Quality By Design 2015

Clinical Software

THE FUTURE IS BEING LIVED TODAY.

In a time, long, long ago, nursing homes were considered a place for custodial care. Now, the Post-Acute Center has emerged.

A place where individuals with complex medical needs can find high quality rehabilitation, advanced treatment protocols, and

clinically experienced and astute medical professionals using

techniques to Rebuild, Recover and Renew a patient’s

health.

Centers

that

are

supported

by

hospitals

of

excellence; centers with communication and assessment

processes;

technology;

and

committed

to

rapid

response. High performing centers are evaluated

on quality metrics which can be measured and compared. Metrics, such as, length of stay, return to

hospital rates , 5 Star government ratings, patient

satisfaction, and staff turnover, to name a few.

Manchester and Vernon Manor Health Care Centers

are such places. They are considered superior

Post-Acute Centers. With an emphasis on q uality assurance and performance improvement, they

participate in and redefine the post hospital

experience. Providing exceptional care

with a patient-centered approach.

www.pointeclickcare.com

1-866-825-5549

email@pcc.com

Clinical Software

Letter From CEO

2

Leadership

3

Innovative Technology

4-5

Our Facilities

6-7

Quality Results

8-9

Patient-Centered Care

10-11

Workforce

www.pointeclickcare.com

12

1-866-825-5549

email@pcc.com 1

It gives me great pleasure to present our 2015 Quality by Design report. For the last few years we have issued an annual quality report to take stock of the past year and to bear witness to the changing health care environment. As a multi-generational business, we have seen many changes. Since the implementation of the Affordable Care Act (2010), every aspect of health care has been catapulted to new and daring heights. The post-acute sector has been included in this transformation. Building on our past performance of high quality, our companies have embraced the opportunity to engage in this new dynamic. We have created a patient-centered culture, invested in plant and equipment, embraced and fully utilized technology, and, trained ourselves to do things differently to achieve a higher level of performance. And it is working.

In 2015, we were introduced to many value-based initiatives due to the changing landscape. Preferred Provider Networks, Accountable Care Paul Liistro CEO and Managing Partner

Organizations, and incentive based payment systems have emerged as hospitals, physician groups, and private parties are aggressively trying to achieve the Triple Aim: To improve the patient care experience; improve the health of populations; and, reduce the per capita cost of health care. We have been selected to participate in all these initiatives.

The future will not be for the faint of heart. The IMPACT Act (2014) will standardize clinical assessments used across all post-acute providers. Hospitals will provide consumers with information on the quality of post-acute providers prior to discharge from the hospital. On October 1, 2018, the Protecting Access to Medicare Act (2014) will implement a 2% withhold of Medicare payments to all SNFs which can be earned back based on a facility’s return to hospital rate. Both statutes call for greater transparency with public reporting on numerous new quality measures related to post-acute care. In the future, the Five-Star Quality Rating System will be enhanced by adding new measures, e.g., rehospitalization, discharges back to the community, antipsychotic use, staffing turnover and retention.

We anticipate an active role in the evolution of post-acute care, achieving higher patient outcomes at lower costs with increasing levels of customer satisfaction.

May the Force be with us,

Paul Liistro CEO and Managing Partner 2

LEADERSHIP Kristi Dougherty, Administrator, Vernon Manor What are our company’s strengths within the industry?

“Family owned business. This provides a unique ingredient that can provide a lasting

competitive advantage. Ownership is committed to the success of the company and sincerely passionate about providing high quality care. This is clearly evident in the resources available; multiple diagnostic equipment, APRN coverage six (6) days a week, weekend physician rounds, new patient rooms, stable staffing, and strong partnerships with major vendors

.”

Billy Nelson, Administrator, Manchester Manor What challenges does our company face in the future and how will we overcome them?

“

Skilled nursing facilities with post-acute care units are positioning themselves for the evolving pay for performance setting. With 40% of our beds dedicated to high-quality, post-acute care, we have the culture, staffing, resources, technology, leadership, and strategic planning to thrive in this new era. We continue to excel at data driven management where the proof lies in our outcomes validating our mutually beneficial relationships with vertical stakeholders. We will continue to operate as industry leaders, quality partners, and patient-centered advocates.

”

Chante Drasdis, Director, Arbors of Hop Brook How does our company strive for and achieve outstanding customer service?

“For

outstanding service to exist and flourish, every employee internalizes the concept that quality is a journey, not a destination. Our commitment to resident welfare is more about meaningful relationships and less about just providing service. Each encounter our staff has is an opportunity to show what sets us apart and makes us truly special. It is our responsibility to exceed residents’ expectations in an effort to ensure they have what they need to live life to the fullest.

”

Marinela Shqina, CFO, Manchester Manor, Vernon Manor and Arbors of Hop Brook How is the industry changing in a financial sense?

“

CMS has identified that one primary driver of rising health care costs is the industry’s reliance on a Fee for Service payment system that creates incentives for providers to increase volume and cost of care. It does not distinguish differences in quality of care being delivered and the care is fragmented creating inefficiencies. These concerns are motivating payers to experiment with Alternative Payment Models that intend to steer the focus from volume-based to valuebased care.

”

Denise McAvoy, Director of HR, Manchester Manor, Vernon Manor and Arbors of Hop Brook

How does the staff contribute to the success of our company?

“Our

success is a direct outcome of our staffs’ proficiency in serving patients, residents, and their families. Staff proactively responds to the needs of those we serve with palpable compassion. Our staff is superior in that they exude kindness and work collaboratively in an effort to safeguard patients’ wellbeing and dignity.”

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INNOVATIVE We like to view ourselves as not just a healthcare company but a technology company too.

Investment in innovative technology is one of our core values and an important part of our daily operations. It influences every department from nursing to recreation; it has a positive impact on the way we perform our jobs and enhances our ability to provide exceptional care for our patients producing the best possible outcomes. Our continuous investment in technology, strong focus on the future and pioneering attitude, make us a leader in this industry. In fact, this year, we were awarded the Mcknight’s Silver Award for Innovator of the Year as part of their national, annual Excellence in Technology Awards. We were awarded for our innovative use of Novaerus to improve care and the bottom line.

E INFECTION TECHNOLOGY

Novaerus scrubs the air using a unique plasma field that destroys airborne bacteria, pathogens, mold, allergens, and odor. We utilize this technology to close the loop on infection prevention and thus help control the spread of infections, reduce hospital readmissions, eliminate odors, and eliminate closures due to outbreaks. We are the only two facilities in the area to utilize this technology.

n units have been tested and proven by plasma technology to help reduce the bacteria, pathogens, mold, allergens EKG Monitors offerand many benefits in caring for post-acute patients. For example, it can easily assist in identifying ffective against even the most harmful the cause of unexplained chest pain or pressure. Having these results means better care decisions about treatment A, C-diff, Norovirus and influenza.

options.

D AND PROVEN

dent Study done by: earch Laboratory June 2014 Control Tests

at for urs

Novaerus Plasma Treatment

Zoe Fluid Monitor is a noninvasive monitor that acts as an early predictor for heart failure patients and prevents CHF exacerbation and hospitalizations.

Destruction in 0.002 secs

Ozone 700 ppm for 2 hours

END RESULT: Total destruction of organism and genetic material

Bladder Scanner is a noninvasive tool that can help detect urinary retention without the risk of infection, resulting fewer environment invasive catheterizations and increased patient comfort. ith a cleaner, in healthier the

cilities realize measurable financial and bility to lower spending associated with sulting hospital readmissions rates, and

novaerus.com.

NESS BENEFITS

technology for protecting and driving census

Span America Beds, this five positional premium bed offers a reverse Trendelenburg and comfort chair position for improved levels of care and comfort. It also features technology for fall prevention, better ergonomics, and protection for the caregiver.

MARKETING BENEFITS

O2 pipeline allows for a higher capacity flow of up to 15 liters per minute while traditional concentrators offer only 6.

It also allows for immediate access and easier application and monitoring. Its quiet operation also permits patients to Platform recoverCo-marketing quietly and focus more on their rehab goals.

Point Click Care & Point of Care is the gold standard for electronic health records in the industry. It provides a central way to manage the complete care cycle of residents.

It also includes Point of Care, a technology that can be accessed at mobile stations.

It provides real time documentation to enhance the health care delivery process by improving accuracy and making data immediately available for medication administration.

Allscripts is a communication tool between the hospitals and our facilities that allows us to receive timely medical and insurance documentation expediting admission decisions and intake of the patient.

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TECHNOLOGY Abaqis monitors and measures outcomes related to quality metrics such as customer satisfaction, readmission rates, and length of stay. We also utilize it to monitor regulatory compliance and prepare the annual QIS survey.

Cloud Server Technology is virtually based so if one server in a single location goes down, the other server will take over to avoid the loss of data or connectivity. Each server is backed up and sent to the cloud giving us the ability to be up and running in minutes after a failure of the servers. This gives us assurance that our key healthcare software will always be accessible and the flow of our patient care will not be interrupted.

PointRight uses predictive analysis to guide clinical and business decisions and helps us to be proactive in reacting to potential issues and high risk residents. It also offers benchmarked and trended data analysis and real-time reports to streamline operations and enhance quality of care.

Modalities are electrical, mechanical, and thermal therapy solutions and equipment that are underutilized in the industry due to cost restrictions. We employ these innovative treatments to help patients with strengthening, pain relief, increased circulation and blood flow, and decreased edema.

Omnicycle System enables patients to exercise both upper and lower body without the need for full control over their limbs. It utilizes smart biofeedback technology to provide immediate feedback about the way the patient’s body is reacting to the exercise. This allows the rehab therapist to make adjustments quicker, therefore, improving outcomes and effectiveness.

Direct Dining is a concept that allows the resident to choose their food from a mobile food cart ensuring a hot, customized meal every time. This gives residents even more freedom of choice and has had a positive impact on quality and cost.

Our Dining Menu is a mix of comfort food and retail food that appeals to a wide spectrum of generations – Traditionalists want comfort food and baby boomers want trendy. Moving forward, implementation of the same menu at both locations and cross training of staff will help us improve consistency, efficiency, and food and labor cost containment.

Ipads in Recreation are being used to communicate with residents who speak different languages and to give them an opportunity to access entertainment and content in their native language. Ipads are also used for trivia and music group sessions.

Ipads in Rehab permit timely and accurate documentation and instant access to educational materials that can be provided to the patient, specific to their diagnosis.

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OUR FACILITIES

www.pointeclickcare.com 6

1-866-825-5549

email@pcc.com

7

Quality Results The healthcare industry has been experiencing a shift which has put more emphasize on quality-driven data and metrics. The industry has been focusing on tracking, analyzing, and reporting metrics related to quality of care and service.

Figure 8A Quality metrics have always been a focus for our facilities. We understand that a focus on quality translates into better care and outcomes for our patients. We are transparent with our customers about our metrics and encourage them to utilize this data to find the most qualified facility to help them achieve their recovery goals. We believe Manchester and Vernon Manor are the right choice and that is evident in our documented results and success.

As affirmation of our commitment to quality, our facilities have been recognized by several leading quality organizations (Figure 8A). In 2010, Manchester Manor was the only recipient of the AHCA/NCAL Gold – Excellence in Quality Award and, Vernon Manor received the Silver-Achievement in Quality Award the same year. Our centers were awarded based on our comprehensive approach to improving our overall quality. Research demonstrates that Gold and Silver recipients have better quality outcomes than that of other members of AHCA. Both facilities also received the 2015 Quality Assurance and Performance Improvement Advance Accreditation from Providigm for excellence in continuously improving quality of care and life for our residents. We are the only two facilities in Connecticut to have received this advance accreditation.

With the current and future penalties, attention has shifted to the hospital readmission rates as an opportunity to reduce cost and improve quality of care.

To help align ourselves with these changes, we have focused on improving this metric (Figure 8B) by connecting with the right healthcare partners, upgrading technology and equipment, elevating our level of care, and increasing our range of capabilities.

2010

GOLD

2010

SILVER

Figure 8B

Figure 8C

With the shifts in the Medicare payment system, having a low length of stay (Figure 8C) has become increasingly important. Our technology, thoughtful application, and sophisticated renovations provide us with an extraordinary advantage in acheiving low lengths of stay, enabling our patients to quickly and safely return home.

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Figure 9A

While occupancy (Figure 9A) has seen a decrease throughout the industry, our facilities have maintained strong occupancy levels. Providers are still referring patients to us (more often than our competition) thus keeping our occupancy stable while the rest of the industry has experienced a drastic dip. This is not by coincidence, but due to our respected reputation in the community.

Figure 9B

In 2015, CMS rebased the scoring for Five-Star ratings, making it more quality orientated and the process more rigorous. CMS predicted this would cause abrupt changes in the proportion of facilities receiving the top score. Vernon and Manchester Manor have maintained their Five-Star rating (Figure 9C) despite this. Only 22% of facilities nationwide are rated as a Five-Star facility, which has dropped from 28% last year.

Figure 9D

As another indicator of our outstanding reputation for high quality care, our volume of admissions (Figure 9B) has steadily increased over the last five years. According to CMS data, only about 9% of facilities are receiving over 300 admissions a year.

We have surpassed that number and our admissions are still climbing. In 2016, we predict our admissions will total close to 600 for the year.

Figure 9C

State Health Surveys are important for determining quality of care and life for patients. As part of CMS’s Five-Star program, a health inspection is performed each year and ratings are calculated based on the results (Figure 9D). Our ratings are far superior to the state and national averages; only the top 10% of facilities receive a Five-Star rating in this category. We take quality of care very seriously and we always aim to help our patients Rebuild, Recover and Renew safely.

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PATIENT-CENTERED CARE Our business is about people caring for people. Our patients’ progress and improvements are the driving forces behind our focus of providing the highest quality care. Focusing on our mission to preserve each patient’s individuality and dignity, we strive to develop and nurture relationships between our staff, patients, and their families in order to offer the best care possible.

Our staff is the key to this success. We encourage and empower each staff member to do their best for patients – to connect with the heart. CARES is one philosophy that we use to help guide our daily interactions with patients based on the five CARES behaviors, Figure 10A.

ompassion ccountability espect nthusiam ervice Figure 10A

Developed by Sodexo (our food service partner), who shares our belief that patients are the heart of everything we do, CARES is the very foundation of the exceptional service and personalized attention we give to all of our residents.

Our residents know they can always find a caring member of our team to help when needed.

The proof of success is in our customer satisfaction survey results. As demonstrated in Figure 10B, we have consistently maintained high customer satisfaction scores at both facilities. We have built a great reputation on the foundation of

our exceptional quality care, proven outcomes, and outstanding service. In fact, a good reputation is cited as one of the top reasons for customers selecting our facilities.

Active since Oct. 2015

Active since Feb. 2015

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4.3 stars

AVERAGE RATING

4.6 stars

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ENGAGEMENT RATE

8%

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Figure 10C

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Figure 10B

We also hold value in the kind words of our satisfied patients and their families that demonstrate our patients’ positive care experiences. We receive many handwritten cards and letters with affirmative sentiments demonstrating to us that we offer quality care and make a difference in our patients’ lives.

To be truly patient-centered, we need to consider all the ways we can engage our patients and the fastest growing tool, to accomplish this, is social media. According to the Pew Research Institute, over 59% percent of adults look for health information online and our facilities are there as resources for information through our Facebook page, blog posts, and enhanced website. Figure 10C represents the success we have had on Facebook in the 2015 calendar year. In the short time we have had a Facebook presence, we have had many engaged customers reading and utilizing our content. In the future, our digital presence will become an even more valuable resource to educate and empower our patients as well as enhance their online experience.

“

Your therapy dept. is staffed by enthusiastic and experienced professionals.”

”

“ The whole staff acte d professiona lly in perfo r ming their duties. The y ma de my stay at Vernon Ma nor, in wha t is now – pleasant m a emor y. I m a d e many frien ds dur ing my une x p ecte d ‘vacation’.

I’m please d w ith my reco ver y.”

“I felt grateful to be able to spend a couple weeks of rehab time here.

I feel that I will be able to make a full recovery because of it.”

ry been ve e v a h e “I employe a y b d e s impres . This truly is n d retentio the Manor an o ng cre dit t this ver y thi on I menti co m men d the re when I rs.” to othe r o n a M

CNAs d n a s urse “ The n caring, , d n i k as lways sional s were a e f o r an d p to the lo ving d e d n o er esp n d oth they r a m o of M nee ds ts.” resi den

e I f irm ly be li e ve obnett e r cou ld n e ve r f in dn ad co n ce rn fa cility fo r ca re ant s.” fo r pat ie “

”

“I have always heard good things about Manchester Manor, so when we needed help in our family, this is the first place we looked.”

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WORKFORCE

Employees are the backbone of our business and the key to our success. Just as we invest in our technology and building, we invest in our employees to build a knowledgeable and professional team that is able to provide the best in patient care. Our caring, compassionate, and experienced team is a prominent reason that customers choose our facility for their recovery.

Being a family owned business, our employees are very important to us and as we do with our patients, we treat everyone like family. We aim to promote a family and community atmosphere amongst our staff and patients.

In October of 2015, our company was recognized as a finalist for the Hartford Business Journal Family Business Awards for this very reason.

To care for our patients, we need to have the right team to provide the highest level of individualized care and attention.

Higher staffing levels have been linked to improvement in survey results, quality metrics, and quality care. Our nursing staff levels exceed the national and state averages (Figure 12A) by as much as 15 minutes.

Staff stability is also an important factor to both the business operations and our patient’s well-being; lower levels of staff turnover have been historically associated with higher quality of care.

Figure 12A

We take pride in our staff stability and longevity statistics.

Over 22% of our staff has been employed with us for over 10 years. In fact, our longest working employee has been with the company for over 38 years. Our turnover (Figure 12B) at both facilities has been below the national averages since 2013 and we have maintained those results over the years.

Figure 12B

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This longevity is evidence of our staff satisfaction which ultimately helps improve our patient satisfaction. Those who work the closest with patients are at the center of providing quality care. Research demonstrates that satisfied staff contributes significantly to quality of life for patients.

The more consistent and committed the staff is, the more they understand their patients and are able to effectively respond to each person’s needs and provide the patientcentered care that is at the core of our business.

You’re known by the company you keep.

Quality Care and Quality Services Go Hand in Hand.

Referral Hospital

Referral Hospital

Referral Hospital

Medical Supplies

Laboratory Services

Medical Supplies

Rehab and Therapy Services

Food Services and Facilities Management

Pharmacy Services

Analytics Services

Accounting and Clinical Software

Airborne Infection Control

385 West Center Street Manchester, CT 06040-4797 (860) 646-0129 www.ManchesterManorCT.com

180 Regan Road Vernon, CT 06066-2824 (860) 871-0385 www.VernonManorCT.com

For Admission Information: Manchester Manor: Lucy.Harrington@ManchesterManorCT.com Vernon Manor: Annette.Dudarewicz@VernonManorCT.com For More Information: Manchester Manor: Billy.Nelson@ManchesterManorCT.com Vernon Manor: Kristi.Dougherty@VernonManorCT.com