 Welcome to Sheboygan County government working for you. I'm Dan Lemihoo, Sheboygan County Board Chairman. I co-host this program with Adam Payne, our administrative coordinator. And each month, we try to bring some of the services that Sheboygan County offers to its residents to you and some of the services we provide. This month, we have Gene Larabee, a director of our healthcare centers with us. Gene, you were with us in one of our first programs when we started this program back in June of last year. And a lot of, we haven't come close to covering all our counties yet. So you're really privileged to be back with us for a second round of this. But a lot of things have been happening at the healthcare centers over the last six, seven months. And that's why we have you back so you can bring all our viewers up to date on what's happening. The biggest thing we have going for the healthcare centers is our consolidation project. And maybe you could just bring us up to date a little bit on the status of the consolidation project. Well, thank you, Mr. Chairman. For us, it's a pleasure to return to your program. I'm glad to be here. As I'm sure many people know, the consolidation project has officially begun. We had our groundbreaking in January. The construction has started. They're digging furiously away on the Rocky Hill campus. And at this juncture, it looks like an anticipated completion date, which would probably be early spring of next year is right on target. When we say consolidation project, what does this encompass? What are we consolidating? Well, actually what we're doing is we're doing two things. We are going to actually physically close the current comprehensive care center and move its location to the Rocky Hill campus. We'll be creating two operating entities on the Rocky Hill campus. A replacement facility for the comprehensive care center. And then we'll also maintain a skilled nursing facility. The healthcare center at Rocky Hill will also stay in place. So we will have actually two facilities on the Rocky Hill campus. One will be the comprehensive care center at Rocky Hill, the other being the healthcare center at Rocky Hill. Sadly to say, when we do projects like this, there's a cost involved. Yes, there is. We don't do them for nothing. And so maybe you could just go over a little bit of the cost of this project. Well, one of the things that I can report with pleasure, even though it's a significant amount of dollars, is that our original budgeted amount for the construction on this project was just a little bit over $8.9 million. And when all the bids were received from the contractors and builders, et cetera, it looks like we could come in significantly under budget if we stay on target in accordance with the bids. The bids totaled about $8.2 million. So that's good news at least. And the goal of this show is to tell our viewers what services we as a county provide. What, after the consolidation project, what services will you be providing out there at Rocky Hill? Well, that's to me probably the most exciting part of this project, although it's always fascinating to watch the bricks and mortar go in place. What's exciting for me is what we're going to have there once we finish. We're going to have a campus that actually has five different programmatic approaches to resident care. On the healthcare center side in the Rocky Knoll facility, we will have three different programmatic approaches to the resident population. We'll have a traditional general skilled nursing population. We'll have a dedicated unit for Medicare residents, which basically is a more intensive medical unit. We'll have a dedicated Alzheimer's unit. So the healthcare center at Rocky Knoll will have three different programmatic approaches. And then in the comprehensive care center, we'll have 37 beds dedicated to ICFMR, which is an intermediate care facility for the mentally retarded. And we'll have 59 beds dedicated to those with mental disorders, cognitive dysfunction, et cetera. So we'll have five different clinical programs going on at once on that campus. And the thing that makes it special is that from what our research shows, we'll be the only facility of our kind in the country. And I think that's pretty exciting. Many of our viewers have been out to both conference center and to Rocky Knoll previously. And I know you have some sketches along of what the consolidation project is going to look like when it's finished. Maybe if you could identify on your diagram where some of these services will be offered, how it will be laid out at Rocky Knoll when it's finished. I'd be glad to do that and I'll get out of my chair so I can use the pointer and hope that I don't pull a Bob Dole. If we start with the bottom diagram here, these sections of the building right now, this brown section and this kind of maroon section right here are the current facility at Rocky Knoll. This is the part of the facility that was built in 1972. This is the part of the facility that was built in 1992. And the base section over here represents the new ICF-MR unit. This base section represents some additional construction and this darker maroon section also represents some new construction. From a clinical program perspective, this will be the ICF-MR unit, will be a self-contained unit with 37 beds and that will house the mentally retarded population. The brown section of the building will become the IMD unit or the facility that will house our residents and population. There'll be 59 beds in this unit. So these two parts of the building together will basically be the replacement comprehensive care center and they'll be the comprehensive care center in Rocky Knoll and in addition to that, this particular area here will be a new dining facility for this resident population. And that's the area that we're now starting to construct. Right, construction is now in progress on the ICF-MR unit itself. Construction has not yet begun on the new dining area, but construction has begun on the ICF-MR addition. And the completion date for this part of the project? Completion date for the whole project in and of itself is end of March of next year. Then in this section of the building, which will be the healthcare center at Rocky Knoll, will have a general skilled nursing population. And then if you note, this wing here goes off as a separate part of the building. And on the first floor, we'll have a specialized dedicated Alzheimer's unit, which will include a new enclosed courtyard, which is represented by this pathway. And then on the second floor of this particular wing will be our dedicated Medicare wing. And in addition to that in the darker maroon right here, we're constructing some additional office space, but also some additional activity space, dining space and therapy suites. So it's a pretty exciting addition. And if you look at the upper drawing, you can get an artist rendering of, architects rendering of what the new construction will actually look like. Right here is represented the ICF-MR, the 37 bed addition. And you can see it is a one story structure as compared to the current Rocky Knoll, which is a multi-storied structure. But architecturally it should fit in design wise, very nicely. And one of the things that I'm eager to see is, when the summer, when we get close to the warmer months and the trees start to bloom, this is really going to be in quite a scenic and aesthetically nice setting. And on the upper picture here, then it shows that the addition that will be going on to the front of the current Rocky Knoll building that will house the administrative areas and therapy suites and extra dining spaces that I referred to before. So we're really excited about the complex, what we're creating there and even more excited about what the results will be when we're finished. Well, it looks like the facility will be a state of the art. We're doing things as modern as we can do them to give that level of care that our residents expect. One of the, we haven't gotten to this point in a short period of time. Correct. And we've been discussing this long before you were on the scene. And one of the concerns over the years and that we've been discussing this is when we consolidate, are we going to have enough bed space, enough beds, enough facility to take care of the needs of the residents of Shabai County? Well, if we look statistically over the average total census amongst the three facilities, including Sunny Ridge over the calendar year 2000, our average census at all three facilities was 520 residents. Right now, the way the consolidation plan is designed, there'll be 514 licensed beds when all is said and done. But we also have the ability to expand that capacity by an additional 24. So we have the ability, if need be, to have a total of 538 beds. If we go based on statistics, we should have more than enough bed space available to provide for the needs of the county. So you're talking about a flexibility of an additional, what did you say, 20? 24. 24 licensed beds that we could have. That we could have. What about space in the facility? And then a licensed bed doesn't do us any good if we don't have a room to put it in. We will have the room to put those beds because right now we are creating a facility at the Rocky Null Campus especially that will have a uniquely high number of private rooms. And these rooms are being converted from rooms that were traditional semi-private or two-bed rooms. So if we decided to increase, for example, the licensed capacity at Rocky Null, we would still have more than an adequate number of private rooms available and yet have the flexibility to create additional bed space by turning what is planned now to be private rooms back into semi-private rooms that they traditionally were. Maybe another concern is how will you physically move? Resident, we're building a new structure or adding to Rocky Null. At some point, we have to physically move the residents from one facility to another. At that point and between now and then, which is a year away, do we have room in our facilities to move people or are we full right now at Rocky Null? No, Rocky Null right now, as a matter of fact, currently right now in accordance with our licensed bed capacity, we have a substantial number of empty beds at each building. We will have the ability, and we have a phase down plan that will phase in over the next year and a half to two years, which will de-license the beds that we aren't currently using, because right now our total license capacity is about 700 beds. And as we approach the consolidation project, we'll phase down the number of licensed beds, but we have designed a program to do that so that we still have plenty of adequate flexibility if there's any need to move residents during construction, if there's any need to move residents from facility to facility on a short-term basis, which that we really don't anticipate, but should the need arise, we will have the ability to do that because our phase down plan is planned so that the majority of those licensed beds aren't surrendered until actually your construction is completed. There's been a lot of discussion throughout this whole process, also on the status of the facility that comps the health center out on D, and which was one of the reasons we're doing the consolidation we were doing is because of the status of that facility, that actual brick and mortar of that building. Could you just tell us a little bit about that and what the status is of that building? Well, to be quite candid with you, and I want to make it very clear before I state anything negative, we are not in a situation at comp center structurally or any other way that places in doubt the safety and welfare of the residents that we're taking care of, and I want to make that extraordinarily clear, but we do have a building that's 62 years old. We have a building whose systems mechanically are beginning to wear out. We have a major problem with the sewage treatment system at the facility, which the Department of Natural Resources has already been pretty tough on the building and told us either we have to close it off or fix it, the cost of repairing just that system would be well over a million dollars, which was a contributing factor in deciding to close the facility. We've had a recent problem at the facility with a water main break that really, after it broke, turned into a domino effect that caused problems with our water tower, that caused problems with our boiler. We're still waiting to see what the total dollar expense to those reparations are going to be just to keep our water system in place. And we're kind of sitting here with our fingers crossed, hoping that we don't have any other major maintenance type or structural problems between now and the time that the consolidation construction is finished and it's time to relocate our residents. I know that in the budget for our comprehensive health center this year, there is some monies, there are some monies in there for maintenance and repair because we know that because of the age of the facility we need to do something so you can assure us that the facility will be repaired as things happen so that the residents will be well taken care of. Yes, and there is a significant amount of money budgeted just for that purpose and I credit both the county board and the finance committee for the foresight to take into consideration the potential of that happening. Well, and again, I think the paramount concern was the law for the residents. Right. And in order to ensure that the monies had to be put aside for the facility. Correct. We've talked quite a bit about the consolidation project and that investment, $9 million of infrastructure investment there. The healthcare centers is our second largest department, over $30 million annually. We certainly rely a lot on federal funds, Medicaid funds for operating. Although this past year was one of the first years in some time that we've levied a significant amount of funds for operations. Just this week, the county board, as you all know, took action on the Intergovernmental Transfer Program, which could be a real benefit, not only to Sheboygan County, but nursing homes across the state. Could you share with our viewers a brief overview of what the Intergovernmental Program is? Hopefully I can do so simplistically. It becomes a fairly complex mechanism. But the Intergovernmental Transfer Program was initially set up by the federal government to provide a mechanism where in especially non-state operated governmental facilities could be reimbursed to assist them in making up the costs for taking care of the Medicaid populations that they have in their facilities. And when I say non-state operated government facilities, that means primarily those nursing homes that are operated either by a county or a municipality. The original concept behind the program, as far as its necessity was concerned, was geared toward the fact that typically, especially facilities like ours, will take care of many residents that the private sector does not care to admit because they're more difficult cases either because of their medical complexity or because of psychiatric or behavioral problems. So it was recognized by the federal government that there's an additional cost to operate a county facility because of the simple reason of resident acuity and necessity to have higher staff ratios to take care of a more difficult population. The way that the Intergovernmental Transfer Program works is that states certify to the federal government Medicaid expenditures for those facilities. And then in exchange for that, are eligible to receive matching funds to help fund the Medicaid program. The recent action by the county board, which approved a wire transfer to the state of about $227 million, is a mechanism in which the state can maximize the matching federal dollars that it receives. By counties in Wisconsin, and in this particular case, Sheboygan is one of three, participating in the program, the state government then becomes eligible to receive additional matching dollars. What that means in practical terms for our health care centers is that we'll have a significant amount of reimbursement realized from it that historically we had not realized, and that will come in two ways. One, there'll be a significant increase to our share of the Intergovernmental Transfer Program, but the additional funding to the Medicaid program in the state of Wisconsin will also enable the state to grant Medicaid rate increases to all the industry. So we will be receiving rewards in essence in two different ways. We'll have a substantial increase in our share of the Intergovernmental Transfer money pool, and we'll also have a significant increase in our revenues due to a Medicaid rate increase. So it was a program, I think, that first of all, from my perspective, appreciate the very strong support that the county board gave to it when they approved participation in the program. And secondly, from my perspective, an almost risk-free way for us to participate and realize enhanced revenues that will significantly help the bottom line of our operations and hopefully place us in a position, at least for the next couple of years, where it won't be necessary for us to ask for a levy to subsidize operations. So how more specifically does it relate to the consolidation project that we're involved with right now, as well as more specifically, what kind of dollars do you see coming to Sheboygan County if this is approved by the state and federal government? One of the advantages to our participation as one of the counties selected to participate in this wire transfer of monies is that our share of Intergovernmental Transfer funds will be enhanced because of our participation. And one of the criterion that was used by the state to select counties participating were those counties that were already actively involved in a phased-down program, and I mean phased-down, and what I mean by that is, we were voluntarily surrendering licensed beds. In our case, interestingly enough, the licensed beds we're surrendering are unoccupied, but some counties are actually surrendering licensed beds that are occupied. But because of that, we will be assured during our participation in the program during our phased-down period that all of the losses that we generate that are eligible losses under the Medicaid reimbursement formula will be reimbursed back to us. In dollar amounts, when you take the amount of additional dollars that the IGT program will generate and add to that the additional dollars that will be generated by the Medicaid rate increase, it should enhance our revenues at the Schwoding County Health Care Centers by about five to six million dollars over the next state biennium, so it's a substantial amount of money. It's a wonderful opportunity for the county. With the consolidation, $9 million in the work that's going there, with the activity now trying to draw more federal dollars to the county, I mean there's just a lot of positive things going on with our health care centers. Whenever you have this kind of change, certainly there's gonna be questions from personnel on how is this gonna affect me? And one of the concerns that we've heard is, are we gonna be looking at any possible layoffs as a result of the consolidation? What are your thoughts there? Well, at this particular juncture, what we have to do is examine not the fact that we're delicensing a number of beds because we're delicensing primarily beds that have no residents. What we have to do is we have to look at the number of people we still have to care for. The number of people we still have to care for unless for some disastrous, unknown, unpredictable reason our resident census takes a drastic drop in numbers, we're gonna be taking care of the same number of people a year from now that we're taking care of today. That means we're gonna need the same number of staff that we have today to take care of those people. So as I sit here right now, we do not anticipate that any staff members will be asked to be laid off. We do not anticipate that there will be any significant reduction in positions. I cannot guarantee to all staff that they will all be in the same locale, so to speak, that they might be now. I do anticipate there may be a small percentage of our staff who may be reassigned to another facility. And I say that in order to be honest and candid and frank. But I do not at this juncture anticipate that we'll have any layoffs or anyone who will lose employment, who continues to choose to stay employed. You touched on earlier some of the values of the consolidation and the broader continuum of care we're gonna have here. You've emphasized now that layoffs don't appear to be in the picture. And although people may have to move, certainly they don't have to worry about layoffs. That was one of the things early on that the county board thought we might see some savings and if we're not gonna see savings in the area of personnel, what cost savings do you think will occur as a result of the consolidation? Well, actually we are gonna see some major cost savings in the area of personnel, but not in a direct fashion. We're not going to necessarily see any significant reductions in wages or benefits, but we're gonna see some significant reductions in personnel related areas. Right now, because we're operating three facilities in three different locations, with a higher bed capacity than we need, we have a number of open positions that we continue to recruit for. Once we consolidate the chances of us needing as many people to fill the positions that we will need will minimize. So we will save a substantial amount of money in indirect personnel areas, such as the cost of recruiting, the cost of help-wanted advertising, those kinds of things should significantly decrease in the costs that we have to incur. Additionally, because we will be able to consolidate some of our services at the Rocky Knoll campus, we'll be able to save some operating expenses in that area. In other words, we will be able to have one dietary department to serve two facilities. We will be able to have one maintenance department to serve two facilities, one housekeeping department to serve two facilities. So there will be some effort to save because we'll be more concentrated and consolidated operationally. Again, does not mean we're not going to be cutting staff in those areas, but we will be able to save money because we'll have one rather than two operations. Very good. We've been talking for most of this half hour about the Rocky Knoll campus. We're also making some improvements at Sunny Ridge. Yes, we're just in a minute or two, just cover some of those improvements that we're making. Well, we're doing over a million dollars in renovation work at Sunny Ridge. A lot of it, most of it is cosmetic, new tile on the floors, redecorated hallways, those kinds of things, just a general building facelift. But one of the exciting things that we're also doing at Sunny Ridge is we're going to create a large courtyard in the back of the building for residents that can go out and stroll or just take a walk and relax, spend time with their families, which also adds to the aesthetics of the campus. We were talking just before we started taping the show that you've been here nearly a year now. And during that year, I'm sure you've been more than busy with all the things that have been happening. And we were talking about our immediate concerns, our facilities and the services we're providing. But now that you've had your first year in in Chewagon County and you see what we're doing with our facilities, any long-term goals or any, what is your vision for our healthcare centers in Chewagon County? Well, my anniversary date is February 28th. I'm just glad I didn't start on February 29th. I'd have to wait three more years for my first anniversary. But I am probably more excited now about being here than I was the day I started. This is a very, very special organization. In the private sector, the healthcare philosophy has changed significantly during my career. Quality care is not a consequence any longer of management philosophy. It's a mere coincidence. In our organization, quality care can be a consequence of our management philosophy. We really have, regardless of the differences, we may have politically amongst people who participate in the oversight. There's never been a question that the ultimate goal is to provide the best quality care possible. And that's what excites me. We're at the right place, at the right time in history to really create an organization that I believe eventually can become a national model for long-term care. Well, this project is scheduled to be finished in spring, late spring, early summer of next year. Right. My guess is that not only have you been on our show twice, but before spring of next year, we're probably gonna get you on again and we'll bring our viewers up to date on the progress of the consolidation, of the construction. And I don't know about the ability of our, of TVA, but maybe we can go out to the project and get some pictures out there. I would look forward to that. I would look forward to that. Bring those to our viewers and so that they can firsthand see what's going on out there and we'll wait till some warm weather. We don't wanna go out there today with our hard hats and freeze our ears off because it's a little cold today, but when the weather breaks a little bit and maybe we'll take some pictures out there and so that they can see what's going on and they don't have to go out there and get their shoes muddy. Well, that would be terrific. I would look forward to that. I know, Mr. Chairman, as well, that Gene has developed a newsletter that anyone can get on the mailing list and that's been a real effective means to get information out to people and if folks are interested in getting on that mailing list they should contact Gene or someone at our healthcare centers and we'll be sure to add them. But that's been greatly appreciated. Thank you. Well, next month we're going to have our personal director, Luala Conway, as our guest and we're going to talk about some of the things that go on in the personal office for an employer that employs 1,350 people and how it relates to our personal office. That's going to be our show for next week and we thank you for watching and we welcome your comments. Thank you.