1. Rising Storm in LTC How to Prepare for the Worst

3. Economic Squeeze Resource Shortage Workload Pressure Union Attack Government Interference

4. Economic Squeeze Medicaid/Medicare catastrophe Labor Costs & Turnover Access to Funding

5. Medicaid/Medicare Economic Squeeze 5 14 25 29

6. Economic Squeeze Medicaid/Medicare

7. Labor Costs: 70% Turnover rates: 40% - 166% CNA Turnover: 70% Costs: 25% of annual compensation Labor & Turnover Costs Economic Squeeze

8. Access to Funding Economic Squeeze

9. Resource Shortage Aging of America High-Growth Market Fewer Trained Workers Hospital Releases

10. Aging of America 65+ 2000: 35 million 2010: 40 million 2020: 55 million 2030: 72 million 6.5% 65+ in residential care Resource Shortage 35 40 55 72 Population Over Age 65 (in Millions)

11. High Growth Market Direct Care Workers 2 nd Largest Occupational Group New Job Growth: 1.Registered Nurses 9.Nursing Aides, Orderlies & Attendants Community Care Facilities: up 31% Nursing Care Facilities: up 28% Resource Shortage

12. 1,113,000 needed 850,736 available Resource Shortage Fewer Workers NeededAvailable

13. Hospital Releases Resource Shortage 1985 - 2000

14. Workload Pressure Higher Acuity Staffing Litigation Pressure

15. Higher Acuity Diabetes Deaths in Nursing Homes Alzheimers ADL Dependence Workload Pressure

16. Staffing Shortage Workload Pressure

17. Litigation Workload Pressure

18. Union Attack Survival Requires Growth Markets Targeted Campaigns Political Influence

19. Growth Markets Union Attack

20. Targeted Campaigns Union Attack

21. Political Influence Union Attack

22. Government Regulation Specialty Healthcare DOL/OLMS Rule Changes NLRB Rule Changes

23. Specialty Healthcare Rehabilitation Center of Mobile Government Regulation

24. DOL/OLMS Persuader “Advice” Exemption Government Regulation June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) Persuader activities include drafting, revising or providing: 1.Materials for presentation, dissemination, distribution to employees 2.Speeches 3.Audiovisual, multimedia presentation 4.Website content 5.Planning, conducting one-on-one or group meetings 6.Employee attitude surveys concerning union awareness, sympathy or “proneness” Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406) Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406)

25. DOL/OLMS Persuader “Advice” Exemption Government Regulation June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) Persuader activities include drafting, revising or providing: 7.Training supervisors to conduct meetings 8.Coordination or directing activities of supervisors 9.Establishing or facilitating employee committees 10.Developing personnel policies 11.Deciding which employees to target for persuader activity or disciplinary action 12.Conducting a seminar for supervisors 13.Other (must explain) Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406) Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406)

26. Watch Webinar and Get Other Resources Here: http://lrionline.com/olms-advice-rule Comments Due September 21, 2011 DOL/OLMS Persuader “Advice” Exemption Government Regulation

27. NLRB “Quickie” Elections Rule Government Regulation Hearing suspended to post- election if issues effect less than 20% of unit Statement of Position Form (all future litigation limited to statement of position) Eliminate 25-30 day waiting period to allow review of Regional Director decisions Provide voter phone numbers, email, shift & departments within 2 days of direction of election (and immediately to Board) Key Changes

28. NLRB “Quickie” Elections Rule Government Regulation Key Changes Election can be held within 10 days of transmission of eligibility list (or earlier if union agrees) Use of electronic signatures to support a showing of interest Election Notices required (electronic posting required where possible) Review all individual voter eligibility issues post- election

29. NLRB “Quickie” Elections Rule Government Regulation Watch Webinar and Get Other Resources Here: http://lrionline.com/nlrb-streamlined- elections Comments Due August 22, 2011

30. What Do I Do Now? Comment Political outreach Proactive ER Government Regulation

31. BOOM Right of BOOM Left of BOOM Situation Assessment Counter-Campaign Strategy Alert Legal, Consulting, Jump Team Vulnerability Assessment Positive ER, Engagement Hiring/Onboarding Tripwire Team Left of Boom

32. Frontline Focus

33. How Companies Screw Up Training You don’t need one of these

34. How to Evaluate Effective Training Intervals shrink the knowing- doing gap Active intervals - “bursts” Awareness, values, skills Accountability Leverage self-learning

35. Try Active Intervals Awareness Values Skills Try one module FREE One pulse survey FREE Copy of Next 52 Weeks

36. Webinar Conclusion To participate in training or pulse survey call Greg at 800-888-9115 or email gkittinger@lrims.com