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In the Balance

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In its early days, Kindred Healthcare’s business strategy focused on institutional care for seniors who could no longer live independently. However, over the last 15 years Kindred has evolved and become a leader in rehabilitative care. Today, Kindred’s primary focus is no longer on traditional long term care, rather it is to provide post-acute medical care and therapies to enable a patient’s safe return home.

Marc D. Rothman, MD, is Kindred’s senior vice president and chief medical officer of the company’s Nursing Center Division, which includes more than 100 stand-alone skilled nursing facilities (SNFs) across the country, most of which serve both long-term institutional patients and post-acute rehabilitation care patients. For Kindred, a Fortune 500 health care services provider based in based in Louisville, Kentucky, that dual-purpose mission offers both opportunities and challenges.

“Half of the residents may be living there permanently – it is their home – but the other half are people who are in transition – being admitted, rehabilitated, and discharged home. Serving different types of patients means we have to be good at more than one thing,” Rothman says. “We are regulated as a long-term care provider for institutionalized seniors, but we have to be nimble and flexible because those regulations don’t really address what it takes to provide high quality care for patients transitioning from hospital to home.” The goals of transitional care include quickly restoring people to their highest functional potential and preventing adverse outcomes and re-hospitalizations. “Those expectations aren’t built in to nursing home regulations, so our job is to merge those two competing interests,” Rothman says.

Integrating services in the name of patient care is a major element of Kindred’s approach, says Susan Sender, RN, chief clinical officer and vice president of Clinical Services for the Kindred at Home division. With about 113 programs in the US, Kindred at Home provides home health agency care, Medicare-certified home health care, hospice, private duty care, and durable medical equipment. Sender says Kindred is trying to address the sometimes fractured nature of the health care system, particularly in the area of senior care.

“Problems can arise when there are so many patients going from home to hospital to nursing centers or rehab facilities,” Sender says. “For many patients in the health care system overall, there’s a lack of coordination of care.” This is particularly true for older seniors (85 and above, for example) whose care often involves numerous physicians, services, and facilities. “The most important thing to know about our organization is that we provide the full complement of services. That allows us to shepherd these patients between and among settings, and fill in the blanks that are often left unfilled in seniors’ care management. The coordination we’ve created between our SNFs, home care agencies, long-term acute care hospitals (LTACs), and hospices is essential for our patients to have good outcomes.”

To help smooth the patient’s transition from one type of care to another, Kindred is hiring transitional care nurses. For each local market in which Kindred is offering integrated care services (the company refers to these as Integrated Care Markets), Kindred has hired a number of transitional care nurses, each responsible for 25–40 patients. According to Sender, “These nurses’ main responsibility is to be very focused on the patient’s needs regardless of the setting. They stay with patients and work very closely with the doctors and staff from one setting to another, whether it’s LTAC or in the acute care external hospitals in our system.” The presence of the transitional care nurse helps prevent the patient from missing medications, or even meals, which studies have shown are common problems that occur when elderly patients move from one care setting to another.

“As a health care organization, we’re transitioning from case management to care management. Our approach is more personal, usually in-person, and it brings the family members, staff, and the patient together,” Sender says. Care management also involves delving into pharmacy, rehabilitation goals, and expectations, and bringing in the kind of community services that a traditional telephonic case manager might never have known about. “We’re providing a much more hands on, high-touch kind of experience,” Sender says.

To further streamline the patient care process, Kindred is also going digital in its Nursing Center Division and has installed electronic health records (EHR) systems in over 100 facilities to date. Rothman says this represents an evolution in the philosophy of how nursing homes can work for both patients and physicians. All of Kindred Healthcare’s divisions either have or are in the process of installing an EHR system.

“Nursing homes are ready and willing to step into the 21st century. There’s a bit of a misconception that nursing homes are hopelessly inefficient and stuck in the past, but that isn’t true. For physicians, it’s now a very attractive place to grow a practice.” Rothman says. “We’re working to make it easier for physicians to practice in our settings. We’re trying to make EHR systems more accessible to physicians off-site and working with our pharmacy to streamline remote prescribing for patients.”

Rothman says that practicing in one of Kindred’s facilities is a more financially viable option than many physicians may realize because in the last 10 years, “reimbursement for physician’s visits to nursing homes have achieved financial parity with visits to hospitals.”

In addition, Rothman says, “With a concentration of well-trained nurses and rehab therapists, an invigorated approach to quality, and the influx of new technology, it’s really a pretty exciting time to be involved in nursing home care.”