Consultants tell Rock County Rock Haven can be viable but must fix staffing, payroll and admissions policies

Consultants from Health Dimensions Group told the Rock County Board of Supervisors on Nov. 14 that Rock Haven, the county-operated nursing home in Janesville, remains a competitive facility with recent quality improvements but faces structural problems that must be fixed to restore financial health.

Brian Ellsworth, vice president for public policy and payment transformation at Health Dimensions Group, said the long‑term care sector experienced a “perfect storm” during and after the COVID‑19 pandemic that depressed nursing‑home use and tightened the workforce. His firm projected the local elderly population that drives Rock Haven demand will grow about 17% over five years and identified demand for roughly 60 assisted‑living units and 33 memory‑care units in the market.

The nut of the report, HDG said, is operations and workforce. The consultants found Rock Haven’s physical plant and quality ratings were strengths — the facility’s federal quality rating recently rose from three to four stars — but they flagged high operating costs driven by overtime (estimated at about 19% of salaries) and generous fringe benefits (reported at 57.9% of salary compared with county and non‑county peers). “Those are important cost drivers,” Kathy Carr, HDG vice president for clinical services, said during the presentation.

HDG recommended a three‑part approach: a prioritized set of expense and operational process changes; reopening the Limestone East unit and consolidating short‑term rehab there to improve census; and a disciplined, systematic implementation process. The consultants said selected scenarios in the report, combined with cost cuts and reopening the unit, could generate a positive margin in the range of 7–13%, but they emphasized the plan’s success depends on solving staffing constraints.

Board members pressed HDG on specific policies. Supervisor Schultz asked about the county’s practice of hiring many staff at a 0.7 FTE level that can produce overtime incentives; HDG recommended reviewing FTE structures, tightening overtime controls and improving onboarding timelines (onboarding was reported to take 45–60 days in some cases). HDG also urged an on‑site HR representative empowered to act quickly, saying local control and day‑to‑day authority are essential to recruiting and retention.

Several supervisors raised marketing and admissions policy. HDG explained the IRIS program (self‑directed personal care) shifted some workers into home‑based care and suggested digital marketing to recruit both staff and residents. On the county‑resident admissions restriction, HDG recommended replacing a blanket prohibition on out‑of‑county admissions with a prioritized, nuanced policy that protects county residents while allowing revenue‑generating placements if needed.

The consultants pointed to several quality and billing issues that affect revenue, including falls and higher infection rates that reduce Medicare reimbursement. HDG recommended fixing internal processes, strengthening payroll and billing controls, and increasing employee engagement through up‑to‑date surveys and regular wage‑scale reviews.

HDG estimated the current projected operating loss for Rock Haven in 2024 at just shy of $3 million, down from roughly $4.8 million in 2022, and said the recommended changes would likely take 12 to 24 months to implement fully. The board did not take a final action on implementation during the meeting; supervisors asked staff to review the report and follow up.