report on quality
DESCRIPTION
Quality Report from HCR ManorCareTRANSCRIPT
in Post-Acute Care
Quality RepoRt 2010
We are driven to be the preeminent care provider, committed to standards of excellence which serve as the hallmark of the industry.
We are HCR ManorCare 5
We are a Proven leader in Post-Acute Care and Returning People Home 6
Embracing Quality to Better Serve Our Customers 11
Our Quality Workforce 24
What’s Inside
intro
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Section Page
Home Health Care and Hospice Agencies
Skilled Nursing and Assisted Living Centers
Hospice ServicesHome Health CareIV CareInpatient Hospice
Skilled NursingAlzheimer’s Assisted LivingAssisted LivingRetirement Centers
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5
We Are HCR ManorCare
Providing care in more than 500 locations in 32 states•
Through 60,000 caring employees•
The largest provider of post-acute skilled nursing and rehabilitation •through more than 275 centers, most of which provide care under the respected names of Heartland and ManorCare Health Services
Rehabilitation also provided through more than 60 outpatient therapy •clinics, primarily under the Heartland name
The third largest U.S. provider of hospice care in over 100 markets •under the Heartland name
A leading U.S. provider of home care under the Heartland name•
A leading provider of Alzheimer’s/dementia care in many of our skilled •nursing centers and through 54 Arden Courts residences
With rehabilitation outcomes for Medicare patients comparable to and •often exceeding those of independent rehabilitation facilities
SECtiOn
1 We Are a Proven Leader in Post-Acute Care and Returning People Home6
SECtiOn
1We Are a Proven Leader in Post-Acute Care and Returning People HomeAt HCR ManorCare, our primary focus is caring for post-acute patients with complex medical and rehabilitation needs. Today, patients who have been hospitalized for a disabling illness, surgery or injury are spending less time in the hospital than ever before. This doesn’t mean they are ready to get on with their lives. It means the job of providing vital inpatient rehabilitation to help patients regain their ability to walk, dress, bathe and eat, and to resume meaningful lifestyles has been shifting from hospitals to skilled nursing centers.
We believe that a patient’s best way home is through our doors. At HCR ManorCare, we are able to admit many patients with “hospital-level” acuity and offer them a combination of clinical excellence and rehabilitation sophistication we believe is unmatched by our competitors. Our intensive approach teaches lifestyle adjustments to promote continued independent living.
HCR ManorCare’s clinical and rehabilitation teams are dedicated to treating the whole person and providing the greatest opportunity for our patients to reach their care goals and have a successful transition back home.
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7
i was so satisfied with my first experience at Heartland Health Care Center – Georgian Bloomfield eight years ago, that i requested to come here after each time i’ve been hospitalized. the therapists’ knowledge, experience and understanding of my diagnosis and situation are very apparent with the individualized treatment plan they created for me. the results of their care are very evident. the day of discharge, i walked out to my car with crutches and drove myself home! thank you Heartland.
Larr
y
Sending back to the community 150,000 skilled nursing and rehabilitation patients annually
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SECtiOn
1 We Are a Proven Leader in Post-Acute Care and Returning People Home8
after i fell and had five fractures in my pelvis, my doctor told me that i wouldn’t be able to walk without a walker for almost five months. after about two months of intense rehabilitation at ManorCare at arlington Heights, i am walking around with no devices! the therapists have been excellent. they are tough, but i know i wouldn’t be where i am today if it wasn’t for that. My room was spacious and the food was great – it was like being at a Four-Star hotel!
Cind
y
Admissions to our skilled nursing and rehabilitation centers exceeded 150,000 in 2009.
We discharge over 65 percent of our skilled nursing and rehabilitation center patients in less than 40 days.
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RESidEnCE PRiOR tO adMiSSiOn tO HCR ManORCaRE
Acute Care Hospital Nursing Home Home Other
The vast majority of our skilled nursing and rehabilitation center patients came to us from the hospital in 2009.
On average in 2009, the Medicare patients in our skilled nursing and rehabilitation centers returned to the community in less than 40 days.
Almost all of our skilled nursing and rehabilitation center Medicare patients received at least one form of rehabilitation therapy in 2009.
0
avERaGE lEnGtH OF Stay in dayS
50
100
150
200
300
Day
s
Insu
ranc
e/M
anag
ed C
are
250
Med
icar
e
Hosp
ice
VA
Priv
ate
Pay
Med
icai
d
0
PERCEnt OF MEdiCaRE PatiEntS RECEivinG tHERaPy
20
40
60
80
100
Perc
ent Any
TherapyPhysicalTherapy
OccupationalTherapy
SpeechTherapy
SECtiOn
1 We Are a Proven Leader in Post-Acute Care and Returning People Home10
Community Relationships Boost Quality of CareIn meeting the post-acute needs of our patients, we have formed relationships with a great many organizations that have recognized our capabilities in helping patients meet their outcome goals.
• We have a proven track record of rehabilitating patients in an efficient, cost-effective manner. Over 200 managed care organizations nationally have included HCR ManorCare in their health care plans for providing post-hospital rehabilitation.
• We received admissions for short-term rehabilitation from nearly 2,000 hospitals in 2009 -- over one-third of the hospitals in the U.S.
• With our “Fasttrack” Nurse Liaison program for an expedited admission process, there is no need to prequalify for admission. In most major hospitals, our nurse representatives can visit patients at bedside to answer any questions they may have about our post-hospital programs.
• We have the clinical programs and a vast network of attending and specialty consultant physicians to care for patients’ post-hospital needs.
• Regardless of a patient’s post-hospital needs, our continuum of care can meet his or her needs through post-acute rehabilitation, clinical care, home care and hospice services.
We have formed relationships with nearly 2,000 hospitals and hundreds of other prestigious health care organizations to help ensure potential patients are aware of our services and our ability to meet outcome goals.
One thing we’ve learned is that our patients have preferences about food and meal services. the food, nutrition and dining experience at HCR ManorCare is about respecting a patient’s choices so we can increase contentment, nutritional status and success in meeting rehabilitation goals.
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SECtiOn
2 Embracing Quality to Better Serve Our CustomersBEttER tOGEtHERHCR ManorCare provides quality services through several business groups, and our quality is enhanced by collaborating to share resources and best practices. Promoting collaboration of our wide variety of proprietary programs and vast knowledge across business lines reinforces the HCR ManorCare continuum of care. And sharing programs and knowledge among our skilled nursing, rehabilitation, home care, hospice and assisted living operations serves to increase the quality of life and clinical outcomes for our patients. Working collaboratively extends our reach and ultimately our quality. We are better together, and have the capability, knowledge and expertise to meet patient needs wherever they are in the continuum and to make their return to the community a successful one.
SECtiOn
2 Embracing Quality to Better Serve Our Customers12
From the front-line caregivers to our extensive support network, our team is warm and caring. Patients receive care from a multidisciplinary team composed of doctors; nurse practitioners; registered and licensed practical nurses; certified nursing assistants; physical, occupational and speech therapists; social workers; life enhancement activity directors; nutrition professionals; and other service professionals including housekeeping, maintenance and laundry.
HCR ManorCare independent advisory Committee on QualityHCR ManorCare has created an Independent Advisory Committee on Quality to provide advice and recommendations to the company’s Board of Directors on ways to measure, maintain and improve quality of care for HCR ManorCare patients and residents. The distinguished three-person panel is composed of Vincent Mor, Ph.D., Professor and Chair of the Department of Community Health at the Warren Alpert Medical School, Brown University; Robyn Stone, Dr.P.H., Executive Director for the Future of Aging Services and Senior Vice President of Research for the American Association of Homes and Services for the Aging; and Gail Wilensky, Ph.D., Economist and Senior Fellow at Project HOPE.
In 2009, the Independent Advisory Committee on Quality visited many of our skilled nursing and rehabilitation centers, met with staff, observed clinical practices, discussed training initiatives and made recommendations. The initial focus of the committee has been on understanding how clinical information and quality improvement tools provided by support services are being used in planning care, quality improvement initiatives and on the manner in which medical services are being integrated into clinical care systems.
As part of its focus on quality improvement, HCR ManorCare is also a strong supporter of the national Advancing Excellence in America’s Nursing Homes campaign. 100 percent of our skilled nursing and rehabilitation centers have re-enrolled in the program. The centers can choose among eight goals to pursue, including such topics as staff turnover, pain and pressure ulcers, and most of our centers have chosen three goals to focus on.
In addition to providing rehabilitation in each of our nearly 280 skilled nursing and rehabilitation centers, we provide rehabilitation through more than 60 outpatient therapy clinics. 65 percent of our skilled nursing and rehabilitation centers also provide rehab on an outpatient basis.
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MEdiCal SERviCESSelecting the medical team who will manage a patient’s medical care is fundamental in transitioning a patient into the post-acute care environment. Each of our post-acute care centers is supported by a medical director who works as a part of the leadership team. The medical director is a physician who is responsible for reviewing and assisting in the implementation of patient care policies, coordinates medical care within the center and provides quality assurance oversight. Additionally, each patient selects an attending physician who oversees his or her medical status, prescribes medications and therapies, authorizes plans of care and conducts scheduled on-site patient evaluations.
Many of our post-acute centers admitting patients with complex medical and rehabilitation conditions also have a full-time nurse practitioner who is able to make comprehensive assessments, diagnose acute and chronic conditions, prescribe medications, treat illnesses, educate staff, perform alternating required regulatory medical visits and counsel patients on health care issues.
SkillEd nuRSinGOur skilled nursing and rehabilitation centers provide quality medical, skilled nursing and rehabilitative care through registered and licensed practical nurses; certified nursing assistants; and physical, occupational and speech therapists. This care is complemented by social work, activities, nutrition services, and housekeeping and laundry services. We work with patients and their families to design an individualized plan of care that best addresses patient needs. For patients choosing to make our center their home, we offer therapeutic recreation and social activities to provide mental and physical stimulation in a warm and home-like environment.
The percentage of our standard surveys with High Scope and Severity (G tags and higher) has declined 44 percent over the past five years, a significant improvement compared to the national average.
PERCEntaGE OF SuRvEyS WitH G taG SEvERity OR HiGHER
5
0
2
Perc
ent 2004 2009
3
1
4
HCR ManorCareNational
SECtiOn
2 Embracing Quality to Better Serve Our Customers14
POSt-aCutE MEdiCal CaREMany of our skilled nursing and rehabilitation centers have been recognized within their communities for their ability to treat patients with multiple complex medical conditions. The medical and clinical teams have demonstrated success in working with community hospitals and specialty physicians to manage post-acute patients just days after coronary artery bypass surgery or organ transplants; those awaiting heart transplants who are sustained on a left ventricle assist device (LVAD); and post-trauma patients being actively weaned from a respiratory support system. Additionally, many centers are also known as specialized wound care centers within the community for their ability to treat and heal complex wounds.
POSt-aCutE REHaBilitatiOnHCR ManorCare’s commitment to post-acute care largely defines our skilled nursing and rehabilitation services today. Changing trends in health care have placed more emphasis on moving from the acute care setting to more cost-effective environments. We have maintained a leading position by:
• Increasingourclinicalcapability.
•Buildingnewrehabilitationcentersandexpandingand enhancing existing facilities, especially rehabilitation areas.
• Providingongoingeducationtoclinicalstaff to help ensure up-to-date clinical care delivery.
• Investinginstate-of-the-artequipment.
Patients who require rehabilitation undergo a comprehensive assessment and receive a patient-specific plan of care. We track the patient’s progress and assess outcomes. HCR ManorCare is one of the few skilled nursing companies collecting this type of data. Our therapy regimen includes the use of advanced therapy systems to successfully treat orthopedic, neurological and other injuries. Using these advanced systems in combination with HCR ManorCare’s clinical standards and physician protocols enables our therapy team to treat a high volume of complex patients. The program utilizes state-of-the-art therapeutic equipment which was developed by Accelerated Care Plus (ACP) to provide electrical stimulation, ultrasound and diathermy and which has been specifically designed to effectively treat pain and a wide variety of conditions such as orthopedic injuries and neuromuscular and circulatory dysfunctions.
Over the past three years, we have invested more than $350 million in new construction, renovation and expansion of existing facilities (including therapy areas and state-of-the-art gyms), new equipment and information technology.
Over the five-year period from 2004 to 2009, our skilled nursing and rehabilitation centers have shown significant improvement in the key quality measures of pain, restraint use and pressure ulcers.
iMPROvEMEnt in Quality MEaSuRES
100
0
40
2004 2009
60
20
80
PainRestraint UsePressure UlcersPe
rcen
t of
Redu
ctio
n
4 new skilled nursing centers
38 expansions for additional beds or therapy areas
More than 1,200 renovations of more than $30,000 each
1515
Over the last quarter of 2009, an average of nearly 5,500 physical, occupational and speech full- and part-time therapists provided rehab to our patients.
Achieving customer satisfaction begins with educating our patients and families about the normal aging process. We use a wide variety of communication materials to enhance their understanding of this process. Achieving customer satisfaction also involves training our employees. We have developed a training program called “Patient-Focused Customer Service.” This program helps employees understand how service is perceived by patients and family members. The program focuses on improving professionalism in three areas -- Appearance, Attitude and Action. All employees complete “Patient-Focused Customer Service” annually, and new employees complete it at general orientation. In addition, brief monthly in-services are provided to each skilled nursing and rehabilitation center to reinforce concepts taught in the training program.
We also realize that providing quality care is about more than just quality clinical care. It also involves ensuring that our patients feel that they have received the care they expected. As a member of the Alliance for Quality Nursing Home Care, HCR ManorCare participates in a regular independent customer satisfaction survey. We are proud to report that results from these surveys show high levels of satisfaction. In 2009, 21,000 discharged patients from our skilled nursing and rehabilitation centers returned surveys, which has helped us create a good gauge of patient satisfaction.
90% of patients rated the quality of the rehabilitation therapy they received as “Excellent” or “Good.”
86% of patients rated the respect shown them by staff as “Excellent” or “Good.”
85% of patients rated our efforts in helping them make progress toward their rehabilitation goals as “Excellent” or “Good.”
section
2 Embracing Quality to Better Serve Our Customers16
our Post-Acute outcomesHCR ManorCare has a track record of success in achieving desired outcomes for our patients and their families. We believe that to provide effective medical care and rehabilitation, outcomes must be measured and compared to expectations. Further, we believe it is vital for patients and their families, as well as those who recommend our services to patients, to examine evidence of a post-acute care provider’s success before making an admission or referral decision.
We measure important indicators of clinical outcomes—not only to provide objective evidence about our success in producing targeted outcomes, but also to emphasize our ongoing commitment to improve clinical effectiveness.
0.00
imProvement in self-cAre from Admission to dischArge for medicAre PAtients (2009)
0.50
1.00
1.50
2.00
2.50
HCR ManorCare Inpatient Rehabilitation FacilitiesIn
dexe
d Sc
ore Orthopedic Cardiac Pulmonary Stroke
0
AverAge WAlking distAnce imProvement of medicAre orthoPedic PAtients (2009)
50
100
150
250
300
Upon AdmissionUpon Discharge
Feet
Hip Fracture
Hip Replacement
Knee Replacement
Multiple Fractures
200
0
PercentAge of PAtients Able to mAnAge their cAre needs (2009)
20
40
60
80
100
Perc
ent Upon Admission Upon Discharge
Overall, nearly 90 percent of our patients discharged to the community after rehabilitation report they are prepared to manage their care needs, compared to less than 3 percent of patients upon admission.
HCR ManorCare’s companywide average shows progress in rehabilitation Self-Care skills that is significantly greater than U.S. inpatient rehabilitation facilities (IRFs).
From admission to discharge, HCR ManorCare’s companywide average shows our rehabilitation patients make a dramatic improvement in their ability to walk.
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i thank everyone at ManorCare Health Services – venice for getting me back up on my feet so soon. When i was first admitted, i was in extreme pain and couldn’t walk. With all the wonderful help at ManorCare, i was able to be discharged back home and manage everything on my own once again. i would recommend ManorCare to anyone because of their professional staff and experienced therapists.
Marjorie
what patients aRE SayinG
after surgery to repair my broken left ankle, i was given the opportunity to go home or to ManorCare Health Services – Boca Raton. i’m glad i chose to go to ManorCare. i found the concern and care of all employees – nurses, aides, therapists and staff – to be much better than i would have believed. i could go on and on, but for now i will simply close with a very sincere tHank yOu.
Emanuel
i came to ManorCare Health Services – northbrook for post-operative orthopedic rehabilitation. Both therapy teams – physical and occupational – helped me build up my strength so i would be able to function well at home. i was pleasantly surprised at the short period of time it took to achieve my goal of going home.
david
SECtiOn
2 Embracing Quality to Better Serve Our Customers18
i live in a different state than my father, so much of my contact with hospice personnel was long distance. the people i dealt with were all terrific, called me frequently and took excellent care of my father.
a Hospice family in Pennsylvania
Heartland Home Health Care and Hospice
CaRinG PROMiSES
We promise to care for the mind, body and spirit.
We promise to provide care that is comforting and compassionate.
We promise to respect patient and family choices.
We promise to unite with community partners in care.
We promise to be accepting and supportive of patients
wherever they are in life’s journey.
i loved the home care and that of the rehabilitation center. Everyone was very kind and concerned for my care. i have gladly recommended Heartland to everyone.
a Home Care patient in Wisconsin
Heartland Hospice was outstanding. they were there for dad and me, especially at the end. the staff here is the best hospice i have dealt with. they treated dad with integrity.
a Hospice family in Michigan
1919
HOSPiCE SERviCESOur hospice services integrate holistic principles with palliative disease management, expert pain and symptom control, family education and psychospiritual support for end-of-life care. Hospice also provides the education, counseling and other resources that can help with emotional needs. Care is culturally sensitive, respecting the traditions and heritage that are important to patients and their family members. These services can be provided within a skilled nursing center or the individual’s home.
HOME CaRE SERviCESRecovery often comes quicker in familiar surroundings and with the support of family and friends. Our home health caregivers assist with a transition home after a hospital stay, outpatient surgery or a stay in a nursing center. Registered and licensed practical nurses and therapy professionals provide medical services such as wound care and dressing changes; diabetes management; cardiac and pulmonary rehabilitation; and physical, occupational and speech therapies to address orthopedic, neurological and other general medical conditions. Home IV care services are provided by specially trained pharmacists and nurses who work with the patient’s physician to oversee the administration of IV medications and tube feeding at home. Caregivers also provide assistance with services to address mobility and activities of daily living, activities such as personal hygiene, assistance with walking and getting in and out of bed, and medication management.
Heartland is developing a library of disease management programs to serve our patients better and expand the services offered in our markets. For example, our heart disease program integrates evidence-based practices to effectively manage the patient’s disease process and prevent potential complications through proactive symptom management. The goal is disease management that allows patients to maintain quality of life and remain at home. Care services are provided based on risk, and patients are educated to promote self-management of symptoms.
Our home health care rehospitalizations in 2009 were below the national average.
0
PERCEnt OF HOME HEaltH CaRE PatiEntS WHO REtuRnEd tO tHE HOSPital
10
20
30
Perc
ent HCR ManorCare Industry
Average
25
15
5
0
PERCEnt OF PatiEntS and FaMiliES WHO WOuld RECOMMEnd HEaRtland HOME CaRE and HOSPiCE tO OtHERS
20
40
60
80
100
Perc
ent Hospice Home Health
Care
A high percentage of our hospice and home care patients would recommend our care to others.
SECtiOn
2 Embracing Quality to Better Serve Our Customers20
94% of the families of Arden Courts residents would tell others that our services rate “Excellent” or “Good.”
98% of the families of Arden Courts residents rated the respect shown them by staff as “Excellent” or “Good.”
dEMEntia SERviCESHCR ManorCare offers specialized services to advance the care of those with memory loss from Alzheimer’s disease or other dementias. Our Arden Courts assisted living centers tailor care specific to the unique characteristics of the individual with dementia and provide approaches that help preserve remaining abilities. Scheduled programs and daily routines, including performing familiar household and day-to-day activities, enable residents to maintain skills and enjoy social interaction. Professional program staff designs life engagement activities utilizing information taken from past and present habits and hobbies of our residents, their career and lifestyle in order to create programs that help residents restore a sense of identity.
94% of the families of residents rated their overall satisfaction with our Arden Courts centers as “Excellent” or “Good.”
95% of the families of residents rated the home-like environment of our Arden Courts centers as “Excellent” or “Good.”
96% of the families of residents rated the safety of our Arden Courts centers as “Excellent” or “Good.”
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if i could find a hundred more ways to say thank you for the care your wonderful staff has bestowed upon my father and family, that would not be enough…your entire staff is remarkable for not only the kindness and care they give to my father, but for the understanding and warmth they have shown our family. Even though we are aware that our father’s/husband’s health will eventually get worse, we know that we were able to provide the best care and quality of life for him as long as possible. that is so comforting.
arden Courts center in Maryland
i would like to share with you my gratitude and my very sincere compliments regarding the staff and the leadership in place at arden Courts. What has impressed, no, i would actually say “astounded,” us has been the very personalized, close, caring and highly professional approach of your staff – at every level in this facility…as a nurse in my younger days and a manager today, i have managed hundreds of people across many countries. i know what it takes to instill a spirit such as that present at arden Courts, and i am in admiration. My life is much nicer knowing my mom is in the hands of this group.
arden Courts center in Florida
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what family membeRs aRE SayinG
SECtiOn
2 Embracing Quality to Better Serve Our Customers22
After a combination of total right hip replacement and the installation of a defibrillator done at Ohio State University Hospital East, Jozsef required both physical and occupational therapy treatments. After careful and detailed evaluations by phone and visits to available skilled nursing facilities, he and his wife chose ManorCare Health Services of Westerville, Ohio. Jozsef, a professor at The Ohio State University, says it’s one of the best decisions they’ve made.
“From the moment I entered my well-maintained room, I was treated like a member of a loving family consisting of highly qualified professionals whose goal was to do everything in order to help me recover from this difficult surgery,” Jozsef said. “The standard-setting therapists helped me to graduate from wheelchair to walker to cane to being able to walk without any assistance within three weeks. In addition, the other personnel did their best to make me feel comfortable in a relaxed environment by providing me with the proper medication and quality food to regain my pre-surgery weight, and all the comfort necessary to relax after exhausting exercise schedules.
“It should be noted that the encouragement and the emotional support given to me during these three weeks will have long-lasting effects on my continuing efforts for total recovery at home. Thank you all for everything that you have done for my recovery. I will miss you all.”
With the help of professional staff, a patient goes from being wheelchair-bound to walking without assistance in three weeks.
impRoving patients’ Quality OF liFE
23
Working with the National Football League Player Care Foundation
HCR ManorCare has been selected to provide post-surgery rehabilitation and physical therapy to National Football League (NFL) players who qualify for financial assistance from the NFL Player Care Foundation.
Glen Edwards is a former star safety in the NFL who underwent a total left knee joint replacement at the age of 61. Glen is best remembered for his years with the Pittsburgh Steelers from 1971 to 1977 where he won a championship ring in both Super Bowl IX and Super Bowl X as part of Pittsburgh’s famed Steel Curtain defense. He also played for the San Diego Chargers from 1978 to 1981.
After retirement, Glen suffered from painful arthritis in his hip and knee and at times had difficulty walking. He underwent a total hip replacement for the pain in his right hip in 2004. Recently, Glen underwent the total left knee joint replacement surgery at Broward General Medical Center in Florida. Denise, case manager at HCR ManorCare, met with him at the hospital on the day following his surgery and upon discharge. A home assessment was performed immediately post-surgery to evaluate for any necessary modifications or durable medical equipment for safe mobility at home.
On the first day of outpatient therapy at ManorCare Health Services – Palm Harbor, Glen was ambulating with a rolling walker, bearing as much weight as could be tolerated, with a gait to help avoid pain in his left leg. He had difficulty getting in and out of a car, moving from low surfaces, and going up and down steps and curbs. Lea, a physical therapist at ManorCare Palm Harbor, evaluated Glen, and a plan of care was established. The program consisted of strengthening exercises, gait training, aggressive range of motion exercises, pain and swelling management, and functional training for activities of daily living. The exercises included prolonged static stretches, neuromuscular re-education, scar management and modalities as indicated. The intensity of stretches and resistance exercise was increased as Glen’s tolerance increased.
After six weeks of therapy, Glen was discharged with a home exercise program. He was walking two miles outdoors without an assistive device. The range of motion on his knee improved from 70 degrees to 120 degrees. His muscle strength improved from being barely able to move his leg against gravity to where he could resist a moderately strong force exerted by his therapist pushing against his leg. At discharge, pain in his knee had also decreased from a self-rating of 8 out of 10 to 2 out of 10 or less. Glen has now returned to his previous level of function without any knee pain complaints, and has also returned to playing golf and regular exercise.
SECtiOn
3 Our Quality Workforce24
Our Quality WorkforceOur employees understand that the ability to deliver high-quality outcomes rests in their hands. We understand that workforce excellence involves recognizing and rewarding the achievement of our employees.
Circle of Care is a philosophy, a philosophy focusing on how we should treat one another. It is also a program in which each of our employees participates. Several hours of programming include classes, group discussions, videos and role-playing activities to help employees enhance their caring attitude not only toward patients, but to patients’ families, vendors and other employees, as well.
• We spend more than $20 million annually on training.
• There are 135 online courses offered through HCR ManorCare University. In 2009, nearly 60,000 employees completed at least one university course, and that led to completion of over 575,000 courses during the year.
• More than 15,000 continuing education credits were earned by our employees in 2009, through attendance at 450 continuing education sessions offered within the company.
SECtiOn
3
24
25
EMPlOyEES EnROllEd in EduCatiOn aSSiStanCE PROGRaMS
0
# of
Em
ploy
ees
500
1000
1500
2000
2500
Nurse Scholarship
Program
Tuition Loan Program
Nurse/ Therapist Loan
Repayment Program
Over the past three years, investment in our Education Assistance Plan has increased by an annual average of 43 percent.
Since the inception of our program in 2002, we have awarded scholarships totaling $13.5 million to employees pursuing careers in nursing and rehabilitation therapy.
In 2009, nearly 5,000 employees were taking advantage of our Nurse Scholarship Program, Tuition Loan Program and Nurse/Therapist Loan Repayment Program.
invEStMEnt in tHE nuRSE SCHOlaRSHiP PROGRaM, tuitiOn lOan PROGRaM and nuRSE/tHERaPiSt lOan REPayMEnt PROGRaM
0
3
4
5
6
7
$ M
illio
ns
2006 2007 2008 2009
2
1
SECtiOn
3 Our Quality Workforce26
Rami Ubaydi has been a part of HCR ManorCare for 23 years – since he was in high school. HCR ManorCare gave Rami his first job, and he combined his skills with the educational and other opportunities within our company to become an important part of our leadership team.
Rami joined the company as a Dietary Aide/Waiter and today is a Regional Director of Operations in our skilled nursing and rehabilitation operations.
RamiUbaydi
EMPlOyEE pRofile
1987
Started his career with HCR ManorCare as a Dietary Aide/Waiter in a skilled nursing center in Michigan. He continued employment as a waiter and cook while using the company’s educational assistance program to help pursue a bachelor’s degree in accounting.
1993
Promoted to Business Office Manager at a skilled nursing center in Tennessee.
1995
Became a Business Office Manager at a skilled nursing center in Ohio.
1996
Promoted to Financial Services Consultant, and while in this position, once again used the Education Assistance Plan to earn a master’s degree in business administration.
1999
Promoted to Senior Financial Services Consultant. Later this year, he was promoted to Director of Operations Support for the South Division of our skilled nursing and rehabilitation operations.
2005
Promoted to Regional Director of Operations in the West Division of our skilled nursing and rehabilitation operations with responsibility for nine centers in California and Nevada.
27
EMPlOyEE Recognition
We publish on a monthly basis a newsletter, We Are HCR ManorCare, which highlights the contributions of employees in the workplace and in their communities. the newsletter features photos, quotes and stories about our employees and the special things they do each and every day.
an employee at Heartland Hospice Services in Philadelphia receives a framed reproduction of his story in We Are HCR ManorCare.
SECtiOn
3 Our Quality Workforce28
Staffing hours per patient day have increased steadily over the past five years for nursing, rehabilitation therapy and all complementary care provided to patients.
StaFFinG HOuRS PER PatiEnt day
Nursing HoursOther Patient Care HoursRehabilitation Hours
Hour
s
6
0
2
2005 2009
3
1
4
2006 2007 2008
5
.44
1.57
3.385.39
.47
1.55
3.455.47
.58
1.60
3.535.71
.64
1.64
3.565.84
.67
1.64
3.595.90
Over 8,500 employees will celebrate 10 or more years of service with HCR ManorCare in 2010, and 440 of those have 30 or more years of service.
Our employee retention has been steadily increasing for nurses, therapists and certified nursing assistants as measured by the number of employees with one or more years of service each of the past four years.
PERCEnt OF EMPlOyEES WitH OnE yEaR OF SERviCE OR MORE
80
30
50
2006 2008
60
40
70
Registered NursesLicensed Practical NursesNurses AidesTherapistsAll Employees
Perc
ent o
f Em
ploy
ees 2007 2009
29
My son had figured out what he wanted to do with his life. He wanted to help people. He was a loving and compassionate kid who loved children and really valued people. He achieved a 3.6 grade point in high school and started college majoring in pharmacy. He was the father of a beautiful baby boy and worked hard to support him. He went to college with the intention of majoring in pharmacy, changed his major to nursing after working part-time in a nursing home, and then said, “Mom, I’m going to change my major one more time; I think I want to teach.” I didn’t know then that he would never have the opportunity to fulfill his dream.
My son was staying with his grandmother, my mother-in-law, because it was close to the university. My husband was making waffles for me and our five-year-old son. It was just a typical Saturday morning. The phone rang, and it was my mother-in-law. She asked us to please come to her house because our son had been shot.
When we arrived, the ambulance was just leaving. The driver told us to follow them to the hospital where they rushed my son to surgery. He had a head injury and a gunshot wound. We later learned that my son had been the victim of a robbery. He had planned to meet a friend from school to look at a car that was for sale. The “seller” brought the car to an alley behind my mother-in-law’s house. Instead of buying a car, my son was robbed, beaten and shot in the back as he tried to run away.
My beautiful 19-year-old son was placed on life-support after surgery. He never woke up. We never said good-bye. The doctors determined that he had no brain activity. Three days after that typical Saturday morning, my son died from his injuries. The father of a beautiful baby with plans and a bright future was gone.
Because my son was a student, we are financially responsible for his medical bills. Those bills and the time I had to take off work to grieve and cope with this loss created tremendous financial stress for my family. We were overwhelmed. We still have two sons in college that need our help, bills to pay, and now medical bills and a funeral. It was all so devastating. We needed financial help, and the Hug Fund provided just what we needed.
It is humbling to be part of an organization where the people step up and wrap their arms around you and hold you and give you the strength that you need in the darkest hours of your life. Knowing what I now know, firsthand, about the Hug Fund, I realize that it is vitally important that we continue to support this fund so that any other family, regardless of the tragedy they may be facing, can have financial help available to them.
Employees Helping their Fellow Employees2010 marks the fifth anniversary of the Hug Fund, a nonprofit, tax-exempt, charitable fund operated and supported by the employees of HCR ManorCare. The mission of the Hug Fund is to embrace our fellow employees in a time of need by providing financial assistance to them for an unexpected catastrophic event such as a natural or civil disaster or severe economic hardship when the employee is unable to meet his or her basic needs. Since its inception, the Hug Fund has made 1,150 employee grants totaling nearly $1.2 million. The Hug Fund is truly a partnership of employees helping employees, giving and responding to the needs of our employees nationwide.
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Help at Journey’s EndThe Heartland Hospice Memorial Fund is a non-profit organization whose purpose is to support a wide variety of community-based services, research and education and assist those who are coping with life-limiting illness, death, and the process of grief and bereavement.
The Heartland Hospice Memorial Fund contributed approximately $1.0 million in charitable gifts in 2009 to hospice patients and their families and for hospice-related activities. The fund provides families with assistance for items such as living expenses, funeral bills and travel costs to bring together a loved-one and his or her family for a final goodbye. The Heartland Hospice Memorial Fund also supports grief camps for children and adults, as well as other community education and bereavement activities.
Megan, a Heartland Hospice social worker, was shocked to learn that one of her patients had been battling multiple cancers for the past 30 years. During her struggles, the patient’s husband and children cared for her. Then the patient’s husband was also diagnosed with cancer, so they became each other’s caregivers. During both of their illnesses, the couple accumulated significant medical bills, and the day-to-day financial needs and upkeep related to their household became an afterthought. They simply spent all of their time and energy trying to live, battling their diseases.
After her husband’s death, the patient’s cancer worsened. She now found herself alone in her home. Her life partner, who provided care for the home and the yard, was gone, and the burden fell on her shoulders. There was so much to be done, and there were bills that needed to be paid. What had been a double income home was now down to a single income with the same amount of bills. The patient was overwhelmed. She would not only be facing her end-of-life journey on her own, she would also be facing the upkeep and financial responsibilities related to her home alone.
Megan found that the patient was hesitant to ask for help, but the financial stressors were just too much for her to handle by herself. Megan explained, “When patients deal with end-of-life issues, it can be totally consuming to them. There is very little energy left for one to worry about finances and household repairs.” The Heartland Hospice Memorial Fund was able to provide financial relief which, in turn, provided emotional relief for the patient. “She was very humbled by the financial assistance that she received from the fund, and words could not describe her gratitude,” said Megan. “She is the type of person who always thinks of others before herself.”
Receiving this money without strings attached was so deeply appreciated by the patient. The fund covered her household bills so she could focus on her family and caring for herself. Megan feels that “this patient’s story is a beautiful example of the value of the Heartland Hospice Memorial Fund and the relief that it can provide to those in dire need. I am grateful that this fund was available for my patient.”
Fighting cancer for 30 years is commendable. Helping to meet the needs of those warriors during their end-of-life journey is an honor.
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© 2010 hcR healthcare, llc hcR-mc-0058b