Kindred Nursing and Rehabilitation Mountain Valley – Profile

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Malcolm Baldrige National Quality Award 2016 Award Recipient, Health Care

Highest-Ranking Official* Maryruth Butler Executive Director

Public Affairs Contact

*At time of award

For more information Kindred Nursing and Rehabilitation – Mountain Valley 601 West Cameron Avenue Kellogg, Idaho 83837 (208) 512-2767 [email protected] www.mountainvalleycare.com Providing hope and promoting healing and recovery: that is the mission of Kindred Nursing and Rehabilitation – Mountain Valley, a 68-bed skilled nursing center in Kellogg, Idaho, a rural community set in the foothills of the Rocky Mountains. Kindred – Mountain Valley is operated by Kindred Healthcare Inc., a for-profit corporation with approximately 90 centers across the nation. Kindred – Mountain Valley provides skilled nursing and rehabilitation services for patients who require short-term (six months or less) and long-term (longer than six months) care. The center has 92 employees on staff and reports a total net revenue of $6.4 million.

Highlights

 For seven consecutive years, Kindred – Mountain Valley has achieved a five- star quality rating—the highest possible—from the Centers for Medicare and Medicaid Services. Less than 1 percent of 15,600 skilled nursing facilities nationwide achieved the five-star rating over that period of time.

 One-hundred percent of Kindred – Mountain Valley residents and family members surveyed have expressed either “very” or “extreme” overall satisfaction levels since 2013, which is above the national industry average by 20 percent for residents and by 10 percent for families.

 Kindred – Mountain Valley maintains a 90 percent employee retention rate, which is more than 20 percent above the national industry average.

 Kindred – Mountain Valley’s occupancy rate of 89 to 90 percent has exceeded national and state benchmarks from 2010 to 2016.

Mountains of Recognition for Superb Care

 For seven consecutive years, Kindred – Mountain Valley has achieved a five- star quality rating—the highest possible—from the Centers for Medicare and Medicaid Services, a ranking designed to help potential residents, families

and caregivers compare nursing homes. Less than 1 percent of 15,600 skilled nursing facilities nationwide achieved the five-star rating over that period of time.

 Kindred – Mountain Valley was listed in 2016 by U.S. News and World Report as one of the “Best Nursing Homes” in the United States. The center received five-star scores—the highest possible—in all three rating categories: health inspections, nurse staffing, and quality measures.

 In 2016, Kindred – Mountain Valley received a “deficiency-free survey” from the Idaho Department of Health, which requires each nursing and rehabilitation facility in the state to be thoroughly inspected and evaluated in areas such as safety, quality of care, patient rights, food service, nursing care, and administration.

 Kindred – Mountain Valley earned the 2011 Gold – Excellence in Quality Award from the American Health Care Association/National Center for Assisted Living. The national honor is based on the Baldrige Award.

A Healthy Dose of Customer Satisfaction

 Based on an analysis of Centers for Medicare and Medicaid Services data comparing nursing homes, Kindred – Mountain Valley demonstrates the “best possible results” for several long- and short-term resident outcomes. For example, since 2014, the center has achieved the best possible performance for pain management for long-term residents and outperformed state and national benchmarks by 10–20 percent for short-term residents.

 One-hundred percent of Kindred – Mountain Valley residents and family members surveyed have expressed either “very” or “extreme” overall satisfaction levels since 2013, which is above the national industry average by 20 percent for residents and by 10 percent for families.

 Based on social media ratings listed by Reputation.com, a provider of online reputation management technology and services, Kindred – Mountain Valley’s scores significantly exceed the target levels set by its parent, Kindred Healthcare, the largest provider of post-acute care in the United States.

 Kindred – Mountain Valley outperforms the Idaho state benchmark for customer survey dissatisfaction results and currently has zero citations.

Dedication to Employees Yields Dedication to Mission

 Kindred – Mountain Valley maintains a 90 percent employee retention rate, which is more than 20 percent above the national industry average.

 Nursing staff turnover for Kindred – Mountain Valley is 22 percent compared to the 50 percent or higher levels typically seen nationally for nursing homes.

 Nearly 100 percent of the workforce reports feeling encouraged to come up with new and better ways for the center to operate. The same number reports that they have received proper training to do a quality job.

 Kindred – Mountain Valley increases its workforce capability and capacity through online scheduling, cross training, ongoing education, and career advancement. With a strong, loyal workforce in place, direct staff care hours are consistently above state, national, and competitor results.

Involving All Stakeholders Drives Excellence

 To ensure excellent customer service, Kindred – Mountain Valley incorporates several approaches including senior leader visits (known as “rounding”) with residents, regular care planning meetings, post-discharge follow-up calls, input from the resident council, the center’s Service Excellence and Open Door programs, and regular “Stand Up” meetings (5- to 10-minute daily update sessions where everyone stands to keep the meeting focused and short).

 Kindred – Mountain Valley’s Service Excellence Program measures the level of service provided to all of its customers. The program consists of eight elements for success: pride, compassion, fun, teamwork, integrity, respect, professionalism, and responsibility.

Sound Management Makes for Sound Finances

 Kindred – Mountain Valley’s occupancy rate of 89 to 90 percent has exceeded national and state benchmarks from 2010 to 2016.

 Compared to national data from its parent company, the center demonstrates favorable levels and trends for actual and targeted financial marks in four areas: average wage rate, total net revenue, Medicaid revenue, and Medicare Part B revenue.

 Meeting one of its financial strategic goals, the accounts receivable days (the number of days that a customer invoice is outstanding before it is collected) for Kindred – Mountain Valley is 28.2 days. This is significantly lower than its targeted mark of 40 days.

Dedicated to Hope, Healing and Recovery

2016 Malcolm Baldrige National Quality Award Application

601 West Cameron Avenue

Kellogg, Idaho 83837

www.mountainvalleycare.com

Kindred Nursing and Rehabilitation – Mountain Valley 2016 Malcolm Baldrige National Quality Award

Table of Contents

TABLE OF CONTENTS Eligibility Certification Forms:

Organization Chart…………………………………………………………………………………………………………………………… O-1 Page A-1 ………………………………………………………………………………………………………………………………………… A-1 Glossary of Terms and Abbreviations ………………………………………………………………………………………………… G-1 Responses to All Criteria Items:

Organizational Profile……………………………………………………………………………………………………………. i P.1 Organizational Description …………………………………………………………………………………………… i P.2 Organizational Situation……………………………………………………………………………………………… iii

Category 1: Leadership…………………………………………………………………………………………………………..1 1.1 Senior Leadership…………………………………………………………………………………………………………1 1.2 Governance and Societal Responsibilities………………………………………………………………………..5

Category 2: Strategic Planning ……………………………………………………………………………………………….9 2.1 Strategy Development …………………………………………………………………………………………………..9 2.2 Strategy Implementation ……………………………………………………………………………………………..11

Category 3: Customer Focus …………………………………………………………………………………………………13 3.1 Voice of the Customer…………………………………………………………………………………………………13 3.2 Customer Engagement ………………………………………………………………………………………………..15

Category 4: Measurement, Analysis, and Knowledge Management…………………………………………18 4.1 Measurement, Analysis, and Improvement of Organizational Performance ………………………..18 4.2 Knowledge Management, Information, and Information Technology ………………………………..20

Category 5: Workforce Focus ……………………………………………………………………………………………….22 5.1 Workforce Environment ………………………………………………………………………………………………22 5.2 Workforce Engagement……………………………………………………………………………………………….25

Category 6: Operations Focus ……………………………………………………………………………………………….29 6.1 Work Processes ………………………………………………………………………………………………………….29 6.2 Operational Effectiveness…………………………………………………………………………………………….31

Category 7: Results……………………………………………………………………………………………………………….33 7.1 Health Care and Process Results …………………………………………………………………………………..33 7.2 Customer-Focused Results …………………………………………………………………………………………..39 7.3 Workforce-Focused Results …………………………………………………………………………………………41 7.4 Leadership and Governance Results………………………………………………………………………………47 7.5 Financial and Market Results ……………………………………………………………………………………….49

Kindred Nursing and Rehabilitation – Mountain Valley 2016 Malcolm Baldrige National Quality Award

Glossary of Terms and Abbreviations Page G-1

GLOSSARY OF TERMS AND ABBREVIATIONS

AD Activity Director

AHCA American Health Care Association

AOS Available On Site

BCC Best in Class Comparison

BOD Board of Directors

BOM Business Office Manager

CC Core Competencies

CCM Clinical Case Manager

CMS Centers for Medicare and Medicaid Services

CNA Certified Nursing Assistant

DNS Director of Nursing Services

DVP Divisional Vice President

ED Executive Director

EMR Electronic Medical Record

FAST Find, Analyze, Stabilize, Track

HSG Health Services Group

IDT Interdisciplinary Team

Kindred Kindred Healthcare, Inc.

or KND

KNECT Kindred’s Intranet

KNRMV Kindred Nursing and Rehabilitation – Mountain Valley

KPDOT Key Process for Determining Objectives and Timeline

LMS Learning Management System

LPN Licensed Practical Nurse

LTC Long Term Care

MAR Medication Administration Record

NCD Nursing Center Division

NWD Nursing Center Division Northwest District

PDSA Plan, Do, Study, Act Cycle for Improvement

PIP Performance Improvement Process

RN Registered Nurse

RSM Rehab Service Manager

SA Strategic Advantages

SC Strategic Challenges

SDC Staff Development Coordinator

SEP Service Excellence Program

SNF Skilled Nursing Facility

SO Strategic Objectives

SPP Strategic Planning Process

SS Social Services

TAR Treatment Administration Record

TSI the name of the company providing software solutions for long-term care facilities

QAPI Quality Assurance / Performance Improvement

QI/QM Quality Indicator / Quality Measure

Kindred Nursing and Rehabilitation – Mountain Valley 2016 Malcolm Baldrige National Quality Award

Organizational Profile Page i

ORGANIZATIONAL PROFILE

P.1 Organizational Description

P.1.a. Organizational Environment: Kindred Nursing and Rehabilitation – Mountain Valley (KNRMV or Mountain Valley) is owned by Kindred Healthcare, Inc. (KND or Kindred, a for-profit corporation) and is located in Kellogg. Kellogg is a town of about 2,000 residents in the picturesque “Silver Valley” of Shoshone County in Northern Idaho and is named after Noah Kellogg, a mining prospector. Legend has it that his donkey wandered off to a large outcropping of galena, which led to the discovery of several mines. Those mines led to the founding of our city, where the welcome sign reads “this is the town founded by a jackass and inhabited by his descendants.” While some may not be fond of being referred to as his descendant, all would agree the sign represents the pride our community has of our long mining heritage. Starting in 1981, mines in the area closed or greatly reduced operations, leaving thousands out of work. As a result this economic decline, the total population of Shoshone County has dropped 36% in census from 1970 to 2010. The resilience of the remaining residents, pulling together to take care of their neighbor and their community, was demonstrated through the transitioning of Kellogg to a resort town. New condominiums, hotels, restaurants, and shops were developed along with an indoor water park and 9-hole golf course located at the base of the Silver Mountain Gondola. This is the world’s longest single-cable gondola spanning 3.1 miles from the base to the ski lodge at the top of Kellogg Mountain. Although the setting is beautiful, it masks some of the very real challenges that make long-term care among the most difficult on the spectrum of healthcare service. One is the shortage of qualified workers who can deliver the level of health care services required in a long-term care setting, in particular, licensed nurses. Another challenge for long-term care facilities in rural settings is finding and retaining physicians who are not only willing to practice medicine in a rural area but in a long-term care environment. Current research shows that only about 10 percent of physicians practice in rural America despite the fact that nearly one- fourth of the population lives in these areas. Of those, most prefer private practice or work in the rural critical care access hospitals. Surrounding communities and even the closest rural critical access hospital lack the specialty providers to offer psychiatric services, chemotherapy, or surgical care. A lack of local after-hour urgent care necessitates trips to the emergency room with long waiting times and significantly increased costs. These challenges and others make us even more proud of our outstanding health care and customer satisfaction results and the recognition we have received over the years, shown in Figure P.1-1.

FIGURE P.1-1 Facility Selected Awards and Honors

Recognition Years

Received

US News & World Report, “America’s Best Nursing Homes” – The ranking is based on health inspection results, adequacy of nursing staffing, and quality of

medical care.

2010, 2011, 2012, 2013, 2014, 2015, 2016

CMS 5-Star Quality Rating System “Overall Quality” – There is one Overall 5-Star rating for each nursing

home with only the top 10% of nursing homes receiving

5 stars.

2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

Qualis Health Award of Excellence in Health Care – Qualis Health is the Idaho and Washington CMS Quality

Innovation Network

2012, 2014, 2015

State of Idaho L. Jean Schoonover Quality Award – Gold Level – The award is based on three annual federal/state surveys that measure quality of care and

compliance with regulatory guidelines.

2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

Providigm (Abaqis Quality Management System) Embracing Quality Award for exceptional achievement in Customer Satisfaction – This award began in 2012 and honored only 258 facilities in the U.S. and Canada.

2012, 2013, 2014, 2015

MyInnerView Excellence in Customer Service – Awarded to facilities in the top 10% of MyInnerView’s

more than 5000 facilities participating. (Kindred

discontinued MyInnerView in 2013)

2007, 2008, 2009, 2010, 2011, 2013

P.1.a(1) Health Care Service Offerings: Our key health care offerings are short-term skilled nursing and rehabilitation (less than 6 months length of stay; 32% of our average daily census) and long-term nursing and rehabilitation (greater than 6 months length of stay; 68% of our average daily census), as shown in Figure P.1-2. All services are delivered directly through our facility workforce. Delivery of our therapy services are through a contract with RehabCare Rehabilitation, an operating segment of Kindred, and delivery of our laundry and housekeeping services are through a contract with Health Services Group (HSG). Both subgroups of employees are integrated at the same level as all the employees of KNRMV and are included in this application under our workforce, meeting all the same requirements and expectations.

FIGURE P.1-2 Key Health Care and Service Offerings

and Delivery Methods

SERVICE OFFERING Relative Importance

to Success

Mechanism used to

Deliver Service

Short-term Care

(Rehab) 22% of Total Revenue

Direct Nursing / Contracted Rehab

Long-term Care 78% of Total Revenue Direct Nursing /

Contracted Rehab

P.1.a(2) Mission, Vision, Values: Our mission, vision, and values are shown in Figure P.1-3 along with our core competencies. Our core competencies are directly related to our ability to execute our mission and achieve our vision.

Kindred Nursing and Rehabilitation – Mountain Valley 2016 Malcolm Baldrige National Quality Award

Organizational Profile Page ii

Distinct characteristics of our organizational culture that support our Strategic Framework are sense of family and sense of community. In our rural setting, we often provide care for our own families, community members in which we have strong personal relationships such as life-long friends, church members, teachers, family members of childhood friends, parents of our partners/collaborators, and past employees. Our unique ability to provide the highest quality care with dignity and respect surrounded by excellence in customer service is a badge of pride that all members of our workforce proudly represent while supporting our community. Our mission, vision, and values are highly personal for us.

P.1.a(3) Workforce Profile: We are a very small organization with only 90 employees. Our workforce profile is shown in Figure P.1-4.

FIGURE P.1-4 Workforce Profile and Segments

Gender: Female 81%, Male 19%

Position: CNA 39%, RN 12%, Management 10%, Janitor/Laundry/Housekeeping 8%, Therapy 9%, Culinary 8%, LPN 8%, Clerical 3%, Activities 3%, Driver 1%

Tenure (years): <1: 23%, 1-4: 22%, 5-9: 32%, 10-14: 3%, 15-19: 7%, 20-24: 5%, 25+: 8%

Education: Doctorate 1%, Graduate School 4%, College 31%, Technical/Certified 48%, High School/GED/Other 16%

Employment Status: Full-time 82%, Part-time 16%, PRN 2%

Shift: Day 51%, Evening 19%, Night 5%, Weekend 25%

Ethnicity: White 94%, Hispanic 4%, Native American 2% (Reflective of the community we serve)

Changes in our workforce needs are the result of different expectations among the younger generation of employees who don’t want to work extra hours or pick up an open shift. Key drivers of workforce engagement are shown in Figure P.1-5.

FIGURE P.1-5 Drivers of Workforce Engagement

1) Confidence in Senior Management leading us in the right direction for future success

Figure 7.4-4

2) Job makes good use of my skills and abilities Figure 7.3-10

3) Comfortable in reporting errors or unsafe acts without fear of retaliation or disciplinary action

Figure 7.3-18

4) People in my team are protected from health and safety hazards

Figure 7.3-16

5) I have a clear idea of what is expected of me Figure 7.3-9

Although we value the individuals and groups who serve as volunteers, we do not consider them a true workforce segment since they provide companionship and participate in activities but do not perform any tasks in our key work processes.

We have no organized bargaining units. Special health and safety requirements include infection prevention and prevention of musculoskeletal injuries. Analysis has confirmed that we have no differences in the drivers of workforce engagement for our various work groups. P.1.a(4) Assets: Our building, constructed in 1970-71 with our doors opening in the summer of 1971, has 68 licensed beds (4 private rooms, 20 semi-private double occupancy rooms, and 6 quad occupancy rooms) with a total of 25,700 square feet and is centered on 3.3 acres. We have the standard equipment for a long-term care facility with additional supportive rehabilitation equipment that includes Invacare Hoyer and Sara lifts, bladder scanner, IV and feeding pumps, SureStep Flexx Blood Glucose machines, Code Alert System, Wound Vac, Xcell ultrasound/electrical stimulation and two resident handicap accessible transport vans. Additionally, we have all the hardware that supports our software programs for EMR and wound care telemedicine needs. We operate both wireless and cable networks for communication.

P.1.a(5) Regulatory Requirements: Our key regulatory requirements are shown in Figure P.1-6.

FIGURE P.1-6 Legal and Regulatory Requirements

Agency Measures Standards/

Targets

Results (Figure)

REGULATORY REQUIREMENTS

State of Idaho Bureau of Facility Standards

Survey Outcomes Current Survey 7.4-14

OSHA Specific Measure 100% Compliance 7.4-15

Full Licensure AOS CMS Specific Measure

100% Compliance 7.4-15

HIPAA Compliance

Training 100% Compliance 7.4-15

LICENSURE REQUIREMENTS

Background Checks

100% Compliance 7.4-15 Workforce Security Check

Reference Checks 100% Compliance 7.4-15

Facility Licensure Assessments

Current Licensure Full Licensure 7.3-1

INFECTION CONTROL

Compliance Training

100% Compliance 7.4-15 Panhandle Health

District Dietary Certification

100% Compliance 7.3-1

FIGURE P.1-3 Strategic Framework – Mission, Vision, Values

Focus on our people, on quality, and customer service, and our business results will follow. VISION

To promote healing, provide hope, preserve dignity and produce value for each patient,

resident, family member, customer, employee and shareholder we serve.

MISSION

CORE COMPETENCIES

(1) Highly Engaged Workforce (2) Resident / Patient-Centered Care (3) Excellent Customer Service

• Quality • Dignity • • Respect • Integrity • Excellence •

VALUES

Kindred Nursing and Rehabilitation – Mountain Valley 2016 Malcolm Baldrige National Quality Award

Organizational Profile Page iii

P.1.b. Organizational Relationships:

P.1.b.(1) Organizational Structure: Kindred Healthcare is the largest diversified provider of post- acute care services in the United States. Kindred operates 90 long-term care nursing facilities nationwide and our corporate office is located in Louisville, Kentucky. Our Northwest district office, consisting of 14 Kindred nursing facilities in Oregon, Washington, Idaho, and Montana, is located in Boise, Idaho. Our organizational structure and governance system are shown in the organizational chart and in Figure P.1-7.

FIGURE P.1-7 Organizational Structure / Governance Reporting System

Parent Organization – Kindred Healthcare, Inc.

Board of Directors → Responsible to Stakeholders

President / Chief Executive Officer: reports to Board of Directors ↑

President, Nursing Center Division: reports to President / Chief Executive Officer ↑

Chief Operating Officer, Nursing Center Division: reports to President, Nursing Center Division ↑

Divisional Vice President, Nursing Center Division: reports to Chief Operating Officer, Nursing Center Division ↑

Facility Organization – KNRMV

Executive Director: reports to Divisional Vice President, Nursing Center Division ↑

Senior Leaders: reports to Executive Director ↑

Departmental Workforce and Volunteers: reports to Senior Leader / Supervisor of Specific Department ↑

P.1.b.(2) Patients, Other Customers, and Stakeholders: Our key market segments are long-term care and short-term rehab. Our patients and other customers (our patients’ families) and their requirements are shown in Figure P.1-8. Analysis has found no difference in the key requirements among our residents and patients. Stakeholders include the community, Shoshone Medical Center, and other health care providers.

FIGURE P.1-8 Key Customer Requirements RESIDENTS (or PATIENTS reflective of short-term rehab care)

1) Quality Care (free from pain, free from falls, free from pressure sores/ulcers, free from restraints)

7.2-6

2) Ability to make Choices relating to Activities and Socialization

7.2-3

3) Kept Safe in a Clean Environment 7.2-11

4) Adequate Staffing Levels 7.2-7

5) Adequate Trained Staff 7.2-7

6) Communication 7.2-1 OTHER CUSTOMERS (FAMILIES)

1) Treated with Dignity and Respect 7.2-13

2) Adequate Staffing Levels 7.2-18

3) Kept Safe in a Clean Environment 7.2-22

4) Choices Regarding Activities, Meals, Friendships 7.2-14

5) Notification of Status/Changes (Communication) 7.2-19

6) Trained Professional Staff 7.2-18 <