Stille Havn Hus I Long Term Phsychiatric Care I Walker, Minnesota

To enhance the quality of life of our residents by providing superior services in a light-hearted community guided by values of human dignity, mutual respect, and brotherly love.

Vision Statement
We will be the standard by which quality of living for individuals with serious and persistent mental illness is measured.

My name is Jim Rogen and in 2004 my team developed a 16 bed, long-term, care facility for middle aged and older individuals who suffer from Severe and Persistent (S&P) Mental Illness. I hope to explain in the next couple of pages why I got myself in this position.

It all started with being raised the son of a Lutheran minister and a social worker. They permanently warped my psyche so that I could only find satisfaction in working with the needy. Like many in the field, I started at 17 as an orderly in the neighborhood nursing home in St. Paul. I found the work satisfying, stimulating, and fun. To this day I remember telling my buddies that I had other friends that just happen to be 90 years old.

In college, at the University of Minnesota, I studied psychology and sociology. I got a student job across the river at Fairview Riverside Hospital as a psychiatric technician on their new adolescent psych unit. I had worked the summer I was 19 at Montana State Hospital on a maximum security unit due to the fact that my father knew the superintendent. The nursing home and state hospital experience got me the Fairview job. I worked there through school and stayed for 20 years.

During that time Fairview expanded from three psych units to eight. Most of my time was spent on the secure adult units. My duties covered everything from keeping the milieu safe to admitting new residents. From assisting with a shower to counseling concerned loved ones. From physical take downs to comforting hugs. From orienting new staff to sharing my personal struggles with a patient in order to build trust. From being a superb team player to being viewed as a pragmatic maverick. From laughter to tears.

I found the work satisfying and meaningful. Some other staff burned out, I didn't. I met my wife Ann of 20 years at Fairview. She is an RN with the bulk of her experience in psych. We have two sons. The youngest still lives at home. Some of my highest highs and lowest lows have been as a father.

My building maintenance skills started with our purchase 24 years ago of a run down, three story, Victorian in a good neighborhood in St. Paul. I improved the property as time and money allowed. Nineteen years ago we bought the duplex next door to our house. More rehab and repair. As another way of learning more about buildings I attended some classes on building maintenance at Northeast Technical in White Bear Lake.

We moved to Walker in 1996 to be closer to my side of the family. Ann worked part time at Grand Rapids Hospital and I opened Rogen's home and Cabin Maintenance. I also bought an old rundown hotel on Shingobee Island outside Walker. Over the next year I rehabbed that property bringing six apartments on line over a 12 month period.

We bought a four acre parcel in Walker in 1997 that we developed into a 26 unit assisted living for seniors called May Creek Lodge. We opened the doors in 1999 with Ann as the Director. I was the primary developer and general contractor of that $2.3 million project. Gross revenues are in the area of $600,000 with a payroll of about $400,000. Occupancy has been stable for the last seven years.

While developing May Creek I approached the local sheltered workshop for developmentally disabled to see if they would be interested in helping with the housekeeping at May Creek. The Director, Dave Terdan, said he would love to but he did not have enough workers because of the lack of housing in the area. That conversation led to the opening of Shingobee Island Lodge in May 2000. Shingobee is an adult foster care group home with 24 shift staff. We now serve nine adults with developmental disabilities. We opened with a capacity of four and filled with in one month. One year later, after more rehab, we added capacity for four more and filled those in three months. Shingobee has gross revenues and payroll numbers similar to May Creek. First National Bank of Walker financed both of these projects with Todd Schoeck acting as lead.

In January 2003 I promoted a gentleman to clinical director at Shingobee. This freed me up from much of my day to day responsibilities. One of the ideas I wanted to explore was an expansion of services. After some soul searching I came to the conclusion that I really enjoy the challenges and creative process of developing a new business.

In doing my research it became increasingly apparent that there was a significant need for community based residential service for people with serious and persistent mental illness. These are my kind of people. Several others of my key staff also have strong mental health backgrounds.

This need for more residential housing options arises from a 1999 Federal Supreme Court ruling called the Olmsted Law. This ruling came from two women in New England living in a state hospital who felt they should be offered some type of choice as to where they receive services for their S&P mental illness. In the next couple of years the federal government created significant financial incentives for the development of more home like alternatives for these needy people.

The specific incentive, now in place, is that for facilities that have 16 beds or fewer the federal government will pay half the cost of their care. They are using Medicaid dollars via a medical assistance classification. Some additional dollars come from SSI due to disabilities. Right now the cost of care for individuals at Ah-Gwah-Ching or Brainerd Regional Treatment Center is 90% paid by the State and 10% paid by the home county. These daily rates vary from about $275 to $475 plus per day.

My long term care facility is charging an average of $265 per day for services. There is an additional Room and Board charge of $776 per month called the Group Housing Rate. I based these numbers on discussions with other providers outside my market area, Cass County, the MN Department of Health, and my own projected costs. The cost to the State will be cut in half due to federal participation. The cost to the Home Counties will also drop. To further encourage the counties to find alternative housing to state operated facilities as of July 1, 2004 the counties share was increased from 10% to 20%. This surcharge was implemented by the State.

The state and the county are supportive of this project. The licenses that were granted by Tim Crawford of Cass County are Rule 203 Adult Foster Care. This decision was made in consultation with the Department of Human Services of the State of MN. These are the same types of licenses I have for Shingobee Island Lodge. We are familiar with their requirements.

The name of my project is Stille Havn Hus which means "Calm Harbor House" in Norwegian. On March 3rd, 2004 I closed on a 23 acre site 1 ½ miles from downtown Walker. I wanted some acreage for privacy, but not too far from town. The proximity to town helps with convenience issues and easier exposure of our residents to the community.

I chose land in the Walker designated JOBZ economic development parcel. The details for the classification were concluded the spring of 2004. The primary business incentives are a waiving of State sales and income tax for twelve months. In return, I pledged to crate 20 FTE's jobs in two years at an average wage of $12.50/hour.

The land is gently rolling and wooded. We cleared the middle nine acres, leaving a substantial natural border around the site. We have built four 4 bedroom group homes fanning out from a common activity/office building. These are all connected under one roof by four season breezeways. The homes are wheelchair friendly Ramblers with single occupancy bedrooms. The décor and furnishings is comparable to Shingobee Island. That means warm and homey with plenty of decorating of an up-north style. It is a far cry from the institutional settings most of these people have been in for decades.

The buildings are top of the line modular built by All American Homes in Dyersville Iowa. The nature of the separate buildings lent itself well to the modular approach. I am very pleased with the quality of the product and service. The project has approximately 9,000 finished square feet. There is an additional 6,000 square feet of walk-out style basements that have been finished with apartments and offices. There is an unheated five stall detached garage. The grounds have been landscaped with flower and vegetable gardens. We have excavated for two ponds with a connecting creek. All drives and parking areas are paved. I was the general contractor with Village Homes of Walker acting as the project managers.

As important as nice location, buildings and grounds is the philosophy. We are primarily focusing on quality of life issues rather than life skills. The majority of the residents coming to Stille Havn Hus have been very disabled for decades. These are the people that have not responded to advances in therapy and medication. The likelihood of any of them succeeding in anything resembling an independent living setting is remote. In my mind what they will respond to is an accepting environment that respects and admires them for being the brave survivors of major mental illness that they are. Give them a nice place with meaningful activities filled with brotherly love. Hugs are a good thing.

Our site lends itself to a broad variety of activities. In addition to indoor activities, we are involved in therapeutic gardening, some small animal husbandry, and boating and fishing as the residents tolerate. We have a waterfront with boats at Shingobee. We are providing some employment on site for those capable. The critical mass of the residential program supports our day program. To help facilitate exposure to the community a sedan, a cross over, and a minivan is dedicated to the site. The 15 passenger, May Creek Lodge, wheelchair bus is available on an as needed basis. To give some context our vehicles at Shingobee average 3,000 miles per month servicing our nine residents on the Island.

I am budgeting for 6-8 staff during the waking hours and 4 staff at night. This requires about 25 FTE's resulting in a payroll of approximately $850,000 a per year. The pay range is from $9.50 to $32.00 per hour. The majority of these are benefited positions. There is an RN on duty every day. We staff our own day program as none is available in the area. Psychiatric coverage is handled by two psychiatric nurse practitioners. MeritCare Clinic in Walker handles our medical needs. Dr. Peterson is on site every month. When needed, blood draws are on-site

Most of my team is people I've known or employed for years. It is the depth and quality of this team has allowed us to attain the level of quality these resident and their loved ones deserve. The advanced practice psychiatric nurses have worked at Ag-Gwah-Ching for years. My general manager has been with me since 2001 bringing strong psych and training skills. I have a solid business attorney, accountant, and bookkeeper.
What is our competition? At this point, not much. There are a handful of small group homes in the region that accept S&P mentally ill people. Most of these mix in developmentally disabled. That is a mistake. It's "apples and oranges". Some nursing homes accept older stable individuals with few active symptoms. Most are transferred back to the State Operated Services as soon as they act a little strange. Ah-Gwah-Ching and Brainerd's RTC have closed. These services are to be replaced by projects like mine. To support these community based providers several 16 bed acute care psychiatric hospitals are being built. These will be State Operated with the closest in Bemidji and another in Baxter.

Stille Havn Hus is the first of its kind in Northern Minnesota. We are accepting individuals with significant psychiatric and medical problems. We expect odd behavior. We plan for aging in place. We are set up to handle those that others don't want. An added reason is this is my favorite population to work with. As of today, 1-27-09, we have one open bed. Our residents range in age from 48 to 75 years old. Most have come from other community settings with seven coming from state operated facilities. We do business with 14 counties in the region. We have built three supported living apartments in our walkouts.

One of the reasons we are targeting those of middle age and older is that younger people are likely to feel constrained in our small town. An additional reason is our target population allows for more stable occupancy at higher fees. In short, it's a more predictable and viable business model.

We opened the doors November of 2004. We are making every effort to have Still Havn Hus a facility we can all be proud of. A fact that we are very proud of is our low rate of re-hospitalization. We have had three psych hospitalizations in four years. This helps make us a cost effective option for the hard to place individual. The facility is being well received by the residents and their loved ones. Most of our residents are gradually improving. I think the place is a hoot!



PHILOSOPHY & HISTORY Mission Statement To enhance the quality of life of our residents by providing superior services in a light-hearted community guided by values of human dignity, mutual respect, and brotherly love. Vision Statement We will be the standard by which quality of living for individuals with serious and persistent mental illness is measured. Core Values Excellence of service We are all bound together by a common humanity Everyone has a unique value Creating a sense of belonging and community Enhancing quality of life Stille Havn Hus has respect for: Quality of life Common humanity Gifts and limitations Individuals unique value Individual choice Creating a sense of belonging and community HISTORY My name is Jim Rogen and in 2004 my team developed a 16 bed, long-term, care facility for middle aged and older individuals who suffer from Severe and Persistent (S&P) Mental Illness. I hope to explain in the next couple of pages why I got myself in this position. It all started with being raised the son of a Lutheran minister and a social worker. They permanently warped my psyche so that I could only find satisfaction in working with the needy. Like many in the field, I started at 17 as an orderly in the neighborhood nursing home in St. Paul. I found the work satisfying, stimulating, and fun. To this day I remember telling my buddies that I had other friends that just happen to be 90 years old. In college, at the University of Minnesota, I studied psychology and sociology. I got a student job across the river at Fairview Riverside Hospital as a psychiatric technician on their new adolescent psych unit. I had worked the summer I was 19 at Montana State Hospital on a maximum security unit due to the fact that my father knew the superintendent. The nursing home and state hospital experience got me the Fairview job. I worked there through school and stayed for 20 years. During that time Fairview expanded from three psych units to eight. Most of my time was spent on the secure adult units. My duties covered everything from keeping the milieu safe to admitting new residents. From assisting with a shower to counseling concerned loved ones. From physical take downs to comforting hugs. From orienting new staff to sharing my personal struggles with a patient in order to build trust. From being a superb team player to being viewed as a pragmatic maverick. From laughter to tears. I found the work satisfying and meaningful. Some other staff burned out, I didn't. I met my wife Ann of 20 years at Fairview. She is an RN with the bulk of her experience in psych. We have two sons. The youngest still lives at home. Some of my highest highs and lowest lows have been as a father. My building maintenance skills started with our purchase 24 years ago of a run down, three story, Victorian in a good neighborhood in St. Paul. I improved the property as time and money allowed. Nineteen years ago we bought the duplex next door to our house. More rehab and repair. As another way of learning more about buildings I attended some classes on building maintenance at Northeast Technical in White Bear Lake. We moved to Walker in 1996 to be closer to my side of the family. Ann worked part time at Grand Rapids Hospital and I opened Rogen's home and Cabin Maintenance. I also bought an old rundown hotel on Shingobee Island outside Walker. Over the next year I rehabbed that property bringing six apartments on line over a 12 month period. We bought a four acre parcel in Walker in 1997 that we developed into a 26 unit assisted living for seniors called May Creek Lodge. We opened the doors in 1999 with Ann as the Director. I was the primary developer and general contractor of that $2.3 million project. Gross revenues are in the area of $600,000 with a payroll of about $400,000. Occupancy has been stable for the last seven years. While developing May Creek I approached the local sheltered workshop for developmentally disabled to see if they would be interested in helping with the housekeeping at May Creek. The Director, Dave Terdan, said he would love to but he did not have enough workers because of the lack of housing in the area. That conversation led to the opening of Shingobee Island Lodge in May 2000. Shingobee is an adult foster care group home with 24 shift staff. We now serve nine adults with developmental disabilities. We opened with a capacity of four and filled with in one month. One year later, after more rehab, we added capacity for four more and filled those in three months. Shingobee has gross revenues and payroll numbers similar to May Creek. First National Bank of Walker financed both of these projects with Todd Schoeck acting as lead. In January 2003 I promoted a gentleman to clinical director at Shingobee. This freed me up from much of my day to day responsibilities. One of the ideas I wanted to explore was an expansion of services. After some soul searching I came to the conclusion that I really enjoy the challenges and creative process of developing a new business. In doing my research it became increasingly apparent that there was a significant need for community based residential service for people with serious and persistent mental illness. These are my kind of people. Several others of my key staff also have strong mental health backgrounds. This need for more residential housing options arises from a 1999 Federal Supreme Court ruling called the Olmsted Law. This ruling came from two women in New England living in a state hospital who felt they should be offered some type of choice as to where they receive services for their S&P mental illness. In the next couple of years the federal government created significant financial incentives for the development of more home like alternatives for these needy people. The specific incentive, now in place, is that for facilities that have 16 beds or fewer the federal government will pay half the cost of their care. They are using Medicaid dollars via a medical assistance classification. Some additional dollars come from SSI due to disabilities. Right now the cost of care for individuals at Ah-Gwah-Ching or Brainerd Regional Treatment Center is 90% paid by the State and 10% paid by the home county. These daily rates vary from about $275 to $475 plus per day. My long term care facility is charging an average of $265 per day for services. There is an additional Room and Board charge of $776 per month called the Group Housing Rate. I based these numbers on discussions with other providers outside my market area, Cass County, the MN Department of Health, and my own projected costs. The cost to the State will be cut in half due to federal participation. The cost to the Home Counties will also drop. To further encourage the counties to find alternative housing to state operated facilities as of July 1, 2004 the counties share was increased from 10% to 20%. This surcharge was implemented by the State. The state and the county are supportive of this project. The licenses that were granted by Tim Crawford of Cass County are Rule 203 Adult Foster Care. This decision was made in consultation with the Department of Human Services of the State of MN. These are the same types of licenses I have for Shingobee Island Lodge. We are familiar with their requirements. The name of my project is Stille Havn Hus which means "Calm Harbor House" in Norwegian. On March 3rd, 2004 I closed on a 23 acre site 1 ½ miles from downtown Walker. I wanted some acreage for privacy, but not too far from town. The proximity to town helps with convenience issues and easier exposure of our residents to the community. I chose land in the Walker designated JOBZ economic development parcel. The details for the classification were concluded the spring of 2004. The primary business incentives are a waiving of State sales and income tax for twelve months. In return, I pledged to crate 20 FTE's jobs in two years at an average wage of $12.50/hour. The land is gently rolling and wooded. We cleared the middle nine acres, leaving a substantial natural border around the site. We have built four 4 bedroom group homes fanning out from a common activity/office building. These are all connected under one roof by four season breezeways. The homes are wheelchair friendly Ramblers with single occupancy bedrooms. The décor and furnishings is comparable to Shingobee Island. That means warm and homey with plenty of decorating of an up-north style. It is a far cry from the institutional settings most of these people have been in for decades. The buildings are top of the line modular built by All American Homes in Dyersville Iowa. The nature of the separate buildings lent itself well to the modular approach. I am very pleased with the quality of the product and service. The project has approximately 9,000 finished square feet. There is an additional 6,000 square feet of walk-out style basements that have been finished with apartments and offices. There is an unheated five stall detached garage. The grounds have been landscaped with flower and vegetable gardens. We have excavated for two ponds with a connecting creek. All drives and parking areas are paved. I was the general contractor with Village Homes of Walker acting as the project managers. As important as nice location, buildings and grounds is the philosophy. We are primarily focusing on quality of life issues rather than life skills. The majority of the residents coming to Stille Havn Hus have been very disabled for decades. These are the people that have not responded to advances in therapy and medication. The likelihood of any of them succeeding in anything resembling an independent living setting is remote. In my mind what they will respond to is an accepting environment that respects and admires them for being the brave survivors of major mental illness that they are. Give them a nice place with meaningful activities filled with brotherly love. Hugs are a good thing. Our site lends itself to a broad variety of activities. In addition to indoor activities, we are involved in therapeutic gardening, some small animal husbandry, and boating and fishing as the residents tolerate. We have a waterfront with boats at Shingobee. We are providing some employment on site for those capable. The critical mass of the residential program supports our day program. To help facilitate exposure to the community a sedan, a cross over, and a minivan is dedicated to the site. The 15 passenger, May Creek Lodge, wheelchair bus is available on an as needed basis. To give some context our vehicles at Shingobee average 3,000 miles per month servicing our nine residents on the Island. I am budgeting for 6-8 staff during the waking hours and 4 staff at night. This requires about 25 FTE's resulting in a payroll of approximately $850,000 a per year. The pay range is from $9.50 to $32.00 per hour. The majority of these are benefited positions. There is an RN on duty every day. We staff our own day program as none is available in the area. Psychiatric coverage is handled by two psychiatric nurse practitioners. MeritCare Clinic in Walker handles our medical needs. Dr. Peterson is on site every month. When needed, blood draws are on-site Most of my team is people I've known or employed for years. It is the depth and quality of this team has allowed us to attain the level of quality these resident and their loved ones deserve. The advanced practice psychiatric nurses have worked at Ag-Gwah-Ching for years. My general manager has been with me since 2001 bringing strong psych and training skills. I have a solid business attorney, accountant, and bookkeeper. What is our competition? At this point, not much. There are a handful of small group homes in the region that accept S&P mentally ill people. Most of these mix in developmentally disabled. That is a mistake. It's "apples and oranges". Some nursing homes accept older stable individuals with few active symptoms. Most are transferred back to the State Operated Services as soon as they act a little strange. Ah-Gwah-Ching and Brainerd's RTC have closed. These services are to be replaced by projects like mine. To support these community based providers several 16 bed acute care psychiatric hospitals are being built. These will be State Operated with the closest in Bemidji and another in Baxter. Stille Havn Hus is the first of its kind in Northern Minnesota. We are accepting individuals with significant psychiatric and medical problems. We expect odd behavior. We plan for aging in place. We are set up to handle those that others don't want. An added reason is this is my favorite population to work with. As of today, 1-27-09, we have one open bed. Our residents range in age from 48 to 75 years old. Most have come from other community settings with seven coming from state operated facilities. We do business with 14 counties in the region. We have built three supported living apartments in our walkouts. One of the reasons we are targeting those of middle age and older is that younger people are likely to feel constrained in our small town. An additional reason is our target population allows for more stable occupancy at higher fees. In short, it's a more predictable and viable business model. We opened the doors November of 2004. We are making every effort to have Still Havn Hus a facility we can all be proud of. A fact that we are very proud of is our low rate of re-hospitalization. We have had three psych hospitalizations in four years. This helps make us a cost effective option for the hard to place individual. The facility is being well received by the residents and their loved ones. Most of our residents are gradually improving. I think the place is a hoot!

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