2013 Quality and Social
Responsibility Report
Creating Solutions in Post-Acute Care
Through Patient-Centered Care
Management
CONTINUE THE CARE
Providing Care Management and
Improving Outcomes Across the
Post-Acute Continuum for More
Than 500,000 Patients in 2013
Sending More
Patients Home
Faster
Outperforming
National Quality
Benchmarks
Reducing
Rehospitalizations
Kindred’s Transitional Care
Hospitals treated the most
medically complex patients,
discharging nearly
70% of patients home
or to a lower setting of care
after an average length of
stay of 27.1 days.
In 2013, Kindred therapists
helped more than 518,500
patients attain nearly 80%
OF THEIR PRIOR LEVEL
OF function before
transitioning home or to
their next level of care.
From 2009 to 2013,
we reduced
rehospitalizations by
14% from our Transitional Care
Hospitals, and by 15% from
our Nursing and Rehabilitation
Centers.
Kindred’s Nursing and
Rehabilitation Centers
discharged 56% of
patients home – after
an average stay of 32 days.
From 2009 to 2013, we
reduced the total average
length of stay in our
Transitional Care Hospitals
by 10.3% and in our
Nursing and Rehabilitation
Centers by 11%.
2
Patients in Kindred’s
freestanding inpatient
rehabilitation hospitals
achieved 19.9%
greater functional
improvement than the
national average.
46% of Kindred’s home
health locations were
named to the 2013
HomeCare Elite, a
compilation of the top
25% of home health
agencies in performance
measures.
Patient-Centered Care
Care management is vital in delivering patient-centered care,
yet it is often missing in care options for our nation’s aging population. As the nation’s largest, fully
diversified post-acute care provider, Kindred is breaking down the silos, delivering solutions to
patients, families, hospitals, and managed care organizations to improve patient care and
lower costs.
At Kindred, we are committed to playing a leading role in solving the challenges of aging.
By managing and coordinating the unique care and rehabilitative needs of each patient,
we believe that recovery, wellness and a full life is possible.
The Nation’s Largest, Fully Diversified Post-Acute and Rehabilitation Care Provider ................................4
Care Management: Smarter Patient-Centered Care..................................................................................6
Case Studies: Continuing the Care.........................................................................................................10
Kindred at Home: Home Health and Hospice Services............................................................................12
Kindred Transitional Care Hospitals........................................................................................................14
RehabCare.............................................................................................................................................16
Inpatient Rehabilitation..........................................................................................................................18
Kindred Nursing and Rehabilitation Centers...........................................................................................20
Investing in Our People and Communities..............................................................................................22
3
The Nation’s Largest, Fully Diversified
Post-Acute and Rehabilitation Care Provider
Providing Integrated Post-Acute Care in Local Communities
TRANSITIONAL CARE HOSPITALS (101)
INPATIENT REHABILITATION HOSPITALS (5)
HOSPITAL-BASED ACUTE REHAB UNITS (104)
NURSING AND REHABILITATION CENTERS (100)
REHABCARE SITES OF SERVICES (1,789)
HOME HEALTH, HOSPICE AND PRIVATE DUTY LOCATIONS (159)
LOCAL KINDRED MARKETS with A
DEVELOPING continuum of post-acute
services AND active integrated care
partnerships
Kindred is
taking care of
in over
in
dedicated employees
patients and residents
every day
locations
states.
63,300 62,600 2,200 47
4 | About Kindred
OUR MISSION
Kindred’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.
OUR MANAGEMENT
PHILOSOPHY
At Kindred, we believe that if we focus on our people,
on quality and customer service, our business results
will follow.
Kindred is expanding its capacity and expertise in delivering post-acute care across
a continuum of care settings – from hospital to home – to enable the best in care coordination and
clinical outcomes.
Integrated Care Markets
As our nation’s healthcare system moves to one
that rewards value over volume for patient care,
greater care coordination will be essential to
achieve improved patient outcomes, seamless care
transitions and lower costs.
Kindred’s Integrated Care Market strategy
recognizes the need for all Kindred service lines to
partner with healthcare networks, managed care
providers and other healthcare entities in local
markets to best meet patient needs, reduce costs
and improve clinical outcomes.
In 2011, 43% of Medicare beneficiaries discharged from a hospital required
post-acute care. – Mark Miller, MedPAC Executive Director, June 2013 Congressional Testimony
Kindred Is Positioned to Help Determine the Most Appropriate Care Setting for Patients as They Continue Their Care
Throughout a Post-Acute Episode
PATIENTS
DISCHARGED FROM
KINDRED HOSPITALBASED INPATIENT
REHABILITATION
FACILITIES
PATIENTS
DISCHARGED
FROM KINDRED
TRANSITIONAL CARE
HOSPITALS
38%
Skilled
nursing
AND
REHAB
centers
25%
Home
17%
Home
Health
6%
inpatient
rehabilitation
facilities
77%
23%
52%
Skilled
nursing
AND
REHAB
centers
Home
Home
Health
PATIENTS
DISCHARGED
FROM KINDRED
NURSING AND
REHABILITATION
CENTERS
56%
Home
26%
Home
Health
Source: Kindred Internal Data
About Kindred | 5
Care Management:
Smarter Patient-Centered Care
Kindred’s diverse foundation of quality post-acute care enhances our care management expertise,
allowing us to return patients home as soon as possible while also providing care and services that will
promote wellness and avoid hospitalizations.
Our nation’s healthcare delivery system requires and
encourages collaboration among providers. Kindred
has embraced this approach. In 2013, we actively
developed programs to enable us and our partners to
better manage episodes of care, create more seamless
transitions between care settings and improve patient
satisfaction and clinical outcomes.
We provide care and support to each patient so
that people can either remain at home without the
need of a hospitalization, or to safely and efficiently
transition through appropriate post-acute settings to
return home as soon as possible.
Kindred’s care approach is to provide a continuum of
post-acute care in local integrated healthcare delivery
markets. The unique and specialized care delivered
across all Kindred settings is integral to patient
recovery and wellness.
Patient-Centered Care Management Model
Our Care Management approach coordinates
five core capabilities to meet the unique needs
of each patient throughout their pre-acute and
post-hospital care.
6 | Care Management
Building upon this foundation, in 2013, Kindred
created its Care Management Division to further
develop these capabilities to deliver coordinated care
throughout the care continuum and our organization.
Care Managers to Smooth Transitions
In 2013, Kindred established Care Transitions
Managers (CTM) to follow patients with specific
diagnoses and/or risk factors through the entire
care continuum in key markets. The CTM
follows the patient throughout his or her stay at a
Kindred Transitional Care Hospital, Nursing and
Rehabilitation Center or at home with Kindred at
Home until 35 days post-discharge.
Early data has shown that by smoothing transitions
of care, Kindred has improved the patient experience
and reduced lengths of stay and unplanned hospital
readmissions. Just as important is the difference our
program has made in the lives of the patients we
serve as they feel empowered, engaged and supported
during the most difficult times.
In our Boston Integrated Care Market, our
Care Transitions Managers helped reduce
readmission rates to 5.6% for high risk patients.
This is in stark contrast to the nation’s average
Patients and families
expect and deserve
rehospitalization rate of 18-21%.
quality-driven coordinated
care throughout an entire
episode – from hospital to
home. Creating safe and
seamless transitions between
care settings is just one way
Kindred Continues the Care.
Care Managers to
Smooth Transitions
Physician
Coverage Across
Sites of Care
Mechanisms
to Make Patient
Care Placement
Decisions
Information
Sharing and IT
Connectivity
PATIENT-CENTERED
CARE MANAGEMENT
APPROACH
ConditionSpecific Clinical Programs,
Pathways and Outcome
Measures
Personal
Home Care
Assistance
Transitional
Care Hospitals
Inpatient
Rehabilitation
Higher
Subacute
Units
Nursing and
Rehabilitation
Centers
Outpatient
Rehabilitation
Home
Health
Care
Hospice
Lower
Assisted
Living
Patient Acuity
Care Management | 7
Physicians Driving Care Management
In facilitating physician coverage across sites of
care, Kindred has established physician leaders in
our Integrated Care Markets. Building on these
capabilities, in 2013, we acquired a senior care homebased primary care medical practice situated in our
Cleveland Integrated Care Market. The practice
provides full service primary care and urgent care
services through “house call” services to patients
throughout seven counties who cannot easily access
traditional outpatient care settings. This homebased model has helped patients avoid unnecessary
hospitalizations and emergency room trips – with a
30-day rehospitalization rate below seven percent
for four consecutive years. Moving ahead, we will test
and advance new care management models which
encourage greater direct physician involvement.
Kindred and Cleveland Clinic Partner in
“Connected Care” and Bundling Initiatives
A January 13, 2014 Modern Healthcare cover story
which assessed the role of post-acute care providers
within the context of a full-service continuum
discussed the evolving relationship between Kindred
and the Cleveland Clinic. As reported:
Kindred has contracted for the past five years
with the Cleveland Clinic for the coordination of
post-acute care for that health system’s patients
in Cleveland. “Healthcare reform is pushing all
of us to figure out how to take care of a patient in
a very seamless manner across different venues
where they receive healthcare,” said Dr. Eiran
Gordeski, director of the Cleveland Clinic’s Center
for Connected Care. “We definitely want to work
with post-acute care providers who are thinking
about the continuum of care and are trying to make
that transition of patients from one venue to another
as seamless and as safe and as well-coordinated as
possible.”
The Cleveland [Clinic] partnership was selected
last January to take part in a three-year CMS
demonstration of a bundled-payment model based on
performance accountability for episodes of care. The
medical director for the Cleveland Clinic’s Center for
Kindred is transitioning “to become more of a full-service post-discharge continuum,
able to support a patient following hospitalization no matter what their needs.”
Jared Landis, Senior Consultant for the Post-Acute Care Collaborative of the Advisory Board Company
8 | Care Management
“If we’re creating a more seamless experience
helping to manage these care transitions, we can
simultaneously not only improve patient outcomes
but reduce costs,” said Kindred CEO Paul Diaz. “That
will clearly differentiate us in the minds of payers,
accountable care organizations, hospital systems,
physicians and most important our patients.”
Excerpted from Modern Healthcare, January 13, 2014 cover story:
“Quarterbacking Post-Acute Care”
Our Health Information Exchange
will provide easy access for
physicians across sites of service to
patient records.
Rehabilitation, who also serves as chief medical director
for Kindred’s integrated-care market in Cleveland, is
providing medical oversight for the demonstration.
Under the CMS’ Bundled Payments for Care
Improvement initiative, Kindred is responsible
for the health outcomes and cost of treatment
for Medicare patients diagnosed with seven
conditions – chronic pulmonary disease, congestive
heart failure, major joint replacement, sepsis,
pneumonia and other respiratory infections –
for 60 days after discharge from the acute-care
hospital.
COMMUNITY
HIE
SHORT-TERM
ACUTE CARE
HOSPITALS
Kindred Nursing
and Rehabilitation
Centers
Kindred
Transitional
Care Hospitals
Health Information Exchange
PHYSICIANS
MANAGED CARE
PATIENT
Kindred began to roll out its enterprisePAYORS
(Primary Care,
CARE
Attending and
SUMMARY
CASE
wide Health Information Exchange (HIE),
Specialist)
MANAGEMENT
which will facilitate the sharing of electronic
patient data between Kindred sites of care
Kindred at
RehabCare
Home
and with external healthcare partners. The
interoperable IT framework, built on dbMotion’s
technology, will rely on a single patient identifier
assigned by NextGate’s Enterprise Master Patient
Index (EMPI) to help manage care across settings
and coordinate care transitions. Kindred’s HIE will
provide clinicians easier access to current and historical patient
For more information about our Health Information
information, simplifying the coordination of care and delivering
Exchange, visit us at www.kindredinnovations.com.
increased value to our patients and partners.
Care Management | 9
Paul and Carole Guilmette and
their Care Transitions Manager,
Kim Ramos, at their home in
Framingham, Massachusetts
Care Transitions Managers
Continuing the Care
When 81-year-old Paul Guilmette’s wife, Carole,
also 81, tripped, fell and seriously injured her leg, he
dialed a familiar number: Kindred Care Transitions
Manager Kim Ramos.
The Guilmettes met Ramos when Carole Guilmette
was a patient at Kindred Hospital Northeast –
Natick, after being hospitalized at an acute care
hospital with congestive heart failure and renal
failure. Ramos provided counseling, education and
support as Carole recuperated at the transitional care
hospital and was then discharged home with Kindred
at Home care.
As a care transitions manager, Ramos’ role is
to follow patients through Kindred’s post-acute
continuum, collaborating with primary care
physicians and making sure they are involved every
step of the way as well as improving patients’ selfmanagement skills and enhancing communication
between the patient, healthcare delivery teams and
the patient’s primary care physician. Care transitions
managers like Ramos physically and telephonically
follow patients like Carole through the entire postacute episode of care.
When Paul Guilmette called Ramos that morning
his wife fell, she advised him to call 911 for
emergency care. After surgery on her femur and a
blood transfusion, Carole required extended hospital
care for recovery, so with Ramos’ assistance she
returned to the Kindred hospital.
Her stay at the transitional care hospital was
followed by about ten days of rehabilitation at
Kindred Transitional Care and Rehabilitation Avery
Manor, and another discharge home with Kindred at
Home care – with Kim Ramos there to offer support
to the Guilmettes every step of the way.
Ramos’ job – like all Kindred care transitions
managers – is to get to know the patients with
whom she works and understand what their needs
are, to head off problems before they arise, educate
the patients and their families about the disease
process and medication management, and serve as an
advocate.
Carole is largely back to her old self now,
participating in the activities she loves – the
Guilmettes give Ramos, who still checks in on them
weekly, a lot of credit for that.
Said Paul: “It’s always like having a conversation
with an old friend, who is confident and
knowledgeable about the subject.”
“Building those long-term relationships, that’s what’s most
rewarding about what I do.” – Kim Ramos
10 | Case Studies
“By providing high quality medical house call services to patients who are at high
risk for hospitalization, we can keep more people where they want to be – out of
hospitals and at home.” – Dr. William Mills, Founder of Western Reserve Senior Care, now a part
of the Kindred Continuum
Physicians Continuing the Care
Care Where and When People Need it Most
88-year-old Virginia Wagner has a history of
chronic obstructive pulmonary disease, congestive
heart failure, diabetes, atrial fibrillation, stroke and
gastrointestinal bleeding. Living in an independent
senior apartment building, but using a traditional
“office based” care model, Virginia was hospitalized
four times in four months between November 2010
and March 2011 for exacerbations of her heart and
lung disease.
Frustrated by the trips back and forth to the hospital
and nursing home, her daughter asked Dr. William
Mills and his home-based primary care team to
assume her care. The group began making monthly
house calls, and arranged for regular blood work at
home, medication assistance, a visiting home health
nurse who weighed her regularly and helped her
manage her salt intake, and a physical therapist who
helped her gain strength and walk.
Virginia was slowly able to regain her health and
independence, and is thrilled that she has not been
back to a hospital or emergency department in three
years. Besides the obvious benefit to Virginia’s health
and well-being, the cost effectiveness of keeping her
out of high cost care settings for the last three years
represents a solution for many patients just like her.
Dr. William Mills and
Virginia Wagner at her
assisted living facility in
Kent, Ohio
Case Studies | 11
Home Health and Hospice Services
Kindred at Home professionals deliver cost-effective care and support with the goal of maintaining a
patient’s quality of life at home.
As part of our efforts to be a full-service healthcare
provider across the continuum, we have grown to be
one of the nation’s leading home health and hospice
operators with 159 locations in 13 states. Setting
Kindred at Home apart from most competitors is
the electronic linkages to a patients’ prior health
needs, enabling home health clinicians and therapists
to Continue The Care. Similar to Kindred’s Care
Transitions Managers, many of our home health
agencies feature Clinical Integration Specialists who
serve as patient advocates, working directly with
patients, families and the entire care team to help
prepare for the transition to home with appropriate
care and services.
Home Health
Our homecare professionals deliver care and services
for patients who need medical care and are able to
remain in their home rather than enter an inpatient
setting or those who are ready to return home but
require additional therapy and/or nursing care.
We offer medical interventions such as wound care
and rehabilitation therapy, which are delivered in the
comfort of a patient’s own home. Experienced nurses,
therapists and aides work with each individual
and family members to maximize physical abilities,
improve health and wellbeing, and provide essential
education and management of medications and
medical conditions, including IV therapy.
Palliative Care
Our palliative care teams include physicians, nurse
practitioners and other specialists who work together
with a patient’s other physicians to coordinate
healthcare resources and promote quality of life
through pain and symptom management for people
suffering from serious illnesses. They also serve as a
resource in providing assistance with decision making
and advance directives. These palliative care services
are available to patients at the same time that they
are receiving aggressive, curative treatments.
“As a home-based service, home health can be utilized to improve outcomes and
achieve savings by managing patient transitions to and from facility-based care,
teaching patients to self-manage their conditions in order for them to remain at
home, and coordinating care across settings to ensure overall patient safety.”
– Dobson, et al, 2012, “Clinically Appropriate and Cost-Effective Placement” (CACEP)
12 | Kindred at Home
Kindred at Home Home Health
Patient Satisfaction
Kindred at Home Home Health Key Quality Measures
70.4% 61%
95.1% 92%
93.7% 92%
99.6% 97%
88.8% 88%
52% 51%
79.2% 79%
16.9% 16%
Improvement
in Ambulation
Kindred
Improvement
in Management
of Oral Meds
How Often
How Often
Patients Taught Care Began in
about Meds
Timely Manner
How Often
Checked
for Risk of
Falling
How Often
Patients
Admitted to
Hospital
Overall Care
Benchmark
Source: Centers for Medicare and Medicaid Services; Home Health Compare 2013
Kindred
Patients
Recommending
Kindred at Home
Benchmark
Centers for Medicare and Medicaid
Services; Home Health Compare 2013
Hospice
Our hospice professionals provide a familyoriented model of care in order to meet the
physical, spiritual and emotional needs of terminal
patients and their families. Our multidisciplinary
services enable patients to stay in a familiar and
comfortable environment while delivering pain
management, aggressive comfort measures and
psychological support to create the best possible
end-of-life experience.
Kindred at Home Hospice Key Quality Measures
86.2% 85.9%
Satisfaction/
Evaluation
77%
64.9%
Kindred
Benchmark
Source: Kindred Internal Data
Patients Brought to
Comfortable Pain
Level Within 48 Hours
Kindred at Home home health and hospice locations outperformed
national benchmarks in key quality measures, including
patient satisfaction.
66 of Kindred’s home health locations were named to the 2013 HomeCare Elite,
a compilation of the top 25% of home health agencies in performance measures.
Kindred at Home | 13
Kindred Transitional Care Hospitals
Kindred Transitional Care Hospitals play a vital role in the recovery process for the sickest and most
medically complex patients who require acute care and rehabilitation over an extended recovery period.
Transitional care hospitals are unique in their ability
to care for difficult-to-treat, critically, chronically
ill patients who require specialized and aggressive
interdisciplinary care over an extended treatment
period.
These hospitals are certified as long-term acute care
hospitals and licensed as acute care hospitals by the
Centers for Medicare and Medicaid Services (CMS)
with additional Medicare certification that patients
require a prolonged clinical intervention (more than
25 days on average) rather than a typical short fiveday stay in a traditional hospital.
Our Patients
Patients requiring care in a transitional care hospital
often have multiple comorbidities, multi-organ
system failure, or require a lengthy reliance on a
ventilator – many of them following an ICU stay
in a traditional hospital. Our specialized clinical
services and extended care are best suited to treat
those medically complex patients who are unable to
recover in a short-term setting.
Kindred Transitional Care Hospitals Quality Indicators
2.08
Kindred
Benchmark
Source: Kindred Internal Data
2
1.06
Catheter Associated UTI
per 1,000 Device Days
Kindred 2007
1.07
Line-Related Blood Stream
Infection
per 1,000 Device Days
Kindred Transitional Care Hospitals are Reducing
Rehospitalizations
9.65%
8.28%
Kindred Transitional Care Hospitals
Ventilator Wean Rates
14%
Reduction
44.42%
1.28
Source: Kindred
Internal Data
.88
2009
Pressure Wounds
2013
14 | Transitional Care Hospitals
2013
per 1,000 Patient Days
Kindred Transitional Care Hospitals Are Reducing
Average Length of Stay
30.2 days
27.1 days
10.3%
Reduction
Source: Kindred
Internal Data
Source: Kindred Internal 30-day
Return to Acute Data
2009
49.26%
2009
2013
Since 2008, Kindred Transitional Care Hospitals Have
Increased the Percent of Patients Discharged to a
Lower Level of Care by 7.4%
70.0%
Source: Kindred Internal Data
65.2%
– American Journal of Medical Quality
(2013): Long-Term Acute Care
Hospitals Have Low Impact on Medicare
Readmissions to Short-Term Acute Care
Hospitals
26.7% 25%
2008
Discharges to a Lower
Level of Care
Discharges to Home
2013
Interdisciplinary Care Coordination
Kindred Transitional Care Hospitals provide expert
interdisciplinary and collaborative care that is tailored
to the unique needs of each patient, including 24hour physician support, special care units, telemetry
units with on-site laboratory and radiology services
and operating rooms. The complete team approach
with condition-specific clinical programs facilitates
improved outcomes and a greater chance of recovery.
Kindred Patient Family Satisfaction Scores
(% Usually/Always)
86.54%
Call Light
Response
93.41%
94.75%
94.65%
How Often
Nurses
Explained
Things
Understandably
How
Often Was
Pain Well
Controlled
96.85%
96.36%
“The low rates of readmissions
from [long-term acute care
hospitals] to [short-term acute
care hospitals] suggest an
appropriate level of care for the
LTCHs studied.”
91.73%
Overall
Coordination
Recommend
of Care
From Shift to
Shift
Source: CMS Hospital Consumer
Assessment of Healthcare Providers
and Systems
The Role of
Transitional Care
Hospitals Within the
Care Continuum
In late 2013, criteria to better define which
patients are most appropriate for longterm acute care (LTAC) hospital level of
care was signed into law. Enacting criteria
has long been sought by Kindred and
other LTAC providers as a way to affirm
the important role of LTAC hospitals in
the healthcare continuum for the most
critically, chronically ill patients and to
achieve a measure of predictability and
stability for the sector.
With Congress affirming the role of LTAC
hospital care, the criteria also presents an
opportunity for other medically complex
patients to benefit from LTAC hospital
care at a “site-neutral” rate similar to
that paid to short-term hospitals. The
new law establishes a platform that
fosters stronger relationships and greater
flexibility for managed care and shortterm hospital partners to discharge
patients into our transitional care
hospitals.
Cleanliness
How Often
of Room and
Doctors
Bathroom
Explained
Things
Understandably
Transitional Care Hospitals | 15
Rehabilitation Therapy Services
Rehab therapies are essential to improve patients’ functional abilities and independence. The delivery
of cost-effective and medically necessary therapies to drive down the overall cost of care by shortening
lengths of stay in hospitals or other settings and reducing readmissions to the hospital.
Rehabilitation for a Full Recovery
Throughout the entire healthcare delivery system –
including acute and post-acute care – rehabilitation
services are critical to achieve the goal of
improving the well-being and physical abilities
of each individual so that they may enjoy the
highest quality of life possible. Regardless of care
setting, the provision of physical and occupational
therapies and speech-language pathology are an
essential component in making recovery and
wellness possible.
In 2013, therapists in Kindred’s rehabilitation
division, RehabCare, delivered intense, medically
necessary therapies to more than 518,500 patients
in 1,789 distinct service locations providing
improved function and ability.
In addition to providing therapy services in the full
spectrum of Kindred facilities and care settings, our
therapists treated patients and residents across the
entire care continuum – from hospital to home –
as a contract rehabilitation partner to unaffiliated
16 | RehabCare
hospitals, inpatient rehabilitation hospitals, skilled
nursing facilities, assisted living communities and
home health agencies nationwide.
Clinical Training and Expertise
In order to ensure expert care, our rehabilitation
teams receive ongoing education and training
on clinically-proven best practices, protocols
and precautions. Our national presence provides
a vast knowledge base and experience level to
apply advanced interdisciplinary rehabilitation
interventions to bring out the best outcomes
for each patient. Special clinical programs have
been developed and disseminated related to
falls management, cognitive retraining, pain
management, positioning and other clinical
conditions.
Applying innovative approaches to care, including
the use of Smart® handheld technologies, enables
our therapists to improve clinical outcomes and
operational results.
At Kindred, 22,000 iPads and iPhones are now being used by therapists nationwide, resulting in
higher quality, lower costs and millions of dollars in savings and productivity gains for Kindred
and its customers.
RehabCare’s Increase (%) in Functional Outcome Measurement Scores from
Admission to Discharge
69.72
79.91
79.29
80.48
81.06
81.01
Stroke
Cardiac
Wound
Brain
Dysfunction
Neurological
Orthopedic
77.45
80.0
Pulmonary
Other
68.96
74.68
Spinal Cord
Injury
Amputation
88.44
86.34
Arthritis
Pain Syndrome
Source: Kindred Internal SRS Division Data, Using Modified “Functional Outcomes Measures” (FOMS)
Intensive Therapy Reduces Length of Stay
25
20
10
5
0
Stroke
Less Than 1 Hour
of Therapy
Orthopedic Condition
Cardiovascular and
Pulmonary Condition
1 to 1.5 Hours
of Therapy
1.5 or More
Hours of Therapy
Source: Dianne Jette, et al (2005), Archives of Physical Medicine
and Rehabilitation
RehabCare | 17
“We see an increase in both [IRF Quality] measures from 2011 to 2012, about a
3 percent increase in Functional Improvement Measure gain and about a 1 percent
increase in rates of discharge to the community.” – MedPAC Staff, December 6, 2013
18 | Inpatient Rehabilitation
Inpatient Rehabilitation
Physical rehabilitation provided in an acute care setting facilitates rapid recovery and return home
through interdisciplinary care management.
Inpatient Rehabilitation Hospitals and
Acute Rehabilitation Units
Through expert, intense and aggressive
interdisciplinary therapy and medical care, Kindred’s
freestanding Inpatient Rehabilitation Hospitals
and RehabCare managed hospital-based Acute
Rehabilitation Units (ARUs) – all certified as
Inpatient Rehabilitation Facilities (IRFs) by CMS –
provide rapid recovery and improved function
for patients.
Our Patients
Patients are treated for at minimum a total of
three hours of therapy five days per week. Treatment
delivery and intensity of service is determined as
Kindred Freestanding IRFs Performance in Key
Quality Measures (%)
15
35
10.42
9.97
0
69.76 72.74
Interdisciplinary Care Management
Kindred Inpatient Rehabilitation Hospitals and
RehabCare managed Acute Rehabilitation Units
provide expert interdisciplinary and collaborative
rehabilitative and medical care that is tailored
to the unique needs of each patient, including
24-hour physician support. The complete team
approach with condition-specific clinical programs
facilitates improved function and independence.
Kindred/RehabCare Managed ARUs Performance in Key
Quality Measures (%)
10
8.17
2.94
26.58
9.06
26.46 26.29
5
0
FIM Gain
2.45
0
FIM Efficiency
Kindred Freestanding IRFs
0
Rehospitalization
80
75.3
2.39
0
FIM Gain
FIM Efficiency
75.17
RehabCare Managed ARUs
National Average
National Average
Source: Weighted eRehabData
0
30
2.39
0
Rehospitalization
75
5
31.88
part of the individualized plan of care and will
typically be a combination of 30-60 minute therapy
sessions provided throughout the day by Physical
and Occupational Therapy. Speech Therapy will be
included if clinically necessary.
Source: Weighted eRehabData
0
Discharge to
Community
Discharge to
Community
Inpatient Rehabilitation | 19
Kindred Nursing and
Rehabilitation Centers
Kindred’s Nursing and Rehabilitation Centers provide intensive clinical and rehabilitative services in a
cost-effective setting to make recovery possible and help patients return home.
Transitional Care and Short-Term
Rehabilitation
As the type of patient requiring skilled nursing care
and therapy after a hospital stay has evolved over the
past several years, we have focused the care delivered
within our transitional care centers/units to focus
on patients who benefit from aggressive short-term
rehabilitation and medical care enabling regained
function, independence and their return home.
Our goal is to improve patient outcomes, increasing
function and ability, while reducing the length of stay
in a center. Typically the patients best served in this
setting are recuperating from joint surgery, stroke or
other debilitative conditions.
Subacute Units
Situated within our transitional care hospitals, our
subacute units – licensed as skilled nursing facilities –
provide medical care and rehabilitation to the patients
whose medical condition improved to a level where
they can be treated in a lower intensity, lower acuity
setting. Being co-located within the hospital enables
care coordination and seamless medical treatment by
the same physicians, therapists and care professionals
ensuring a safe transition.
20 | Nursing and Rehabilitation Centers
Alzheimer’s and Dementia Care
For many individuals with advanced dementia
or Alzheimer’s disease, a Kindred Nursing and
Rehabilitation Center is their home as they are no
longer able to safely and securely live independently
in the community. We offer safe, compassionate
care delivered by specially trained clinicians in
an environment that fosters dignity and respect –
providing peace of mind for their loved ones.
From 2009 to 2013, Kindred Nursing and Rehabilitation Centers reduced
rehospitalizations by 15% and average length of stay by 11% while delivering care
to more and sicker patients.
Kindred Nursing and Rehabilitation
Centers Are Discharging More Patients
Home
22,600
14,206
Kindred Nursing and Rehabilitation Centers National Patient
Family Satisfaction
100%
79.2%
75%
Source: Kindred
Internal Data
80.7%
76.6%
79.3%
Kindred
National
Median
Benchmark
50%
25%
0%
Very Satisfied
2009
2013
Source: ABAQIS Quality Management System
Kindred Nursing and Rehabilitation
Centers Are Reducing Average Length
of Stay
85.5 days
Very Likely to Recommend
Kindred Nursing and Rehabilitation Centers Are Caring for More
and Sicker Patients, and in Turn Are Investing in Additional Clinical
Resources
60%
76.4 days
11%
Reduction
0%
2009
2013
Admissions
From Hospital
17%
Rehab Hours/
Patient Day
4%
Nursing Hours/
Patient Day
30%
Source: Kindred
Internal Data
2009
45%
2013
Source: Kindred Internal Data
Kindred Nursing and Rehabilitation
Centers Are Reducing
Rehospitalizations
Kindred Nursing and Rehabilitation Centers Survey Quality
Performance and Peer Benchmarks
27.7%
20.6%
17.6%
Kindred
15%
Reduction
21.08%
National
Source: January 2014 CMS Data
Source: Kindred
Internal Data
6.16
2.41% 2.74%
2009
2013
% “Severe”
Deficiencies
% Substandard
Care
6
Average
Number of
Deficiencies
Nursing and Rehabilitation Centers | 21
Investment in Our People Is an
Investment in our Mission and
Quality Care
Leadership Development
In order to assure a strong future, we offer a series
of leadership development programs to train
tomorrow’s leaders today. These programs include
Kindred’s Executive Fellowship, Nurse Leadership
and Rehab Manager-in-Training programs. Each is
designed to provide operational experience as well
as the practical tools, training and resources to grow
professionally. As well, our Rising Stars program
mentors and assists individuals for officer leadership
positions.
Employee Retention (%)
79.6
70
Through ongoing support by the Kindred
Foundation, we have strong national and regional
partnerships with the American Lung Association,
the American Heart Association and the Alzheimer’s
Association.
Turnover Rates (%)
80
79
74.3
Giving Back to the Community
Kindred is committed to ongoing efforts to raise
awareness and critical funds for the diseases and
conditions that most affect our patients and residents.
We are proud of our ability to demonstrate increased
support in local communities by providing matching
donations to funds raised by employees.
67.1
71
72
37 38 43
21 18 21
Kindred
2008
2013
Hospitals
Nursing
Centers
RehabCare
Employees who have been with Kindred at least one year
Hospitals
2009
13 17 14
Nursing
Centers
2011
RehabCare
2013
38
30 32
Kindred at Home
Home Health and
Hospice
Source: Kindred Internal Data
Source: Kindred Internal Data
“Retention and turnover rates are stable, but we can do better,” stated Benjamin A. Breier, President and COO of
Kindred. “In order to reduce turnover, improve retention and employee engagement, we have implemented enhanced
hiring processes, optimized leadership development training and better targeted total rewards packages.”
22 | Our People
Kindred is the 145th largest nongovernment employer in the United
States and in 2013 paid over $2.9
billion in salaries and labor costs.
• over $95 million in employee state
income taxes
• approximately $160 million in
company-paid health and benefit
programs
• over $144 million in provider,
property and income taxes
• over $530 million in products and
services from vendors
Providing HOPE
Since 2005, the HOPE (Helping Others Persevere
through Emergencies) Fund has provided much
needed assistance to Kindred employees facing
challenging and catastrophic life events. This has
included $4.3 million to more than 3,900 employees.
In 2013, our compassionate employees donated 6,690
hours of paid time off to their fellow teammates
in need.
Reduction in Contract Labor ($ In Millions) –
Improving the Consistency of the Patient/Caregiver
Relationship
$24
$18
2007
2013
$4
Hospitals
Over $457 million was invested in our
employees in 2013 including:
• $29 million in employee training
• approximately $160 million to our
employee health and benefit plans
• $3 million to employees in tuition
reimbursement
• over $57 million invested in employee
recognition and bonus programs
for non-management employees throughout the year
Supporting Economic Growth
and Employee Wellness
As the nation’s 145th largest non-government
employer, Kindred helps drive economic activity in
states and local communities nationwide. In 2013,
Kindred paid $2.9 billion in salaries and labor costs,
$160 million in company-paid health and benefit
programs, over $95 million in employee state income
taxes, over $144 million in provider, property and
income taxes, and purchased over $530 million in
products and services from vendors.
Through ongoing support by the Kindred
Foundation, we have created strong
national and regional partnerships with the
American Lung Association, the American
Heart Association and the Alzheimer’s
Association.
$1
Nursing Centers
Source: Kindred Internal Data
Our People | 23
680 South Fourth Street
Louisville, Kentucky 40202
www.kindred.com
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COPYRIGHT © 2014 Kindred Healthcare Operating, Inc. CSR177456
Dedicated to Hope, Healing and Recovery