The current market leaders could run into some challengers.
The former administrator of Sunnycrest Manor said she did resign the post she held for about six years.
But she had little choice, she told TH Media on Monday.
Cathy Hedley said she was given two choices on Jan. 29 - resign or be fired.
"I was told that the county didn't want me working (at Sunnycrest) anymore, and they would allow me to resign and stay until Feb. 1," she said. "I felt like I was kicked in the gut."
Hedley worked in a number of roles at the county-owned care facility over the course of 32 years. But on Jan. 29, county Personnel Director Mary Ann Specht showed up alone to her office, handed her a pre-typed resignation letter to sign and laid out her two options, Hedley said.
Hedley said she didn't even have time to consult her husband, who was at work at the time.
When contacted by TH Media on Monday, Specht declined to answer questions, saying the matter was a personnel issue. The three members of the Dubuque County Board of Supervisors also declined comment.
More than a month after her departure, Hedley said she was very upset by the Jan. 29 ultimatum, which came as a shock to her.
She recalled making a decision to resign in order to keep her health insurance for another 30 days, as her husband has a disability. Her last day at the facility was Jan. 31.
"I didn't know what to do," she said. "I signed the letter because I had to think about my family."
Hedley's departure came two weeks after county supervisors were critical of Sunnycrest's financial situation. In a Jan. 17 presentation of Sunnycrest's draft fiscal year 2015 budget, county supervisors took aim at Hedley's budget forecast and questioned why the facility was projected to go over its fiscal 2014 budget.
Her departure also came just days before a consultant hired by county supervisors started on-site work at Sunnycrest. The supervisors hired Health Dimensions Group to look into the facility's operations and finances to identify any cost savings or potential revenue sources to cut down on the average $3 million in taxpayer support the facility receives yearly.
Hedley said she previously expressed her support of hiring HDG to evaluate Sunnycrest and offer any suggestions to keep the facility open and serving county residents. She said she thought HDG staff would work toward what was best for Sunnycrest, and she hoped their input would help the supervisors understand health-care financing and operations of a long-term care facility.
In the wake of Hedley's departure, an HDG consultant is serving as the facility's interim administrator.
In addition to losing her job, Hedley said she and her husband also lost their home.
They had lived in a house on the Sunnycrest property offered as part of the administrator's position, and she was given a month to find a new place to live.
She said the county's Hospital Board of Trustees gave her an extension to stay while she and her husband closed on a new house. They hope to move out to their new home after Friday, she said.
Hedley said she has consulted an attorney about recourse against the county, though she did not know if she would pursue the matter.
Leo Kennedy, a member of the Hospital Board of Trustees, said he was upset at how the supervisors treated Hedley after her years of service. He said she committed no misconduct in her position to merit an abrupt end to her tenure.
"They really put her over a barrel for no reason," he said. "It was hard to understand why they needed to kick her out without at least an attempt to let her work with HDG."
In a letter published Monday in the TH, Kennedy chastised the supervisors and commended Hedley for her years at Sunnycrest.
Hedley said she appreciates the support she has received from her colleagues, though it takes on a bit of a morbid tone.
"It feels like my wake, like people are mourning," she said. "I thought I would be able to celebrate my retirement in two years ... not leaving in shame."