2009 QUALITY AND SOCIAL RESPONSIBILITY REPORT

Transcription

1 2009 QUALITY AND SOCIAL RESPONSIBILITY REPORT

2 Each year, more than 8.5 million people 23,000 a day are discharged from short-term acute care hospitals and require some form of post-acute care. CONTENTS About Kindred Healthcare...4 A Case Study: The Kindred Post-Acute Care Continuum...6 Quality Care Across the Continuum...8 Long-Term Acute Care Hospitals Nursing and Rehabilitation Centers Peoplefirst Rehabilitation Investing in Our People...20 Kindred s Economic and Community Impact...22

3 POST-ACUTE CARE The most common hospital setting in America is one that provides short-term acute care for patients with pressing health issues emergencies or surgeries brought on by illness or an accident. The immediate objective is to stabilize the patient and begin the recovery process. For many of these patients, however, a quick recovery is unrealistic they are too sick and they need continued specialized care and extended recovery time. They need continuing post-acute care. They need Kindred Healthcare. Kindred Healthcare understands that when people need postacute care, they are faced with a multitude of choices. To meet the individual needs of these often medically complex patients, we offer healthcare services in a variety of settings. Through our hospitals and nursing and rehabilitation centers we provide long-term acute care, transitional rehabilitation or subacute care, and skilled nursing services, including dementia and Alzheimer s care. The result is quality, cost-effective patient care with outstanding clinical outcomes. 117,820 PATIENTS AND RESIDENTS WERE ADMITTED TO KINDRED HOSPITALS AND NURSING AND REHABILITATION CENTERS IN ,915 (54%) WENT HOME OR TO A LOWER LEVEL OF CARE AFTER AN AVERAGE STAY OF 32 DAYS, AND 90% WOULD RECOMMEND KINDRED AGAIN FOR CARE.

4 Kindred Healthcare is 54,100 dedicated employees taking care of over 32,000 patients and residents every day in 621 sites of service in 41 states. Mo s t m i r e d Ad m i r e d Ad s t Healthcare Companies in the World, Mo Fortune Magazine 2009 and About Kindred

5 KINDRED HEALTHCARE Kindred Healthcare s mission is to promote healing, provide hope, preserve dignity and produce value for each patient, resident, family member, customer, employee and shareholder we serve. HOSPITALS (83) NURSING AND REHABILITATION CENTERS (222) PEOPLEFIRST REHABILITATION EXTERNAL CUSTOMERS (316) As of December 31, About Kindred

6 LONG-TERM ACUTE CARE A CASE STUDY AN ILLUSTRATION OF KINDRED S POST-ACUTE CARE CONTINUUM Chrissy was admitted to Kindred Hospital Arizona Tucson on a ventilator with a diagnosis of atypical Guillain-Barré syndrome a disorder affecting the nervous system resulting in severe physical fatigue and pain. When admitted, she was dependent on a ventilator to breathe, and our interdisciplinary care team of doctors, nurses and therapists went to work. Chrissy s pulmonary muscle strength and pain management were a serious challenge. The team of doctors, nurses and Peoplefirst Rehabilitation therapists began working together to wean Chrissy from the ventilator while managing her pain. They worked for two months before she could tolerate 11 straight hours breathing on her own off the ventilator. Upon discharge her speechlanguage functional score went from a 1 (on a 1-7 scale) to a 3. THE POST-ACUTE CARE CONTINUUM Kindred offers services across the post-acute care continuum through our long-term acute care (LTAC) hospitals and nursing and rehabilitation centers. Our expertise across the post-acute spectrum allowed us to help Chrissy recover to the fullest extent by providing care in the proper care setting. Chrissy s case illustrates how Kindred helps patients get their lives back. SHORT-TERM ACUTE CARE HOSPITALS LONG-TERM ACUTE CARE HOSPITALS INPATIENT REHAB Higher 6 Case Study

7 SKILLED NURSING AND REHABILITATION OUTPATIENT REHAB HOME Once weaned off the ventilator Chrissy was moved to a Kindred nursing and rehabilitation center for further rehabilitation and nursing care. The rehabilitation team from Peoplefirst Rehabilitation worked to improve her strength, stamina and sensory impairment. When Chrissy was admitted she had an average functional score of 1 in skills such as walking and transferring. Upon discharge she improved to an average score of 6. Once Chrissy improved to the point where she could perform many of her self-care tasks herself, she still needed further rehabilitation to achieve complete independence. After Chrissy left our nursing and rehabilitation center she continued her recovery by receiving outpatient rehabilitation. A SUCCESSFUL TRANSITION HOME SKILLED NURSING FACILITIES ASSISTED LIVING OUTPATIENT REHAB HOME HEALTH CARE HOSPICE Intensity of Service Lower 7 Case Study

8 IN THE MOST APPROPRIATE SETTING KINDRED S DEVELOPING POST-ACUTE SERVICE LINES* A COST-EFFECTIVE CHOICE FOR REHABILITATION OR RECOVERY FROM MEDICALLY COMPLEX CONDITIONS 24-Hour Registered Nursing Care Active Physician Supervision Nursing Hours Per Patient Day Respiratory Therapy Hours Kindred Long- Term Acute Care Hospitals (83) General Inpatient Rehab Facilities Kindred Hospital Based Subacute Units (12) Kindred Transitional Care Centers (TCC) (32) Kindred Transitional Care Units (TCU) (102) Yes Yes Yes Yes Yes Yes Daily 3-4 times weekly/ offered daily 3-4 times weekly/ offered daily 2-3 times weekly 2-3 times weekly Kindred Long- Term Care SNFs (Including Alzheimer s and Palliative Care) (84) Every 30 days Multidisciplinary Team Approach Yes (Interdisciplinary) Yes Yes Yes Yes Yes Rehab Therapy At least Typical Length of Stay Typical Reimbursement Per Patient Day 26 days days days days days 92+ days $1,200-1,800 $850-1,250 $ $ $ $ *Kindred s targeted staffing and service approaches. 8 Quality Care

9 At Kindred Healthcare, our goal is to provide quality care, successful outcomes and outstanding customer service. In 2009, Kindred cared for almost 118,000 patients in our longterm acute care (LTAC) hospitals and nursing and rehabilitation centers across the country. LONG-TERM ACUTE CARE FOR MEDICALLY COMPLEX PATIENTS Our LTAC hospitals are designed to provide aggressive interdisciplinary care to medically complex patients who require extended recovery time. This care is overseen by licensed physicians over 8,000 have been credentialed to practice in our hospitals. Our hospitals are fully licensed as acute care hospitals and are accredited by The Joint Commission. We are proud of our quality indicators and of our reputation for providing cost-effective care our hospitals are staffed and equipped to rapidly respond to changes in medical condition, thereby reducing the cost, trauma and risk of shortterm hospital re-admission. Subacute Units Located within our LTAC hospitals, Subacute Units (licensed as skilled nursing centers) are for the patient who needs less than full long-term acute care. These patients might have late-stage emphysema or need wound care by a physician-directed team. The focus of our Subacute Units is to provide medically supervised, comprehensive rehabilitation for medically complex patients who no longer need acute care but need additional rehabilitation through a team of nurses, physicians and our Peoplefirst Rehabilitation therapists. SKILLED NURSING AND REHABILITATION Our nursing and rehabilitation centers offer award-winning care over 75% of Kindred centers have won Quality Awards from the American Health Care Association, which are based on the Malcolm Baldrige National Quality Award Program. These centers provide a full range of medical, nursing, rehabilitation and social services to treat and support each of our patients and residents. Many of our patients go home within a few weeks, and for those residents who are unable to return home, we provide safe, compassionate care in an environment that fosters independence and dignity. Transitional Care Units and Transitional Care Centers Transitional Care Units are located within our nursing and rehabilitation centers and offer short-term rehab and some medically complex care. A nursing and rehabilitation center where the majority of patients are receiving short-term rehab is known as a Transitional Care Center. Our goal is to help patients return home in less than days. ASSISTED LIVING, HOSPICE AND HOME CARE In our assisted living facilities, our residents function independently when they desire it and receive support when they need it. And our hospice and home care programs combine innovation and compassion with our reputation for quality care. 9 Quality Care

10 28,307 PATIENTS (63%) WENT HOME OR TO A LOWER LEVEL OF CARE IN 2009 AFTER AN AVERAGE LENGTH OF STAY OF 31 DAYS. LONG-TERM ACUTE CARE HOSPITALS Kindred long-term acute care (LTAC) hospitals provide aggressive, specialized interdisciplinary care to medically complex patients who require extended recovery time. These patients are critically ill and have few care options left; they come to us because they require the kind of care and prolonged recovery time that conventional shortterm acute care hospitals may not be equipped to provide. Kindred hospitals reduce the cost, trauma and risk of short-term hospital re-admission by being staffed and equipped to rapidly respond to changes in medical condition. Our LTAC hospitals are subject to the same three levels of quality oversight as general hospitals. Kindred hospitals are accredited by The Joint Commission and certified for participation in the Medicare Program by the Centers for Medicare and Medicaid Services. In addition, every Kindred hospital is licensed by state regulatory authorities and inspected for compliance with state standards. KINDRED S QUALITY EXCEEDS NATIONAL BENCHMARKS Kindred has shown improvement in key quality indicators year after year. Kindred s Ventilator- Associated Pneumonia (VAP) and Blood Stream Infection (BSI) rates are 50% and 15% better than national benchmark rates and have improved 35% and 50% respectively over the last five years. Our data also show that Kindred s rate of in-house acquired pressure wounds is low (two per every 1,000 patient days) and has improved about 40% over the last six years. KINDRED S QUALITY EXCEEDS NATIONAL BENCHMARKS ON KEY INDICATORS National Benchmark Kindred 2009 Ventilator-Associated Pneumonia Line-Related Blood Stream Infection Pressure Wounds Kindred 2003 Source: National Healthcare Safety Network and Kindred Internal Data Rates per 1,000 Patient Days 10 Long-Term Acute Care Hospitals

11 Our medically complex patients often need the following types of care: pulmonary care (ventilator management and weaning) complex wound care intensive short-term rehabilitation dialysis IV antibiotic therapy pain management PHYSICIANS DEDICATED TO RECOVERY Kindred understands the vital role of physician participation in everything we do from the Board of Directors to the bedside. Kindred s Board of Directors has an active Compliance and Quality Committee that meets quarterly, chaired by a physician who has provided services to hospitals and nursing homes for over 30 years, with specific expertise in emergency medicine and longterm care. We also have a full-time, boardcertified Chief Medical Officer and a Medical Advisory Board comprised of 15 physicians, both community and academically based, who provide guidance and oversight on physician and clinical practice issues in our hospitals. We also have a Pharmacy Standards Committee that provides guidance on pharmacy standards and medication safety issues. At the hospital level we have a Medical Executive Committee, a primary Medical Director and 11 Long-Term Acute Care Hospitals

12 specialty Medical Directors, charged with oversight of physician practice and quality issues. In terms of attending physicians, over 8,000 have been credentialed to practice in Kindred hospitals. As with all hospitals, Kindred bylaws require that attending physicians be responsible for the care of their patients 24 hours a day, seven days a week. As an additional resource to attending physicians, the vast majority of Kindred hospitals have a contracted physician to be onsite from 7 p.m. to 7 a.m. to provide emergency services, if needed. SERVICES TAILORED FOR THE MEDICALLY COMPLEX PATIENT Many Kindred hospitals provide an intensive level of care that include intensive care units (ICUs), special care units, high observation units and telemetry units. Additionally, Kindred hospitals have ancillary services including laboratory, radiology and operating or procedure rooms. All Kindred hospitals have monitoring capabilities through telemetry. Kindred policy requires that electronic telemetry tracings be monitored 24 hours a day, seven days a week, 365 days a year. To improve caregiver communication and quality, Kindred has developed an electronic health record system called ProTouch. This automated charting and ordering system improves accuracy and helps prevent errors. EMERGENCY CARE All Kindred free-standing LTAC hospitals also have emergency capabilities which are designed to evaluate and triage any changes of condition in our patients including emergency conditions. More than 1/4 of our patients are coming from managed care or commercial insurance case managers because LTAC Hospitals are viewed as a quality, cost-effective alternative to long stays in community hospitals. Our goals are not simply to get the patient through the night, but to work toward improvement over the long term, and ultimately send people home. Sean Muldoon, M.D., MPH Chief Medical Officer, Hospital Division Board Certified in Internal Medicine, Pulmonary Diseases and Preventive Medicine 12 Long-Term Acute Care Hospitals

13 WHO ARE OUR PATIENTS? Kindred uses nationally validated, commercially available patient screening criteria to evaluate the appropriateness of patients admitted to LTAC hospitals. The criteria basically define an LTAC level of care as comparable to an acute hospital level of care with additional criteria for intensity of service and severity of illness. Kindred s length of stay for all patients is approximately 31 days and for Medicare patients is approximately 27 days. Studies show that LTAC patients are more medically complex than those in other settings. Several independent and government sponsored studies report that LTAC hospitals treat the sickest, and most costly to care for, Medicare patients. The majority of LTAC admissions are medically complex and there is general consensus that these cases need the more intensive treatment programs provided by LTACs, and LTACs serve a more severely ill patient population than any other provider category. Government-sponsored study by RTI International, 2007 LONG-TERM ACUTE CARE PATIENTS ARE RE-ADMITTED TO ACUTE CARE HOSPITALS 26% LESS OFTEN THAN SIMILAR PATIENTS WHO DID NOT HAVE ACCESS TO LONG-TERM ACUTE CARE. Source: Medicare Payment Advisory Commission, Report to Congress (2004) PATIENT/FAMILY SATISFACTION SCORES (1 = Poor, 5 = Excellent) Overall Recommendation Overall Care Pain Management Skill and Experience of Nursing Staff Call Light Response LONG-TERM ACUTE CARE HOSPITALS COST SIGNIFICANTLY LESS PER DAY THAN SHORT-TERM COMMUNITY HOSPITALS $2,043 $1,264 $2,423 $1,543 $3,010 $1,776 Short-Term Community Hospitals Long-Term Acute Care Hospitals All Patients Long-Term Ventilator Patients Long-Term Ventilator Patients With a Tracheotomy Source: Government Medicare Data (2008) 13 Long-Term Acute Care Hospitals

14 35,608 PATIENTS (49%) RETURNED HOME AFTER AN AVERAGE STAY OF 33 DAYS IN 2009, AND OF THOSE PATIENTS 95% RETURNED HOME IN LESS THAN 90 DAYS. NURSING AND REHABILITATION CENTERS Nursing and rehabilitation centers across the country have changed to meet the diverse needs of today s patients and residents. Today s patient might be an active senior citizen recovering from a knee replacement before returning to the golf course, or a young mother receiving physical therapy to recover from an auto accident. TRANSITIONAL CARE We recognize these changing needs and have focused on services to meet them. Our Transitional Care Centers and Transitional Care Units are shaping the future of our nursing and rehabilitation centers. These units focus on patients who require short-term inpatient rehabilitation. Generally they are recuperating from joint surgery or other procedures and need an intensive, supervised rehabilitation regimen rather than a traditional stay in a nursing home. Additional rehabilitation services include physical, occupational and speech-language therapies. These services are designed to restore patients and residents to % of their prior level of function. DEMENTIA AND ALZHEIMER S CARE While we are advancing our rehabilitative services, Kindred understands a great percentage of our residents have some sort of dementia, including Alzheimer s disease. Many of our nursing and rehabilitation centers specialize in the unique challenges facing these residents and offer a supportive and safe environment for the resident, and peace of mind for their families. % IMPROVEMENT IN QUALITY INDICATORS 0 Patients With Pressure Ulcers % -35.1% Weight Loss Decrease in Use of Physical Restraints Source: Government Clinical Data -70 December 2002 December % 14 Nursing and Rehabilitation Centers

15 CARE AND SUPPORT All of our services including intensive rehabilitative transitional care, specialized dementia and Alzheimer s care, or hospice and palliative care are designed to provide a home-like environment to allow for independence and enable our patients and residents to receive the medical care they need, the restorative therapy they require, and the support they and their families deserve. We provide care for patients and residents who require: transitional or subacute care (intensive short-term rehab therapy) cardio-pulmonary rehabilitation wound care long-term chronic care dementia and Alzheimer s care hospice and palliative care 15 Nursing and Rehabilitation Centers

16 QUALITY RESULTS AVERAGE NUMBER OF DEFICIENCIES PER STANDARD SURVEY KINDRED PERCENTAGE OF ANNUAL SURVEYS WITH HIGHER SEVERITY TAGS 30% 28.9% 24.0% 15% 20.7% 16.7% Kindred National Average Source: Government Regulatory Data 0% Kindred Nation Source: Government Regulatory Data 6/00-8/01 10/08-12/09 COST OF CARE OVER FULL EPISODE FOR SELECT REHAB CONDITIONS* $20,000 $15,000 9% Cost Savings 19% Cost Savings Inpatient Rehabilitation Facility Skilled Nursing Facility $10,000 16% Cost Savings Joint Replacement Hip Fracture Pneumonia Source: Government Medicare Data (2007) *These data are not adjusted for severity of illness Patients with joint replacement discharged from skilled nursing facilities and inpatient rehab facilities do not differ materially... in terms of functional status and other outcomes. * Both settings provide intensive rehabilitation care and show significant outcome improvement. *DeJong, et al. Archives of Physical Medicine and Rehabilitation, vol. 90 Aug Nursing and Rehabilitation Centers

17 CUSTOMER SATISFACTION IMPROVING 82% % 86% 2008 STAFFING AND ACUITY Rehab Hours Nursing Hours QUALITY IMPROVEMENT EFFORT CONTINUES 81% 81% 83% 74% 76% 68% 69% 71% 75% 70% 74% 74% Activities Laundry Meals Dining Kindred 2008 Kindred 2009 National Average KINDRED HEALTHCARE HAS WON 176 AMERICAN HEALTH CARE ASSOCIATION STEP I AND NINE STEP II AWARDS SINCE Nursing and Rehabilitation Centers

18 PEOPLEFIRST REHABILITATION HELPING PEOPLE GO HOME Peoplefirst Rehabilitation helps patients and residents recover to the highest level of independence possible by providing physical, occupational and speech-language therapies. Our therapists are committed to emphasizing a patient s abilities rather than disabilities, and we use leadingedge technology to help our patients lead the most pain-free, productive lives possible. EXCELLENCE THROUGH INFORMATION These rehabilitation services are provided in our own hospitals and nursing and rehabilitation centers in addition to non- Kindred facilities. Our reputation for clinical excellence includes a clinical information management system. This information helps provide continuous analysis of our clinical results and is used in the successful management of our rehab programs. Peoplefirst has also developed and implemented proprietary handheld technology to improve the productivity of therapists. VALUES THAT LEAD TO RESULTS Putting people FIRST means we value Fun, Integrity, Respect, Support and Teamwork. Our philosophy is centered on people, whether they are the patients and residents we treat, the family members with whom we interact, the therapists we employ, or the facility team members with whom we work. PEOPLEFIRST IMPROVED THE QUALITY OF LIFE FOR OVER 169,000 PATIENTS IN Our services include: physical, occupational, and speech-language therapies Specialized Programs include: cardio-pulmonary rehabilitation palliative care home care and hospice orthopedic rehabilitation neuro rehabilitation wound care lymphedema low vision support medically complex care 18 Peoplefirst Rehabilitation

19 INCREASE (%) IN FUNCTIONAL OUTCOME MEASUREMENT SCORES Dysfunction Source: Kindred Internal Data, Using Modified Functional Outcome Measures (FOMS) Apart from the setting, two things which make for better outcomes are starting rehab earlier after surgery and obtaining more intense therapy, namely more physical and occupational therapy per day.* Peoplefirst has protocols in place to maximize these critical components in our patients recovery. *DeJong, et al. Archives of Physical Medicine and Rehabilitation, vol. 90 Aug Peoplefirst Rehabilitation

20 OUR PEOPLE Kindred understands that employees are central to creating a culture of caring. We also understand that in order to be a leader we need to equip our employees with the leadership skills, training and tools to face the many challenges in the healthcare field. LEADERSHIP DEVELOPMENT Our Executive Fellowship and Nurse Leadership Programs are designed to provide hands-on field experience, practical tools and resources to help our employees better understand what will face them in both the executive and clinical worlds. The things that we do for our employees are not perks. They are an integral part of our culture. This desire to take care of each other results in an engaged workforce that is empowered and encouraged to plan for the future, take care of their own health and that of their families, and live life to its fullest. EMPLOYEE RETENTION (%) TURNOVER RATES (%) WITH OUR 54,100 employees in 41 states, Kindred Healthcare IS one of the top-200 private employers in the United States Our People

21 REDUCTION IN CONTRACT LABOR ($ in millions) IMPROVING THE CONSISTENCY OF THE PATIENT/CAREGIVER RELATIONSHIP $22.6 $17.5 $10.6 $ Contract labor (temporary nurses, therapists and other facility staff) in our hospitals and nursing and rehabilitation centers has steadily declined over the past six years. Decreasing contract labor creates a better culture for employees, reduces the amount of re-orientation for caregivers, and improves quality through more consistent patient/caregiver relationships. Hospitals Nursing Centers 401(k) RETIREMENT SAVINGS AND PROFIT-SHARING PLAN PARTICIPATION (%) 26% 28% 29% ,000 over employees and dependents were covered under Kindred s medical plan in 2009 an increase of 1,130 from IN 2009, KINDRED INVESTED $31.7 MILLION AND 1.2 MILLION HOURS INTO EMPLOYEE TRAINING. $300 Million Over was invested in our employees in $8.5 million to our 401(k) plan over $120 million to our employee healthcare plan $2.1 million to employees in tuition reimbursement over $25 million invested in employee recognition and bonus programs for non-management employees throughout the year 21 Our People

22 Kindred s CONTRIBUTION TO OUR ECONOMy AND COMMUNITY IN 2009, KINDRED S CONTRIBUTION TO THE ECONOMY THROUGH OUR 621 SITES OF SERVICE IN 41 STATES WAS $3 BILLION PAID IN SALARIES, PAYROLL TAXES, HEALTH BENEFITS AND PRODUCTS AND SERVICES PURCHASED FROM OTHER BUSINESSES. KINDRED S ECONOMIC IMPACT Healthcare plays a major role in the economy, and Kindred takes its role in reducing the cost of healthcare seriously. We also understand that Kindred has a role to help support economic recovery. Kindred Healthcare s contribution to the economy is demonstrated in a number of ways, including salaries, taxes, benefits and through being a quality employer. In 2009, Kindred increased the number of net clinical employees by over 2,500, including hiring 865 RNs, 326 LPNs, over 970 CNAs and 341 physical, occupational and speech-language therapists. Over $2.1 billion in salaries and labor costs Almost $72 million in employee state income taxes OVER $120 million in company-paid health insurance Over $135 million in provider, property and income taxes Over $540 million in products and services from vendors 22 Our Impact

23 GIVING HOPE TO EACH OTHER An essential part of the Kindred mission is that we also take care of each other. While life is never easy, some situations are more difficult than others. At these times, maintaining hope can become a daily challenge for our employees and their families. It is specifically for this reason that The HOPE Fund (Helping Others Persevere through Emergencies), a 501(c)(3), was created to assist Kindred employees facing challenging, catastrophic life events. Since 2005, over $2.5 million has been donated to assist employees struggling through seemingly insurmountable difficulties such as deaths, terminal illness and devastating weather events, like floods, hurricanes and wildfires. In all, we have helped more than 1,800 employees. GIVING BACK TO THE COMMUNITY Our commitment to our patients and residents extends to helping raise money to fight the diseases that most affect them and their loved ones. We help enhance local community fundraising by matching donations raised by our employees. Through the Kindred Foundation, a 501(c)(3), we have created strong national and regional partnerships with the Alzheimer s Association, the American Heart Association and the American Lung Association. Since 2005, Kindred and our employees have contributed over $2.8 million to the Alzheimer s Association through participation in the organization s national Memory Walk. Each year, about 3,500 employees participate in more than 100 walks across the United States. $2.8 MILLION HAS BEEN DONATED BY KINDRED AND OUR EMPLOYEES TO THE ALZHEIMER S ASSOCIATION THROUGH THE NATIONAL MEMORY WALK. $2.5 MILLION HAS BEEN DONATED TO ASSIST MORE THAN 1,800 EMPLOYEES THROUGH THE HOPE FUND. KINDRED AND ITS EMPLOYEES HAVE DONATED OVER $100,000 TO THE AMERICAN RED CROSS FOR THE HAITI RELIEF EFFORT. 23 Our Impact

24 680 South Fourth Street Louisville, Kentucky COPYRIGHT 2010 Kindred Healthcare Operating, Inc. CSR