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Rock County studying design for new nursing home

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Rock Haven residents

Pending federal law is forcing Rock County to take a look at the facility and plan for its future.

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JANESVILLE — “Please, have a seat.”

Beulah Rudolph gestures formally to a vinyl covered chair in her small room. She firmly shakes a visitor’s hand.

“Ms. Ames. Welcome. What would you like to talk about?”

The formality lasts for a moment. Then Rudolph starts telling stories. They roll out, one after another. Snapshots of rural life in Rock County.

“Ahhh, good memories,” she says.

For many Rock County residents, it’s hard to picture a county-run nursing home that doesn’t have long, dark halls and cinderblock walls.

That’s Rock Haven, and it looks exactly like what it is: a nursing home built in 1964 to serve 248 people.

Pending federal law is forcing Rock County to take a look at the facility and plan for its future.

By 2013, federal law will require nursing homes to have fire sprinkler systems, which Rock Haven doesn’t have.

After a 2009 study, the county board voted to hire an architect to create a schematic design for a new building, Director Sherry Gunderson has said.

“If I was rich instead of so darned good looking, I’d give half my money to my church and the other half to Rock Haven.”

That’s quite a commitment, seeing as the 80-year-old Rudolph has lived at Rock Haven only since 2007 and is a lifetime member of North Lima Presbyterian Church.

But Rudolph is grateful to live at Rock Haven and raves about the service.

“When we filled out a resident survey, I wrote that I don’t know enough good adjectives,” she says.

She’s not just grateful for her own care. Her husband, Warren, lives down the hall. The couple serve on the home’s resident council.

“The aides know what Warren needs before he says anything,” she says.

They also know when people want to care for themselves.

“If I can brag for just a minute, both Warren and I do our own wash,” Rudolph says.

In September, the Rock County Board will get its first look at plans for a new building. The board in October could direct an architect to continue refining plans.

Cost estimates will be very broad until the architectural plans are finalized. But a new building could cost between $18.8 million and $27.5 million, Administrator Craig Knutson said.

The new building would have one story and serve between 110 and 130 residents. All rooms would be private, and outpatient physical therapy would be available.

Not all patients have private rooms in Rock Haven today.

The county board has not voted to move forward toward construction, but board members are leaning in that direction, Chairman Russ Podzilini said.

“We could, in these tough economic times, say, ‘Let’s let it fall to the private sector,’” Podzilni said. “Our board is concerned about this particular element of our society and committed to caring for them.”

Rudolph would admit only one complaint about Rock Haven.

She nodded at the small air conditioner held in the window with a custom-made wooden panel. Parts of the building aren’t air-conditioned at all. At her age, the real problem is staying warm, she says.

Rudolph points out that she’s wearing a cardigan on an August day. And she’s not even that old, she says with a grin.

“I’ve got friends that are 102 and 90,” Rudolph says. “They’re always cold.”

Rock Haven serves 130 people in need of long-term care. Many have medical issues that doctors couldn’t imagine when Rock Haven was new.

“In 1964, we were not serving such ill people in nursing homes,” Gunderson said.

The population at Rock Haven typically is younger than at the average Wisconsin nursing home because of a number of patients who received traumatic brain injuries at a young age or who need care for progressive developmental disabilities, Gunderson said.

Rock Haven makes it a priority to serve residents who already have been getting county services, Gunderson said. People who are under the care of the county’s developmental disabilities board or human services board would “rise to the top” of the nursing home’s waiting list.

“The majority of county nursing homes care for very specialized populations,” said Sarah Diedrick-Kasdorf with the Wisconsin Counties Association. “They serve a very important role in the state’s continuum of care.”

An important part of weekly service at the North Lima Presbyterian Church was sitting behind Aunt Mary, who fed Rudolph and her sister peppermints to keep them quiet.

Rudolph doesn’t care that the people who volunteer to lead Rock Haven’s church services and Bible study have different religious beliefs than she does.

“I don’t care if they’re pink with polka dots,” Rudolph says. “It’s just good to share.”

To understand why county nursing homes typically have higher caseloads of sensitive patients, you need to know how nursing homes get paid.

The most common forms of payment for nursing care are Medicaid, Medicare and private insurance.

Medicaid is an assistance program that uses state, federal and local money to pay medical bills for low-income families. Patients usually do not pay or pay very little for services, according to U.S. Department of Health & Human Services data.

Medicare is an insurance program for the elderly, some people with disabilities and dialysis patients. It is a federal program and is the same anywhere in the United States.

The bottom line is this: Medicaid payments don’t cover the cost of care, Gunderson said.

For example, Rock Haven gets $157 of Medicaid per day to care for Medicaid patients, she said. Private pay patients are charged $292 per day, Gunderson said. That includes nursing care as well as other services such as therapy, lab work and pharmacy services.

Medicare rates vary based upon therapy and nursing needs, she said. Rates are typically $350 per day to cover all services, which leaves about $250 for nursing services, Gunderson said.

Private nursing homes often limit the number of Medicaid patients they serve because they couldn’t operate on Medicaid payments alone, Gunderson said.

Some private homes don’t accept Medicaid, she said.

In the average Wisconsin nursing home, 65 percent of the patients are on Medicaid. At Rock Haven, it’s 85 percent.

Rock Haven can afford to care for so many Medicaid patients because Rock County uses tax dollars to supplement the facility’s operation.

In 2010, the county budgeted $5.93 million in tax dollars to subsidize Rock Haven residents. The total budget was $15.69 million.

“That is a commitment of the county board over the years,” Gunderson said. “It’s a huge commitment. We would not survive without tax levy.”

Rudolph attended the one-room Morgan School for first- through eighth-graders in Lima Township.

After eighth grade, her dad spent $1.75 a week so she could ride the bus to Milton High School.

Actually, Dad spent $2. Rudolph got to keep the quarter as allowance.

She remembers showing her Shropshire sheep at the Rock County 4-H Fair, and she remembers the boy who bought her a soda at the fair.

“It was a whole dime then,” she says.

Once, Rudolph asked that boy to a girls-ask-boys dance at school.

His brother taught him dance steps in the barn.

In Wisconsin, 35 counties operate nursing homes. The slow trend is for counties to get out of the business, Diedrick-Kasdorf said.

However, Dane and Dodge counties have nursing homes under construction, she said.

Sauk County opened a new home in 2009, and Walworth County’s Lakeland Health Center opened in 2006, Diedrick-Kasdorf said.

Most of the counties in the southern two-thirds of the state operate nursing homes. One exception is Jefferson County.

On June 30, Jefferson County closed the sale of its 120-bed Countryside Home in Jefferson to Alden Group of Chicago for $8 million. The sale followed a failed 2009 referendum in which the county asked residents’ permission to exceed state-imposed tax levy limits for money to operate the home.

The county had budgeted $3.1 million for the home this year, Administrator Gary Petre said. The facility’s total operating cost was $12.4 million.

The county had operated a nursing home for 155 years. The current facility was built in 2003.

State law protects nursing home residents and prevents a buyer from forcing residents out, Petre said. So Alden Group is caring for the people who already were living in the home, Petre said.

The county board researched buyers to make sure residents would get quality care, he said.

On the other hand, Walworth County after much debate chose to stay in the nursing home business, said Bernie Janiszewski, the director of Lakeland Health Care Center.

In 2006, the county moved 120 residents into the new facility on the county campus in Elkhorn. The cost to build the facility was $14.3 million.

The one-story building with modern paint schemes and lots of windows looks a lot different than the aging Rock Haven.

At Lakeland, 75 percent of residents are Medicaid funded. The rest are on Medicare or private insurance.

Lakeland’s private pay rate is $255 per day.

The nursing home’s budget for capital expenses and operations in 2010 is $14.18 million, according to county data. The budget includes $3.6 million in tax levy.

“It’s a popular program in Walworth County,” Janiszewski said.

A pink curtain divides Rudolph’s small room in half. The bed on the other side was empty during the Gazette’s recent visit.

On the wall is an aerial photo of the small Lima Township farm where Rudolph grew up.

Her family smiles down from a shelf on the wall. In one photo, four of her five children stand with arms around each other’s shoulders. In another, Rudolph’s grandpa holds her and her sister. He wears a leather brimmed hat.

The shelf also holds a “thank you” plaque from Veterans Memorial Hospital, Madison, where Rudolph volunteered for 20 years.

Warren “really” volunteered at the hospital, she said. He would come home from a shift at the General Motors plant in Janesville, clean up and go to the hospital for six hours, she says.

When asked if Warren is a veteran, Rudolph responds, “Yes,” as enthusiastically as if it were possible to be more or less of a veteran.

The last time the Rock County Board reviewed a schematic design for a major construction project, it was for a $56.5 million expansion at the Rock County Jail.

While work is progressing on a $5.79 million jail upgrade as part of the project, jail diversion programs have lowered the jail population and made an expansion unnecessary.

But it’s not so easy to find alternatives when it comes to nursing care, Knutson said.

The industry has evolved so that many people who might have once been institutionalized now receive some care in their homes or live in group homes, Knutson said.

That’s left only the most medically sensitive people living in nursing homes, he said. Trying to create a home setting for some patients would not make sense, he said.

“More and more of the people who are in nursing homes really need to be there,” Knutson said. “To try and find alternatives for them … you’re basically creating an institution for one person.”

If Rock Haven didn’t exist, people with sensitive medical needs might have to move out of county for nursing care, Gunderson said. Or they might live in a more expensive facility such as the state run Mendota Mental Health Institute in Madison, Diedrick-Kasdorf said.

“My husband is Santa Claus.”

Rudolph chuckles and settles back into her wheelchair.

Warren is a veteran of World War II and served in the Philippines. Before he moved into Rock Haven, he spent more than 25 years playing Santa for children in the Edgerton area. He also had a Santa gig at East Towne Mall in Madison.

Rudolph visited Warren at Rock Haven twice a day before she had a stroke in 2007. She lost the strength in her left hand and wears a brace on her left leg.

She inches along in her wheelchair by pushing with her right foot.

Her hug is strong, however, when she says good-bye to a visitor. With her hand, she rubs the spot between the visitor’s shoulders.

“Feels good, doesn’t it?” she says. “That’s my trademark.”