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Kindred Healthcare Opportunities

Career GrowthNursing/Case Management

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Objectives

• Be able to verbalize Kindred Healthcare’s mission; what kind of patients are served in the continuum of care, and where facilities are located

• Learn about Kindred’s Case Management roles• Learn about Kindred’s annual MSN Mentorship Program

structure and the 2012 opportunities for new graduates• Learn about Kindred’s investment in nursing case

management growth, development, and career ladder • Discuss actual 2011 Mentorship MSNs’ weekly feedback and

guided educational experiences• Take away “pearl points” from CMSA President’s MSN and

Dr. Abbott’s talk with new grad hires• Answer questions

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Who is Kindred Healthcare?“Dedicated to Hope, Healing, and Recovery””

• Leading Provider of Post Acute Care Services specializing in critically-ill and complex patients

• Publically traded healthcare organization with Corporate headquarters in Louisville, Ky.

• 121 Acute Care Hospitals throughout the U.S. in 40 states

• Also has Skilled Nursing, Rehab-based contracts, and Home Hospice divisions

• Ranked one of Fortune magazine’s Most Admired Healthcare Companies 2009, 2010, and 2011

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$2.7 billion revenues(1)

HOSPITALSLong-term Acute Care Hospitals

Inpatient Rehabilitation Hospitals

Largest operator in U.S. (2) 121 LTAC hospitals

8,585 licensed beds (3)

5 IRFs 183 licensed beds (3)

$2.2 billion revenues(1)

Third largest nursing center operator in U.S. (2)

224 nursing centers 27,252 licensed beds (3)

6 assisted living facilities413 licensed beds (3)

NURSING CENTERSNursing & Rehabilitation

Centers

$1.2 billion revenues(1)

Largest contract therapy company in U.S.(2)

1,563 external locations served through 16,100 therapists (3)

113 hospital-based acute rehabilitation units (3)

REHABILITATION SERVICESRehabCare

(1) Revenues for the twelve months ended March 31, 2011 (divisional revenues before intercompany eliminations).(2) Ranking based on revenues.(3) As of June 1, 2011.

Three Market Leading Post-Acute Service Lines

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LTACHs (121)Inpatient Rehab Hospitals (5)Nursing and Rehabilitation Centers (224)Acute Rehabilitation Units (113)RehabCare External Customers (1,563)Home Care and Hospice (19)

Existing Cluster MarketPotential New Cluster Market(as of June 1, 2011)

Market Specific Integrated and Coordinated Care Delivery Models

With Focus On Developing Cluster Market Service Offerings

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Uniquely Positioned to Take Advantage ofChanging Healthcare Landscape

“Continue The Care”

Patie

nt S

ervi

ce In

tens

ity

Patient Illness Severity

HOME

SKILLED NURSING FACILITIES

HOSPICEHOME HEALTH

CARE

OUTPATIENT REHAB

ASSISTED LIVING

ACUTE CAREHOSPITALS

TRANSCARE

ICU

IN-PATIENT REHAB

LTACsFREESTANDING/ HIH

SAU

TCC &

TCU

ADULT DAY CARE

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Coordinating Clinical Services & Programs Across Service Lines to Improve Outcomes and Prevent Readmissions

Services Services Services Specialty Programs Therapies

Respiratory & Pulmonary Care

Cardiac CarePulmonary Care

Intensive Short-Term Complex Rehabilitation

Cardiac CarePulmonary Care

Cardio-Pulmonary and Medically Complex

Complex Wound CareIV antibiotic Therapy

Clinically Complex CareReconditioning

Wound Care

Severe Stroke, Brain, Spinal Cord, and Other

Neurological ImpairmentWound Care

Wound Care Therapies for Complex Wounds

Short-Term Rehabilitation

Intensive Short –Term & Orthopedic Rehabilitation

Complex Cognitive, Physical Rehabilitation

Orthopedic and Neurological Rehabilitation

Orthopedic RehabNeurological / Stroke

Rehabilitation

DialysisPain Management

IV TherapyDialysis, Wound Care,

Pulmonary TherapyLong-term Chronic CarePalliative & Hospice Care

Palliative & Pain Programs

Long-Term Acute Care Hospitals

Hospital Based Sub-Acute Units

Inpatient Rehabilitation

Facilities

Skilled Nursing & Rehabilitation

Centers

Rehabilitative Therapy

Kindred Long-Term Acute Care Hospitals:

28,766 (64%) patients went home or to a lower level of care in 2010 after an average length of stay

of 30 days

Kindred Long-Term Acute Care Hospitals:

28,766 (64%) patients went home or to a lower level of care in 2010 after an average length of stay

of 30 days

Kindred Inpatient Rehabilitation Facilities

34,960 (76%) patients returned home after an average length of stay of

12 days in 2010

Kindred Inpatient Rehabilitation Facilities

34,960 (76%) patients returned home after an average length of stay of

12 days in 2010

Kindred RehabilitativeTherapy

Patient functional improvement from

evaluation to discharge was 76.4% in 2010

Kindred RehabilitativeTherapy

Patient functional improvement from

evaluation to discharge was 76.4% in 2010

Kindred Nursing and Rehabilitation:

39,836 (50%) patients returned home after an average length of stay of

32 days in 2010.

Kindred Nursing and Rehabilitation:

39,836 (50%) patients returned home after an average length of stay of

32 days in 2010.

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Kindred Healthcare’s Mission…

…is to promote healing,

provide hope,

preserve dignity

and produce value

for each patient, resident, family member, customer, employee, and

shareholder we serve

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Kindred Case Management

Roles and Functions- Complex skills promoted in:

• Resource Management• Complex Discharge

planning • Interdisciplinary care

facilitation and coordination

• Clinical Documentation Improvement (CDI)

• Patient Advocacy

• Kindred has 4 Regions (West, Central, Southwest, and East) in U.S.

• Over 400 case managers (District Directors, Area Directors, Directors of Case Management, Case Managers and Social Worker Case Managers

• Typical caseload 1:15 -1:18

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Kindred/Samuel Merritt Partnership: MSN in Case Management Mentorship Program

• From 2010 - 2011, Kindred hired 7 MSNs and provided them with an intensive “onboarding” 4-week orientation to Kindred complex case management practice and

• A 6- month guided educational experience and mentorship through local Preceptors following orientation period

• Weekly Preceptor and MSN meetings occur to provide resources and guidance for growth

• CMSA Membership support for leadership and practice growth

• Post-Mentorship: Entry into a guided CM Career Ladder: 1, 3, 5 year plan for CM Certification and administrative growth (if desired)

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Evaluation of the MSN-Prepared CM New Graduates’ 2010 Orientation and Mentorship Program

Fusae Abbott, RN, DNSc., Wendy De Vreugd, RN, BSN, FNP, CCDS, MBA, Janet Rowland, RN, MSNSamuel Merritt University & Kindred Healthcare, Inc.

Case Management Program

“What worked and what didn’t”

Factors related to the success of the program Work environment Support provided from senior

administrators to staff CMs Having some experienced CMs to whom the

graduates could go for advice and suggestions

Stable staffing Welcoming atmosphere

Graduates’ characters and skills Positive and “Can Do” attitudes “Self-starters” and flexibility People skills Organizational skills Time management Ability to ask for help

Conclusion

The data indicated that MSN-prepared new graduates could perform satisfactorily at entry-level CM work.

It became clear that the educational needs of the new graduates differed from experienced RNs entering the CM field.

It is necessary to define what RN work experience is critical to CM practice.

The challenge to MSN education is to find how academia can prepare graduates on those critical tasks, and so prepare the next generation of case managers.

Implications

The SMU-Kindred orientation and mentorship program provides an innovative approach to bridging the gap between hospital employment requirements and graduating case managers’ levels of experience.

Based on the successful outcome of this trial in 2010, the partnership between SMU and KH continues and KH has hired four SMU graduates in 2011.

KH has created a Career Ladder to promote professional development of case managers.

Recommendations

To the SMU-CM program:1. Five-minute case presentation exercises in

clinical seminars. 2. Reviewing standard treatment options for five

common disease conditions seen during a student’s preceptorship.

3. Communication simulation exercises involving difficult patients, family members, and physicians.

4. Speaking up in inter-disciplinary meetings during the clinical practicum.

To KH: 5. Strengthen the 4-week orientation to bring

new graduates onboard to KH.6. Provide opportunities for new graduates to

work at least a week with bedside RNs and priority LTAC ancillary services.

7. Teach LTAC-specific equipment and treatments.

8. Develop critical pathways for five common disease conditions at LTAC.

9. Teach about site-specific issues, such as resources in the community, insurance companies and kinds of insurance that patients may carry, physician practice patterns, and types of patients.

Findings

“Subjects”

“Can new CM graduates perform competently as case managers after orientation/mentorship?”

All three SMU new graduates met all the standards for the 90-day evaluations, as assessed by their supervisors at KH.

At the end of the 6-month program the three graduates were rated on a 5-point scale as functioning at “independent” or higher levels for all the CM functions, as assessed by their trainers.

CM Functions and SkillsDischarge process

Assessment (identifying a patient’s clinical trajectory and anticipated treatments, critical thinking) Planning (multi-disciplinary collaboration) Implementation (coordination, education, referrals, resource linkage) Evaluation (documentation and reporting)

Utilization management

Authorization, concurrent review, use of criteria, documentation for compliance, appeal process, managing inappropriate utilization

Communication Patients and their families, physicians, payers, staff, etc. Advocacy Collaboration, negotiation Information search

Identifying best practice, quality improvement

Performance skills

Organization, problem-solving, ability to ask questions and to ask for help

Professionalism

Learning process: Challenges and what

helped

Background

Background

Aging case managers and the potential shortage of qualified case managers are critical issues in the case management field. The CMSA data for 24,000 certified case managers (CCMs) revealed that the average age of the CCMs was 55.1 and only 4.0% of them were younger than 40 years of age (Park & Huber, 2009).

Although the healthcare industry recognizes the shortage issue, SMU ELMSN-CM graduates still face difficulties in obtaining CM positions. Hospitals traditionally require 1 to 3 years of RN work experience for CM entry positions, but ELMSN-CM students can have no more than one year of RN work experience by the time they graduate.

In 2010, Kindred Healthcare, Inc. formed a partnership with the SMU CM Program and hired three SMU-CM graduates who had no RN work experience. KH Hospital Division, West Region provided a 6-month new graduates’ orientation and mentorship program (6/14/10 – 12/31/10).

Time Frame Challenges What Helped Progress

First 4 weeks – Classroom teaching

- Fear, uncertainty, anxiety

- Lack of clinical experience

- Talked about these feelings with a trainer

- Supportive environment - Learned about CM tools

and applied them right after the lectures

- By the end of the 3rd week the new graduates felt confident in applying the CM tools, knowledge, and skills that they learned.

1 to 3 months – By the end of 90

days

- Communication with family members

- Dealing with end-of-life care issues

- Learned about how to deal with difficult patients’ cases

3 to 4 months – Caseloads increased

- Communication with physicians

- Building relationships with physicians

- Learned about how to negotiate with physicians

- Learned to work on time management and prioritization

- Helping others, teaching others - Felt comfortable in dealing with

families – thanked by family members for listening to and answering their concerns

4 to 6 months

– Dealing with difficult cases

- Common challenges faced by CMs at LTAC

- Recognized that they were staying late at work

- Learned to negotiate with insurance companies and SNFs

- Needed to find the balance between work and their personal lives

- Began negotiating with insurance companies, SNFs, and physicians to facilitate discharge decisions

- Each published an article about dealing with a difficult case

Subjects SMU New

Graduates KH Trainers

Number 3 4 Age 25 to 34 51 to 60

Work experience before SMU

1 to 10 years N/ A

Work as an RN 0 more than 30 years Work as a CM 0 6 to 30 years

Work as a manager 0 11 to 30 years

Purpose

The purpose of the study was to evaluate the effectiveness of the CM orientation and mentorship program for MSN-prepared new graduates with no RN work experience.

Research Questions

• Can an MSN-prepared new CM graduate from SMU, with no RN work experience, perform competently as a case manager after completing a 6-month new graduate orientation and mentorship program?• What parts of the orientation and mentorship program helped the graduate to function as a case manager? To what degree? What didn’t work?

Methods

• A case study method • Subjects: Three SMU new graduates and their four trainers.

Data Collected:

• Demographics and characteristics of the subjects • Thoughts and feelings of the new graduates and their trainers in regard to the program• Confidence and competency levels of the graduates• Various on-going assessments at KH as part of their standard practice for new hires• Weekly SWOTT reports by the new graduates

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Kindred Educational Partnerships

• Educational University Partnerships developed to provide opportunities for continued growth to working Kindred RN Case Managers (RN to BSN to MSN to DNP)

• West Region: 4 CM Scholarships awarded annually

• Additional Tuition Reimbursement Policy: $2500/year

• Four-level Case Management Career Ladder for opportunities for engagement, advancement, growth, and recognition

• Kindred Foundation: in 2011 awarded 3 Scholarships to Samuel Merritt University MSN in Case Management students

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Wendy De Vreugd, RN, BSN, PHN, FNP, CCDS, MBA,

Regional Senior Director Case Management

Kindred Healthcare, Hospital Division, West Region

Office (714) 899-5020

Bruce Mattos, West Regional Director Talent Acquisition, Hospital Division Office ( 916) 351-8774

Questions?