The Quality of a Life: 50 Years of National HealthCare Corporation by Bookhouse Group

THE QUALITY OF A LIFE 50 YEARS OF NATIONAL HEALTHCARE CORPORATION

THE QUALITY OF A LIFE

THE QUALITY OF A LIFE 50 YEARS OF NATIONAL HEALTHCARE CORPORATION

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying or recording, or by any information storage and retrieval system, without permission in writing from National HealthCare Corporation.

National HealthCare Corporation 100 East Vine Street Murfreesboro, TN 37130 nhccare.com Dr. Carl Adams Founder Stephen Flatt CEO and Inside Director

BOOK DEVELOPMENT Editor Rob Levin Project Manager, National HealthCare Corporation Celia Taylor Author Amy Meadows Cover and Book Design Rick Korab New Photography Lisa Means Production Director Renée Peyton Copyeditor Bob Land Indexer Shoshana Hurwitz

Nobody knows the quantity of their life. I don’t know how “ many days you have on Earth, nor does anyone else except God. What I’m most interested in is the quality of a person’s life while they are here. That’s the business I am in.

”

— Dr. Carl Adams

F O R E WO R D IX P RO LO GU E XI C H AP T E R

O N E

The Vision 1

CH AP T E R

T WO

A Person-Centered Approach 15

CH AP T E R

T H R E E

In This Together 47

CH AP T E R

F O U R

Taking Care of Business 69

E P I LO GU E 93 I N D E X 94

VIII

W O

By Mark Parkinson NHC had a humble beginning. In 1971, Dr. Carl Adams, then a fifty-eight-year-old surgeon from Murfreesboro, Tennessee, decided he wanted to start a nursing home company. What were the odds that a surgeon at that age would dive into what was, and remains, a notoriously difficult business? The humbling part is that he created NHC when he purchased fourteen nursing homes out of bankruptcy. These were homes that had failed and that no one else wanted. People had to wonder why he would do this. From that humble beginning, Dr. Adams, and his sons Andy and Robert, built a remarkable company. Dr. Adams had a vision of providing seniors different levels of care as they aged. He recognized that NHC needed to develop care plans that were individualized for each patient. He valued each person as unique and believed that the standard plan of one-size-fits-all was outdated and demeaning. He committed to care for both the patients and the staff that take care of them. The results have been stunning. Fifty years later, NHC has become a shining light in the challenging world of senior care. Its growth has been remarkable. NHC now has 167 locations, over fifteen thousand employees, and gross revenues of over $1 billion a year. Additionally, it has no debt—an astonishing fact in a sector plagued by over leverage and poor business decisions. More important than its growth has been the success that NHC has had in providing quality care to its patients and residents. NHC is truly an outlier. At AHCA/NCAL, we keep track of data relating to quality metrics of care in all fifteen thousand nursing facilities across the country. The data shows that NHC is consistently at the top of important quality measures and the CMS Five-Star rating system. In some cases, it’s the quality leader by a large margin. There are often substantial gaps between where NHC is and where the sector is. The result over the last fifty years is hundreds of thousands of NHC patients and residents who have received exceptional care. This clinical success is best explained by the team that NHC has developed. NHC values its workers. The culture recognizes and nurtures its team members, who are appropriately called “Partners.” As a result, the Partners are engaged and stay. In an industry where staff turnover is rampant, NHC has changed the paradigm. The average administrator has been with NHC for sixteen years. This is not normal in the long-term care sector and has provided a stability in the buildings that create excellent patient outcomes. The company has matured. After forty-five years of leadership from Dr. Adams and his sons, the company has now transitioned to a new CEO. For the last five years, Steve Flatt, an outstanding leader in his own right, has led the company. Steve, a former Lipscomb University President, has continued the NHC commitment to great care of both patients and partners. From its humble beginnings fifty years ago NHC is now a public company and one of the most respected providers in the sector. It’s a terrific example of what can happen with vision and leadership. That vision and leadership brought it from fourteen broken down homes to where it is today. It’s exciting to think about where it can go from here.

Mark Parkinson is President & Chief Executive Officer of the American Health Care Association and a former Governor of the State of Kansas.

From the cover of the 2002 Annual Report showing compassionate care between a resident and an NHC Partner. President Andy Adams wrote in his opening letter: “The wellmanicured hand on the cover belongs to my eighty-seven-year-old mother. She lives in the retirement apartments at AdamsPlace and graciously offered to pose with an NHC partner.” X

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THE QUALITY OF A LIFE 50 YEARS OF NATIONAL HEALTHCARE CORPORATION What Would Dr. Adams Do? Judy Powell was catching up on patient profiles at one of National HealthCare Corporation’s skilled nursing centers in Dawson Springs, Kentucky, on a Sunday afternoon in 1974. To her surprise, Dr. Carl Adams and his wife, Jennie Mae, popped in unannounced so that they could spend time chatting with the senior patients who resided at the center. They also wanted to touch base with the center’s Administrator, Director of Nursing, and additional staff members, as well as check on the building’s cleanliness. As a relatively new hire, Powell, a BSN, didn’t realize that this was a common practice for Adams, who founded the renowned National HealthCare Corporation (NHC) in Murfreesboro, Tennessee, in 1971. In fact, conversing with patients and surveying the status of the company’s centers was a trademark for Adams, as he insisted upon seeing for himself the day-to-day care provided to patients. “His work ethic was in view in the office and in the field,” says Powell, who ultimately served as Chief Nursing Officer and Senior Vice President for Patient Services during her forty-five-year tenure with NHC. “To see his insight firsthand like that was just the best.” While many of NHC’s current Partners, as the company’s employees are known, never had the opportunity to meet the esteemed Adams, they know about his passion for providing the best possible rehabilitation and long-term care (LTC) for senior patients. His legendary dedication to that singular goal has been at the heart of National HealthCare Corporation for the last fifty years. His thoughts and prescience are infused into every aspect of the organization and at the forefront of everything that NHC does on a daily basis. Even years after his passing, Partners ask what Adams would do when dealing with everything from a simple challenge to a major decision. That’s because NHC boasts Dr. Carl Adams and an unwavering commitment to implementing Dr. Jennie Mae Adams Adams’s vision throughout the organization he created, as well as across an industry that he helped shape into what it is today. This is the story of the pioneering efforts of National HealthCare Corporation, a company that has been instrumental in changing the face of senior care over the last five decades.

Dr. Carl Adams

THE QUALITY OF A LIFE 50 YEARS OF NATIONAL HEALTHCARE CORPORATION

CHAPTER

ONE

The Vision You have to learn to go all the way on any issue and then you “ must be prepared to go a little further if you need to, but it has to be a continued compromise. In the end, what you are doing is living by example.

”

— Dr. Carl Adams

ndy Adams sat at the large cherry table in the dining room of his treasured childhood home on University Street in Murfreesboro and didn’t mince words. It was early 1968, and the idea that his

father, Dr. Carl Adams, had brought to him was not a sound financial one. In fact, it was a terrible idea. Andy, a CPA at local accounting firm Davis, White & Associates, looked at his father and told him in no uncertain terms that he absolutely should not purchase sixteen failing nursing homes spread across Tennessee, Georgia, and Kentucky. “Dad, no way,” Andy asserted. “That’s exactly what I thought,” Dr. Adams replied.“Let’s do it.”

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

Rutherford Properties Inc. The former opened in 1949, the brainchild of Adams and his colleague, internal medicine physician Dr. S. C. Garrison. The latter was Starting a new business, and essentially launching an established in 1954 in collaboration with Adams and entirely new career, was not something that Carl Adams Garrison’s attorney, Richard F. (Dick) LaRoche, so the intended to do at the age of fifty-eight. By the early 1970s, Partners could purchase land to relocate and expand the he had enjoyed an impressive career that spanned three Murfreesboro Medical Clinic. decades and allowed him to capitalize on both his medical “Rutherford Properties Inc. was a real estate expertise and his entrepreneurial spirit. In addition to investment company,” says Richard F. (Ted) LaRoche Jr., being one of the community’s most renowned surgeons, who followed his father, Dick, into the legal profession Adams was a savvy businessman who cofounded and ultimately served as general counsel for National not only the Murfreesboro Medical Clinic but also HealthCare Corporation for nearly thirty years. For Adams and Garrison, Rutherford “My father and I asked your team to Properties was a vehicle that would allow them to bring community members together to raise do two things—make my mother as enough money to purchase land opposite the entrance of Rutherford Hospital on College comfortable as possible and keep her from suffering Street, where they could build a new clinic. until God took her home. They did both with grace and Their investors would become shareholders

An Offer He Wouldn’t Refuse

compassion. Words cannot express our appreciation so I will simply say God Bless your team and our many thanks for their love and care.”

NHC’s first Home Office building 1971.

C H APTE R ONE TH E VISION

“This is a Corporate Office?” N H C

M E M O R Y

My mother was the legal secretary for Richard F. LaRoche Sr. (his son Ted became the legal counsel for NHC later). Dr. Adams was friends with Mr.

LaRoche so he had him draw up the original charter to start NHC. My mother typed the charter. When I was in seventh grade, I would walk from the Central Middle School to the law office on the square. I was the runner for legal documents to the original NHC office building. It was an old laundry and I remember walking in and thinking, “This is a corporate office?” Twelve years later, I got my job with NHC. —Karla Lane, Administrator NHC Place Farragut

in Rutherford Properties Inc., which would own the building and lease it back to Murfreesboro Medical Clinic. Ted LaRoche continues, “They were ahead of their time. This was really the genesis of what is today called a real estate investment trust.” The plan worked, and over the next several years the medical clinic grew in size and scope. Rutherford Properties thrived as well, even securing a hospital license from the state of Tennessee for the clinic as it added doctors and beds and continuously diversified. Then in 1968, a company called Healthcare Inc. (HCI), led by longtime Murfreesboro resident Campbell Pullias and fueled by its desire to have access to that all-important Tennessee hospital license, acquired Rutherford Properties. The company’s shareholders swapped Rutherford Properties stock in the newly merged organization, and Adams became HCI’s Chairman of the Board. However, as HCI continued to acquire additional healthcare entities in rapid succession, including a group of sixteen financially unstable nursing homes, the writing soon was on the wall. HCI could not survive, and competing healthcare company Hospital Affiliates Inc. (HAI) proposed another merger. “Dad was concerned that the initial investors of Rutherford Properties were going to lose their money,” explains Robert G. Adams, Carl’s fourth child and former CEO and current Chairman of the Board of National HealthCare Corporation. “He wanted to buy back Rutherford Properties and get his investors out of there.”

Carl Adams immediately resigned from the board of HCI and went to work trying to regain control of his original company. However, Robert Adams notes, “Jack Anderson, the CEO of HAI, said, ‘Carl, we’re not going to let you do that unless you also take all of the nursing homes.’” It was then that Carl Adams brought the daunting financials of those nursing centers, laid out on a three-foot-wide spreadsheet full of numbers and brackets, to his son, Andy Adams, who advised his father against the deal. However, the doctor insisted on protecting his first shareholders. He also looked at the agreement as a rare opportunity to do something that had never really been done in the healthcare industry: provide exceptional care to geriatric patients. That opportunity was formalized on July 23, 1971, after negotiating a complicated financial transaction and mortgaging nearly everything he owned with the support of his wife, Jennie Mae. The new entity was named National Health Corporation. When the doors opened, the company boasted a slate of fourteen nursing homes, as two of the original sixteen centers were sold back to their on-site administrators upon completion of the deal. Carl Adams surrounded himself with a small group of dedicated professionals who could help him navigate the intricacies of the senior healthcare business, from tackling the challenges associated with federal Medicare and state Medicaid reimbursements to understanding the distinct clinical needs of the patients who resided in the nursing homes. The team included Andy

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

Dr. Carl Adams and Andy Adams

C H APTE R ONE TH E VISION

Adams, who joined NHC as Executive Officer and rose to CEO; Howard Behm, who previously worked for HCI and came on board as Executive Vice President; Louise Evins, the Accounting Officer; Charlotte Barber, a registered nurse who provided clinical perspective; and Jane Ralston, Carl Adams’s secretary. Together, working out of a tiny, borderline-dilapidated building near Murfreesboro Medical Clinic, the newly established team set out to take a different and truly unprecedented approach to senior care.

Against the Status Quo “Every stereotype you can think of when you hear the words ‘nursing home’ is what existed in the late 1960s and early 1970s. Nursing homes were like warehouses for the elderly,” Ted LaRoche reveals. Carl Adams wanted to change that. As he had spent his entire career

“Over the past nine years you became Mama’s community, her link with the world, her loving caregivers, her entertainment, her providers of food, clean clothes, and medicine, her personal friends and family. You provided all the basic necessities of life with care, expertise, and humor, all the while allowing her to maintain her dignity. You not only styled her hair, you bragged about how pretty she looked! You were her physical therapy cheerleaders. You brought her those mints she liked. You encouraged her to sing. You “let” her win occasionally at BINGO! You listened to her worries or complaints and shared your own problems, allowing her both to receive and dispense advice; she relished both!”

Fay McRady conducting nurse in-service.

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

providing medical care to people of all ages, he keenly understood the particular needs of senior patients. And his approach to ensuring their well-being was very different from the status quo at that time. Doran Johnson, the retired Senior Vice President who served as head of NHC’s South Central Region for forty-nine years, remembers exactly when he began to understand Carl Adams’s vision not only for the company, but also for the senior care industry. In 1972, during his first year as an Assistant Administrator with NHC, he worked at Fairhaven Nursing Home in Pulaski, Tennessee, under the direction of J. L. (Babe) Thompson. “I learned from the very beginning that our number-one priority was to have all the beds filled. There were seventy-five beds, and we achieved seventy-five patients within a reasonably short amount of time,” he recalls. During one of Dr. Adams’s regular visits to the center, Thompson proudly announced that his team had gone 103 days with a full census of seventy-five patients with no admissions and no discharges. “Dr. Adams whistled as he thought of his reply and

Dr. Carl Adams—A Visionary Leader Hailing from Cannon County, Tennessee, Carl Adams was born on January 31, 1913, into a medical legacy. His father, J. F. Adams, was a highly respected country doctor who often did things differently, focusing on continuing medical education and striving to bring new medical developments and surgical techniques to the people of his home county. Carl, the third of nine children, followed in his father’s footsteps, graduating from Middle Tennessee State College (now University) before receiving his medical degree from the University of Rochester School of Medicine and completing his residency at the Nashville General Hospital. He first went to work for his father’s medical practice but left to strike out on his own in nearby Murfreesboro, where he connected with Dr. S. C. Garrison to found Murfreesboro Medical Clinic. As his professional aspirations came 6

Judy Powell

to fruition, Carl placed great emphasis on continuing medical education for the benefit of patients, just as his father did years before. He maintained that philosophy throughout his entire career and until his passing on September 7, 1994. Carl Adams married Jennie Mae Mitchell in 1941, and the couple had six children: Carl E. Adams Jr.; Fred M. Adams; W. Andrew Adams; Robert G. Adams; A. B. Adams; and Joanne Adams Coggin. His visionary company, National HealthCare Corporation, not only became a leader in the senior care industry, but also a family affair, with Andy and Robert ultimately leading the organization in the CEO position and son-in-law Gerald Coggin serving as a Senior Vice President. As Coggin observes, “The methods that he created, the memories that we have of him, his overall attitude towards taking care of seniors is still just as alive today as it was when he was involved. The spirit of Dr. Adams still exists within NHC today.”

C H APTE R ONE TH E VISION

finally said, ‘Babe, you’ve got a problem.’ He explained that our purpose was to help patients who were recuperating to return to their home setting if possible. Then we needed to admit new patients and get them back into the home environment if possible,” Johnson says. “This was our first indication that Dr. Adams had a vision of healthcare for the patients rather than a simple protective environment that provided room and board.” Up until 1971, that’s exactly how nursing homes viewed their role in the lives of elderly patients. In many cases, facility administrators didn’t see a need to modify that attitude because the effort simply would not be profitable. In 1965, the U.S. government instituted the Medicare program for the sixty-five-and-older population and reimbursed hospitals and care facilities for the rehabilitative medical services they provided to this sector of the population. While hospitals received hundreds of dollars per day in reimbursements, nursing

Robert Adams

“I want to extend a special word of thanks to each team member who loved and cared for our parents over the past nine-plus years. From the kindness and attentiveness to our father who was legally blind, to the deep caring spirit gifted to our mother who was an invalid in her last two years of life, the love displayed from the dining room to the bedside was a true reflection of the love of Jesus.”

homes—which hospitals often managed as not-for-profit entities—received much less compensation, as they did not provide comparable medical-based resources, particularly in terms of rehabilitation. This is where Carl Adams saw an opportunity regarding how NHC would

Richard F. LaRoche Jr.

C H APTE R ONE TH E VISION

HomeCare Delivers Love of Flowers We had an elderly female patient who had suffered multiple debilitating injuries as well as a terminal disease, and it had been months since she had been in her beloved flower gardens that sat right outside her kitchen window. Her spouse had passed away very unexpectedly which N H C

M E M O R Y

was devastating to the patient. He was the one who would normally tend to her flowers and make her a bouquet. She kept mentioning to Brenda when

she would come for her visit how much she would love to be able to make it outside to her flowers all of thirty feet away. Brenda decided to make it happen. She set up lawn chairs every few feet for the patient to be able to sit and recover on the way to her flowers—and she did it! She cut numerous bouquets which Brenda set up in vases on her kitchen table, and the patient cried as she had longed for this for too long. Brenda was able to think outside of the box and show empathy for the patient, and the patient told anyone who would listen about Brenda’s actions and how grateful she was. —Dawn Perrone, Administrator

operate its original base of fourteen nursing homes. While the late 1960s and early 1970s saw many facilities go out of business, as they often were audited and lost funds due to the lack of short-term rehab services, Adams decided to transform each of his new company’s nursing homes into skilled nursing centers that would provide a comprehensive suite of services for elderly patients, from on-site therapies and outstanding nutrition to overall wellness amenities. In addition to providing an uncommon level of care that senior patients had not seen, the strategy would open the door to hospital-type reimbursement and a chance for unparalleled growth in an industry that appeared to be withering under the weight of governmental regulation. As Dr. S. C. Garrison once said, “At a time when nursing home ownership and management were looked upon by newly formed hospital management companies as an unprofitable sideline, Dr. Adams saw the possibilities in acquiring nursing homes, and, by proper management, developing a company that would operate a high standard of care and, at the same time, show a profit for the investors and attract capital for the company.”

Finding a Balance According to Andy Adams, “Dad understood the proper relationship between providing quality service and focusing on earnings. You couldn’t have one without the other. So, first and foremost, our patient is the reason for our being. At the same time, we have a fiduciary responsibility to those who have entrusted their money with us, and we owe them a return on that investment.” That dichotomy was a driving factor for Carl Adams, who created a culture within the business that encouraged every Partner, or employee, to understand the importance of both responsibilities and do everything possible to achieve those objectives. He also recognized the natural connection between the two goals. “Dr. Adams was a great believer in the philosophy that if you take care of the patients, the bottom line will take care of itself,” says Gerald Coggin, Carl Adams’s son-in-law, who joined NHC in 1973 and retired as Senior Vice President for Ancillary Services and Corporate Relations. Of course, in those early days, that meant reimagining what it meant to take care of patients in a nursing home setting—a prospect that required time

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

vision forward year after year, also has managed to turn NHC, which became a public “You protected her. You allowed her to company in 1983, into one of the most all-inhave dignity. You fed her, you entertained clusive LTC organizations in the country, covering ten states and reaching far beyond her, you befriended her and led her and followed her the seventy-six skilled nursing centers that and walked alongside her. You were tender.” in 2021 remain at the heart of the company. In fact, NHC, which boasts more than fifteen thousand employees, is now recognized for its full and ever-evolving continuum of care for and money. “In spite of numerous problems during the elderly patients, which today includes twenty-four first eighteen months following the formation of the new assisted living centers, five independent living centers, company, Dr. Adams almost single-handedly stabilized thirty-five home care agencies, twenty-eight hospice operations, conserved cash, and met the company’s programs, and one geriatric psychiatric hospital. obligations in a satisfactory manner,” Garrison told “Wherever seniors are, we want to be there to help Ted LaRoche for his book, NHC: Recollections, which meet their needs,” says Stephen F. Flatt, who joined celebrated the twentieth anniversary of the company. the company in 2005 and became CEO on January “In addition, and most importantly, he was able to 1, 2017, upon Robert Adams’s retirement from the assemble talented people who have helped make the position. “Our vision statement is ‘Caring in a better company such a financial success and have given NHC way, day by day.’ What we’re really trying to do is help its reputation for quality service.” seniors live life to the fullest. That’s what we want for That team of Partners, guided by the leaders who every person we serve. That has never changed.” have been uncompromising in carrying Carl Adams’s

Don Daniel

Jim Keathley

Davy Huff, PTA, supervising a patient’s exercise program.

C H APTE R ONE TH E VISION

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

C H APTE R ONE TH E VISION

Cheryl Orton, LPN, HomeCare nurse

Brigitte Burke, AVP Food and Nutrition, with Margaret Freeman. Margaret began her thirty-two-year career as a dietitian at NHC Anderson and became the first regional dietitian for South Carolina. During NHC’s growth in the state, Margaret was instrumental in the development of the Food and Nutrition departments. Following retirement, Margaret and her husband, Morris, chose NHC Anderson for her care. Morris said Margaret from day one was at home and loved by her NHC family.

THE QUALITY OF A LIFE 50 YEARS OF NATIONAL HEALTHCARE CORPORATION

CHAPTER TWO

A PersonCentered Approach There is an ever-increasing demand for more and better “ services, increased knowledge, expertise and management ability, improved techniques, and more efficient and effective performance. The long-term care industry must be innovative and continually strive for excellence.

”

— Dr. Carl Adams

hen Dr. Carl Adams reviewed a patient’s file so that his skilled nursing center team could begin creating a care plan, he didn’t pose the questions that normally were top of mind in

the senior care industry. Instead, he would query: “What’s the maximum outcome we can expect this patient to obtain?” Gerald Coggin recalls. 15

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

“I want to give specific attention to the final four days of our mother’s life. The NHC team was nothing short of incredible, attentive, meeting every physical and emotional need of our mother and our immediate family, day and night. They loved well.”

“It wasn’t just about getting the patient up at 7 a.m., giving them their daily bath, giving them their food, and then sending them to an activity program until lunchtime. That wasn’t the type of care plan that NHC developed. Our care plan asked how many steps that patient was going to take after their hip fracture surgery. In two weeks, would they be able to walk unassisted to the end of the hallway or not? Would they

Bon AppÉtit When patients are admitted to NHC, one of the first questions asked is what they like to eat. Oftentimes, the food service partners will ensure that a patient’s first meal is his or her favorite, as a way to welcome that individual to the health care center. That effort is maintained throughout a patient’s stay, as the food and nutrition team strives to ensure that everyone not only receives their beloved regional dishes, but also high-quality fare that compares with the best local restaurants or foods the patients would have at home. Focusing on menu development, food production, kitchen efficiencies, and the refinement of this process has always been an NHC objective. Peggy Allen, in her first role as Food Service Manager in the kitchen, learned that the previous manager wrote the daily menu on a trifold paper towel. A recent graduate of Middle Tennessee State University in Home Economics who was working toward becoming a registered dietitian, Allen understood that there was a more efficient way to 16

be able to go home in a month? Would they be out on the golf course in three months? We had to develop a care plan that was specific to the patient.” In fact, under Dr. Adams’s direction, NHC took a holistic, interdisciplinary approach to the care of its senior patients. The key to doing that effectively, according to Adams, was to bring in highly educated and credentialed professionals to oversee and administer a wide range of services, many of which were considered to be unnecessary by others but which Adams thought of as essential to the quality of life of NHC’s patients. He took a strategic approach to building out that menu of services and finding the right people to fill the necessary positions. His goal was to create a system in which in-house experts representing each of the company’s services would work together to provide cohesive yet individualized care plans. And it all started with a focus on the patients’ most basic needs.

plan and implement the menu processes. Gussie Walker recognized the opportunity and put Allen in charge of the project, and she continued to manage the growth of NHC’s menu systems for more than forty-five years. That constant improvement moved NHC’s daily menus from being written on napkins to being planned and implemented using automated and integrated computerized systems.

Lily Mireles, Food & Nutrition Partner, offering choices.

CH APTE R TWO A P ERS O N-CENTE R E D APPROACH

Charlotte Swafford

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

Medical Care: Building a Foundation When Andy Adams joined his father at NHC, he began focusing on the financial side of the business, finding ways to raise capital and ensure that the company remained fiscally viable. That allowed Carl Adams to concentrate on the clinical aspects of the company’s operations and the quality of care provided to patients, which fell right into his professional wheelhouse. His first order of business was to zero in on nursing, and he set out to change the way this department was traditionally staffed in the industry. He planned to place an emphasis on having registered nurses (RNs) as a key part of the equation, which is why he brought the

highly skilled Charlotte Barber on board during NHC’s earliest days. At that time, with such a small core group of leaders, everyone performed a variety of functions; Barber served as Administrator and Director of Nursing for NHC’s University HealthCare center and “moonlighted” as a Regional Nurse consultant overseeing all of the company’s centers. By 1972, Dr. Adams began looking for additional RNs to add to the team and turned to Mazell Tambornini, a well-respected emergency room nurse he had worked with on occasion through Murfreesboro Medical Clinic. “He called me on a Sunday, and I went to work for him on a Monday,” says Tambornini, who initially served as the Director of Nursing and later as the

Margaret Curtis—Still on the Route Very few patients and even visitors enter the building at NHC Healthcare Columbia that don’t come into contact with Margaret Curtis. She has fast become an integral part of the life of the center. For twenty-six years Margaret served her community in another way as a rural mail carrier near Franklin, Tennessee. “I loved it”, she recalls of the job. However, after retirement she A D D I N G

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was involved in a car accident that would eventually lead her to her new home and purpose. Over the long and sometimes

painful road to recovery, Margaret slowly transitioned from being prone and immobile to lifting weights and increasing her time on the stationary bike.

As she

progressed physically and grew in her confidence, she agreed to take a volunteer position in the center as Patient Council President. Margaret describes the role as being sometimes administrative, occasional referee, and always engaging. “If someone has an issue, they come to me, and I go and talk to whomever I need to talk to. But it doesn’t happen very often.” As Patient Council President, she encourages her neighbors to come to activities, to get out of the bed and to start “moving around a bit.” One way she keeps in touch with so many other patients is by going from room to room to deliver the in-house activity schedule. It appears that Margaret Curtis remains on her route, after all. “I still get to be the mail carrier,” she notes and for NHC Columbia they have found a leader in Margaret that influences the lives of so many. 18

CH APTE R TWO A P ERS O N-CENTE R E D APPROACH

first full-time Regional Nurse consultant. Remaining with the company for twentyeight years, she first worked at the twenty-bed nursing center that was attached to the clinic in Murfreesboro. For those first few months, Dr. Adams visited the nursing center nearly every day and made rounds with Tambornini so that they could discuss the patients and their required care. “Some of the patients were very difficult, very sick. So we just had to put our expertise out in front of us and go for it,” she recalls. “Common sense helps you so much in my job, and I knew what I was looking for when I went in to observe the patients.” Recognizing how beneficial it was to have a professional like Tambornini manage the clinical needs of the patients at NHC Murfreesboro, Carl Adams implemented a

“What you do—all of you—is the single most difficult job in the world. It is hard, and thankless, and frustrating and exhausting, and parts of it are unsavory and messy and don’t smell good and are unsanitary. And that you choose to do it is one of the most humbling things I’ve ever witnessed. You arise each day, you put on those uniforms and nametags, you show up at NHC and you LOVE. You hand out buckets and truckloads of LOVE. You are priceless.”

Dr. Carl Adams and Ann Coleman

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N Bea Holton, Registered Dietitian, visiting a patient at the noon meal.

Tammy Martin, Certified Dietary Manager, visiting with a patient in the dining room.

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Vicki Dodson and Dr. Mack Wayne Craig serving the CNAs at their 1994 special banquet.

mandate in 1973 stating that the Director of Nursing (DON) in each NHC skilled nursing center, often called an SNF, had to be a registered nurse. He required that an RN be onsite around the clock to serve patients and endeavored to bring in qualified certified nursing assistants (CNAs) to provide continuous support to both the RNs and the patients. What’s more, he eventually began searching for individuals who had earned a bachelor of science degree in nursing to join each of the company’s SNF teams. He saw this as a master plan for providing top-quality care at all times that was unique to the nursing home setting. “When you are in a hospital, so often you become whatever your diagnosis is,” says Vicki Dodson, who came to the company in 1984 and assumed the role of Senior Vice President of Patient Services in 2019 upon Judy Powell’s retirement. “You are a gallbladder patient. You are a hip fracture. You are a pneumonia patient. But when you’re a long-term or postacute care patient, you come to the center with so many comorbidities, and it’s our job to look at the patient from a

holistic view and how each of those conditions play into the plan for the care of those patients.” That unique grasp of what LTC patients really need permeated every clinical-based decision that Adams made in those early years. For instance, he insisted that each SNF apply to become a Medicare-certified center so that patients could take advantage of the program’s one-hundred-day rehabilitation option; once transferred from a hospital to an NHC skilled nursing center in the community, a patient could receive subsidized services and the type of personalized care that would put them on a road to recovery. Additionally, he wanted to ensure that Medical Doctors were involved in the overall clinical care process. In 1974, when Doran Johnson was serving as administrator of Merihil Nursing Home in Lewisburg, Tennessee—now known as NHC Lewisburg—he remembers Dr. Adams calling often from the home office to discuss the patients’ status. “He would say, ‘This patient is on fourteen medications—that’s too much for anybody.’ Talk it over with the doctors,” continued on page 24

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“In the end, I am forever grateful he was there and simply can’t imagine him being anywhere else. He left surrounded by love and caring hands that cried right beside us. This task was not easy for the NHC staff as they also did not want to let him go. I witnessed professionalism, compassion, love, fear, and pure grief from the staff, especially the last week. He had almost as many visitors from the staff as he did from family. They came to just have a little time with him before he was gone. They came from all areas of the home, not just nursing.”

NHC Murfreesboro Administrator Robert Adams, and Bookkeeper Dawn Thorpe Strawn, reviewing paperwork in 1978 with a patient.

Johnson says. However, getting local doctors to visit the SNFs regularly to check on the patients posed a challenge, as they either did not have the time or the desire to work with senior patients at that level. As a result, Dr. Adams decided that he wanted to have a Medical Director on staff at each skilled nursing center. Unfortunately, as Johnson notes, “It was very hard to get doctors interested in us.” “Dr. Adams had to build a relationship with the doctors in the community, so he would have lunch meetings with physicians to discuss patient care. It really helped build our reputation in the community. The way Dr. Adams looked at it, involving the doctors in the process was just as important as involving his staff,” says Ann Coleman, who began as a Staff Nurse at NHC Murfreesboro in 1975

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and retired in 2016 as NHC’s corporate Assistant Vice President for Nursing Services, returning to offer Director of Nursing training across the company through 2017. “One of the biggest moments for NHC was being able to have medical doctors for each healthcare center. Dr. Adams thought it was very important, and it was.” In fact, he felt so strongly about the role of medical directors in the senior care industry that he helped found the American Medical Directors Association. As NHC began expanding its bed count and growing its number of SNFs, Dr. Adams placed Tambornini in a regional nursing role, which saw her traveling to NHC centers throughout Nashville and the surrounding areas so that she could bring her expertise to them. In her new role, she reviewed clinical processes, assessed patients, assisted with preparation for state inspections, and troubleshot

problems. Through that opportunity, she saw firsthand how Dr. Adams’s approach to long-term inpatient care not only changed patient outcomes for the better but also how people viewed the importance of geriatric care. “Dr. Adams had a vision of what needed to change in that part of the healthcare industry. The company really set up its own system as to what the people needed,” Tambornini observes. “Dr. Adams was very thorough in what he was doing. He had a drive to help people. He just knew what was needed.”

In-House Therapy: An Unprecedented Offering One day in 1974, Dr. Adams surprised Doran Johnson at Merihil Nursing Home. “He came in and brought Linda Brandon, a physical therapist [PT], with him,”

Hurricane Michael Hits NHC—And NHC HomeCare Punches Right Back In October 2018 Hurricane Michael, a Category 5 storm, came ashore in the Florida Gulf Coast area impacting numerous NHC HomeCare offices, including Port St. Joe. The office was completely destroyed by a four-foot storm surge and we lost everything. Several of our partners N H C

M E M O R Y

lost their homes. As a result of the storm’s effects many of our patients and staff were without communications, electricity, internet, food, water, ice—all

of the many things we take for granted each day. It looked as if we lived in a war zone, like you see on television. NHC Port St. Joe and NHC Carrabelle staff rallied and drove all around Gulf County in search of our patients who we knew decided to shelter in place, to ensure they were safe at home and had adequate shelter, water, non-perishable food, and medical supplies. n In the days following, numerous NHC corporate officers and others drove to Florida and delivered a trailer full of supplies for our partners and patients. In turn, we distributed these critical items to many grateful and needy folks who were clearly touched by the compassion shown to them. We also picked up laundry regularly, and brought it home to wash. n There was a bright spot in all of this. NHC paid full-time partners at the Port St. Joe office their full salary for months, even though they weren’t working full time because our census had dwindled due to folks leaving the area. One of the employees choked up and said, “I’ve worked for many organizations over the years, but I’ve never worked anywhere that truly cared so much about their employees. NHC is different and I will remain loyal to them as they were to me.” —Tammi Hardy, Administrator, Port St. Joe

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In the Name of Research

Always looking at how his company’s work could enhance senior care as a whole, Carl Adams encouraged NHC’s Partners to get involved in a variety of activities, including research opportunities. For instance, Ann Coleman, retired Assistant Vice President for Nursing Services, collaborated with John F. Schnelle, professor of medicine in the division of geriatric medicine at Vanderbilt University, on a research project about incon-

tinence. Having worked with patients onsite to address their bladder control issues, Coleman found the topic to be of great importance for the nursing home industry. Together, Coleman and Schnelle applied for and received a grant from the National Institutes of Health to study prompt voiding and the ability of certain patients to be bladder trained. The impressive results of their work were published and became an element of Medicare’s MDS system. According to Coleman, “I think it was one of the finest works that had been done in incontinence care.”

he states. “Dr. Adams sat down with us and talked about his vision of getting patients up and restoring any previous function that could be restored. He explained that though they may not ever be able to get back to some of the things that they had previously experienced, even if they took a few steps or learned how to feed themselves, this was very important to that person. As he left, I realized I had no idea what to do with a physical therapist. He said, ‘She knows what to do. Just support her.’” Little did Johnson know that Dr. Adams was having the same conversation with SNF administrators across NHC, including with his son Robert, who at the time was managing the NHC Murfreesboro center. “It’s hard to imagine, but in 1974, we didn’t have any therapists. Nobody did therapy,” Robert Adams says. “Then one day, Daddy walked in and told me, ‘Robert, we’re going to hire physical therapists. These patients have to go to therapy, and they’re not having that opportunity.’ And I said, ‘Daddy, we can’t afford to hire these therapists.’ We were going to pay them twelve thousand dollars [per year]. Daddy replied, ‘We can’t afford not to pay them,’ and walked out the door. So we hired a therapist.” At the outset, the challenge was finding physical therapists who were willing to work in a nursing home setting. Most PTs then were primarily interested in working in acute care or a private setting, and in the

early 1970s, professionals in the industry simply did not see the rewards associated with serving geriatric patients. But Dr. Adams would not be deterred and forged ahead, seeking out and striving to convince physical therapists to consider NHC, against all odds. NHC Partners realized how serious Dr. Adams was about physical therapy, as well as how quickly he was prepared to bring his vision to fruition. “We got a shipment in the mail one day, and it was a huge whirlpool tub,” Johnson recalls. “At that time, putting people in a whirlpool tub was very good for healing. It’s not a modality of therapy anymore, but it was a modality that everybody used then. So Dr. Adams bought one and sent it to every location. I thought, What in the world am I going to do with this? We had no space, and we had to put it in one of the central baths. But that’s what Dr. Adams wanted for his therapy department.” While some elderly patients may require physical therapy for specific injuries or surgery-related conditions, the process of aging is what leads many seniors to require this ancillary service as well. “With normal aging, our strength declines, especially in relation to power, such as the ability to adequately recruit enough muscle when needed in order to quickly do things like climbing stairs,” explains Linda Bloodworth, Program Director for the Geriatric Physical Therapy Residency at NHC. “If we find deficits in strength and power,

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which we almost always do, then exercise is really the solution to that. And we look for activities that are as therapeutic as possible. We have to find ways to keep patients active and doing things that they can do long enough to experience the benefits of them.” Of course, very early on, Adams discerned that physical therapy was not the only consideration in this arena of senior patient care. He also brought in occupational and speech therapists. The latter was a suggestion from Ann Coleman, who pointed out that elderly stroke survivors who were transferred to NHC SNFs after their hospital stays often had difficulty swallowing—a significant challenge for many

stroke patients. As speech therapists are well versed in addressing swallowing complications, Adams instinctively took Coleman’s recommendation and added speech pathology to the therapy department. In 1976, he hired Joanne Batey, who initially traveled between five centers in West Tennessee and Kentucky to provide speech therapy services. “The old adage when you’re dealing with neurological issues or strokes in older people is that if they don’t show any progress in six months, you no longer do anything,” she says. “We didn’t find that to be true. In some cases, we saw stroke patients who had experienced their strokes long before really respond to therapy.”

1994 NHC Senior Management Team. (Front Row, L-R) Jim Keathley, Judy Powell, Andy Adams, Joanne Batey; (Second Row, L-R) Ted Laroche, Charlotte Swafford, Robert Adams, Gerald Coggin; (Rear Row, L-R) Ernest Burgess, Don Daniel, Ken Denbesten.

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Out in the industry, many people ridiculed Dr. Adams’s attempts to serve geriatric patients with therapy services. However, the results clearly spoke for themselves, as patients and their families saw significant improvements and, in many cases, a return to their home environments. In fact, over the years, therapy has become an industry standard, thanks to Carl Adams’s foresight at NHC, with countless nursing home companies deciding to offer the service nearly a decade after Adams resolved to do so. And today, the service has become an intrinsic part of the industry, offered by long-term nursing centers nationwide. According to Joan Phillips, Assistant Vice President of Rehab Services, who joined the company

in 1979, “Dr. Adams saw the value in it. One of the great things about rehab is that it brings hope. That’s our goal. If you come to one of our centers and you’ve had something devastating happen to you, we bring the hope of getting better. Today, we bring that same hope through rehab provided across the continuum of care, including patients who come to our centers for the intensive rehab program, receive therapy at home, or return for outpatient therapy. We also bring it to those people we prepare to live their best lives in a supported setting, such as in one of our assisted living locations. And years ago, our retired AVP of Rehab, Ann Horton, developed a system for NHC therapists to also provide therapy services

The Best of the Best

Wilma J. Powers was “The Voice of NHC” for thirty-nine years. People would hear her dulcet tones when they called NHC’s 615-890-2020 main line. She took her job of providing the first impression for NHC very seriously and was known for always remembering someone’s name by listening to their voice. She was one of NHC’s greatest listeners and conversationalists.

When it comes to standout Partners, three names often come to mind at NHC. These ladies were instrumental to the company in so many ways, and they left their indelible imprints on the organization through their passion, dedication, and professionalism. Nan Moores began her thirty-four-year career with NHC as Dr. Carl Adams’s Assistant. Over the years, she also worked with Judy Powell in Patient Services; Dr. Linda Shoaf, the first Dietetic Internship Director; Dorothy Chance in Social Services; and Gussie Walker. Upon her retirement, she was described as “sturdy, unshakable, and loyal.” Barbara Harris retired from NHC after fortythree years with the company, ultimately serving as Assistant Vice President of Operations. Having worked with Dr. Adams in the early days of the company, she was a wealth of knowledge about the inner workings of the organization and often was referred to as the “NHC Archives.” She was never afraid to challenge someone who was heading in a direction that she believed veered from Dr. Adams’s goals for the company.

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N Celia Taylor leading patients in exercise during filming of the exercise video, sent to all centers in the late 1980s. The video contained patient exercise groups from five NHC Tennessee centers who named themselves the Nashville Rolling Rockets, Murfreesboro SeniorCisers, Hendersonville Honeys, Sunshine Bunch (Springfield Health Care) and Bodies in Action (University Health Care).

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to other entities such as hospitals and schools in our communities. Dr. Adams’s incredible vision continues to overwhelm and amaze me and it still shapes us today.”

Adams also recognized that so many factors contribute to making a person both healthy and happy. In pursuit of that, he supported three key areas of care: food and nutrition, recreation and wellness, and social work.

The Overlooked Essentials At NHC, quality of life encompasses so many elements—all of which Carl Adams contemplated from the moment he formed the company. While basic medical care and therapy services took precedence, Dr.

Homegrown Productions Harold Bone, retired Assistant Vice President for Partner Relations, had a side love for photography, videography, and editing. Along with the Human Resources team, he created many NHC video productions that were designed to train Partners across the organization. He also had the foresight to video many of NHC’s early leaders during presentations or interviews that allowed them to respond to questions about NHC and their dreams for the company’s future. Fortunately, he saved the videos in various formats, which are housed in the NHC archives and often used in presentations to this day. For many of the training projects, Bone often turned to Partners as scriptwriters and actors. For instance, along with a team of Partnersturned-actors from NHC’s South Carolina region, he recorded and edited The Better Way promise screener, as well as supervisory training videos. He collaborated with Patient Services in the Home Office on numerous projects, including an exercise video for patients, a thirteen-month customer service video series called 20/20 (which resembled a newscast with a roving reporter who presented the “Culture Connection”), the Better Way training videos, the “Focus on the Fix” five-step customer service training, as well as orientation videos and tools. The team also collaborated on numerous clinical training aids and videos, such as a project focusing on fall reduction in the skilled nursing centers and another video about senior skin care titled Skin Is In, which featured TIO the Alligator and the GoodSkin Twins. The latter training package was sent to all of NHC’s centers and included a full alligator costume

Food and Nutrition: Beyond an Apple a Day While building the nursing and therapy departments, Dr. Adams simultaneously shined a light on the nutritional needs of the senior patients. Not long after NHC’s founding, he began looking for a registered

that was worn by an onsite NHC Partner during the training sessions and a traveling scrapbook to capture TIO’s journey. According to Celia Taylor, “The videos were informative, gave helpful tips, and often brought in the use of laughter and creativity to grab the attention of the NHC audience. All of the training tools for each production were created from start to finish by NHC. I don’t think any Partners went on to win an Academy Award, but I believe our NHC viewers appreciated the homegrown messages created just for them.”

“Skin Is In” training with Administrator Kellie Perry and her team. NHC Home Office shipped out the alligator suit, the video, and other supplies to centers upon request. Someone at each location would wear the suit and help create a fun day of training. 31

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dietitian to serve as a consultant for the company’s skilled nursing centers. Fortunately, one of the centers in his original purchase of the nursing homes in 1971 already had a consultant: Augusta “Gussie” Walker. And though she had moved on to a full-time position in charge of the employee cafeteria at Nashville’s Legislative Plaza for the state of Tennessee, she continued to offer her part-time services to several NHC centers. By 1974, she was ready to leave her job and join NHC as the Coordinator of Dietary Services. And she came in with very specific goals in mind. “I wanted the patients to have food that was attractive, nutritious, and tasted good—and that was something I worked on constantly,” she says. In addition to creating a well-balanced menu that provided a variety of colors, textures, and nutrients, Walker, as well

Music to Their Ears In 1981, NHC Murfreesboro wanted to do something innovative and proposed starting a patient handbell program. The assistant director of nursing found local Registered Music Therapist Celia Taylor, who was willing to donate her time. The task of acquiring the handbells posed a challenge, but

as the team of NHC regional dietitians who eventually worked under her direction, strived to ensure that the menu met the particular health needs of the patients. “When someone comes to us from the hospital, typically they have eaten little for several days or they have had diet limitations. Our first step is to liberalize the diets in order to increase their appetite and food intake,” explains Brigitte Burke, who took the reins as Assistant Vice President of Food and Nutrition when Walker retired in 1999. “The dietitians then assess the nutrition component, which plays a role not only in overall outcomes, but also specifically in wound healing and in maintaining lean body mass. Patients need energy for therapy, and that comes from food.” In fact, food is one of the most important aspects of the senior patient care model created by Dr. Adams. Burke

Jennie Mae Adams was interested in helping get the new music program added to the recreation and wellness offerings so she donated the first handbell. Her contribution was followed by donations from other families and community members to create a complete set of handbells. The three patient bell choirs performed for patients, families, and visitors. “One of the most evident benefits of the patients’ newly discovered talent was a sense of purpose and pride, as seen on their faces after hearing the audiences clapping and cheering during their concerts,” recalls Taylor, who was later hired by NHC Murfreesboro in 1982 in recreation and then as a Regional Recreation Director before taking her current position as Customer Service Training Specialist. “Music stimulates almost all of the brain, offering many therapeutic benefits, both physical and mental. Not all NHC locations have access to a music therapist, but all know the beauty of incorporating live music into their programming, whether it’s provided by a Partner, a hired professional, or a volunteer. Music touches hearts, offers another form of expression and communication, engages the patients, and brings back memories.”

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continues, “When working in senior care as a dietitian, you must be proficient in all areas of diet therapy and disease management. The Dietitians and Food and Nutrition Partners must balance acute illness with chronic illness and be thoughtful when considering food in terms of wellness, socialization, and nurturing. Our Food and Nutrition Partners, no matter what their role in the kitchen, care deeply about the quality of the food and the dining experience our patients and families have while they are entrusted in our care.” Recreation, Wellness, and Life Enrichment: Not Just Fun and Games Applying a person-centered perspective to NHC’s wellness offerings has been critical in helping patients retain a sense of self-identity over the years—something that Dr. Adams insisted upon from NHC’s earliest days. The company’s recreation and wellness Partners strive to provide patients with a truly inspired level of individualized leisure choices. After taking into consideration the seven domains of wellness in a person’s life, and learning their individual interests, needs, and capabilities, Partners use their professional skills to implement person-specific plans. The goal is always that the leisure experiences bring patients joy, enrich their lives, improve their overall wellness, increase their quality of life, and add life to their years. Being in this profession offers a great deal of satisfaction for Partners who know they have helped patients connect with the people and things that give them meaning and purpose. They also have many opportunities to bring a sense of fun and creativity to patients, their family members, and Partners. Jennifer Hammond, NHC’s Wellness Regional Coordinator in Missouri, notes that spontaneity and creativity are also extremely important skills for these professionals. She indicates it would not be uncommon for Recreation/ Wellness Partners to invite a camel to visit for “Hump Day,” to dress up as a vending machine to deliver snacks, to organize spontaneous flash mobs, and to celebrate random holidays such as National Ice Cream for Breakfast Day. Diana Melendy, who has been with the company since 1999 and serves as the Eastern Tennessee

Augusta “Gussie” Walker, Coordinator of Dietary Services, conducting ‘puree’ diet classes for Dietary Partners.

Regional Recreation/Wellness Coordinator, agrees, adding, “NHC Recreation and Wellness strives to make that positive difference. We are a way of life that is treating the whole person and hopefully making their heart happy. We aren’t all bingo and games; we are therapeutic programs enhancing your quality of life. Recreation and Wellness is your favorite hobby, your happy place, your warm blanket that creates a comfortable and beneficial space specifically for you.” Social Work: The Social Network As a support service, Carl Adams recognized the importance of social work as a key component in the elder care arena, and he installed Dorothy Wakefield Chance as the company’s first official social worker. “It was his realization and his vision that it took a village,” notes Hanna Clayton, Metro Regional Director of Social Services. “It wasn’t just one person who took care of a patient. It was not only nursing. It was also health and wellness, recreation, food and nutrition services, and social work. It was business management because the patient had to have financial peace of mind as well. Everybody helped take care of the patient.” Often, the social worker is the glue that holds all of the service continued on page 36

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N The Rehab team. (Back Row, L-R) Melissa Quillan, Administrative Assistant, Dee Coleman, PTA, Brad Odum, OTR. (Front Row, L-R) Michelle Yang, PT, Katie Underwood, student, Marette Wood DOR, OTR.

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move at her own speed in everything—from receiving

Additionally, the social worker must take the patient’s family into account. “You’re not only caring for the patient’s individual needs. You’re also often dealing with families in crisis,” Clayton reveals. “They’ve admitted somebody who a week ago was fine and has now had a massive stroke. It falls on social work to nurture that family and walk with them through the loss they are experiencing. Dr. Adams’s vision was of family taking care of family.”

baths and haircuts to participating in events. You

On the Cutting Edge of Technology

“When Mom came to live there with you, her disease had already robbed her of the ability to communicate well. She arrived frightened and untrusting and defensive. I was pretty frightened and untrusting and defensive too. You allowed her to

spoke to her with respect and not as a child. You gave her the privilege of choice even when she was beyond making one. You welcomed her in your offices, in the hallways, on rounds with the docs. She learned to trust again there. ”

continued from page 33

teams together, keeping the patient at the center of all decisions. According to Beth Dault, Assistant Vice President, Social Work, quoting Chance from a 2018 conversation, “‘Social work should always remember that the patient sets the framework. It is the social worker’s core role to keep the patient’s viewpoint as the focus to all. This is your job—plain and simple.’” From the moment a patient arrives at an NHC center, a social worker is responsible for admitting that individual and easing him or her into their new setting. Clayton notes that the social worker’s job is to help every patient feel comfortable in the space, as well as to be that patient’s advocate. In many cases, that process also means helping families make crucial decisions about what happens outside of the skilled nursing center environment—and for NHC, the key is assisting the patient and family with finding the right place at the right time for every patient. Patients and families consult with NHC’s social workers to decide which services are appropriate, always keeping the patient’s best interests in mind.

In the early days, NHC Partners were required to keep track of patient care through the Hospital Utilization Project (HUP); this thirdparty resource looked at patients through a Medicare lens to decide if a patient qualified for the program. HUP collected a very limited set of data, one that was not entirely helpful when it came to Carl Adams’s personalized patient care plans. He wanted to know more about the senior patients and fully track not only their care but also their progress. Additionally, he needed to be able to identify trends both within each SNF and across all of NHC’s locations so that he could see

Dorothy Chance, NHC’s first Coordinator of Social Services.

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Becky Martin, Social Work/Director of Admissions, with Dr. John Turner, retired NHC Medical Director.

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(L-R) Fay McRady, MSN, Nursing Education; Mary Eanes, ADON; Edna McKnight, RN; Dr. Susan Andrews; Dr Henry King Butler; Dr. Randell Rickard; Ann Coleman, BS, RN, Director of Nursing Services; Carol Carole, MS, RN.

what was and was not working. It was information he felt would benefit everyone, from the patients and the NHC Partners to the state and regional organizations that oversee the industry. To streamline the process, Adams collaborated with Judy Powell, a former nursing home surveyor who joined the company in September 1974. Together, they created a computerized patient assessment system unlike anything in the United States to that time. Powell explains, “We had basic demographic information, so we knew the age and sex of the patients. We knew what their diagnoses were. Then we had some activities of daily living, the services they were receiving through rehab and nursing, the number of medications they were receiving, and a bit about cognition and orientation. So, it was a fairly comprehensive look at the patient.” Each center would fill out assessment sheets for patients every month and mail them to the corporate office, where a partner would key the information into a Honeywell computer situated in the basement. The

computer featured a software program developed by Adams and Powell, who worked with a developer in Murfreesboro to write the code that could process the data and run extensive reports. Those reports were printed out on long sheets through a dot matrix printer and mailed back to the SNFs. With the information in hand, the nursing staff at each SNF could see if patient needs were being met and where they might need to improve the treatment. “Dr. Adams would drop by my office in Knoxville with this ream of computer paper. He would go through it and say, ‘This patient needs this many hours a day of care. You’ve got this patient on this particular floor who’s getting less than that. You need to move this patient over here where they’re getting an extra thirty minutes of care a day by the aides and nurses. The patient will have a better outcome.’ He was always right,” Gerald Coggin says. “But that was the kind of detail he did. The government wasn’t telling us to do that. No surveyor was telling us to do that. No doctor, other than him, was telling us to do that. But he knew that if you used the methods

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that you had, the information that you had, correctly and innovatively, you could improve care.” According to Powell, the availability of the data helped in several additional ways, including NHC’s ability to communicate with Medicare and each state’s Medicaid program to ensure proper funding and reimbursement for patient care. Moreover, she says, “Dr. Adams used the data in his speeches to medical association groups at the state and national levels, including the Institute of Medicine Committee on Nursing Home Regulation, talking about what patients looked like because people didn’t have a grand picture in this way. When you grouped all of the data together, you could talk about what patients were like in nursing homes on a much bigger level. We summarized the reports by center, by company, and by state so we could look across the columns to see where the differences were. He also spoke to legislators who had no idea about the patients in nursing homes but were instrumental in creating the programs that paid for their care.” Dr. Adams’s original initiative also caught the attention of an industry in need of the frameworks he crafted, particularly when, in 1987, Medicare officially introduced the Minimum Data Set (MDS) requirement. “In my early career, we were the only long-term care

corporation abstracting medical information,” says Beth Hughes, retired Regional Director of Health Information Management. “In many ways, [the computerized patient assessment system] was the precursor to the MDS, which later became the national standard in Medicare compliance and reimbursement. NHC was in a far better position to transition to the MDS completion and submission than any other corporation.” Christy Beard, Assistant Vice President of Clinical Reimbursement since 2002, adds, “The MDS not only represents the framework for the overall care plan for each patient, but financial reimbursement and numerous quality measurements are taken directly from the document created by Dr. Adams and Judy Powell. There is pride in knowing that their desire to put patient care first would also streamline the manner in which all data is collected and utilized for today’s frontline Partners.” Beard has worked with NHC’s MDS coordinators throughout the years as their roles and responsibilities have changed from meeting regulatory compliance to coordinating the entire holistic view and approach of patient care, and she has seen firsthand the impact of those early efforts. Over time, the computerized patient assessment system paved the way for NHC to promote the health information management (HIM) department

A One-Stop Shop

region typically has a core group of skilled nursing centers that are fed from one or two hospital systems in the area. Instead of those systems having to call around to each SNF to see if a bed is available for a patient, they simply call NHC’s local CRO, which is staffed by Partners who help identify the perfect location for that individual. Often, the staff can find an SNF in proximity to the patient’s home so that they can not only feel more comfortable in a familiar community but also be close to family. “The hospital loved it because it was a one-stop shop,” Dault says. “And that innovation grew out of Dr. Adams’s vision. That was the literal reason for NHC existing. He saw a need, and he wanted to figure out a way to fulfill it.”

Serving patients is NHC’s number-one priority, and one of the ways the company assists those patients is through the hospital referral process. The company takes the lead when a local medical facility recommends admittance to a nearby NHC center. To streamline the experience for the benefit of the patient and the hospital, Doran Johnson, retired Senior Vice President of the South Central Region, developed a centralized referral operations (CRO) system in the mid-1990s. According to Beth Dault, Assistant Vice President of Social Services, each

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Ernest Burgess, Ann Coleman, and Sherrie Gilliam on the cover of the 1983 American Health Care Association Journal.

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Mike Ussery in 1989 accepting the award from Judy Powell for “Most Effective Rehabilitation,” given to Murfreesboro Health Care Center when he served as Administrator.

created by Dr. Adams from NHC’s earliest days and to develop the information technology (IT) department, which together have been responsible for an array of homegrown tech-based initiatives for the company. For instance, between 1993 and 1995, NHC created its own software that could run on individual servers in each skilled nursing center; the Comprehensive Patient Care System (CPCS) allowed Partners to gather and upload all of the information originally captured through the computerized patient assessment system in electronic form so that it could be analyzed for patient care plans at the local, regional, and corporate levels. This effort also extended to the company’s HomeCare agencies, which began using an in-house system called Advanced Data Management (ADAM). These products also made a

significant difference when Medicare moved to the Patient Driven Payment Model (PDPM) in 2019; by having patient data in electronic form and organized in a way that already met Medicare’s requirements, NHC was able to migrate into this new system with very few complications. Overall, these technology innovations, which have been developed over the years by a highly skilled group of in-house coders and analysts, have saved the company from stumbling like so many others, and the seamless transitions allowed NHC’s Partners to keep the focus on the most important people in the equation: the patients. Leslie Joyner, who joined NHC’s HIM department in Dawson Springs, Kentucky, in 1977 and became NHC’s corporate HIM in 1995, notes that Dr. Adams’s

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

Charlotte Barber and Dr. Carl Adams

decision to hire health information professionals in each skilled nursing center undoubtedly gave NHC an advantage over other LTC companies in the transition to the PDPM reimbursement system. The HIMs were already well versed in ICD-10-CM guidelines and had the educational background to apply the Resident Assessment Instrument (RAI) definition of an active diagnosis to what was documented in the record, which could have been a rather complicated process. Over the years, the professionals who constitute NHC’s IT departments have gone above and beyond, doing everything from creating in-house software systems for accounts payable and payroll to equipping every NHC location with computers, WiFi, and more, according to Charlene Forsythe, Assistant Vice President of Information Systems, who has been with the company since 1995. Steve Flatt adds, “Historically, we have done many things internally, creating homegrown processes and systems because it was about quality control. We wanted to make sure we did things correctly so our patients and Partners could depend on them. We took many innovative steps in the 1970s, 1980s, and early 1990s when there weren’t other options on the market and we needed systems that could be tailored to the geriatric market.”

What’s more, NHC’s focus on using technology over the years literally paid off in many ways. “In 2000, the industry-leading accounting team put together by Charlotte Swafford became a profit center, as NHC began offering financial and accounting services to operations not owned or managed by NHC. These services include access to all of NHC’s proprietary systems and trained professionals for accounts receivable and payable, cost reporting, patient trust, and general ledger,” explains Jeff Smith, Senior Vice President and Treasurer, who assumed the role after Swafford’s retirement. “Charlotte was responsible for overseeing NHC’s operational accounting for years. During this time, accounting processes evolved from paper to mainframes to PCs, and communication shifted from First-Class Mail to dedicated lines and, currently, the cloud. NHC accounting has always taken pride in being thorough, accurate, and timely without regard to materiality, and this attitude is the basis for end users’ reliance on NHC’s financials, as evidenced by the company’s recognition as one of American’s Most Trustworthy Companies in 2014.” Today, NHC’s HIM and IT teams continue their efforts to ensure the company’s deftness in its daily operations, providing “the structure needed for the organization, analysis, and oversight of the day-to-day documentation required, thus freeing the caregivers to do what they do best: give excellent care,” Hughes notes. And it all goes back to that first vision that Dr. Adams had in 1974. “I don’t know where Dr. Adams’s initiative came from, but he was always looking for things to do better,” Powell concludes. “He was very visionary, but also very patient. He was able to keep coming back to something that he wanted until he got it done.”

CH APTE R TWO A P ERS O N-CENTE R E D APPROACH Patients and residents look forward to gathering in the in-house beauty shop for a little pampering from hairdressers such as Malinda Frase, a fresh new hairdo, and socialization with their friends.

THE Q UAL I TKing Y OF A Checkers

LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

Fred was the “Checkers King” for almost two decades at NHC Murfreesboro. His old checkerboard, with checkers attached, is even framed in the center’s lobby for all to remember the many games played in that very spot. Fred challenged and beat almost everyone he came in contact with. N H C

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Other patients, Partners, family members, visitors, and a few Murfreesboro city government officials tried their best to beat Fred at his favorite pastime.

NHC founder Dr. Carl Adams even made regular visits to play a few games with Fred. Telling a good joke and making people laugh was also something Fred prided himself in. And when Fred made someone laugh, his own laughter rang out with joy! Fred challenging Bookkeeper Cindy Keyes to a game.

Amy Reed, Registered Music Therapist, and Jenny Fann, Recreation Assistant, visiting a patient.

Mary’s Motorcycle Ride “WORDS” cannot describe the joy, fun and excitement that our resident, Mary, experienced. n For some time, Mary and her sister enjoyed each other’s company as they shared a room together at NHC Johnson City. After her sister died, Chris Abel in dietary gave Mary special attention N H C

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and support and the two became very close. n Chris has a motorcycle that she rides to work occasionally. During one of Chris’s visits, Mary told Chris

that she used to ride motorcycles in her younger days and has dreamed of riding a motorcycle one more time in her life. n After obtaining all the appropriate permissions, the day was planned. Chris supplied Mary with a helmet and CNA Monica Bowery helped Mary onto the motorcycle. As Chris rode around the center parking lot, Mary’s dream came to reality at the age of eighty-one. n Thanks Chris and Monica for “putting your heart” into making a resident’s dream come true. As of today, Mary continues to enjoy that memory and still smiles when she thinks back on her wonderful motorcycle ride.

(L-R) Catina Ross, Director of Nursing; Leanne Matheny, RN

THE QUALITY OF A LIFE 50 YEARS OF NATIONAL HEALTHCARE CORPORATION

CHAPTER THREE

In This Together We need to define the lanes in which each person is to steer the “ ship, with flexibility allowed as far as possible, and without losing sight of our primary function. ”

— Dr. Carl Adams

rnest Burgess, retired Senior Vice President of Operations—who joined NHC in November 1974, retired in 1996, and ultimately became the mayor of Rutherford County, Tennessee, for eight

years—once said,“The growth and success of NHC can be attributed to many people. First, NHC has been blessed with individuals in leadership positions with vision, creativity, and tenacity. Finding ways to make difficult things happen has been a trademark of the NHC process. Secondly, the entire organization, from the Home Office to each autonomous operating entity, has been filled with employees willing to give more than 100 percent to get the job done. 47

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

There has been an inherent sense of responsibility and dedication to NHC, almost likened to patriotism for your country. We’ve had the most loyal people, willing to sacrifice personally just because they wanted to be a successful part of this organization.” That kind of loyalty is directly related to the way Carl Adams perceived and treated the employees of NHC. First and foremost, he saw them as Partners in the advancement of the company. He believed in their capabilities and was determined to equip every individual at every level with whatever they needed to flourish, even in the most challenging circumstances. Mel Rector, who served as Administrator of NHC Murfreesboro, saw Dr. Adams’s sageness firsthand in 1981. At the time, he was dealing with a floor-care Partner who had difficulty with nearly every task

assigned to him and struggled every day. One day, Rector came back from lunch to find the individual pinned against the wall by the floor-care machine. The weary administrator felt he had no choice but to fire the young partner. However, when Dr. Adams appeared in Rector’s office the next day, he imparted some indispensable wisdom. “As I began to explain the situation, Dr. Adams began to whistle, and I had learned that this meant to stop talking and listen,” Rector recalls. “It was after a brief moment of silence that Dr. Adams looked straight at me and said, ‘Well, let me say there is good in everyone and I suspect you need to find it in him.’ At that point, he turned and left my office. It was amazing how Dr. Adams would leave you with a thought that may take a day or two for you to understand. I hired the floor-care Partner back

“It ’s not the leader, but what he leads that results in success.” — Dr. Carl Adams

Top photo: Robert Adams, Dr. Carl Adams, Andy Adams. Bottom left photo: Robert Adams, Mike Ussery, Andy Adams. Bottom right photo: Steve Flatt, Robert Adams 48

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and found a great opportunity in our laundry department for him, and I must say he did a fantastic job there. Dr. Adams taught me in one brief moment how to both treat and encourage people to find what they could be successful with and how I could become a better person.” That philosophy has been indelibly infused into the culture of NHC over the years and undoubtedly has attributed to its Partners’ longevity with the company. In fact, it’s not uncommon for individuals to remain with NHC for decades, even after questioning whether they had the desire to work in the long-term care industry. For many Partners, the bond they create with their senior patients is rivaled only by the support they receive from the company itself.

The Learning Curve It’s no secret that Carl Adams was a proponent of learning, whether it was the latest surgical technique or a new way to approach a business transaction. And he infused the NHC culture with that mindset—something every leader has embraced. For the last fifty years, formal training programs have produced highly skilled Partners and industry professionals who are dedicated to exhibiting NHC’s values with an unparalleled level of expertise and proficiency. According to CEO Steve Flatt, “We have created a culture where Partners believe we care about them and that we want to support them.”

“The most inspiring moments we have encountered are those of laughter. We are in awe of the moments of joy shared daily in your world with all you have been witness to in your profession. Thank you for the many blessings you have shared with us on this journey, and we know there will be many more to come.”

By 1976, NHC formalized that introductory experience into the Administrator-in-Training (AIT) program, under the direction of Vice President of Corporate Affairs Jim Keathley, who indicated his biggest accomplishment was being able to help people succeed in doing the best job they could do. According to Chris West, Vice President of Human Resources and a twenty-four-year veteran of NHC, the two-year

From the Top When Doran Johnson joined NHC as Assistant Administrator at the Pulaski location in 1972, Dr. Adams, who actually was the first licensed nursing home administrator in Tennessee, said to him, “Don’t go in there and start trying to make changes. Just go through every department and learn the business.” That meant working for a few weeks in every department at the skilled nursing center, from nursing and nutrition to laundry and maintenance. “I got the full concept of what it was to work with elderly people. You really got the concept of direct patient care,” Johnson recalls.

Terri Pomeroy, one of NHC’s pediatric therapists who provides outpatient services to children and in schools.

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N Dee Coleman, PTA, instructing a patient in highlevel balance activities.

C H APTE R TH R E E IN TH IS TOGE TH E R

program is designed to give incoming administrators the base knowledge they need to pass the exam to become a licensed nursing home administrator, as well as the skill set needed to manage an NHC SNF successfully. The first year delves into the fundamentals of nursing home administration; the AIT is paired with a preceptor in a center and then moves through each department to learn how it works. After that year, the individual sits for the administrator’s exam. Once the test has been passed, the AIT moves on to year two, which places the individual in a different SNF to serve in an assistant administrator role. It’s during this time that the trainee is expected to show true leadership as they prepare to be placed at the helm of their own center. Over the years, many of NHC’s most beloved and successful administrators have been part of the AIT program, including Ray Blevins. He began his career as a Certified Nursing Assistant (CNA). CNAs are seen as the backbone of NHC, and CNA

training is one of the most critical processes NHC supports. Blevins worked as a CNA at the former Colonial Hill, now NHC Johnson City, while he attended East Tennessee State University. Shortly after his graduation in 1976, he became NHC’s first Administrator-in-Training under the preceptorship of Ron Messimer. Blevins served as administrator in several locations prior to his ultimate role as Senior Vice President of the Eastern Region, from which he retired in 2016. Mike Ussery, a product of the AIT program and longtime Administrator, joined NHC in 1980; he served as a Regional Administrator starting in 1990 and stepped into the role of President and Chief Operating Officer in January 2017. He observes, “The whole precept of the program is that if I’m going to be an administrator and make decisions that are going to impact people, then I need to understand how they’re going to impact them. I need to understand what they deal with every day.”

Leaders Building Leaders NHC Leaders are built in large part by modeling and learning from other NHC leaders. Administrators in Training (AITs) each spend quality time with preceptors who are purposely selected as trainers N H C

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based on their operational success and leadership standards. New supervisors learn from seasoned

leaders who have been trained as Supervisory Trainers. Many disciplines have opportunities for new Partners to be matched with an experienced NHC mentor. This contributes greatly to NHC’s long tenure in leadership positions. n Ron Messimer is a great example of a leader building other leaders. During his forty-four-year career at NHC HealthCare Johnson City, he mentored six DONs and numerous AITs such as Scott Flemmer and Darrin McKamey. Scott

Ron Messimer and Gerald Coggin

Flemmer, RN, and now Eastern Region Nurse, says, “Ron helped shape my personal and professional development. Ron was a pillar of NHC even before it was NHC and helped form some of what NHC is today. I’m grateful to have known and worked with him.” n Darrin McKamey was an AIT candidate with Messimer and graduated from the program in 1989. He now serves as administrator for NHC Lawrenceburg and recalls everything he learned during his training experience, recognizing how much that time influences his effort on a daily basis. n NHC continues to create and enhance training opportunities for those Partners who want to support fellow Partners in being the best they can be for the NHC culture of care.

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

West adds, “Dr. Adams was so visionary because back then you could not go out and find administrators in healthcare programs. They just didn’t exist. You had people with public health degrees, but it was nothing tailored to this industry and what we were looking for. So, we created our own program. It’s a really unique way for NHC to develop its talent. It’s designed to help people to understand what it is to lead for NHC. It plays a significant role as far as carrying forward not only our leadership but also the culture of our company.” NHC leadership has been through the AIT program, including Steve Flatt, who served as President of Lipscomb University prior to joining the company. Upon arriving at NHC as Senior Vice President of Development, Flatt recalls Robert Adams asking him to participate in the company’s training initiative to get a true understanding of the organization and what it

really takes to care for senior patients. “You go through each of the different disciplines. You’re a CNA for four weeks. You are in housekeeping. You are in food and nutrition services. You’re in the business office. You’re in therapy. You go through all of it,” he recalls. “At NHC Murfreesboro, when I was a CNA, I helped feed a retired policeman who had such severe Parkinson’s that he couldn’t move his hands. At the end, he grabbed my hand and looked in my eyes and just said, ‘Thank you.’ I came home and told my wife, ‘I’ve always liked to think that what I do was important, sitting behind a chair and making decisions. But I realized that not since our last child was a baby had I met a primal human need in decades.’ That’s important. If you have a heart to care for people, there’s a unique, special gratification that comes from that.”

NHC Environmental Services Partners

Opposite Page: NHC’s Registered Music Therapist Amy Reed has partnered with Belmont University and Saint Mary of the Woods College to direct a music therapy internship program in which students are mentored and supervised by Amy for six months while they gain valuable hands-on experience with NHC patients and residents. Here, Amyliza de Jesus, an intern, engages patients in rhythm activities, assisted by Robin Lawson, Memory Care Recreation Director.

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

“In March 2020, our world changed. More than ever, YOU became my mother’s link to humanity. You continued providing expert and loving care even while worrying for your own safety and the health of your families. You found creative ways to be entertaining, and you reassured and comforted and LOVED!”

Being a Leader Of course, just as the AITs were learning about how to function within an NHC SNF, the team at the helm of the company felt that it was important to impart comparable training for everyone in a leadership position, including department heads across the organization. Hence, in the early 1980s, Harold Bone worked with Jim Keathley to launch a supervisory training program that, according to West, “provides a baseline of how you should treat your Partners, how you should motivate them, and how you should recognize them.” The one-day Train the Trainer

Workshop is implemented through a network of trainers across the company, who share with their colleagues what it means to be an effective supervisor. Partners also come together to share their own experiences and case studies that are based on events that have actually happened in the centers. West notes, “It has helped us establish a benchmark. We try to treat our Partners the right way, and we work very hard to do that.” One of the highlights was the NHC Leadership Institute, a workshop led by Dr. Mack Wayne Craig, NHC’s Chaplain, who served the company for twenty-five years. During his time with the Partners, he would tell the “Starfish Story,” a tale of a young man who spent the morning tossing starfish he found stranded on the beach back into the ocean. When asked by a passerby why he was doing it, when there was no way to help every starfish along the miles of shoreline, he said, upon tossing one past the waves, “It meant something to that one.” Craig delighted in telling the story, noting, “We have to keep in mind the tremendous importance of finding satisfaction in knowing that what we’re doing is making a difference. We don’t always see how the difference is being made at the moment. But when months later, or even years later, somebody says, ‘I will never forget what you said. I’ll never forget what you did,’ it comes flooding back and you just feel such a boost that you know it’s all been worthwhile.” Once the Leadership Institute was successfully completed, each Partner received a starfish pin, ensuring they would always recognize the importance of the work they do.

Enhancing the Industry

(L-R) Sharon Jacks, Director of Interior Design; Jamie Reinhart, Interior Design Project Manager; Kristin Adcock, Senior Interior Designer.

Interestingly, several of the NHC training programs that have been implemented over the years benefit not only the company but the industry as a whole. In 1981, NHC established the National HealthCare Corporation Dietetic Internship, focused on long-term care and serving the elderly. According to Dr. Patty Poe, Director of the program, it was part of an overall strategy to increase the number of Registered Dietitians

C H APTE R TH R E E IN TH IS TOGE TH E R

(RD) within the specialized field of geriatrics. The dietetic internship is the only one in the United States sponsored by a long-term care company. Graduates of the nine-month program, Poe says, “are prepared for all entry-level nutrition and dietetics jobs and go to work for NHC, other LTC companies, hospitals, and community agencies. They also work as grocery store dietitians, in school food service management, and as wellness coordinators.” In its forty years, the program has graduated more than 280 dietetic interns, with close to 50 percent of graduates accepting jobs with NHC, including Brigitte Burke, Assistant Vice President of Food and Nutrition Services, who has been with NHC since she completed the program in 1991. “Dr. Adams saw an early correlation between the presence of an RD in a long-term care center and the nutritional care and outcomes of patient care,” Poe continues. “His dedication to improving the quality of patient care served as the springboard for

the dietetic internship, as well as a variety of allied healthcare education programs and patient care intervention strategies.” Seeing the success of something like the dietetic internship encouraged NHC’s leadership to branch out and establish additional educational programs through the company, including in-house certified nurse assistant classes in numerous locations to better meet the needs for interested CNAs. Additionally, in 2009, NHC introduced its Physical Therapy Geriatric Clinical Residency Program, which is accredited by the American Physical Therapy Association; it is only the fourth of its kind in the nation and the first created by a senior care corporation. According to Robert Adams, the twelve-month program was designed to enhance the skills of NHC’s therapists, as well as attract therapists from across the country who are interested in providing services to the senior population. The efforts are extending to other therapy-based arenas in some NHC locations that

The Chairs of Excellence at Middle Tennessee State University

Middle Tennessee State University also is home to the National HealthCare Corporation (NHC) Chair of Excellence in Nursing, an endowed professorship established in collaboration with the School of Nursing and other segments of the university to contribute to nursing education, practice, research, and leadership in the state of Tennessee. In January 2019, Deborah Lee, PhD, RN, NBC-HWC, was selected for the prestigious position, which places a special focus on aging and older adults.

Established in November 1988 by Carl and Jennie Mae Adams, the Adams Chair of Excellence at Middle Tennessee State University (MTSU) works across disciplines within the institution to strengthen and enhance the curriculum in health and human services. It allows MTSU to engage in meaningful research and service opportunities, develop partnerships across the state to increase opportunities for students and faculty, and provide workforce data to state agencies to help create and maintain an effective healthcare workforce. The original funds from the Adamses were matched by MTSU and the Tennessee Chairs of Excellence program to create the position, which was held by Dr. Martha Jo Edwards, Director of the Center of Human Services, from 1992 until her retirement. “Holding the Adams Chair has been the greatest opportunity of my career,” she says. “The support from the Adams family and MTSU was a rare opportunity.” And since its establishment, the Adams Chair has secured more than $8 million of funding to improve the health of Tennessee’s citizens and further the development of the health workforce.

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

employ recreation therapists and music therapists. In addition, the locations are sponsoring internships for students studying in these areas who desire experience in the senior care industry. That kind of industry focus also led Carl and Jennie Mae Adams to create The Foundation for Geriatric Education (TFGE) in 1982. Funded primarily by NHC’s skilled nursing centers and their Partners, TFGE promotes increased education for healthcare professionals in the geriatrics arena. Grants and gifts are awarded to educational institutions and organizations across the country that are committed to enhancing the study of geriatrics, from the diseases associated with aging and the training needed to treat them to the aging process and its effects. For instance, in 2019, TFGE granted Greenville Technical College in South Carolina $4,150 to purchase tools to improve geriatric education for students in the Nursing Assistant, Physical Therapy Assistant, and Occupational Therapy Assistant programs.

Additionally, the foundation provides tuition reimbursement for NHC Partners who want to advance their own continuing education in the field of geriatrics. Jessica Moen, Director of Nursing at NHC Dickson in Tennessee, is one of those proud recipients. After working as a CNA for three years, her administrator encouraged her to go to licensed practical nurse (LPN) school, which she was able to do, thanks to the tuition reimbursement program. From there, she wanted to pursue her RN degree, which she received in 2007. “I value NHC and the support through TFGE funds to encourage Partners to further their career and continue their education,” she says. “I am an advocate of this program, and one of the things I’m most thankful for is that I am able to pay forward that which was so freely given to me because someone saw a leader in me. The support NHC has shown to me is something I know I would not have received anywhere else. I have not only grown as a person, but also as a professional.”

Arriving in a Wheelchair—And then Driving Herself Home One patient was admitted to NHC Sumter from a previous hospital stay. She told us that because of her morbid obesity, she was wheelchair bound and had been living at home with her son. She had not been able to drive, go out to buy groceries, or walk for some time. She had lower extremities issues and daily N H C

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activities would cause shortness of breath. She explained to us that she had no socialization outside of her home; it was very sad and the fact that her son worked nights made her very lonely and depressed. Upon

admission, she had goals of losing weight, building her strength and endurance, so that she could walk again. She eventually called her son and told him that she loved it here and chose to stay. She enjoyed the activities, had made several friends, and her daily life was improving as well as her mental health. She also was able to contact an old high school friend she had not seen in many years. She eventually lost a significant amount of weight, improving her health tremendously, to the point she was able to perform her own daily activities. Within six months of being with NHC Sumter, she had evolved into a confident, independent woman who no longer required our level of care. She discharged herself and went back home to live with her son. She would come to visit the staff and friends she had made, driving herself to and from our center. Best of all, she is now engaged to the long-lost high school friend and continues to exercise daily.

C H APTE R TH R E E IN TH IS TOGE TH E R

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

A Better Way Continuous improvement has been the cornerstone of NHC since Carl Adams founded the organization in 1971. In fact, the company’s vision statement is “Caring in a Better Way, Day by Day.” For the doctor, it was imperative to always look for and find better ways to do things. Andy Adams also guided the company with his creativity and forward thinking and never wanted to settle for “good.” He continuously looked for new ideas and brainstormed ways to implement them for NHC. He found an outstanding opportunity when he had lunch at a Ritz-Carlton hotel in 2003 and witnessed an exercise that epitomizes the concept of always doing more. He saw a group of employees having a “line up,” a brief daily meeting during which they shared positive news and

Prayer during Stand Up.

discussed how to provide excellent customer service with each other. Andy was fascinated by the process and gathered a group of Partners for a focus group to meet with leaders from the Ritz-Carlton in an effort to learn more and figure out how the concept might translate to NHC. That meeting paved the way for NHC’s 2004 introduction and rollout of “The Better Way.” “When Andy invited the Ritz-Carlton for the meeting at the Home Office, many of us in attendance were curious about what could be learned from a hotel business. But it soon became very apparent that their customer service training emphasized basic skills that NHC had been introducing to Partners for years,” says Celia Taylor, who helped take the reins of implementing the program across the entire NHC organization. “Whether you are working in a pet store,

C H APTE R TH R E E IN TH IS TOGE TH E R

T H E B ET T E R WAY P R O M I S E S

PROMISE #1

Greet you with a smile and make eye contact. I will make a friendly and professional first impression. PROMISE #2

Use your name always. I will tell you my name and the purpose of my visit. PROMISE #3

Address your needs with a sense of urgency.

PROMISE #11

Provide you with a person-centered experience. My services will be individualized to fit your wants and needs. I will do my best to exceed your expectations. PROMISE #12

Anticipate your needs. Don’t wait until you ask. PROMISE #13

PROMISE #4

Be a part of the NHC team—there is no “I” in TEAM. Each partner will be committed to a positive work environment.

PROMISE #5

Only make promises to you that I can keep. If I promise it, I will do it. My actions will earn your trust.

“Put my heart” into everything I do. Empathize with you, value your perspective, and care for you the way you want. Respect your privacy, dignity, and confidentiality.

PROMISE #14

PROMISE #15

PROMISE #6

Be neatly dressed and well-groomed according to NHC standards. Each partner will take pride in their personal appearance.

PROMISE #7

Respond to your needs rather than maintaining my schedule.

Answer the telephone within three rings and with a “smile.” Transfer the call if needed. Do not leave a caller on hold. Give you as many choices as I can. PROMISE #8

Maintain a safe and secure environment for you. Be aware of all fire and safety emergency procedures. PROMISE #9

Do my part in keeping the environment pleasant. Pay attention to details. Clean and tidy the workplace. Limit or eliminate overhead paging and loud conversations. PROMISE #10

Resolve any of your concerns. A complaint is a gift. I own it. I will fix it.

PROMISE #16

PROMISE #17

Use compassion as my second language. Use the healing power of “touch.” Communicate at eye level. PROMISE #18

Escort you to your destination. PROMISE #19

Recognize that all your concerns are major. Perception is reality. There are no “minor” incidents. PROMISE #20

Maintain a positive attitude. I will demonstrate “My Purpose” with enthusiasm and always speak positively of NHC, fellow partners, and the customer. Take pride in being an important part of The Better Way.

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a gas station, a restaurant, or a healthcare center, there are basic things that all customers want.” The focus group took NHC’s “When You Put Your Heart in It” training, developed by Dr. Craig, and worked to repackage the company’s initiatives for Partners based on the newfound insights from the Ritz-Carlton. The goal was to create something more consistent, distinct, and recognizable for Partners in all locations across the spectrum of services. Under Andy Adams’s direct hands-on leadership, the Better Way focus team worked together to develop twenty promises in the same vein as the Ritz-Carlton’s twenty-one standards. These statements are promises made to the patients and families of NHC, and they are designed to raise the bar for excellence. The promises cover a wide range of goals for Partners to meet every day, from “Greet you with a smile and make eye contact” to “Maintain a positive attitude.” Each day, NHC teams across the organization have standups to discuss the promise of the day and to discuss the talking points sent from the Home Office. Taylor explains, “The standups serve as our ongoing customer satisfaction training. And the talking points provide a consistent message to all Partners across the company.” “Celia writes our talking points 365 days a year, and she’s done that since the program’s inception,” Vicki Dodson says. “So, each day, the standup happens on every shift in every center, every HomeCare agency,

Eastern Region CNA Day

and every NHC entity.” This includes members of senior management at the Home Office, who stand together on the fourteenth floor for their own daily standup. Dodson continues, “Across the company, we’re all focused on that one promise that day. I think that continuous unity and focus on these commitments make our culture what it is.” In fact, by concentrating on one promise each day, the significance of the process remains alive and pertinent, showing Partners how central customer service is to the daily work they do. At times, patients see standups occurring and join in. According to Taylor, it is a welcome occurrence. “We want our customers to know what our promises are, and we want them to hold us accountable to those,” she says. Since 2004 Taylor has worked with an advisory board of center administrators from each region and a homecare representative who closely monitor The Better Way in their areas, suggesting updates and changes in order to continually improve the culture. The Better Way Certification process has been one of their many enhancements and is designed to recognize and reward NHC Partners who personify the promises. Partners who meet the specific criteria are presented with a Better Way pin and become known as Certified Better Way Champions. The advisory board will continue to look for ways to enrich The Better Way and keep it updated, relevant and alive in the day-to-day life of NHC’s Partners.

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Beyond All Recognition

care they give.” With that in mind, NHC began hosting CNA recognition banquets in each of the company’s regions, with each center selecting a CNA of the Year and each region choosing a Regional CNA of the Year. Recipients are treated to a delicious meal and entertainment and are gifted a special pin, a bonus,

While Dr. Adams expected outstanding effort from NHC’s Partners, he was equally attentive to the need to reward individuals for their performance. It was a sentiment that all members of NHC leadership held, and the company spent years finding unique ways to recognize NHC’s superb Partners. “At the end of Mama’s life, it was you who For many years, Partners have been acknowledged at the annual Patient Care held her hand and gave her comfort. It was and Management Conferences, which bring you who held the phone to her ear so her five living together NHC leadership to consider the state of the company and the LTC industry as a children could say our goodbyes to her. I know why whole. Of course, the company also has found Mama loved you!” ways to recognize Partners on a smaller, yet just as significant, scale. For instance, in 1994, Doran Johnson, Harold Bone, and Dr. Mack and a special introduction during the event. It was a Wayne Craig decided to pay tribute to NHC’s certified simple way to say, “Thank you,” for the hard work the nursing assistants. “CNAs are the largest group of Partners do every day. Johnson adds, “The core group Partners that work for NHC,” Johnson explains. of CNAs in each center is the lifeblood of NHC.” And “They are the Partners that have the closest relationthe CNAs greatly appreciate the acknowledgment of ships with our patients. There are many that spend their dedication. Debbie Lindemann, NHC’s longesttheir lifetime as CNAs, pouring themselves into the tenured nurse, recalls “My favorite day of the year is Missouri Region’s CNA Day! It’s the day that we recognize the most important caregivers. The CNAs that are recognized write an essay. They Dr. Mack Wayne Craig share stories of care, friendship and spiritual support. The CNAs tell stories of how they feel a part of the patient’s family. They are there for our patients during happy times when they rehab to home, when they celebrate a new grandchild as well as the sad times of losing a loved one. Many times, it is a CNA who is at the bedside holding the patient’s hand when they need someone. It’s such an honor to thank our CNAs on their special day.” continued on page 65

T H E H E A R T O F T H E M AT T E R NHC’s Certified Nursing Assistants Since NHC’s earliest days, Certified Nursing Assistants (CNAs) have been central to the care provided across the company’s seventy-five skilled nursing centers.These devoted Partners are the people whom patients depend upon every single day, as they care for their many ADL needs, monitor their vital signs, and enhance their quality of life. Yet, their impact goes far beyond the fulfillment of basic patientcentric functions.They also work hand-in-hand with NHC’s nurses and multi-disciplinary teams, ensuring that every decision is implemented proficiently. What’s more, CNAs often fill the roles of companion, trusted confidant, and surrogate family member as they build long-lasting relationships that allow them to know their patients on an entirely different level.The CNAs are, without a doubt, the heart of the company.They are dedicated, compassionate, thoughtful, and masterful at what they do. NHC’s vision statement—Caring in a Better Way, Day by Day—is brought to life by these invaluable CNA professionals.

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Giving Back Being a part of the community and the industry at large is paramount for NHC, and the company strives to support the causes and organizations that mean the most to the Partners who call NHC their professional home. In addition to donating funds to such nonprofit groups as the American Heart Association, NHC is greatly involved with the Alzheimer’s Association. The company participates in the Walk to End Alzheimer’s each year, bringing groups of walkers together from each NHC location to help raise money for Alzheimer’s research. To date, the National team has raised $2 million for the cause. NHC also supports a host of good works through its National Health Foundation (NHF), initially created as a vehicle to allow community members and families to donate items or funds to benefit others. NHF has grown to support not only the patients of NHC but also numerous Middle Tennessee and national charitable organizations. Over the years, more than $1 million has

been gifted to a variety of deserving causes. Additionally, the Compassion Fund, a separate and distinct account within NHF, has been designated to support extraordinary challenges NHC Partners have faced in their personal lives. Since 2007, nearly $1.3 million has been provided in support of these deserving individuals.

Susanne Adams, Robert Adams, Melinda Vance at the 2006 Alzheimer’s Memory Walk.

Dietetic Internship class participating in The Walk to End Alzheimer’s fund raiser. (Front Row) Amanda Welker. (Second Row, L-R) Olivia Horn Simmons, Katie Massman, Kylie Hill DeSmet, Maia Dutta. (Back Row, L-R) Ashley McIlwee, Internship Director Patty Poe.

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continued from page 61

While the honoring of superlative Partners is something everyone looks forward to annually, NHC does not pass up the opportunity to commend individuals with fiscal rewards throughout the year as well. Since the early 1990s, NHC has commended Partners through the Partners Incentive for Excellence (PIE) program and Partner Excellence Program (PEP). According to Chris West, Partners are eligible for a bonus through the PIE program based on each center’s ability to reach goals associated with six pieces of the NHC pie, including such items as customer satisfaction, the consumer view (or the appearance of the building), the patient care survey, and a reduced in-house pressure injury percentage. Each center has a PIE scoreboard, and Partners can keep up with how their center is doing in meeting the company’s objectives. At the end of the year, full-time and part-time Partners receive a piece of the “pie” as a reward for demonstrating teamwork. “With the kinds of

goals we have, you have to have a team working together,” West notes. “It’s not just one or two people—it’s got to be everybody. And it’s not only important to their center’s success—it’s important to their patient’s success.” Similarly, the Partner Excellence Program rewards Partners monetarily based on their individual performance. In each patient room and lobby, Partners have a PEP card, on which patients, visitors, supervisors, and colleagues can note particular instances of exceptional service. Each PEP card has a dollar value, and those funds are totaled up regularly and added to the Partner’s paycheck. “It’s really meaningful when those cards are turned in to administration,” West says. “When you praise someone, it can be a very quick event. The PEP card is a good way to do that.” All of these efforts are a testament to Carl Adams’s belief that NHC’s Partners are the people who make the company what it is. As he once said, “It is not the leader but what he leads that results in success.”

Commitment To Our Partners • Hire for Heart

• Empower Partners

• Embrace New Partners

• Lead with Optimism

• Prioritize and Enhance the Orientation Experience

• Communicate Effectively

• Train for Success

• Appreciate and Appropriately Recognize Partners

• Know Your Partners

• Unify the Team

Caring in a Better Way, Day by Day.

“As we older ones pass on and the younger ones move in with new ideas, energy and vision, there is assurance of continued growth with improvement and a better world in which to live.” — Dr. Carl Adams

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On NHC’s 50th Anniversary the following Partners had an amazing 40+ years of service 49 YEARS

Doran Johnson* 48 YEARS

Gloria Sivels* 47 YEARS

Martha Hughey 45 YEARS

Peggy Allen* James Freeman Julia Powell* Eva Ann Talbert* Sherry Young* 44 YEARS

Leslie Joyner Sarah Jones* Betty Rhodes Vicki Land 43 YEARS

Gerald Coggin* Rhonda Essex Barbara Harris* Sue Lewis Sharon Mutter* Wanda Potts Carolyn Smith Martha Stevenson * Charlotte Swafford* Janie Tharp* Kathy Wray

42 YEARS

Robert Adams* Ray Blevins* Judy Cherry* Ann Chunn Dwinna Cunningham Vanessa Duke* Lois Gray* Judy Groves Charlene Holt* Pamela Linam Joan Phillips Janie Reeves Melvin Rector 41 YEARS

James Burns Willie Byrdson Ann Coleman* Ora Freedle* Janice Hall Easter Hunter Patricia Johnson Ronald Messimer* Geraldine Shabazz* Linda Tummins* Michael Ussery Vivian Whitfield 40 YEARS

Debora Chapell Glenda Chism Lynda Fults* Lisa Graybill Karla Pigg Brenda Riley Dorothy Shelton Carolyn Shirley* Gary Shirley* Frances Thompson * Indicate retirees

National HealthCare Corporation Home Office, established 1989. City Center 100 East Vine Street Murfreesboro, Tennessee (Photo by Tyler Bartlett)

THE QUALITY OF A LIFE 50 YEARS OF NATIONAL HEALTHCARE CORPORATION

CHAPTER FOUR

Taking Care of Business

Any jackass can kick down a barn, but “ it takes a good carpenter to build one. ” — Dr. Carl Adams

ccording to Mike Ussery, when people think about National HealthCare Corporation, they should envision a wheel. In the center of that wheel sits the skilled nursing centers, which have

been the nucleus of NHC since its start. Extending out from that core, like the spokes of a wheel, are all of the other entities that make up the company: assisted living, independent living, HomeCare, Hospice, behavioral health, insurance, pharmacy, third-party management, and more.“To tell the story of who we are and what’s happened during the last fifty years, you have to look at all of those elements.” continued on page 72

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Across the Board: The Enduring Leadership

hen Dr. Carl Adams founded National HealthCare Corporation five decades ago, he made an unprecedented move when it came to assembling the board of directors that would help guide the fledgling company to ultimate success. He didn’t turn to a group of management experts or financial professionals in those early days. Instead, he asked three of his most trusted colleagues to join him on the four-person board of directors, a company that Adams knew could play an integral role in changing the face of senior care. The gentlemen he selected were Dr. S.C. Garrison, Dr. Olin Williams, and attorney Whitney Stegall. And it was by design that three of the four members of the board were eminent physicians, while the remaining member boasted an illustrious career as a lawyer. “I think it reflected Dr. Adams’ desire to get leaders who would appreciate his vision to start a senior care company that would offer exceptional care to its patients,” observes CEO Steve Flatt, who became the inside director of the board on January 1, 2017. Together, Adams, Garrison, Williams, and Stegall navigated the purchase of NHC’s original fourteen nursing homes and supported the implementation of policies that have allowed NHC to place great emphasis on providing the highest standard of clinical care to elderly patients. The board also worked closely with senior management as NHC evolved and grew during those initial years, expanding its other senior care service offerings while simultaneously focusing on earnings and profitability. By 1972, the board added two members: Dr. J.K. Twilla and Jerry Puckett. While Puckett resigned two years later to pursue his own interests in the senior care industry, the core group of board members remained intact for the next fifteen years, adding then-president Andy Adams in the early 1980s and Robert Adams and Ernest Burgess in 1991. By the mid-1990s, the

board expanded further to welcome attorney Richard “Ted” LaRoche. By this time, NHC had tackled a wide range of initiatives, including becoming a publicly traded company in 1983, broadening its geographic footprint into states like Missouri and Florida, and establishing its first real estate investment trust, National Health Investors, Inc., in 1991. All the while, the board of directors made strategic decisions to ensure the company proceeded with an equal amount of caution and courage. And it was steadfast in its dedication to maintaining the ideal balance between providing exceptional service across NHC’s skilled nursing centers and remaining solvent on behalf of the company’s shareholders. In 2021, the board had seven members whose participation have helped to elevate the directors’ capabilities, bringing with them expertise in business, operations, financial administration, and more. Four of the seven members also have decades of previous experience at NHC. Such experience helps the board understand the challenges and risks associated with daily operations, as well as the best opportunities for growth. Of course, the board’s vision, which has always been that of Dr. Carl Adams, has never wavered. To this day, its members strive to uphold and maintain NHC’s culture, a bona fide hallmark of the pioneering company. And as NHC celebrates its first fifty years and looks into the future, the board intends to mature as well, noting that at least one female will be added by the middle of 2022 to ensure a more diverse group of voices is represented in the years to come. “No sector in our country is going through more revolution than healthcare,” Flatt concludes. “Our board is constantly looking at how to position ourselves for success going forward in that ever-changing healthcare world. And everything we do goes back to our mission statement—to be the senior care leader in customer and investor satisfaction.”

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of NHC’s Board of Directors

(Top Row, L-R) Ernest G. Burgess III, Emil E. Hassan, Lawrence C. Tucker, Dr. J. Paul Abernathy. (Bottom Row, L-R) Richard F. LaRoche Jr., Stephen Flatt, Robert G. Adams, W. Andrew Adams.

Board members in 1990: Andy Adams, Dr. S. C. Garrison, Dr. Carl Adams, COB, Ernest Burgess, Robert Adams, Dr. J.K. Twilla, Dr. Olin Williams, Ted LaRoche.

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continued from page 69

While NHC is a multifaceted, billion-dollar company, it took many years of evaluating, pivoting, and adapting to become what it is today. And just like the clinical side, the business side of the organization has offered its share of challenges and triumphs. Without fail, though, Carl Adams and every subsequent leader of the company have strived to maintain NHC’s financial health, protecting its shareholders while allowing the corporation to grow beyond everyone’s wildest imagination, both geographically and in its service offerings. And along the way, the company has demonstrated a great deal of ingenuity and resourcefulness, which can be traced back to Adams himself.

A Decentralized Approach In 1989, NHC relocated its corporate office, known as the Home Office, to City Center in Murfreesboro. To this day, the company resides in the tallest building in town—a fourteen-story structure that helps define the skyline. And while it might seem that all of the directives for the company derive from this corporate edifice, that’s not exactly the case. The Home Office, in reality, is designed to serve as support for NHC’s locations, which are organized by regions throughout the states

A Seat at the Table In 1979, Carl Adams wanted to ensure that his company and his industry had a seat at the legislative table. Therefore, NHC started a political action committee, NHCPAC, to address issues at the state and federal levels. In 1986, Gerald Coggin was asked to head up the new government relations program for the company and oversee the PAC, which focused heavily on addressing reimbursement issues. “As Director of NHC’s government relations, I spent the bulk of my time working in the state capitols in both Nashville and South Carolina,” Coggin says. “That

in which they reside. And that is exactly the way Carl Adams wanted the company to run. After stabilizing NHC’s finances during its first two years and ensuring that the original fourteen SNFs had positive cash flow, Carl Adams, Andy Adams, Howard Behm, and Ted LaRoche began working to grow the company by acquisition, moving outside of Tennessee, Georgia, and Kentucky, and purchasing additional nursing homes in southeastern states including South Carolina, Alabama, and Virginia. Don Daniel, who joined NHC in 1977 and served as Chief Accounting Officer, was a key member of the hard working and inventive senior management team. Daniel was instrumental in creating the Employee Stock Ownership Plan (ESOP) in the 1970s. He continues today as a Trustee of the NHC ESOP. The ESOP was instituted to raise capital for the company’s expansion, and the slate of nursing homes grew exponentially, with the ESOP becoming the largest single shareholder of NHC. Wanting to streamline the operation of newly acquired centers, Carl Adams approached his son Robert, Doran Johnson, and Gerald Coggin, who each served as an Administrator of an individual SNF at the time, about modifying their roles with the company. “My role expanded to be a Regional Administrator over East Tennessee, North Carolina, South Carolina,

gradually worked into more of federal legislative areas, which meant trips to Washington. I developed relationships with our elected officials—our senators and House of Representatives’ members— and worked to find champions that we could talk to and ask for help. What impressed our political contacts the most was the fact that our PAC funds were donated by the company’s Partners rather than corporate dollars. Our Partners understood the important relationships we needed to form with the Medicare and Medicaid decisionmakers. For me, the key was getting people to understand that these are real people at NHC. Once they understood that, it was the key to having some success.”

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Robert Adams, Jennie Mae Adams, and Andy Adams during the construction of AdamsPlace.

and Eastern Kentucky,” Coggin says of his new position over the East Tennessee region. Doran Johnson assumed the South Central Region covering Tennessee and Alabama, while Robert was put in charge of the Central Region encompassing Middle Tennessee, Kentucky, and Georgia. This shift to a more decentralized structure was designed to give each region a bit of autonomy, with the Home Office providing support to those areas. While the regions operated under the company’s umbrella, they had the flexibility to make decisions and changes that were best for their locations. And within each region, the SNFs had that same level of autonomy, with each administrator being given the power to be the de facto CEO of their own center. Sarah McEvoy personally saw the benefits of this structure when NHC acquired her Manchester, New Hampshire, nursing home, Villa Crest, in 1999. “I always felt encouraged to run the center as if it were my own business,” she observes. From clinical care

“Never forgotten will be the days you brought Mom to the window for a visit or assisted her with FaceTime when we were unable to come inside to see her. And we have now been blessed to know each one of you as we have been able to enter NHC.”

and equipment decisions to finances and budgeting, McEvoy had the opportunity to make choices that benefited her patients and staff, all with the underlying support of NHC. “That autonomy made a difference. They allowed people to work in a way that was successful for them versus doing it in a prescribed manner. There were guidelines, but it allowed people a level of creativity to do things in a way that worked for their particular center—because every center has a life of its own.” 73

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74 Years Old, One New Hip, One New Knee—and Miles to Go Rosemary McBee is no stranger to medicine. In her career, she was a nurse, ran a hospital wound-care center in West Virginia, and was a case manager for a Florida hospital, keeping track of therapy and A D D I N G

L I F E

Y E A R S

rehab for patients. In her mid-sixites Rosemary tripped over her dog and

broke her hip. She told the surgeon she wanted physical therapy at NHC Bluffton in South Carolina, across the street from where she lived. n “I was in therapy twice a day. The staff was wonderful,” she recalls, noting not only their skills, but their “caring and kindness.” Everyone assured Rosemary she’d eventually get back to running. “But I really did not think I would be completing a 10K race only eight weeks post op. I took second place in my age group!” she wrote in a thank-you note. Now seventy-four, Rosemary still remains very active, pedaling an elliptical, doing sit-ups, pumping iron, and playing golf. More recently she had a knee replacement and just two weeks after was throwing for strikes at the local bowling alley. And as for the running, Rosemary says, “Let me be perfectly honest, my times aren’t that great.”

A Growth Mindset According to Steve Flatt, “I’ve always described NHC’s growth as prudent, cautious growth.” Certainly, every move made by NHC’s leadership from the very beginning has had a strategic component. And that shrewdness has been offset by a continuous effort to reach as many patients as possible whenever possible. “The period of growth for the company, I would have to say, has always been there,” says Charlotte Swafford, who joined NHC in December 1973 working with Louise Evins and later becoming the company’s Treasurer. “There was a slowdown now and then, but there was always growth and there was always change. Whether it was one new center or one new state, or multiples of each, it was always happening.” One of the first major growth opportunities came in the early 1980s when NHC had the opportunity to purchase eleven long-term healthcare centers that were yet to be built in Missouri. The group that owned the properties wanted to set the construction process in motion before the state enacted its Certificate of Need law, which would require every new healthcare

center to have that specific documentation before being approved for construction in a new community. However, it had no funding for the project. Andy Adams, who had assumed the responsibility of NHC’s development efforts, saw a small window of opportunity to make that move into Missouri before regulations made it an impossible prospect. After extensive negotiations, NHC purchased the properties. Yet with each of the eleven nursing centers costing $3.5 million to build, the project was challenging at best. NHC brought in an investor, Stuart Yacknawitz, to help, but it was not enough. According to Ted LaRoche, “Andy realized we had to do something. We could not finish this project in Missouri without being a public company.” Therefore, after an arduous months-long underwriting process that included a last-minute disagreement between NHC and Yacknawitz about the public filing and the protection of the company’s shareholders, Andy Adams and Ted LaRoche hopped on a flight that landed in New York City at 6 a.m. on July 13, 1983, to deliver the underwriting paperwork to become a publicly traded organization. And on that day, National HealthCare Corporation officially went public on the American

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THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

Dr. Frank Carter, Dr. George Hester, and Teresa McCoy, LPN

Gerald Coggin, Mazell Tambornini, and Tim Sullivan

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Belinda Boggs, Food & Nutrition Partner, serving patients, Partners, and guests in the dining room.

Stock Exchange at twenty-one dollars per share and raised 15.3 million dollars in capital, allowing NHC to move forward with its Missouri expansion.

The Sunshine State Awaits For several years before going public, NHC was interested in entering the Florida market, as the state boasts the largest percentage of elderly individuals in the country. After the official public offering, the company decided to purchase two existing freestanding nursing homes in St. Petersburg and Fort Lauderdale, sending Regional Administrator Mike Neal to the Sunshine State to oversee that process. However, an opportunity to grow very quickly in the state unexpectedly appeared in 1984 when a firm out of Texas approached NHC with sixteen Certificates of Need for buildings that needed to be constructed across Florida, all within a year. Immediately upon the acquisition of those certificates, Robert Adams, as a Regional Administrator, was sent to the state to oversee the quickly ballooning opera-

tions there and delve more deeply into the construction process, which would cost upward of $80 million. “It was a great experience for me because I learned so much,” he says. “I had to walk in and deal with all of the government agencies. And when you had a Certificate of Need, you had to find the land, get zoned, get the drawings approved, and have the footings in the ground within eighteen months.” And when the buildings were complete, NHC planned to operate each of them. To streamline the management of those centers, NHC leadership split Florida into two regions; Mike Neal would be the Regional Administrator for South Florida, while Steve Strawn, an NHC Administrator from Oak Ridge, Tennessee, relocated to manage North Florida. According to Karen Parenti, a Regional Nurse since 1989, who served with Mike Neal in Florida and later in the Northeast region, NHC added to the list of Florida centers regularly, acquiring existing nursing homes in addition to building new ones. At one time, she personally oversaw eighteen nursing homes in her regional position. “Every center was unique and had

THE Q UAL I T Y OF A LIF E 5 0 YEAR S OF NAT I O N A L H EA LT H CA RE C O RP O RAT I O N

of 1987, NHC Interior Design was created with the addition of two licensed interior designers. “Your therapist never stopped believing in The goal of the new department was to work my [child]. I am so unbelievably proud of with the architects designing the company’s new buildings, particularly in Florida, to create [my daughter] for working hard. I am also grateful for functional and aesthetically pleasing spaces. all the various (NHC) therapists who have worked with NHC interior design also provided products and services to maintain and improve the her over the years to prepare [her] for the future.” interiors of the company’s existing buildings, some of which were dated. The effort provided a sense of consistency and quality across the board, making NHC’s skilled nursing centers the place its own style,” she says. “And Mike Neal 100 percent to be for senior patients. believed in the autonomy of those centers. They did their own thing, and they did what they were supposed An Unwelcomed Change of Plans to do.” For the next several years, NHC stabilized, and its As the expansion of NHC’s Florida enterprise hummed systems matured. There remained a desire to expand the along into the mid-1990s, unexpected trouble lay ahead company’s footprint geographically and in terms of its when Wilkes & McHugh, a highly litigious Tampa law services. Growth in NHC’s existing markets, including firm, began a campaign of elder care lawsuits. The Missouri, South Carolina, and Florida, was led by problem was that the firm targeted mainly the wealthiest Tom Morgan, who was later joined by Bruce Duncan. long-term corporations in the state to access their The company also decided to focus on creating a truly seemingly deep pockets, regardless of the actual level welcoming environment within its centers. According of care provided to their patients. Unfortunately, with to Sharon Jacks, Interior Design Director, “In the fall its success in the region, NHC became a top focus of Wilkes & McHugh, which filed a flurry of spurious lawsuits against the company across Florida. “It got to a point at the end of 1999 and going into 2000 that we couldn’t get professional liability insurance,” Flatt reveals. NHC tried to fend off the attacks and even founded its own professional liability insurance company, Premier Plus, to provide insurance for itself. However, the innovative move was not enough to save the operations in Florida. So NHC once again had to take an unconventional route: Steve Strawn formed his own company, and NHC subleased all of its Florida centers to him. With the transition, NHC no longer operated the Robert Adams, Doran Johnson, and Steve Strawn centers or provided any direct patient

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care. We did contract with Steve’s new organization to provide financial and accounting services for a separate fee. By ceasing to operate or manage centers, it removed NHC from any professional liability.” Flatt continues, “We made lemons into lemonade.” Of course, the decision to pull out of the state was the right one, but it had to come quickly. It also occurred at the same time that NHC had an opportunity to move into the New England region in 1999 by managing seven nursing homes in New Hampshire and Massachusetts that National Health Investors Inc., a real estate investment trust founded by NHC,

was in the process of purchasing. The pragmatic pivot to the new region occurred almost instantaneously for the company. Parenti recalls, “Mike [Neal] and I were at a conference in Florida and got a phone call from the head of the survey agency in New Hampshire. He said if we didn’t get up there right away, that they would put a conservator at one of the healthcare centers up there and the state would take over the building. A patient had recently been injured and the Director of Nursing had put her keys on the desk and left. It was a bit of a mess. So, we left the conference after the banquet, drove home, packed, and flew from Orlando

The Corner Office In addition to Carl Adams, three gentlemen have helmed NHC. They each brought their own style and viewpoints to the table, but they never veered from Dr. Adams’s original vision for the company.

Andy Adams served as President of NHC beginning in 1974 and President/CEO from 1994 to 2004. He graduated from Lipscomb University and earned his MBA from Middle Tennessee State University. He became a Certified Public Accountant before joining his father at NHC in 1972. Additionally, Andy served as Chairman of the Board from December 1994 to December 2008 and today remains an NHC Board member.

Robert G. Adams assumed the role of President and CEO in 2004. He graduated from Middle Tennessee State University before joining the military in 1969, based in Germany. Upon his return he earned a certificate in medical technology at Vanderbilt University, then joined the family business in 1974. Robert gained experience in several leadership positions before joining the senior management team and retiring at the end of 2016. Today, he serves as Chairman of the Board of NHC.

Stephen F. Flatt came to NHC after a successful tenure as President of Lipscomb University. He joined the Company in 2005 as SVP of Development and moved into the role of President in 2009. He assumed the positions of CEO and Inside Director on January 1, 2017, upon the Retirement of Robert Adams. Flatt holds a B.A. degree from Lipscomb University and an MS and PhD from George Peabody College of Vanderbilt University. 79

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Some of NHC’s past and current members of the Senior Management team, listed alphabetically: Andy Adams, Robert Adams, Joanne Batey, Gerald Coggin, Don Daniel, Vicki Dodson, Andy Flatt, Steve Flatt, Sabrina Gann, Brian Kidd, Bubba McIntosh, Josh McCreary, Judy Powell, Jeff Smith, Charlotte Swafford, Mike Ussery, Chris West

to Manchester to try to straighten the place out on Saturday.” Fortunately, Neal and Parenti were able to sort out the issues and quickly—if not unexpectedly— embark on the new effort for NHC in the region.

Corporate Ingenuity That ability to be flexible and make changes when necessary is one of NHC’s trademarks. As Flatt says, “Healthcare doesn’t stay static, and neither do we.” For its entire fifty years, corporate ingenuity and financial creativity have been at the forefront for NHC,

allowing the company to adapt to new situations while preserving the organization’s integrity. For instance, after becoming a publicly traded company, NHC ran into some tax-related complications as it raced to get its new Florida nursing homes under construction and meet the regulations of the Certificates of Need. By 1985, to increase cash flow and protect the company’s shareholders and their dividends, NHC decided to convert itself into a publicly traded limited partnership, which placed the organization in a different tax structure that would last for eleven years. Andy Adams and Ted LaRoche led the

“Like Asking for $40 Million” A few months after becoming the administrator, the state held our Medicaid money for months. I received a call from our grocery provider that we would no longer receive our grocery orders because we had not paid our bills. I had to call Andy to ask him for money, and I was N H C

M E M O R Y

prepared to be fired that day because I felt I had failed the center. Andy showed compassion and understanding toward me and the center. I

will never forget him saying to me “What’s wrong with you, girl?” when I called him. Of course, I only needed $40,000 to get us by, but I felt like I was asking for $40 million. —Becky Helton, South Central Region

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Above: L – R Ted LaRoche, Andy Adams, Dr. Carl Adams, Howard Behm, Ernest Burgess. Below: Robert Adams with Tom Morgan and Woody Robinson in Development and Construction.

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A New Spin Finding unique avenues like that actually became second nature to NHC. In late 1990, Andy Adams was on the hunt for additional opportunities that would help NHC make the most of its limited partnership status. He found it when he discovered the undeniable tax benefits of creating a real estate investment trust (REIT), a company that owns and operates commercial real estate holdings. By creating a REIT, deeding several of its properties to the company, and then leasing them back, NHC could avoid double taxation and save its shareholders a great deal of money. Thus, From humble beginnings in Murfreesboro, TN, to the heart of New York City, NHC spun off a second publicly traded NHC CEO Robert Adams rings the bell to open trading at the New York Stock company, National Health Investors Inc. Exchange in 2009. Looking on is Joanne Adams Coggin, Gerald Coggin, and Susanne Adams. (NHI) and deeded forty-two of its newest SNFs to the organization, which started endeavor, which began in earnest in September 1985 selling shares on the New York Stock Exchange on and had to be completed by December 31 to qualify October 31, 1991. NHI had its own board of directors under that fiscal year—a four-month window. Every and operated independently from NHC, and by 2004, one of NHC’s sixty healthcare centers had to file the Andy Adams left NHC to become the CEO of NHI. appropriate paperwork and have new deeds recorded Upon his move, Robert Adams assumed the role of at their local government offices; it was a race to the CEO of NHC. “We have a mindset for change,” Gerald finish, but each location came through before midnight Coggin explains. “We adapt easily and maintain our on New Year’s Eve 1985. focus on the patient.” “That structure was innovative, but there was In 1997, NHC founded another REIT, National nothing easy about it. It’s quite complex,” Charlotte Health Realty (NHR), registering its stock with the Swafford says. “We all had to do a lot of learning, and American Stock Exchange and deeding to it the newer it accommodated us for many years. Then, in 1998, we SNFs built throughout the 1990s. In 1991, and again converted back to a corporation.” in 1997, Don Daniel handled the complex accounting The initiative also ushered in the use of the term necessary for the successful “spinoffs” of both these “Partners” to refer to NHC’s employees, as they officially two REITS, NHI and NHR. Together, the REITs were became partners of the limited partnership. NHC responsible for NHC’s entrance into New England, leadership recognized that the company could not Kansas, Indiana, and Washington State. While the operate successfully without its Partners, even when it latter three no longer are part of NHC’s regional returned to corporation status, so the name remained. makeup, they allowed NHC to expand its footprint in To this day, everyone at NHC, regardless of position, is a a truly unique way. By 2007, NHR merged back into Partner in the company’s mission and recognized in that NHC, while, to this day, NHI remains as its own solid, way. independent multi-billion-dollar entity.

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The In-House Advantage When Carl Adams launched NHC’s HomeCare division in 1976, making the company the first licensed home care operator in Tennessee, it proved the benefits of his forward-thinking nature. He realized that care had to be provided beyond the walls of the company’s SNFs, and his foresight opened the door to a new service line, led in large part by Joanne Batey, who took over the division in 1986. According to Sabrina Gann, the current Vice President of HomeCare, the department serves thirty-two hundred patients daily, offering medication management, wound care, IV care, and therapy services within the home. Offering this type of care was the beginning of an effort to diversify NHC while keeping the emphasis on providing outstanding care to seniors. It also heralded the company’s longstanding dedication to establishing homegrown service lines that would enhance its core offerings. For example, in 2003 the partnership with Caris Healthcare LP took NHC to a new level in the hospice arena. In 1984, the company recognized the need to enhance its level of care during the end-of-life period and worked with Dr. George Hester, Medical Director,

Caris Registered Nurse Amanda Brewer visiting a patient in his NHC Assisted Living apartment.

on the venture that became the first Medicare-certified hospice organization in Tennessee. This hospice was eventually gifted by NHC to the local hospital. The new hospice opportunity with Caris went far beyond what had been done within the organization. According to Caris founder Norman McRae, the joint venture allowed NHC to bring this type of care to rural regions

An Honor to be Recognized Over the years, NHC has accumulated a number of awards, several of which truly stand out. In 2014, Forbes named NHC as one of “America’s 100 Most Trustworthy Companies.” And in 2020, NHC received two prestigious awards from NRC Health, a provider of analytics, insights, and other data: the 2020 Customer Approved Award, with which patients, residents, and families recognize overall excellence in care, and the 2020 Employee Approved Award, bestowed for creating an outstanding culture that engages and inspires the company’s Partners.

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Marcelle Jenkins, Food & Nutrition Partner, serving chocolate cream pie.

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of Tennessee and South Carolina that did not have it before. The care could be provided to patients with the same level of professionalism, respect, and attentiveness for which NHC is known. Initially, NHC owned a 50 percent stake in Caris Healthcare; in 2021, NHC acquired total interest of the partnership, making Caris a wholly owned and consolidated subsidiary of NHC. “The culture has been the strength between NHC and Caris,” McRae says. “We shared the mindset that quality care takes commitment. We go beyond the business side of things and try to provide excellent, personalized, compassionate service. NHC allowed us to innovate and supported us when needed—it’s been the best of both worlds.” For years, NHC has dabbled in adding service lines to its repertoire. From an in-house laundry service to a wholesale food company, NHC has experimented with various options. The 1990s saw the company establish insurance company Premier Plus in response to the challenges of finding liability insurance, as well as to

Tim Moore, OTR, helping a patient get back to his passion for golf.

A Successful Walk to Red Lobster After reviewing the chart of our new admission, we knew we had a complex patient on our hands. Another therapist and I bounded into the room with high hopes. We left an hour and a half later with two bags of soiled linen and a bag of soiled briefs and lots of wipes. Our new patient had a long history of hospitalizations for respiratory complications related to asbestos exposure, and had already flatlined N H C

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once. n To read his chart, you would have thought you were walking in to see a corpse. If I’ve seen it once, I’ve seen it one hundred times: poor prognosis, patient

will never walk again, no functional mobility, and my favorite, recommend hospice. But when we walked in the door, we met a feisty rotund Italian man. He was full of energy; it just wasn’t very positive energy. It was hard to tell if he was oriented because he wouldn’t answer our questions for cussing and spitting at us. He even bit me twice and was abrupt and matter of fact. n So much happened over the next few months. Through his therapy, I learned just how stubborn the man could be. And I learned the amazing results of therapy. He did not understand it, but his ability to yell at me for longer periods of time each day meant his lungs were becoming stronger. His legs were able to extend more, and his muscles began to take shape. After three months of therapy, he was ready to stand, and about a month after that he was walking! He made a miraculous recovery. According to his wife, the surgeon and therapists at the hospital were astounded. n Being the good Italian he was, he had an appreciation for food. Before being discharged, his request was to go out to dinner and walk into a restaurant. He chose Red Lobster. So, we, along with his OT and his wife, headed to Red Lobster. That night we watched a man who would never walk again, walk into the restaurant. —Kimberly Pearigen, NHC Anderson

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offer financial and accounting services to both NHC locations and outside entities—a service that remains part of the corporation. Additionally, NHC acquired Nutritional Support Services (NSS), which provided medical supply products like feeding tubes to nursing homes and other providers; this opportunity led NHC further down that path, ultimately setting up four of its own institutional pharmacies to serve NHC SNFs and other locations. Forging uncharted paths always has been an NHC hallmark. In 2014, the company opened its first geriatric psychiatric hospital in Osage Beach, Missouri. The Osage Beach Center for Cognitive Disorders was formed in partnership with Reliant Healthcare LLC to meet what NHC leadership saw as an underserved need in the marketplace. “Behavioral health is a great need in America in general, but geriatric behavioral health

is a tremendous need, particularly as individuals begin to suffer from dementia,” Flatt explains. “While our memory care locations offer ongoing day-to-day care and support for individuals who have advanced dementia, the behavioral health hospital really focuses on the drug administration that patients need when they’re dealing with any type of mental health issue, whether it’s Alzheimer’s disease, schizophrenia, or depression. This is where you go when you need treatment to improve a particular situation, and it allows you to function better when you get back to your home setting.” The Osage Beach Center has been so successful that NHC has added a new division for Behavioral Health. The development of additional geriatric psychiatric hospitals, including two under construction in Maryland Heights, Missouri, and Knoxville, Tennessee, are slated for completion in 2022. The latter is a collaboration

Hurricane Hugo: “It Looked as if a Bomb had Gone Off.” “We had our first experience with hurricanes beginning with Hugo in 1989. At that time, NHC had no coastal centers, but Hugo was so powerful that it reached Sumter Health Care two hours inland and still packed sustained winds of 109 mph. I was on my way to a Patient Care Conference in Nashville when it hit. After finally reaching the centers by phone, I realized I needed to head there to assist. I called my then administrator in training Brad Moorhouse and told him to pack a bag. n N H C

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There was significant damage to the Hopewell HealthCare building (one of NHC’s original centers), and Brad recalls it looking as if a bomb had gone off

with trees everywhere knocked down and pieces of the roof either hanging from the building or strewn around the property. n There was no capability for patients to be transferred to a safer location and our Partners worked all day and night to care for the patients. Water was brought in to us by the National Guard in what’s called a Water Buffalo container and it provided enough drinking and cooking water.” Brad and I spent day and night gathering rainwater and pond water in barrels to flush commodes. n We had no power other than four small portable generators and we set our clocks to refuel them every four to five hours. This allowed for drop cords and for lamp illumination at the nurse’s stations as well as fans. The Partners did patient care with flashlights at night and during the day it wasn’t too bad with light coming through the windows. n The beautiful thing was the dedication of the Partners to care for their patients at all times. They never complained and they worked crazy hours to ensure the health and safety of their patients. The ladies in the kitchen were unbelievable. They cooked all meals outside on a large BBQ grill brought in by the guard until propane was depleted. Then they cooked on open fire, being as creative as possible with large pots and pans. We both agree those meals were some of the best fried chicken, scrambled eggs, and bacon meals we have eaten to this day.” 86

—South Carolina Senior Vice President Sonny Kinney (retired)

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with the University of Tennessee Medical Center and will offer geriatric as well as adult psychiatric services. “We have had patients in every one of our skilled nursing centers who have needed this kind of care, and all too often it’s not been available,” Flatt says. “We want seniors to have access to these kinds of services.” That kind of unprecedented thinking also encouraged NHC to most recently form NHC Advantage LLC, which offers institutional special needs plans for patients looking for managed care options beyond Medicare and Medicaid. “These plans are specific to long-term care,” Flatt says. “You can tailor your plan to what we do, and the plan pays for an extra level of care, covering things like podiatry and dental care. The idea is to offer preventative care to keep patients healthy and out of the hospital. We are one of the first nursing home companies to adopt this, and we are a trendsetter in this area.” All of these health offerings have given NHC a chance to take an even more comprehensive approach to patient care. “We can offer a more continuous, seamless level of care,” Flatt states. “The more control you have of the care continuum, the better care you can provide.”

Weathering the Storms Of course, being in control is not always possible when it comes to the long-term care industry. From natural disasters to the COVID-19 pandemic, NHC has weathered many storms. One of the more significant ones occurred in 2003, when one of NHC’s skilled nursing centers in Nashville caught fire, resulting in loss of life. At the time, Tennessee did not require sprinklers to be added to the mid-1960s-era brick-and-steel building that housed the SNF— nor did any of the states in which NHC operated. However, after that horrible event and well before the state—and the nation—changed its building code requirements, Andy Adams insisted that all NHC centers have sprinkler systems installed. The effort was just one way that NHC has demonstrated its willingness to go above and beyond for its patients, and also its resilience in the face of unimaginable circumstances.

One of the many parades held at NHC centers for families to drive by and greet their loved ones and Partners.

Often, those circumstances occur because of turbulent weather, from hurricanes in coastal areas to floods to tornadoes. In 2011, an F5 tornado swept through the heart of Joplin, Missouri, killing 158 people; one of the area’s two NHC centers was destroyed, but thanks to the quick actions of Partners, no one was seriously injured or killed. And in a four-year period between 2016 and 2019, Hurricanes Matthew, Erma, Florence, and Dorian caused sixteen NHC locations to evacuate. Again, determination and resilience kept every patient and Partner safe and ready to move forward beyond the destruction. In 2020, this adaptability once again was on display as COVID wreaked havoc on nursing homes across the country, yet NHC’s Partners have strived to keep patients safe and healthy. “Our centers are built of strong teams, and this pandemic challenged us daily. But it has made our teams stronger,” Vicki Dodson says. “It is amazing to watch our CNAs and nurses work tirelessly, always attempting to deliver a high quality of care and quality of life. Our departments supported each other in ways they never expected.” Many Partners cross-trained as

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CNAs. Food and Nutrition Partners made extra meals for their teammates to take home at night. Administrators provided household items that Partners could pick up and take home, while other Partners helped their teammates with childcare while they took care of patients. “Our Partners are so amazing,” Joan Phillips says. “When COVID began, our Partners stepped up. They have done everything in the centers, from laundry and housekeeping to food and nutrition services. The therapists would come in and do their therapy and then stay to work night shifts and weekends as CNAs. I was so amazed and proud of them.” According to Brooke Vanderpool, Assistant Vice President of Patient Services, NHC has strategically designed the regional teams to mirror the center leadership teams. Each regional brings valuable hands-on knowledge and experience to their role of supporting their center counterparts as the majority of them were Partners in the centers before becoming regionals. So, in the day-to-day business, and especially in a crisis, this allows Partners the comfort of knowing they have someone to rely on and who understands

Partners Breanna Blomgren, RN Unit Manager, and Miatta Hampton, DNP, Director of Nursing, enjoy socializing with a patient.

their job and the challenges they may face. For example, during the pandemic, Greg Bidwell, Senior Vice President for the Central Region, worked side by side with Partners from all disciplines in multiple locations. According to his regional team, “Greg encouraged the centers and advocated for the Partners. He was the first person there each morning and the last person to leave each evening. He was willing to do any job that needed to be done, and as a registered nurse by trade, he did everything he could to help with direct patient care. He was fearless and showed courage and hope when it was needed most. He made Partners feel like they could get through all of the chaos, grief, fear, and exhaustion, and he never quit spreading encouragement and hope.” “NHC has taken challenges and things that have gone wrong and looked at them as gifts that allowed us to learn. We used them as an opportunity to improve,” Mike Ussery concludes. “I think that’s what Dr. Adams was always about. How can we be better this week than we were last week? As a company, we’ve always looked for opportunities to grow and impact more lives. And we always want to do it better over time.”

A mother receives a window visit from her son during the 2020 pandemic.

Giving Purpose to the Job NHC Partners write purpose statements as part of earning their Better Way Certification and Better Way pin. This provides them an opportunity to look at the amazing ways they support and care for patients, families, and their fellow Partners. A purpose statement is their own personal mission statement and a wonderful way to put into words the “why” of what they do each and every day with NHC. This sampling of statements come from some of the many Better Way Champions in the company.

“I am helping people maintain their nutritional status and this helps them to heal while in our care.” —Food & Nutrition Manager

“I will provide patientcentered care with the best evidence-based practice available in order to inspire hope and improve quality of life in each patient.”

“My purpose is providing the best care. My reward for what I do is a thank you, a hug, a touch, and a laugh. The stories and wisdom I get are priceless. I enjoy taking care of others and I put my heart in it every day. I always feel great after my shift.” —Certified Nursing Assistant

—Physical Therapist

“My purpose as a housekeeper is to serve the residents of NHC with whatever is needed. My aim is to create a clean environment and present a smiling face to each person when I enter their room.” —Kathy, Housekeeper

“The purpose of my being an RN is to provide quality care and support for my residents and Partners. I strive to bring happiness and smiles to everyone I meet. Working here at NHC has brought much happiness to me also.” “I enjoy my work. It is not just a way to earn a living, it’s something more than that—it’s falling in love with your job.”

“When I do my job well, it makes me happy knowing how happy I have made someone else.”

—Peggy

“My purpose as a nurse is to help care for my residents to the best of my ability, as well as provide excellent teamwork to my fellow Partners. I address my residents’ needs and concerns, listen to them, show them they are important to me, and treat them with love and respect.” —Julie, Nurse

“My purpose as the AVP of Food & Nutrition

Services is to foster environments which encourage & engage my fellow Partners to delight & nourish those entrusted in our care.” —Brigitte

“The purpose of my being a housekeeper is to help the CNAs and sing to the patients and make sure their rooms are clean.” —Housekeeper

“I create a positive experience and encourage my patients/ customers to shine bright as they walk through their path/journey!”

“I believe I bring happiness and care to what I do.” —Certified Nursing Assistant

“The purpose of my being a Social Worker is to advocate for and support the residents and their families through all aspects of life that they face while here. By listening to, advocating for, and making the residents feel comfortable in expressing themselves, it lets them know that their opinions, thoughts, desires, fears, concerns, and emotions matter, are recognized, appreciated and heard.”

—HomeCare Partner

“My purpose as the Administrator is to lead our Partners by example and direction and exceed our customer’s expectations. Furthermore, my purpose is to build relationships that will enhance our work environment and promote a family atmosphere.” —Darrin

“By listening to our patients and doing the little extra things just the way they want, I make them smile. That smile or ‘I love you’ from a patient tells me that I am improving their quality of life, which is my reason for being here.” —Certified Nurse Assistant

“I strive to energize each day with a positive, fun, and consistent healthy attitude.” —Certified Nursing Assistant

“My ultimate purpose as a night shift Licensed Nurse Assistant is to meet all residents’ needs so they may obtain a good night sleep and restoration in preparation for the next busy day ahead!” “My purpose as Recreation Coordinator is to bring happiness and beauty to our patients, families, Partners, and our center. I create a warm, open, loving environment for all who enter our doors.”

“As Director of Maintenance, I look to take a proactive stance into every aspect of physical plant operation to effectively create a positive, safe, and pleasant work environment for all patients and Partners alike.”

National HealthCare Corporation Home Office Partners July 23, 2021 50th Anniversary (Photo by Parker Feazel)

L O

“Look backward only to improve the road ahead.” — Dr. Carl Adams

For the last fifty years, NHC has demonstrated its ability to do one thing very well. “We are going to find a way. We’re always going to find a way. We won’t just survive, but we’re going to thrive,” Steve Flatt says. “With everything that healthcare, and particularly healthcare for seniors has gone through, this is a company that has been successful for both patients and stockholders. It has maintained its soul, and our culture reflects that soul.”

With that in mind, NHC looks forward to many more years of not only serving senior patients in a truly outstanding manner, but also to increasing the ever-expanding list of services the company provides. From growing its assisted and independent living locations to addressing senior behavioral health with the construction of its new geriatric psychiatric hospitals, NHC is looking forward to a bright and exciting future. It is a future based on the vision of one man, who understood so much more about senior patients and the long-term care industry than anyone else even comprehended. His aspirations undoubtedly have come to life through National HealthCare Corporation, and the company and its dedicated Partners will continue to carry his goals forward. And in his own words, those objectives are very simple. As Dr. Adams said, “The public is demanding more from us as caregivers in both quality of care and quality of life.”

In this, NHC leads the way.

I *Numbers in italics indicate photos A Abel, Chris, 45 Abernathy, Dr. J. Paul, 71 Academy Award, 31 Activities of Daily Living (ADL), 38, 56, 62 ADAM (Advanced Data Management), 41 Adams, A. B., 6 Adams, Carl E. Jr., 6 Adams, Dr. Carl Sr. biography, 6 Chairs of Excellence of, 55 cooperative approach of NHC, 47–49, 52, 55–56, 58, 61, 65–66 dedication to NHC of, xi expansion of NHC, 69, 72, 83, 88 future of NHC, 93 leadership board of, 70 person-centered approach of, 15–16, 18–19, 21, 24–26, 28– 29, 31–33, 36, 38–39, 41–42 photos, xi, xii, 4, 6, 19, 42, 48, 55, 71, 81 political side of, 72 support of checkers games, 44 support of medical centralization, 39 support of medical research, 26 vision of, 1–3, 5–7, 9–10 wingmen of, 79 wingwomen of, 29 Adams, Fred M., 6 Adams, J. F., 6 Adams, Jennie Mae, xi, xi, 3, 6, 32, 55–56, 55, 73 Adams, Joanne. See Coggin, Joanne Adams Adams, Robert G., 3, 6, 7, 10, 24, 26, 28, 48, 52, 55, 64, 67, 70, 71, 72–73, 73, 77, 78, 79, 79, 80, 81, 82, 82 Adams, Susanne, 64, 82 Adams, W. Andrew (Andy), x, 1, 3, 4, 5–6, 9, 18, 28, 48, 58, 60, 70, 71, 72, 73, 74, 79, 80, 80, 81, 82, 87

Adams Chair of Excellence, MTSU, 55 AdamsPlace, x, 73 Adcock, Kristin, 54 ADL (Activities of Daily Living), 38, 56, 62 Administrator-in-Training (AIT) program, 49, 51–52, 54, 86 Advanced Data Management (ADAM), 41 Alabama, 72–73 Allen, Peggy, 16, 67 Alzheimer’s Association, 64 American Health Care Association Journal, 40 American Heart Association, 64 American Medical Directors Association, 25 American Physical Therapy Association, 55 American Stock Exchange, 74, 77, 82 “America’s 100 Most Trustworthy Companies,” 42, 83, 83 Anderson, Jack, 3 Anderson, NHC HealthCare, 14, 85 Andrews, Dr. Susan, 38 Annual Report, NHC, x Assisted Living, NHC, 10, 29, 69, 83

B Barber, Charlotte, 5, 18, 42 Batey, Joanne, 28, 28, 80, 83 Beard, Christy, 39 Behm, Howard, 5, 72, 81 Belmont University, 53 The Better Way, 31, 58–60, 90 Bidwell, Greg, 88 Blevins, Ray, 51, 67 Blomgren, Breanna, 88 Bloodworth, Linda, 26 Bluffton, NHC HealthCare, 74 Board of Directors, HCI, 3 Board of Directors, NHC, 3, 70–71, 71, 79 Board of Directors, NHI, 82 Board of Trustees, NHC, 72 Bodies in Action, 30 Boggs, Belinda, 77 Bone, Harold, 31, 54, 61

Bowery, Monica, 45 Brandon, Linda, 25 Burgess, Ernest G. III, 28, 40, 47, 70, 71, 81 Burke, Brigitte, 14, 32, 55, 90 Burns, James, 67 Butler, Dr. Henry King, 38 Byrdson, Willie, 67

C Cannon County, Tennessee, 6 Caris Healthcare LP, 83, 85 Carole, Carol, 38 Carrabelle, NHC HomeCare, 25 Carter, Dr. Frank, 76 Center of Human Services, MTSU, 55 Central Middle School, 3 Central Region, NHC, 73, 88 Centralized Referral Operations (CRO), 39 Certificate of Need, 74, 77, 80 Certified Better Way Champions, 60, 90 Certified Nursing Assistant (CNA), 21, 45, 51–52, 55–56, 60–62, 60, 62, 63, 87–88, 90–91 Chance, Dorothy Wakefield, 29, 33, 36, 36 Chapell, Debora, 67 Cherry, Judy, 67 Chism, Glenda, 67 Chunn, Ann, 67 City Center, Tennessee, 72 Clayton, Hanna, 33, 36 CNA (Certified Nursing Assistant), 21, 45, 51–52, 55–56, 60–62, 60, 62, 63, 87–88, 90–91 CNA Day, 60, 61 CNA of the Year Award, 61 Coggin, Gerald, 6, 9, 15, 28, 38, 51, 67, 72, 76, 80, 82, 82 Coggin, Joanne Adams, 6, 82 Coleman, Ann, 19, 24, 26, 28, 38, 40, 67 Coleman, Dee, 34, 50 Collage, 66 Adams, Andy Adams, Dr. Carl Adams, Robert Allen, Peggy Barber, Susan

I Barret, Drew Batey, Joanne Bayley, Joan Beard, Christy Bebber, Leigh Bentley, Rosemary Betschart, Lori Bidwell, Greg Bidwell, Scott Bishop, Bill Blevins, Ray Bloodworth, Linda Bond, Lisa Bone, Harold Bollinger, Amber Brown, Penny Buha, Jill Burgess, Ernest Burke, Brigitte Burnham, Emily Burns, Stephen Burwin, Allison Bryant, Jenny Campbell, Kathy Campbell, Tom Chambliss, Su Clayton, Hanna Claytor, Ashlee Coggin, Gerald Coleman, Ann Coop, Linda Corey, Karen Craig, Dr. Mack Wayne Crieghton, Pat Cunningham, Dwinna Curtwright, Nancy Daniel, Don Dault, Beth Deckman, Jill Doby, Laura Dodson, Vicki Donnell, Cindy Duckett, Lee Ann Duncan, Bruce Duncan, Sandy Effland, Karla Fairchild, Senora Fieldhouse-Thomas, Jane Fisher, Ann Flatt, Andy Flatt, Steve Fleming, Delores Fraley, Charla

Frebis, Myra Freeman, Margaret Freeman, Jim Funderburk, Diane Goodman, Liz Graham , Anna Groeneveld, Tina Hagan, Courtney Hall, Sharon Hammond, Jennifer Harris, Barbara Haynes, Dan Helton, Becky Hempfner, Carol Henderson, Kathy Hill, Julia Holley, Debbie Horsman, Kami Huddleston, Debbie Hughes, Beth Hughey, Martha Hunt, Mary Hope Johnson, Doran Kincaid, Mitch Kinney, Sonny Kircher, Diana Knight, Phyllis Knowles, Michelle Kurtz, Jim Lane, Karla LaRoche, Ted Lassiter, David Leeman , Terry Lindemann, Debbie Mabry, Janet Makos, Amy Manlove, Gwen Maxwell, Tonya May, Judy McCrary, Beth McDougle, Cheryl McDowell, Kathryn McIntosh, Bubba McKamey, Darrin Meiring, Karen Melendy, Diana Merk, Laura Mobley, Mary Moore, Brandy Moorhouse, Brad Moorhouse, Bryan Morrow, Glenn Nason, Jay

X Neal, Mike Norfleet, Judy Oliff, Wayne Outland, Jeff Parenti, Karen Phillips, Joan Philpot, Sherry Pittman, Doris Pitts, Cassie Pollard, Kathleen Powell, Judy Powers, Wilma Price, Debbie Ragsdale, Sam Rector, Mel Reed, Jana Richard, Glenn Roberts , Meadow Rogers, Danny Rogers, Lottie Ruggles, Elaine Sage, Kristen Sample, Rick Sanders, Holly Sellars, Rick Selman, Rhonda Shearer, Rickie Shelly, Tim Siddell, Anne Smith, Jeff Smith, Lori Smith, Tamara Stark, Beth Stephens, Beth Stephens, Jean Stephens, Joan Strawn, Steve Sullivan, Keely Sullivan, Carl Sumners, Sherry Swafford, Charlotte Sweeney, Thelma Swift, Charles Tambornini, Jeff Taylor, Celia Tennyson, Dee Trice, Valerie Tucker, Emily Ussery, Mike Vanderpool, Brooke Vetter, Stacia Wagner, Patty Walker, Gussie

I Walker, Julie Watson, Pat Webb, Patty Weir, Beth West, Chris Whittenburg, Merv Wilson, Charlotte Wong, Maria Wright, Jennifer Wynne, Tom Wysocki, Charles Young, Sherry College Street (Murfreesboro, Tennessee), 2 Colonial Hill, 51 Columbia, NHC HealthCare, 18 Committee on Nursing Home Regulation, Institute of Medicine, 39 Compassion Fund, NHF, 64 Comprehensive Patient Care System (CPCS), 41 COVID-19, 87–89 Craig, Dr. Mack Wayne, 21, 54, 60–61, 61 CRO (Centralized Referral Operations), 39 “Culture Connection” [video segment], 31 Cunningham, Dwinna, 67 Curtis, Margaret, 18, 18 Customer Approved Award, NRC Health, 83

D Daniel, Don, 10, 28, 72, 80, 82 Dault, Beth, 36, 39 Davis, White & Associates, 1 Dawson Springs, Kentucky, xi, 41 de Jesus, Amyliza, 53 Denbesten, Ken, 28 Department of Admissions, NHC, 37 Department of Ancillary Services and Corporate Relations, NHC, 9 Department of Behavioral Health, NHC, 69, 86, 93 Department of Clinical Reimbursement, NHC, 39 Department of Corporate Affairs, NHC, 49

Department of Development and Construction, NHC, 81 Department of Development, NHC, 52, 79 Department of Dietary Services, NHC, 14, 16, 20, 32–33, 44–45, 54–55 Department of Environmental Services, NHC, 52 Department of Food and Nutrition Services, NHC, 14, 16, 31–33, 49, 52, 55, 77, 84, 87–88, 90 Department of Health Information Management (HIM), NHC, 39, 41–42 Department of Housekeeping, NHC, 52, 88 Department of Human Resources, NHC, 31, 49 Department of Information Systems, NHC, 42 Department of Information Technology (IT), NHC, 39, 42 Department of Interior Design, NHC, 54, 78 Department of Laundry, NHC, 49, 85, 88 Department of Maintenance, NHC, 49, 91 Department of Nursing Services, NHC, xi, 18, 21, 25–26, 31–32, 38, 46, 49, 56, 79, 88 Department of Operations, NHC, 29, 47 Department of Partner Relations, NHC, 31 Department of Patient Services, NHC, xi, 21, 29, 31, 88 Department of Recreation and Wellness, NHC, 31–33, 44, 91 Department of Rehab Services, NHC, 29 Department of Senior Management, NHC, 28, 60, 70, 72, 80 Department of Social Services, NHC, 29, 33, 39 Department of Social Work, NHC, 31, 33, 36–37 Department of Therapy, NHC, 31 DeSmet, Kylie Hill, 64 Dickson, NHC, 56

Dietetic Internship, NHC, 29, 54–55, 64 Director of Nursing (DON), xi, 18, 21, 25, 32, 38, 46, 56, 79, 88 Dodson, Vicki, 21, 21, 60, 80, 87 Duke, Vanessa, 67 Duncan, Bruce, 78 Dutta, Maia, 64

E Eanes, Mary, 38 East Tennessee Region, NHC, 33, 72–73 East Tennessee State University, 51 Eastern Kentucky Region, NHC, 72 Eastern Region, NHC, 51, 60 Edwards, Dr. Martha Jo, 55 Employee Approved Award, NRC Health, 83 Employee Stock Ownership Plan (ESOP), 72 Essex, Rhonda, 67 Evins, Louise, 5, 74

F FaceTime, 73 Fairhaven Nursing Home, 6 Fann, Jenny, 44 Farragut, NHC Place, 3 Flatt, Andy, 80 Flatt, Stephen F. (Steve), 10, 42, 48, 49, 52, 70, 71, 74, 78–80, 79, 80, 86–87, 93 Flemmer, Scott, 51 Florida, 25, 70, 74, 77–80 “Focus on the Fix” [video segment], 31 Forbes magazine, 83, 83 Forsythe, Charlene, 42 Fort Lauderdale, Florida, 77 The Foundation for Geriatric Education (TFGE), 56 Franklin, Tennessee, 18 Frase, Malinda, 43 Freedle, Ora, 67 Freeman, James, 67 Freeman, Margaret, 14 Freeman, Morris, 14 Fults, Lynda, 67

I G Gann, Sabrina, 80, 83 Garrison, Dr. S. C., 2, 6, 9–10, 70, 71 Georgia, 1, 72–73 Geriatric Physical Therapy Residency, NHC, 26 Germany, 79 Gilliam, Sherrie, 40 GoodSkin Twins, 31 Gray, Lois, 67 Graybill, Lisa, 67 Greenville Technical College, 56 Groves, Judy, 67 Gulf County, Florida, 25

H HAI (Hospital Affiliates Inc.), 3 Hall, Janice, 67 Hammond, Jennifer, 33 Hampton, Miatta, 88 Hardy, Tammi, 25 Harris, Barbara, 29, 29, 67 Hassan, Emil E., 71 Healthcare Inc. (HCI), 3, 5 Helton, Becky, 80 Hendersonville, NHC, 30 Hester, Dr. George, 76, 83 Hixson, Stella, 44 Holt, Charlene, 67 Holton, Bea, 20 Home Office, NHC, 2, 31, 47, 58, 60, 72–73 HomeCare, NHC, 13, 25, 41, 60, 69, 83, 91 Honeys, Hendersonville, 30 Hopewell HealthCare, 86 Horton, Ann, 29 Hospice, NHC, 10, 69, 83, 85 Hospital Affiliates Inc. (HAI), 3 Hospital Utilization Project (HUP), 36 House of Representatives, U.S., 72 Huff, Davy, 11 Hughes, Beth, 39, 42 Hughey, Martha, 67 “Hump Day,” 33 Hunter, Easter, 67 HUP (Hospital Utilization Project), 36 Hurricane Dorian, 87 Hurricane Erma, 87

Hurricane Florence, 87 Hurricane Hugo, 86 Hurricane Matthew, 87 Hurricane Michael, 25

Indiana, 82 Institute of Medicine, 39

Lindemann, Debbie, 61 Lipscomb University, 52, 79 LNA (Licensed Nurse Assistant), 91 Long-Term Care (LTC), xi, 10, 15, 21, 39, 42, 49, 54–55, 61, 87, 93 LPN (Licensed Practical Nurse), 13, 56, 76

Jacks, Sharon, 54, 78 Jenkins, Marcelle, 84 Jesus Christ, 7 Johnson, Doran, 6–7, 21, 24–26, 39, 49, 61, 67, 72–73, 78 Johnson, Patricia, 67 Johnson City, NHC HealthCare, 45, 51 Jones, Sarah, 67 Joplin, Missouri, 87 Joyner, Leslie, 41, 67

K Kansas, 82 Keathley, Jim, 10, 28, 49, 54 Kentucky, xi, 1, 28, 41, 72–73 Keyes, Cindy, 44 Kidd, Brian, 80 Kinney, Sonny, 86 Knoxville, Tennessee, 38, 86

L Land, Vicki, 67 Lane, Karla, 3 LaRoche, Richard F. (Dick) Sr., 2–3 LaRoche, Richard F. (Ted) Jr., 2–3, 6, 7, 10, 28, 70, 71, 72, 74, 80, 81 Lawrenceburg, NHC, 51 Lawson, Robin, 53 Leadership Institute, NHC, 54 Lee, Deborah, 55 Legislative Plaza, 32 Lewis, Sue, 67 Lewisburg, NHC, 21 Lewisburg, Tennessee, 21 Licensed Nurse Assistant (LNA), 91 Licensed Practical Nurse (LPN), 13, 56, 76 Linam, Pamela, 67

Manchester, New Hampshire, 73, 79–80 Martin, Becky, 37 Martin, Tammy, 20 Maryland Heights, Missouri, 86 Massachusetts, 79 Massman, Katie, 64 Matheny, Leanne, 46 McBee, Rosemary, 74, 74 McCoy, Teresa, 76 McEvoy, Sarah, 73 McIlwee, Ashley, 64 McIntosh, Bubba, 80 McCreary, Josh, 80 McKamey, Darrin, 51, 91 McKnight, Edna, 38 McRady, Fay, 5, 38 McRae, Norman, 83, 85 MDS (Minimum Data Set), Medicare, 26, 39 Medicaid, 3, 39, 72, 80, 87 Medical Center, University of Tennessee, 87 Medicare, 3, 7, 21, 26, 36, 39, 41, 72, 83, 87 Melendy, Diana, 33 Memory Care, 53 Merihil Nursing Home, 21, 25 Messimer, Ronald (Ron), 51, 51, 67 Metro Region, NHC, 33 Middle Tennessee Region, NHC, 73 Middle Tennessee State University (MTSU), 6, 16, 55, 79 Minimum Data Set (MDS), Medicare, 26, 39 Mireles, Lily, 16 Missouri, 33, 70, 74, 77–78, 86–87 Missouri Region, NHC, 33, 61 Mitchell, Jennie Mae. See Adams,

I Jennie Mae Moen, Jessica, 56 Moore, Tim, 85 Moores, Nan, 29, 29 Moorhouse, Brad, 86 Morgan, Tom, 78, 81 Most Effective Rehabilitation Award, 41 MTSU (Middle Tennessee State University), 6, 16, 55, 79 Murfreesboro, NHC, 19, 24, 26, 30, 32, 44, 48, 52 Murfreesboro, Tennessee, xi, 1, 3, 6, 19, 38, 44, 72, 82 Murfreesboro Health Care Center, 41 Murfreesboro Medical Clinic, 2–3, 5–6, 18–19 Mutter, Sharon, 67

N Nashville, NHC, 30 Nashville, Tennessee, 25, 32, 72, 86–87 Nashville General Hospital, 6 National Guard, U.S., 86 National Health Corporation, 3 National Health Foundation (NHF), 64 National Health Investors, Inc. (NHI), 70, 79, 82 National Health Realty (NHR), 82 National Ice Cream for Breakfast Day, 33 National Institutes of Health, 26 Neal, Mike, 77–80 New England Region, NHC, 77, 79, 82 New Hampshire, 73, 79–80 New York, New York, 74, 82 New York Stock Exchange, 82 NHC Advantage LLC, 87 NHC Chair of Excellence in Nursing, MTSU, 55 NHC: Recollections (LaRoche), 10 NHCPAC (NHC Political Action Committee), 72 NHF (National Health Foundation), 64 NHI (National Health Investors, Inc.), 70, 79, 82 NHR (National Health Realty), 82

North Carolina, 72 North Carolina Region, NHC, 72 North Florida Region, NHC, 77 Northwest Region, NHC, 77 NRC Health, 83 Nutritional Support Services (NSS), NHC, 86

O Oak Ridge, Tennessee, 77 Odum, Brad, 35 Orlando, Florida, 79 Orton, Cheryl, 13 Osage Beach Center for Cognitive Disorders, 86 Osage Beach, Missouri, 86

P Parenti, Karen, 77, 79–80 Partner Excellence Program (PEP), 65 Partners Incentive for Excellence (PIE) program, 65 Patient Care and Management Conference, NHC, 61, 86 Patient Council, NHC, 18 Patient Driven Payment Model (PDPM), 41–42 Pearigen, Kimberly, 85 PEP (Partner Excellence Program), 65 Perrone, Dawn, 9 Perry, Kellie, 31 Phillips, Joan, 29, 67, 88 photos Abernathy, Dr. J. Paul, 71 Adams, Dr. Carl Sr., xi, xii, 4, 6, 19, 42, 48, 55, 71 Adams, Jennie Mae, xi, 55, 73 Adams, Robert G., 7, 24, 28, 48, 64, 71, 73, 78, 79, 80, 81, 82 Adams, Suzanne, 64, 82 Adams, W. Andrew (Andy), 4, 28, 48, 71, 73, 79, 80 AdamsPlace, 73 Adcock, Kristin, 54 American Health Care Association Journal, 40 “America’s 100 Most Trustworthy Companies,” 83 Andrews, Dr. Susan, 38

Assisted Living, NHC, 83 Barber, Charlotte, 42 Batey, Joanne, 28, 80 Blomgren, Breanna, 88 Board of Directors, NHC, 71 Boggs, Belinda, 77 buildings, NHC, 2, 68, 92 Burgess, Ernest G. III, 28, 40, 71 Burke, Brigitte, 14 Butler, Dr. Henry King, 38 Carole, Carol, 38 Carter, Dr. Frank, 76 Certified Nursing Assistant (CNA), 60, 62, 63 Chance, Dorothy Wakefield, 36 CNA Day, 60 Coggin, Gerald, 28, 51, 76, 80, 82 Coggin, Joanne Adams, 82 Coleman, Ann, 19, 38, 40 Coleman, Dee, 34, 50 compassionate care of residents, x, 8, 11, 12–13, 14, 20, 24, 27, 30, 43, 44, 45, 50, 53, 58, 75, 81, 83, 85, 88, 89 Collage, 66 Craig, Dr. Mack Wayne, 21, 61 Curtis, Margaret, 18 Daniel, Don, 10, 28, 80 de Jesus, Amyliza, 53 Denbesten, Ken, 28 Department of Development and Construction, NHC, 81 Department of Environmental Services, NHC, 52 Department of Senior Management, NHC, 28, 80 DeSmet, Kylie Hill, 64 Dodson, Vicki, 21, 80 Dutta, Maia, 64 Eanes, Mary, 38 Eastern Region, NHC, 60 Fann, Jenny, 44 Flatt, Andy, 80 Flatt, Stephen F. (Steve), 48, 71, 79, 80 Forbes magazine, 83 Frase, Malinda, 43 Freeman, Margaret, 14 future of NHC, 66 Gann, Sabrina, 80

I Garrison, Dr. S. C., 71 Gilliam, Elizabeth, 40 Hampton, Miatta, 88 Harris, Barbara, 29 Hassan, Emil E., 71 Hester, Dr. George, 76 Hixson, Stella, 44 Holton, Bea, 20 Huff, Davy, 11 Jacks, Sharon, 54 Jenkins, Marcelle, 84 Johnson, Doran, 78 Keathley, Jim, 10, 28 Keyes, Cindy, 44 Kidd, Brian, 80 LaRoche, Richard F. (Ted) Jr., 7, 28, 71 Lawson, Robin, 53 Martin, Becky, 37 Martin, Tammy, 20 Massman, Katie, 64 Matheny, Leanne, 46 McBee, Rosemary, 74 McCoy, Teresa, 76 McIlwee, Ashley, 64 McIntosh, Bubba, 80 McCreary, Josh, 80 McKnight, Edna, 38 McRady, Fay, 5, 38 Messimer, Ronald (Ron), 51 Mireles, Lily, 16 Moore, Tim, 85 Moores, Nan, 29 Morgan, Tom, 81 Odum, Brad, 35 Orton, Cheryl, 13 parade, NHC, 87 Partners, NHC, x, 92 Perry, Kellie, 31 Poe, Patty, 64 Pomeroy, Terri, 49 Powell, Judy, 6, 28, 41, 80 Powers, Wilma J., 29 Quillan, Melissa, 34 Reed, Amy, 44 Reinhart, Jamie, 54 Rickard, Dr. Randell, 38 Robinson, Woody, 81 Ross, Catina, 46 Simmons, Olivia Horn, 64 Skin Is In [video], 31 Smith, Jeff, 80 Strawn, Dawn Thorpe, 24

Strawn, Steve, 78 Sullivan, Tim, 76 Swafford, Charlotte, 17, 28, 80 Tambornini, Mazell, 76 Taylor, Celia, 30 TIO the Alligator, 31 Tucker, Lawrence C., 71 Turner, Dr. John, 37 Twilla, Dr. J.K., 71 Underwood, Katie, 35 Ussery, Michael (Mike), 41, 48, 80 Vance, Melinda, 64 Varnell, Sally, 81 The Walk to End Alzheimer’s, 64 Walker, Augusta “Gussie,” 33 Welker, Amanda, 64 West, Chris, 80 Williams, Dr. Olin, 71 Wood, Marette, 35 Yang, Michelle, 34 Physical Therapy Geriatric Clinical Residency Program, NHC, 55 PIE (Partners Incentive for Excellence) program, 65 Pigg, Karla, 67 Poe, Dr. Patty, 54–55, 64 Political Action Committee, NHC (NHCPAC), 72 Pomeroy, Terri, 49 Port St. Joe, NHC HomeCare, 25 Potts, Wanda, 67 Powell, Judy, xi, 6, 21, 28, 29, 38–39, 41, 42, 80 Powell, Julia, 67 Powers, Wilma J., 29, 29 Premier Plus, 78, 85 Puckett, Jerry, 70 Pulaski, NHC, 49 Pulaski, Tennessee, 6 Pullias, Campbell, 3

Q Quillan, Melissa, 34

R RAI (Resident Assessment Instrument), 42 Ralston, Jane, 5 RDs (Registered Dietitians), 14, 16, 20, 54–55

Real Estate Investment Trust (REIT), 3, 70, 79, 82 Rector, Melvin (Mel), 48, 67 Red Lobster, 85 Reed, Amy, 44, 53 Reeves, Janie, 67 Regional CNA of the Year Award, 61 Registered Dietitians (RDs), 14, 16, 20, 54–55 Registered Nurses (RNs), 5, 18, 21, 38, 46, 51, 55–56, 88, 90 Reinhart, Jamie, 54 REIT (Real Estate Investment Trust), 3, 70, 79, 82 Reliant Healthcare LLC, 86 Resident Assessment Instrument (RAI), 42 Rhodes, Betty, 67 Rickard, Dr. Randell, 38 Riley, Brenda, 67 Ritz-Carlton, 58, 60 RNs (Registered Nurses), 5, 18, 21, 38, 46, 51, 55–56, 88, 90 Robinson, Woody, 81 Rolling Rockets, Nashville, 30 Ross, Catina, 46 Rutherford County, Tennessee, 47 Rutherford Hospital, 2 Rutherford Properties Inc., 2–3

S Saint Mary of the Woods College, 53 Schnelle, John F., 26 School of Nursing, MTSU, 55 SeniorCisers, Murfreesboro, 30 Shabazz, Geraldine, 67 Shelton, Dorothy, 67 Shirley, Carolyn, 67 Shirley, Gary, 67 Shoaf, Dr. Linda, 29 Simmons, Olivia Horn, 64 Sivels, Gloria, 67 Skilled Nursing Center (SNF), 9, 15–16, 21, 24–26, 28, 36, 38–39, 41–42, 49, 51, 54, 72–73, 82–83, 86–87 Skin Is In [video], 31 Smith, Carolyn, 67 Smith, Jeff, 42, 80

I SNF (Skilled Nursing Center), 9, 15–16, 21, 24–26, 28, 36, 38–39, 41–42, 49, 51, 54, 72–73, 82–83, 86–87 South Carolina, 14, 56, 72, 74, 78, 85 South Carolina Region, NHC, 14, 31, 72, 86 South Central Region, NHC, 6, 39, 73, 80 South Florida Region, NHC, 77 Springfield Rehabilitation HealthCare Center, 30 St. Petersburg, Florida, 77 “Starfish Story,” 54 Stegall, Whitney, 70 Stevenson, Martha, 67 Strawn, Dawn Thorpe, 24 Strawn, Steve, 77–79, 78 Sullivan, Tim, 76 Sumter, NHC HealthCare, 56, 86 Sunshine Bunch, 30 Swafford, Charlotte, 17, 28, 42, 67, 74, 80, 82

T Talbert, Eva Ann, 67 Tambornini, Mazell, 18–19, 25, 76 Tampa, Florida, 78 Taylor, Celia, 30, 31–32, 58, 60

100

Tennessee, xi, 1, 3, 6, 18–19, 21, 25, 28, 30, 32–33, 38, 44, 47, 49, 55–56, 64, 72–73, 77, 82–83, 85–87 Tennessee Chairs of Excellence program, 55 Texas, 77 TFGE (The Foundation for Geriatric Education), 56 Tharp, Janie, 67 Thompson, Frances, 67 Thompson, J. L. (Babe), 6 TIO the Alligator, 31, 31 Train the Trainer Workshop, 54 Tucker, Lawrence C., 71 Tummins, Linda, 67 Turner, Dr. John, 37 20/20 [video series], 31 Twilla, Dr. J.K., 70, 71

U Underwood, Katie, 35 University HealthCare, NHC, 18, 30 University of Rochester School of Medicine, 6 University of Tennessee, 87 University Street (Murfreesboro, Tennessee), 1

Ussery, Michael (Mike), 41, 48, 51, 67, 69, 80, 88

V Vance, Melinda, 64 Vanderbilt University, 26, 79 Vanderpool, Brooke, 88 Villa Crest, 73 Virginia, 72

W The Walk to End Alzheimer’s, 64, 64 Walker, Augusta “Gussie,” 16, 29, 32, 33 Washington, D.C., 72 Washington State, 82 Welker, Amanda, 64 West, Chris, 49, 52, 54, 65, 80 West Virginia, 74 When You Put Your Heart in It training, 60 Whitfield, Vivian, 67 Wilkes & McHugh, 78 Williams, Dr. Olin, 70, 71 Wood, Marette, 35 Wray, Kathy, 67

Y Yacknawitz, Stuart, 74 Yang, Michelle, 34 Young, Sherry, 67

“When I founded this company years ago, my vision was to provide superior nursing and medical care in a Quality of Life environment for our patients at each health care center. Excellent patient care has always been a high priority. I hope you will help us protect that priority in our HealthCare Centers at all times. Those who need our services deserve the best health care possible. The best health care comes only from dedicated people like you who want to feel the satisfaction of helping patients preserve a Quality of Life environment at all times. Being sensitive to the needs of our patients and their families is a characteristic I hope each of you will develop as a standard in doing your job.” Dr. Carl Adams, Founder, NHC