Experience makes a difference 2017 REPORT ON QUALITY
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HCR ManorCare’s commitment to care and caring is the driver of our quality. Our experience makes a difference. This report presents a snapshot of who we are.
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OUR COMMITMENT TO quality
The Heart in Quality Health Care Our experience, standards of performance and the outcomes we achieve for our patients and residents have made us the preeminent provider in our health care markets. You can learn more of our quality story online at hcr-manorcare.com/quality. The information on our website expands on what is contained here, shares words of appreciation from those we’ve served, provides statistical support, offers helpful information on a wide variety of health care topics, helps those looking for care through their decision process, and covers a wide variety of other topics for those wishing to learn more about who we are and our commitment to quality health care.
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OUR REACH
Quality Care No Matter Where We care for people nationwide, and a single principle within Our Vision unites our caregivers – We are dedicated to providing the highest quality in health care services. We research, evaluate, train, implement and in-service the care programs that work toward the highest practicable level of well-being for our patients and residents. The footprint may be large, 30 states across the U.S., but instilling our proven care principles and protocols is just as broad in carrying out our commitment to quality.
Proudly serving hundreds of communities across the U.S.
50,000+ Helpful, Caring and Responsive Employees
195,000+ Patients and Residents Admitted Annually
178 Nurse Practitioners Providing Support
This map shows HCR ManorCare Skilled Nursing, Assisted Living, Home Health Care, Hospice and Outpatient Rehabilitation locations.
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Skilled Nursing and Rehabilitation Centers Providing care primarily under the respected Heartland and ManorCare Health Services names.
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Hospice and Home Health Care Agencies Positioning us as the third largest provider of end-of-life care through Heartland Hospice Services and a leading provider of home health care and IV care, also under the Heartland name.
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Assisted Living Locations Distinguished as a leading provider of care for those in the various stages of dementia through our Arden Courts memory care communities and in many of our skilled nursing centers.
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Outpatient Rehab Clinics Providing outpatient rehabilitation in a variety of settings, primarily under the Heartland name. Additionally, we offer managing, consulting and staffing through MileStone Healthcare for a wide variety of health care providers including hospitals and inpatient rehabilitation facilities.
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SKILLED NURSING AND POST-HOSPITAL REHABILITATION
Back to Active At HCR ManorCare’s Heartland and ManorCare Health Services skilled nursing and rehabilitation centers, we specialize in effective and efficient post-acute care that gets patients back to their active lives following a hospital stay. Each year, we continue to invest in our rehabilitation capabilities by developing our staff’s professional skills, our rehabilitation equipment and technologies, improving upon our patient care and treatment environment, and testing and measuring the effectiveness of our rehabilitation programs.
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More than 90 percent of the patients admitted to our centers for shortterm rehabilitation are discharged home and back to their active lives, often in less than 30 days.
A Bridge from Hospital to Home
Our capability to achieve superior medical and rehabilitation outcomes has been enhanced by the widespread introduction of our MedBridge post-hospital units in a growing number of our skilled nursing and rehabilitation centers. These distinct units are specifically for shorter-stay patients who still require intensive medical and rehabilitation care after their time in the hospital. MedBridge is the pathway to take them safely and confidently from the hospital to home.
105 of our centers are MedBridge-certified, and approximately 15 more are expected to be certified in 2017. MedBridge units are 20 to 60 beds in size where care is provided for patients with similar diagnoses and discharge goals. An interdisciplinary team of therapists works with attending physicians, nurse practitioners and specialty physicians to deliver post-hospital services focused on maximizing individual patient goals.
Nearly 88 percent of our skilled nursing and rehabilitation centers earned 3 stars or more for Quality Measures under the Five-Star Rating System, with 70 percent earning a 4 or 5 star rating.
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Reducing Hospital Readmissions
Our company rehospitalization rate of 16.1 percent is well below the national average. Average Length of Stay in Days
I nsurance/Managed Care: 21.2 Medicare: 30.6 Hospice: 66.6 Private Pay: 67.4 Veterans Administration: 83.7 Medicaid: 273.0
Pharmacy Services and Innovation
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Reducing the number of people who return to the hospital is a priority for payers, providers, legislators and, especially, patients. The issue centers on improving health care while lowering ever-increasing health care costs. Discharged patients are leaving the hospital much sooner than in the past, so they are more likely to be readmitted to the hospital due to lingering or new medical complications. The cost of these rehospitalizations is prohibitive to the health care system and a target of government agencies looking to remove cost from the system. Minimizing rehospitalizations has become even more important to our hospital referral sources over the past couple of years as the Centers for Medicare & Medicaid Services (CMS) has provided both incentives and instituted penalties related to rehospitalizations in an attempt to improve care and lower costs. Our referral sources, in turn, have looked to providers such as HCR ManorCare to help them meet their goals. Referral sources want partners that they can depend on and that share the same patient recovery goals.
On average in 2016, the combined length of stay of our Medicare and managed care patients in our skilled nursing and rehabilitation centers was about 26 days.
Pharmacy Services continues to expand the installation of automated dispensing systems (ADS) in centers across the company. These units can provide on-site, on-demand access for up to 500 different medications, which reduces the length of time between new medication orders and initial dosing. This state-of-the-art technology improves response time to changes in patient condition, thereby potentially reducing unnecessary rehospitalizations.
Dining Services The patient dining experience continues to evolve to meet the needs and expectations of our changing populations. The development of selective menus that integrate with the electronic patient food and nutrition application is under way. Popular specialty dining styles such as buffet dining, restaurant-style dining and availability of smaller intimate Internet cafes are breaking the barriers to the provision of “homelike” services in a health care setting.
HCR ManorCare Independent Advisory Committee on Quality In 2008, HCR ManorCare created an Independent Advisory Committee on Quality to provide advice and recommendations to the company’s Board of Directors on ways to measure, maintain and improve quality of care for HCR ManorCare patients and residents. The distinguished three-person panel is composed of Vincent Mor, Ph.D., Professor of Medical Science in the Department of Health Services, Policy & Practice at the Warren Alpert Medical School, Brown University; Robyn Stone, Dr.P.H., Executive Director of the Institute for the Future of Aging Services and Senior Vice President of Research for LeadingAge; and Gail Wilensky, Ph.D., Economist and Senior Fellow at Project HOPE.
Quality Care Reflected in Satisfaction Surveys As a member of the American Health Care Association, HCR ManorCare participates in a regular independent customer satisfaction survey. Facility teams use the information from this survey to identify and improve important areas that impact the patient experience. We are proud to report that results from these surveys show high levels of satisfaction. In 2016, more than 23,000 discharged patients from our skilled nursing and rehabilitation centers returned surveys, which has helped us create a good gauge of patient satisfaction.
93 percent of patients rated the respect shown them by therapists and nurses as “Excellent” or “Good.”
“I had a very good stay at ManorCare Health Services - Laureldale. I loved the nursing staff and the therapists; they were so encouraging. They got me on my feet and walking again.”
“I’m calling to praise the staff and services at ManorCare Health Services - Palos Heights East. I was carried in, but I walked out. They got me back up on my feet! I highly recommend ManorCare for those who need extreme therapy.”
“I was more than pleased with the rehabilitation therapist/caregivers at Heartland of Mentor who aided me in gaining my independence. All were very professional, compassionate and very friendly. They made me feel as though I was very important to them. They gave me great confidence when I didn’t always have confidence in myself.”
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Hospice and Home Health care
The Heartland Hospice Difference Heartland Hospice caregivers enrich patients’ lives and provide support by developing individualized care plans, setting goals, encouraging personal choices, working together in caregiving decisions and supporting meaningful experiences. Our hospice services integrate holistic principles with palliative disease management, expert pain and symptom control, family education and psychospiritual support for end-of-life care. We also provide the education, counseling and other resources that can help with emotional needs. Care is culturally sensitive, respecting the traditions and heritage that are important to patients and their family members.
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“Heartland Hospice of Fremont was definitely the best decision for my mother-in-law that we could have made. You guys stepped in and were completely amazing. You took a huge weight off my shoulders. The nurses, aides, social workers and everyone from hospice was wonderful. My mother-in-law was treated with dignity and respect. Everyone was so good to her. Thank you from the bottom of our hearts.”
The Heartland Mission
We believe that our mission is to enrich lives. That begins with every life we encounter – our employees, our patients and those who love and care for them, the communities in which we operate, our stakeholders and those who are yet to become our customers.
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The Heartland Hospice Group The Interdisciplinary Group (IDG) Patients with heart failure and other chronic diseases benefit most with care from the entire interdisciplinary group. This necessitates employing specialized professionals to efficiently guide patient care throughout the episode of the illness. The physician’s role is essential in providing the medical perspective to develop the plan of care in keeping with the patient’s and family’s wishes. Nurse The registered nurse has experience in physical assessment, pain and symptom management. Social Worker The medical social worker assesses the patient’s psychosocial and cultural needs; educates on topics relevant to the illness; facilitates communication among the patient, loved ones and community partners in care; and provides interventions as needed to assist in attaining their goals. Spiritual Care Coordinator A spiritual care coordinator offers compassion, understanding and acceptance of diverse religious and spiritual beliefs. Bereavement Coordinator Chronic and terminal illnesses bring about multiple and ongoing losses for patients and their loved ones. The bereavement coordinator will assess the bereaved for complicated or prolonged grief and develop a plan of care appropriate for each person. Nurse Practitioner The hospice nurse practitioner works under a collaborative agreement with the hospice medical director and/or team physician(s) to provide clinical expertise, consistent care and accountability.
We Honor Veterans Heartland Hospice is proud to be part of the We Honor Veterans program launched by the National Hospice and Palliative Care Organization in collaboration with the Department of Veterans Affairs to help improve the care veterans receive from hospice and palliative care providers.
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Heartland Hospice’s record of controlling pain within 24 hours was 86.7 percent better than the national average in 2016.
The Heartland Home Health Care Team
Safe and Easy IV Care
For most people, home is the most comfortable place of all. Heartland’s compassionate caregivers provide health care at home, whether that’s the house a patient has lived in for years, a temporary family member’s home or some other community setting he or she calls home. Heartland’s care and services are coordinated and supervised by a registered nurse or therapist, and are focused on enriching patients’ lives by helping them restore their independence and once again feel as if they are in control.
Heartland employs specially trained pharmacists and nurses who work with the patient’s physician to oversee the administration of IV medications and tube feeding at home for conditions such as infections, cancer, multiple sclerosis and diseases of the digestive tract. Our home IV pharmacies prepare medications, provide administration supplies and coordinate care with the patient’s physician and nursing provider.
• Provides comprehensive skilled nursing care services and physical, occupational, and speech and language pathology therapy services. • Helps patients become more independent with activities of daily living. • Educates patients, families and caregivers on a wide variety of illnesses and injuries. • Makes patients aware of the best way to manage their medications. • Helps patients face anxiety, fear and feelings of isolation. • Assists with transitioning patients to hospice when the need arises.
“I recently got the benefit of the services of Heartland Home Care of Roanoke. I had a shoulder replacement, and all of the people assigned to me were very good at their jobs, very professional and very helpful. I’m going to Heartland Rehab Services for outpatient therapy also. I picked that service because of how great I thought the home care therapy was, and I was not disappointed. They are also very good, very professional, welcoming and friendly.”
Heartland Home Health Care’s improvement in the status of surgical wounds was 91.5 percent in 2016.
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Memory Care
The Arden Way HCR ManorCare’s Arden Courts memory care communities serve those living with memory loss from Alzheimer’s disease and other types of dementias.
Every day, we enrich the lives of 3,000 residents and their families.
Types of Dementia Our memory care communities have extensive experience in treating all forms of dementia, including: Alzheimer’s disease Parkinson’s disease Vascular dementia Lewy body dementia Frontotemporal dementia Wernicke-Korsakoff syndrome Normal pressure hydrocephalus Mixed dementia
33 percent of our residents live with Alzheimer’s disease.
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Experience Matters For more than 20 years, Arden Courts has been serving individuals with memory loss from Alzheimer’s disease and other types of dementia. Our memory care communities are freestanding communities that enable residents to wander in a protected, secure environment. We have found that when structuring the day for someone living with dementia, programs must be based on that individual’s interests, hobbies and habits, which have been formed over a lifetime.
Effective programs rely on activities that are created and adjusted to individual needs and functional ability. Daily life programming at Arden Courts distinguishes abilities, capabilities and preferences and falls into four primary categories. Individual Pursuits benefit residents who do not like or are cognitively unable to participate in structured group programs.
Providing Peace of Mind Arden Courts communities know the emotional commitment and critical decisions that families must manage as dementia progresses and greater loss occurs. Making an informed care decision includes understanding changes, safety risks and determining the right time to choose a protected and safe environment. Waiting until a crisis can result in heartbreak and misfortune for the individual with memory loss and for family members seeking to allow independence when what’s needed is a protected environment. 94 percent of the families of residents rated their overall satisfaction with Arden Courts communities as “Excellent” or “Good.” 94 percent of the families of Arden Courts residents rated peace of mind as “Excellent” or “Good.” 63 percent of the families selecting Arden Courts have toured three to five communities prior to making their decision, and 91% toured two or more communities.
Engagement Therapy Treatment® is an exclusive Arden Courts program that provides an opportunity for residents with similar functional and cognitive abilities to socialize and share with others in a friendly group setting. Lifestyle Programming is similar to Engagement Therapy in that it involves interaction with others. The Namaste Care Program is used most effectively with individuals with advanced dementia when verbal communication is limited due to the disease process, and touch becomes the meaningful language.
'Throughout my mother’s stay at Arden Courts of Winter Springs, I was continually impressed with the people, leadership and operation of the facility. The facility was run in a professional manner by a staff that treated all of the residents as family. Throughout the past six years, I have had the peace of mind that my mother was being taken care of in the best way possible and that she was being treated with dignity and respect.”
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Outpatient Rehab HCR ManorCare operates 50 Heartland Rehabilitation Services outpatient clinics that provide a wide variety of services encompassing physical, occupational and speech therapies. This includes traditional orthopedic therapies, sports medicine and aquatic programs. Many of our therapists have specialized training in areas such as geriatrics and neurology and programs for the back, hand and wrist, and treating whiplash. Other programs include: Concussion rehabilitation Therapeutic weight management Fall prevention, balance and dizziness ASTYM and instrument-assisted soft tissue techniques Pediatrics Workers’ compensation Vestibular rehabilitation Functional movement assessments
Filling a Critical Gap with Advanced Disease Management Heartland Care Partners is a provider of short- and long-term health care with a particular emphasis on effectively treating medically complex patients. Heartland Care Partners has developed the Advanced Disease Management Program (ADM), which is a palliative service that provides nurse practitioner consultative services designed to help minimize the impact of a patient’s advanced disease. Heartland Care Partners employs more than 30 nurse practitioners in the ADM program and serves over 20 markets. Visits with patients number about 2,000 per month in which a dedicated, palliative care-trained nurse practitioner spends on average about one and a half hours providing a comprehensive assessment, counseling, support and care coordination. The program receives more than 400 referrals a month, while maintaining an active daily patient census of nearly 1,400 patients. About 13 percent of active patients elect hospice care each month, and nearly 85 percent of these choose Heartland Hospice as their provider.
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Running rehabilitation programs for recreational and competitive runners and walkers In addition, therapists are working with employers, especially those in the industrial sector. Therapists perform pre-employment screenings to ensure employers that candidates are capable of performing the job. If an employee is injured on the job, therapists will perform functional capacity evaluations to determine what the employee is capable of doing. Oftentimes, therapists will be contracted to do job site analyses, checking out the job site to point out the risk of injury, such as in jobs that require repetitive motion or considerable lifting. The analysis leads to preventative procedures that can be implemented to minimize injury risk. For some customers, therapists provide rehabilitation on-site to injured employees, which has the advantage of being able to take employees through similar activities to their work responsibilities. Our outpatient clinics are assisting patients in their homes and assisted living residences, at schools, and in hospitals and other health care settings. Relationships are growing with athletic groups and teams, running stores, training gyms, club athletics, senior groups, and community groups and events.
OUR COMMITTMENT
We Are Helpful, Caring and Responsive
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Our Circle of Care For nearly 30 years, our Circle of Care program has welcomed employees into a culture that promotes helpful, caring and responsive quality care. The program provides employees with tools to help them with their caregiving, helps prepare them for the myriad situations that come up in their workday, and encourages them to feel good about themselves and the career they have chosen.
Our commitment to quality health care has led to longtenured employees.
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Go to the “Our Commitment” section of hcr-manorcare.com/quality to meet six of these long-tenured employees.
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Developing Our Leaders It is important for the long-term success and sustainability of a company to develop highpotential employees who can step into leadership roles and help them achieve their career goals. The overall objective of HCR ManorCare’s Leadership Development Program is to identify, recognize and develop our high-potential employees in preparation for them to be considered for more senior, critical positions within the company. It means identifying those individuals whose attributes single them out as ones who aspire to more responsibility, who have the talent and skills to be effective in a more senior role and who are committed to building a longterm career with HCR ManorCare. Go to the “Our Commitment” section of hcr-manorcare.com/quality to meet seven employees who have moved up through the ranks and who now have responsibility for several locations as regional directors of operations.
Education and Training HCR ManorCare has committed to employee growth and development by providing high-quality learning and professional continuing education opportunities. Employees can learn and reinforce their knowledge and skills through a variety of learning modalities, including the HCR ManorCare University. The university is a state-of-the-art learning management system that enables 24/7 delivery, tracking, reporting and administration of learning content. Since launching the learning management system, over 9 million online courses, tests, materials and curricula have been completed by employees in over 50 subject areas. Employees in our skilled nursing facilities completed over 1.5 million courses in 2016 alone. Our relationship with Relias Learning, a leading provider of online training in the post-acute care industry, enables us to provide professional and clinical continuing education courses to our licensed staff across the country. HCR ManorCare also supports ongoing professional development through our continuing education programs. We are an approved provider of continuing education by the
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American Speech and Hearing Association (ASHA), the American Occupational Therapy Association (AOTA) and the Ohio Nurses Association (ONA), which is an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Higher Education As a helpful, caring and responsive employer, we believe investing in our employees’ career growth enhances the future for us all. Several highereducation programs help us achieve this goal. • In 2017, we introduced a Nursing & Therapy Tuition Assistance Program to help full- and part-time employees achieve their career development goals. Up to $2,500 is available each year (with a $10,000 lifetime maximum) to help employees cover education costs up front for select nursing and rehabilitation therapy degrees. • HCR ManorCare brings education savings and scholarship opportunities to employees through partnering with the National Education Alliance (NEA). NEA provides educational savings to HCR ManorCare employees and family members, starting with a complimentary membership to access education and tuition discounts, including LPN to RN grants, scholarships, NAPNES certificates, career training and more. • HCR ManorCare RNs have access to a discounted group tuition rate through the Chamberlain College of Nursing to pursue an RN to BSN, RN-BSN to MSN, MS in Nursing and Doctor of Nursing Practice, with 100 percent of course work online.
HCR MANORCARE GIVES
HCR ManorCare Gives is our company’s commitment to our patients, employees and communities demonstrated through our many philanthropic programs, including the Hug Fund and Heartland Hospice Memorial Fund.
The Hug Fund
The Heartland Hospice Memorial Fund
The Hug Fund, a non-profit charity, is a partnership of HCR ManorCare employees helping their fellow employees who have experienced a catastrophic event causing financial hardship. The fund provides financial assistance to employees who are unable to meet their urgent need. Through the financial support of HCR ManorCare employees, the Hug Fund is able to offer hope and peace of mind for our employees across the nation.
The Heartland Hospice Memorial Fund, a non-profit charity, believes that people who are at the end of their lives should be able to focus on enjoying time with their family and friends, cherishing their last days and making lasting memories. But financial stressors due to a terminal diagnosis often complicate the end-of-life journey, leaving little time for families and friends to focus on this important time with the patient. The fund can relieve the financial pressures experienced by patients and their families coping with terminal illness and its aftermath by providing financial assistance with the daily expenses of everyday life.
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HCR ManorCare, Inc. | 333 N. Summit Street | Toledo, Ohio 43604
hcr-manorcare.com ® 2017 HCR Healthcare LLC HCRMC-0058I