While the operational takeover of Oak Hill will not be finalized until the beginning of December, the lease of the county-owned senior living and rehabilitation center to Accolade Healthcare began last Wednesday.

A special meeting of the Monroe County Board last Wednesday afternoon at the Monroe County Courthouse, beginning with public comment before adjourning to a closed session. 

Following this closed session, commissioners approved commencement of a five-year lease and consulting agreement with Accolade from Oct. 1 through Nov. 30.

Comments from the public varied, with most individuals – among them former Oak Hill employees – lobbing criticism at the board for, as they said, withholding information from the public or not seeking out alternatives to leasing the facility.

One speaker raised the issue of the county having charged Oak Hill for “overhead reimbursement” beginning in 2016.

The charges began as a way to offset county resources used to manage Oak Hill operations, such as the services of the Monroe County State’s Attorney and consideration of Oak Hill matters by county  commissioners.

The speaker pointed out that no other county department is charged a similar overhead charge.

Several county departments reimburse the county for insurance premiums or salary payments, but Oak Hill is the only “overhead” reimbursement listed on Monroe County budget documents since Fiscal Year 2016.

The budgets, available at monroecountyil.gov, indicate the “Nursing Home Overhead Reimbursement” was first collected in FY16 in the amount of $60,000.

In subsequent fiscal years, $30,000 was collected in 2017, $120,000 in 2018, $240,000 in 2019, $340,000 in 2020 and 2021, $250,000 in 2022 and 2023 and $100,000 in 2024, totaling about $1.75 million over 10 years.

An overhead reimbursement of $250,000 was requested for the current fiscal year. 

As of press time, commissioners George Green and Vicki Koerber had not responded to a request for comment on this matter.

Further critique honed in on the board’s agreement with Accolade, with some taking issue with Accolade’s management of low-rated facilities compared to Oak Hill which has consistently rated between four and five stars.

One question from the public concerned the county’s tax for Oak Hill, with Monroe County Clerk Jonathan McLean noting this tax will be suspended with the closure of the lease.

Among the last to speak was Anna Johnson, who has been serving as a contracted interim director of Oak Hill in recent weeks.

She emphasized her place as a neutral party separate from the board and Accolade, speaking in their defense.

Johnson spoke in favor of the board’s recent behavior surrounding Oak Hill, saying commissioners seem to be striving to maintain the facility and arguing that a board with many other responsibilities simply isn’t able to properly manage or oversee a care facility nowadays given the tremendous amount of nursing facility regulations that have been added over the years – especially in the years since the start of the COVID-19 pandemic.

On this matter, Johnson particularly noted how the board is not equipped to have identified the issues with Medicare billing that have come to light in recent months.

“I have talked personally with the person who found the problems, who looked at them, who figured out what had been going on,” Johnson said. “Do you know what that person told me? ‘There is no way that the county board or even the auditors would have found this because they don’t know what they’re looking at. They are not Medicare and Medicaid billers. They would not have caught it because they don’t understand.’”

She further spoke to the dire situation care facilities like Oak Hill have found themselves in since the start of the pandemic, with the relevant work force being drastically reduced.

Further, Johnson defended those Accolade facilities with poor ratings, arguing such facilities with a low rating have still seen improvement and suggesting Accolade has taken no-star facilities and built them up.

Referencing her experience in the field, she also argued that such ratings don’t paint a full picture of a facility’s capability. Though some facilities can receive glowing assessments, she said, any mistake or infraction can heavily impact their rating, even if the issue has been addressed and amended.

Ultimately, Johnson urged those present to “shift your thinking on this to the big picture,” reiterating her view that the board is striving to maintain Oak Hill.

“This has nothing to do with the deed to the property,” Johnson said. “This has to do with a board who has said, ‘We were elected, and we have this responsibility, and we recognize we don’t have the ability to do it.’”

The consulting agreement will allow Accolade to assist Monroe County with Oak Hill operations while approval of a required “certificate of need” is pending through the Illinois Health Facilities and Services Review Board.

The state board is scheduled to vote on Accolade’s certificate of need during its Nov. 18 meeting.

The lease agreement is required by the HFSRB as part of its issuance of a certificate of need.

A motion to authorize Green to execute the lease was approved during an Aug. 26 special meeting.

At the time, county officials anticipated the lease being enacted Oct. 1, although several setbacks since then led the involved parties to believe lease authorization would not be possible until November or December.

However, McLean told the Republic-Times he received word about 1 p.m. last Monday that all issues had been resolved, clearing a path for execution of the lease.

McLean previously explained that any changes at Oak Hill would need to begin on the first of the month due to payroll, billing and other considerations.

The unusual meeting time was due to a desire to begin the lease term on Oct. 1 while also satisfying requirements of the Illinois Open Meetings Act.

A public body that has a website must post any meeting agenda online at least 48 hours in advance. Since the agenda for last Wednesday’s meeting was posted on monroecountyil.gov shortly before 3 p.m. Sept. 29, the earliest the meeting could begin was 3 p.m. Oct. 1.

With the lease authorized, Accolade will still need to be issued a certificate of need to officially assume operations at Oak Hill.

As previously reported, a hearing to gather further public input on Accolade’s certificate of need application will be held from 4-7 p.m. Oct. 8, at the Monroe County Annex in Waterloo.

HFSRB representatives will be on hand during the hearing for the sole purpose of officially recording public comment to be considered during the Nov. 18 meeting. 

Monroe County and Oak Hill officials are not required to attend this meeting.  

Comments may also be submitted in writing for entry into the official record. 

All written public comments must be received by the board by Oct. 29. 

Comments may be mailed to “Illinois Healthcare Facilities and Service Review Board, 525 W. Jefferson Street (2nd Floor), Springfield, IL 62761.

Once all comments are documented, HFSRB staff will then release a report Nov. 5 which will be available online at hfsrb.illinois.gov.

Those wishing to comment on the Nov. 5 report’s findings may do so in writing, although submissions about that report must be received by Nov. 10. 

If the certificate is issued, the operational transfer of Oak Hill to Accolade is expected to begin Dec. 1.

During the five-year lease, county officials are planning to conduct periodic reviews of the state of business and quality of service at Oak Hill, although Accolade will then be responsible for all operational aspects of the facility.

Monroe County will retain its ownership of Oak Hill’s “real property” – namely the buildings and land – for the duration of the initial lease.

Accolade will pay $750,000 for use of the property and business operations with a 2 percent “rent escalator” increase for each of the four remaining years.

If all parties agree to enter into a second lease agreement, commissioners have stated a referendum would be placed on a ballot in 2030 or 2032 asking Monroe County voters if Oak Hill facilities and land should be sold to Accolade for $14 million.

Despite the lease being approved last Wednesday, commissioners submitted a legal notice for bid to repair the roof at Oak Hill. This notice appears on page 2C of this week’s issue of the Republic-Times.

The roof repairs were to be performed at the county’s expense per the lease agreement, McLean told the Republic-Times on Tuesday. 

McLean added the roof had some minor leaks recently, and a property inspection prior to lease authorization confirmed the need for repair.

Oak Hill is only one of a series of county-owned senior care facilities to be considered by the HFSRB in recent years.

The sale of county-owned facilities in Vermillion, Champaign and Stephenson counties were approved in 2013, 2018 and 2025, respectively. 

A June 19 report from WIFR News in Rockford states the Stephenson County sale was approved despite members of the community expressing concerns from residents. 

The sale of the Dekalb County Rehabilitation and Nursing Center was “terminated” in 2023 after the prospective buyer failed to address HFSRB concerns, according to an April 16, 2025, report by Crystal Lake-based news outlet Shaw Local.

The county recently settled a lawsuit against the would-be buyer. The county alleged monetary damages were sustained as a result of the buyer refusing to address the HFSRB concerns, thereby failing to complete the agreed-upon sale.