky Hill and let's just start with a little bit of background about yourself Kayla please share a little bit about your background and your experience in the health care area. Well Sheboygan County has been my home for a little over three years now. I grew up in South Texas but I've been in Wisconsin. I finished high school and college in Wisconsin. I studied political science and public administration. I've been in long-term care for six years. I've been the Administrator at skilled nursing facilities in the Madison and Milwaukee areas and then prior to coming to Rocky Hill I was at a skilled nursing facility in Sheboygan. So you I was able to be at the former skilled nursing home that you were at just to check you out a little bit, check up the facility and all was positive and so again we're so pleased that you're now working for Rocky Hill. What was your first impression of Rocky Hill? I think one of the first things that stuck out about Rocky Hill is that it had an actual campus. 62 acres is what Rocky Hill is sitting on and it's incredibly beautiful. It's a rural setting but just the mixture of woods and countryside made it a wonderful first impression with a beautiful setting. As far as the exterior I really like the brick. I like how the arcades or the arches were kept from the original building and then even after a few renovations they were able to keep that. As far as the interior of the building there's a lot of space it's much bigger than some of the other facilities I've been at so there's ample space for private rooms and activities and different events as well as a lot of other wonderful living space for the residents and staff. It is a beautiful facility and we're so fortunate that Bishop Boyden County Board continues to support Rocky Hill. When I started nearly 20 years ago we had three facilities the Comprehensive Health Care Center, Sunny Ridge and now Rocky Hill and it's just a beautiful facility and the most important thing of course is the quality of care that we provide and what if your impressions been there how was Rocky Hill doing in that regard? Sure I would say the reputation of Rocky Hill is incredibly strong and the quality of care is something that a lot of people know and recognize Rocky Hill for. My first impression and first exposure to Rocky Hill was back in 2012 when they had piloted the music and memory program for people with dementia and Rocky Hill is one of the first facilities that was seeing positive results from creating playlists that would bring back memories to those with dementia so from the very beginning just hearing of Rocky Hill the quality of care the innovation was something that Rocky Hill was being known for. I've personally had family members live and pass away there in fact one of my distant cousins I think was what was the oldest male resident to ever live and pass away at Rocky Hill and just as such a such a good reputation in the community and as people make those decisions you know we hope as we go through life that one day you know if things go as planned we'll be working with our loved ones and possibly looking for a good skilled care facility and how do people make those decisions? I know one of the methods is to go online and look at some state survey results. We recently regained our five star quality rating from the Center for Medicare and Medicaid. That's a quick tool that you can use that compares the quality of nursing homes. It's measured there's a couple of different measures from staffing to quality measures to how facilities have performed on annual inspections that determine that five star rating. I think in our community a lot of it is word of mouth. People choose our facility because they have had neighbors family members or loved ones that have been at that facility and have had positive experiences. So it's a combination. It's also specific services different skilled nursing facilities specialized in different areas and then the setting too. A lot of times it's nice to be closer to family but we've also had people choose Rocky Hill because of the beautiful setting. Years ago I used to hear some people say well I live in Sheboygan I can't make that long drive out to Plymouth but from a standpoint of quality of care doctor referrals word of mouth and just as you said the beautiful setting nestled into the hillside there and surrounded by woods and it's not unusual to see deer or turkeys pass through that area it's just a very nice place to take a loved one. I'm proud that the county owns and operates it and you mentioned earlier you know that quality of care and how we now have five stars which is the highest rating the state surveyors can provide. A big reason for that is the outstanding employees we have and my understanding is we have an experienced workforce. We have about 200 employees and there's a lot of tenure and longevity in our employees. One of my first impressions with the staff is I was amazed how many people have been there 20, 30, 35 years of experience so it's a tribute to Sheboygan County as well as those committed individuals who are there doing a great job to achieve that quality that we have. Helps when they know their residents because some of them do live there for quite some time they certainly call it home so it's been about six months now on the job what would you consider to be one or more of your greatest challenges working at Rocky Knoll? I think the biggest challenge entering any new facility is learning the systems the policies just the day-to-day activities and how it might be different from where I came from. I think that's one of the biggest challenges as well as this year starting in 2016 the regulations that skilled nursing facilities follow were updated. The mega rules is something that all skilled nursing facilities that receive federal money have to implement so it's over 600 pages of revised regulations, new regulations. We are implementing an emergency preparedness plan so because I came in in the middle of phase two of all these new regulations it's not only learning the Rocky Knoll policies and procedures it's also updating and implementing and training to making sure that we are in compliance with these new regulations so that's kind of been my biggest challenge on the forefront coming in. And as you think about that challenge and maybe that leads to one of the goals for the year ahead what are some of the key projects or accomplishments you hope to achieve in the first year? I think that compliance is the biggest one we have our annual survey coming up in I would say the next five six months so we have a little bit of time something that we just recently did was we expanded our memory care unit we added nine beds to our memory care unit which is based on a community need we were seeing that the people were looking for places to put their loved ones and there aren't a whole lot of dementia beds available right now in our community so we were able to expand our memory care unit and be able to fill those beds almost immediately. Another focus like I said was the emergency preparedness some of the recent events just throughout our nation have really put a spotlight on making sure that health care facilities are prepared for man-made or natural disasters so in collaboration with public health and emergency preparedness that's a goal of mine is to make sure that we are well equipped to be prepared for any type of situation. Excellent well you certainly hit the ground running and I can't recall a smoother transition it's just been so seamless Kayla so we're just so pleased you're here. Tom. Thank you Adam. Hi Kayla. Thank you for coming. As you know most counties do not operate a health care facility like we do in in Wisconsin. What do you think are some of the advantages and disadvantages of us operating health care center like Rockingwell? I think some of the biggest advantages are the resources the county resources. Rockingwell is successful because we're also supported by HR finance purchasing IT so I think being able to have that level of expertise across all of those areas helps make Rockingwell successful and county facilities successful. I think maybe a disadvantage because there's a lot of checks and balances and accountability and oversight there are some processes that do take a little bit longer which could be one advantage but like I said it's for that protection and oversight but just some of my initial impressions of the county run facility those resources are incredibly helpful and if you do have a question it's very easy to just call a brother or sister in the county and get what you need. To what extent you think the county can compete with the private sector in this area? I've worked in for-profit and non-profit companies in long-term care and there's a lot of similarities when it comes to running your business and we always say we're in the business of people and helping people but there is that business aspect that you have to maintain in order to continue to care for those people because regulations primarily dictate how we provide care. It doesn't necessarily matter whether it's county run or for profit we all have those same regulations because we're receiving federal money from Medicare and Medicaid so from that aspect we can compete just as easily with the private sector because of those regulations and those reimbursement from the federal government. What are some of the different services that we provide and what do you think Rocky Null stands out in if you had to pick one or two? Sure Rocky Null has five distinct units we're a larger facility we're licensed for 149 beds we have our specific dementia unit so we have specialized programming for those with Alzheimer's and dementia we also have a behavioral unit or psychiatric care that we provide which also might be different than other skilled nursing facilities and then we have our short-term rehab unit so your hips knees ortho we're able to do rehab rehabilitation for those individuals to go home. Our other two units are kind of your traditional long-term care there are clinical needs but we do have two units that are able to accommodate someone who might need nursing care whether it be 24 hours or just the occasional assistance. I would say what stands out for Rocky Null is we do have some specialized services in addition to those five distinct units we have a TB room it's a negative pressure room which is fairly unique and you don't see a whole lot of that allows us to take someone or treat someone who has active tuberculosis or a highly contagious respiratory illness we also can accommodate bariatric people so we have all of that equipment to be able to accommodate those needs as well. Tom if I can interject my grandfather actually was at Rocky Null when at one point it was built as a TB center way back in the day and fortunately he was able to come out of that my mother recently was at Rocky Null recently a couple years ago for in the recovery area rehab for a double knee surgery and my mom's a former school teacher and pleasant yet tough and I was really interested in hearing her feedback about the facility because I knew she wouldn't pull any punches and she was very positive about the staff there that the quality of care the food I think that's really improved over the last few years in particular I've heard wonderful things about the food there but that just warmed my heart that she was taken such good care of and really felt good about the facility so it really is a full-service facility serving a lot of needs in this community. I would agree with that I live in the city of Plymouth so it's not that far from Rocky Null and I certainly hear people because they're even volunteers who go out there to help out you know they're close by and I hear many positive things frequently about Rocky Null so you mentioned that we have us I think 144 beds is what we're licensed for is that correct? 149 and how many patients or residents do we have right now? We're currently at 134 residents so about 90% occupancy. Excellent and how does that a 90% occupancy is there any standard relative to that maybe not but that does matter how many people we have occupancy definitely matters because skilled nursing facilities pay a bed tax for each bed the occupancy is very important just as you you manage your business so there are opportunities if you aren't able to operate at a higher occupancy rate it to the license some of those beds but in our case some I know we we have begun that process we've settled at 149 and because we've been able to run consistently high that's been a good a good number for us it helps the bottom line at the end of the day right what is your total budget and how have you been performing how they've been performing in the last five years sure our budget is 13 million dollars a little over 13 million dollars over the last five years I would say Rocky Null has been heading in the right direction with their budget each year we try to reduce the the tax levy that's always our focus and to be good stewards of tax dollars that we receive from last year to this year we've reduced the tax levy by 27 percent so going into 2018 we're hoping to use and have budgeted to use 600 and about 640 thousand dollars of the tax levy which is substantially less than it was 10 and 15 years ago right Adam it's remarkable and in 2007 when we owned two facilities sunny Ridge and Rocky Null the tax levy subsidy to operate these two nursing homes was 6.1 million dollars so if you can imagine of a about a 45 million dollar total tax levy 6.1 million going to help support or subsidize subsidized two nursing homes that we don't even have to be in that line of work so it was one of the reasons why the county board took the initiative it did to privatize sunny Ridge and then thankfully thanks to excellent management good teamwork and perhaps some good fortune as well we've been able to reduce that tax subsidy from 6.1 million to closer to 600,000 and it's heading in the right direction so it's a real compliment to everyone involved at Rocky Null thank you so so speaking of good things and what a nice transition that is I mean there are probably viewers years ago who can remember when Sheboygan County owned and operated three facilities we had more beds than any county in the state it was difficult it was a trying time for the county board to close the comprehensive health care center which was a grand old facility served our community well but it was just time and we close comprehensive and put a ten million dollar addition on Rocky Null years later regulations changed and now that area is where our rehab residents predominantly reside so change is always happening in the health care center industries it's just remarkable and please touch on that a little bit frame that for our viewers that you know all of this ongoing change in regulation it has to make it challenging for not only you as a leader of that organization but all your staff everyone involved I would say that our environment even in the last five years has changed tremendously like I said with the mega rules we now have updated rules and regulations prior to this update there hadn't been any updates or changes since 1991 in those regulations I would say the the culture and just the perception of long-term care has has changed over time there's there was more of a focus to keep people out of skilled nursing facilities or the institutional setting to even at the state level to provide more funds to allow people to stay at home longer and that's always our goal as well but it just it gets to that time where someone or a family isn't able to to keep their loved one at home based on their clinical needs so I would say that mentality as far as allowing people are wanting people and prioritizing people to stay at home was kind of a big a big shift and so our patient population has changed with those changes and regulations we see by the time we see people in our setting their clinical needs are higher and also a lot of times personal funds have have been spent down so we do see a lot of our Medicaid population and we provide for for that population so it's just those trends and the philosophy and then our patient population is what has changed with that though the goal and our regulations they want it to be person-centered they want it to be home-like a lot of just kind of those the details and the minutiae of what's in that regulations doesn't necessarily allow us to to meet that type of needs with the reimbursement that we're getting and so as the regulations change as we continue to focus on quality care person-centered care it does make it very difficult to balance all of those needs. Incredibly challenging as I think of you know this evolution you know I think it's the right direction who among us doesn't want to stay home as long as possible or who among us doesn't prefer to go to an assisted living facility or something where you you get some help yet it's not a traditional nursing home until ultimately you have to go to that nursing home and get that skilled care I think those types of alternatives for people is really beneficial but as you said it definitely put a strain on nursing homes ability to maintain a census maintain a budget and we've adjusted accordingly in fact Rocky know he used to have about 200 beds and now as you said it's 149 they used to be shared now they're all private right they're all individual which is nice but as you look forward in your crystal ball Kayla five years out what do you think Rocky know and Sheboygan County has to do to continue to position our nursing home for success I think we always have to be creative we always have to be budget conscience conscious and I think that we are positioned while to continue going in the future with that creativity though I think it's always beneficial to look for creative streams of revenue we manage our expenditure very well but there comes a point where we still have to provide that care we still need to meet those needs and there are some costs that aren't controllable like drug costs we don't control those necessarily but we have to provide what the doctor has prescribed so I think finding and being open to to those efficiencies we're always looking at ways we can be more efficient but still provide that quality of care that will be essential to the future of our success I also think to just just being creative we've looked at an assisted living option we've looked at kind of what what we can do to make up for for those gaps where we are seeing seeing the loss in our reimbursement and then the cost of providing that care so I hope in the next five years I don't have that crystal ball per say but we continue to to be open and look for for alternate ways we can make up in those areas and I know in the food service area and how meals are provided there's been a number of changes to to make it feel more like home and allow for more individual choices well one of the other challenges that you're certainly facing we're all facing and I think most employees are facing our staffing shortages and my wife's a registered nurse Kayla knows I just think the world of that profession and the people who provide that care takes special remarkable people I think to work at nursing home facilities and provide that important care and CNAs in particular are providing hands-on care and you generally work as a CNA before you come become a nurse we're struggling as most nursing homes I think if not all nursing homes are struggling to find people what's happening there yes so the the certified nursing assistant or the CNA workforce shortage is a huge priority across the state some of the reimbursement rates attribute to not being able to increase compensation so individually we we do have a plan and how we recruit a lot of it our forces outside of our control Sheboyin County is very fortunate to have already a very low unemployment rate as well as ample jobs for people to choose from so it is a blessing and a curse in that standpoint but ultimately we're involved we're a clinical site with LTC for nurses as well as certified nursing assistants so we just want to give people we're looking for the right people with that caring and compassionate heart to do the job so we want to make sure we get the right people but with all of the options and then competitive wages we are seeing that there there is a drastic need for certified nursing assistants good CNA certainly earn every dollar that comes their way it's not a real high paying wage but very important work and the one nice thing you know if you happen to be watching this and you are CNA are looking to go into that area as you said we provide training at the facility and one of the upsides of working for a county owned and operated facility are the benefits are stronger it's a stronger benefit package usually the wages are pretty similar to the nonprofit or private sector but our benefits are a little stronger though as you know Kayla a lot of young folks aren't necessarily that enthusiastic or care as much about the benefits they're looking at that dollar but if you're planning on being in the profession for a while Rocky Knoll is a great place to work in a great place to provide quality care only have a few minutes left but we also have a Rocky Knoll foundation and I know they're helping make good things happen at Rocky Knoll please touch on that sure one of the other advantages of a county owned facilities we have the county and community support and that's reflective in things like the women's auxiliary and the Rocky Knoll foundation so their single focus is to provide life enriching services and activities and material items for our residents that is separate from our budget so they have been an instrumental in providing activities and equipment for things like our music and memory program our iPod shuffles they have been responsible for some small construction projects like our bistro outside which is a fire pit and grills so in the summer when we have outdoor music we can also kind of have a cookout which is wonderful so their support has just been incredibly helpful in enriching the lives of our residents and we're very grateful to have the foundation some of our viewers are probably thinking bistro you have a beast all that Rocky Knoll you're darn right we do we have a beautiful area for residents and family members to come and cook out or grill out if they want and again that foundation has been instrumental in helping raise funds and and we won't name names but there are some major companies in this community and in the Plymouth area that have been very generous and providing amenities at Rocky Knoll that have been good for both the residents and the staff so it's wonderful what that foundation has done so final question so folks might want to get involved Tom talked about it earlier we have all these wonderful volunteers that come out to Rocky Knoll and provide assistance how if someone wants to volunteer at Rocky Knoll what are some of the things they can do how do they contact you for more information sure I think the best way if someone is looking to make a positive impact is is to just give the gift of your time there's no need for any special talents or services I would say that all of our residents they they just love the one-on-one the personal conversation the personal touch we do have kind of established avenues for our volunteers our life enrichment director is the one that coordinates the volunteers but it doesn't have to be formal if you're only looking to to pop in and say hello then then that's a blessing to us and our residents and we're grateful for that if you do have a specific gift or talent that you want to share I think the best way is just to reach out to life enrichment and get something set up but it doesn't it doesn't take much and we appreciate anyone who's just willing to pop in and say hello wonderful well thank you so much for being our guest today Kayla covered a lot of ground if you have any further questions about rocky nola or want to learn more don't hesitate to reach out to Kayla or a member of her staff we have a county website where more information can be found and again Kayla it's just really wonderful to have you part of our county family and the good work you're doing thank you so much thank you thank you Kayla next month we're going to talk about another area of county government that also touches on state government and that's UW extension which is now co-located here with UW-Sheboygan and there's been a lot of changes at the state level as you may have heard or read with consolidation of UW-Sheboygan with UW-Green Bay consolidation of extension with the university system and Cindy Sarcady our new regional department head overseeing the extension offices is going to be with us to share more about what's happening with extension and the very good work that extension and all the volunteers do so until then thank you for joining us we'll see you next month