Rock County supervisors review consultant recommendations to stabilize Rock Haven nursing home

The Rock County Board of Supervisors on Tuesday heard a presentation of consultant findings and committee recommendations on Rock Haven, the county-owned nursing home, and discussed steps to address staffing shortfalls, the financial burden on taxpayers and whether to reopen an unused wing of the facility.

Consultants’ recommendations and an ad hoc committee report were presented to the board by county staff including Randy Terrones, who summarized the history of Rock Haven, and by Natalie, the nursing home administrator. The Health Dimensions Group report presented last fall contains more than 80 recommendations covering operations, staffing, financial management and marketing, and the county’s ad hoc committee said it is generally supportive of the consultant recommendations.

Why it matters: Rock Haven has operated with a reduced census and elevated costs for contracted agency staff for several years, prompting concern about sustainability and the size of the county tax levy used to subsidize the home. Board members pressed staff for timelines, benchmarks and follow-up information to measure whether any investments or policy changes improve operations and reduce the county subsidy.

Board discussion and staff presentation

Randy Terrones told the board the county must decide “are you gonna be in this business in the future?” and, if so, what investments and structure should be used. He described Rock Haven’s history and finances, saying the 2025 budget shows about $19 million in total operating expense with roughly $2.5 million covered by the county tax levy — “just under 12% of the total expenses,” he said. He also recounted that the county used about $1.2 million in ARPA funds in prior years and that consultants retained since 2015 cost the county about $227,000.

Natalie, the nursing home administrator, summarized operational barriers the facility faces: staffing shortages that have kept a 32-bed wing empty since January 2022, high costs for agency (temporary) staff and recruitment challenges. “We’re spending a million dollars on agency, and they come in maybe 1 day, and they’ll sign up to say, okay. I’m gonna come in day 2. And if they don’t, we’re scrambling,” she said during the meeting.

The report and presenters identified several specific options and near-term proposals that the board could consider: targeted incentive pay for direct-care staff (a $2-an-hour incentive for RNs/LPNs/CNAs and a $5-an-hour weekend-only premium for certain positions was discussed by staff as examples from the consultant), converting some part-time positions to full time to stabilize schedules and benefits, relocating certain administrative “work rules” to the Health Services Committee to speed decisions, and embedding human resources capacity closer to Rock Haven operations to shorten hiring timelines.

Reopening the closed wing

The board debated whether to reopen the 32-bed wing that has been idle since January 2022. Natalie said the beds remain certified for Medicare/Medicaid but that the county lacks enough permanent staff to staff that wing; it could be staffed with agency personnel, but that would raise costs and risk regulatory citations. She told supervisors the county does have referrals from within Rock County sufficient to fill beds if staffing and care capacity were available.

Supervisor Garret Schwartz asked how quickly the wing could be reopened; Terrones and Natalie said a timeline depends on which consultant recommendations the board authorizes and on benchmarks tied to recruitment and admission numbers. Terrones recommended setting specific performance metrics if the board approves pay increases or authority changes (for example, “within 3 months, we’re gonna increase staffing by 20% and increase our recruitment to get this many patients in the wing”).

Costs, pay and alternatives

Supervisors pressed staff on per-resident cost and budget details. Natalie and Terrones provided context: the county budgeted for 90 residents in 2025 and the facility’s budgeted operating expense is roughly $19 million; the facility’s current census was reported at about 91 residents at the time of the meeting. Terrones noted the building debt service will be paid off in 2026, which will factor into longer-term choices about use of the building.

Several supervisors urged higher wages rather than or in addition to recruitment or signing bonuses, noting temporary agency staffing can be extremely costly. Supervisor Fuglseth warned about a longstanding scheduling policy that paid time-and-a-half to part-time employees who picked up shifts and said that policy can create budget distortion and animosity between staff categories: “When you have part time employees and a policy where if you pick up an extra shift, you automatically get time and a half, it is ripe for abuse.”

Board directions and next steps

No formal policy decisions or votes on the consultants’ recommendations were taken during the meeting. The board asked staff to provide more detailed follow-up information, including a status dashboard showing which of the roughly 80 recommendations are implemented, in process or not pursued; a breakdown of current census by payer (private pay, Medicare, Medicaid and Medicaid-pending); the exact counts of full-time and part-time staff by role; historical operating costs (including comparisons to prior years such as 2015) and national benchmarks; and options and legal constraints if the county decides to admit non–Rock County residents. The board set a deadline for supervisors to submit additional questions by July 7; staff said they would collect questions, provide estimated ETAs for answers, and distribute consolidated responses to the full board.

What was not decided

The board did not vote to reopen the wing, change wage schedules, or adopt consultant recommendations at this meeting. Several supervisors said they support keeping Rock Haven open and exploring options to make it sustainable; others emphasized caution, performance metrics and the need for more detailed fiscal analysis before authorizing any expanded spending.

Ending

County staff and committee chairs said they will return with supplemental data and a sequencing plan for committee review. Supervisors and staff agreed to continue the discussion in committee meetings and to use the July 7 deadline for written follow-up questions so the board can consider data-driven benchmarks before making formal decisions.