1. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Thinking Differently about Hospital Readmissions LaNita Knoke RN, BS, CMCN Healthcare Strategist

2. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician.

3. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Senior Care Continuum Family Caregiver Primary Care Specialists Hospitals Hospice Home Care Home Health Physical/ Occupational Therapy (other needs) Rehab Family Caregiver

4. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Nutrition Medication Management Doctor Appointments Warning Signs Four Areas of Focus

5. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Knowledge Compliance Meeting Basic Need Personal Side of Care Knowledge Compliance Communication BASIC NEEDS

6. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Home Instead Re-Admissions Studies 2 Livonia, MI Richmond, VA 1

7. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Desired Outcome 21 Both Studies were designed to determine if patient compliance with discharge instructions along with monitoring of key quality outcome indicators in the home, correlated to reduced unnecessary hospital readmissions

8. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Study May 1, 2012 – April 1, 2013 Large for profit hospital system 1 GOAL: Reduce hospital readmissions of 16% by 1% 55 patient pilot study Primary diagnosis: CHF (Heart Failure) 30 Day Plan of Care

9. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Study July 2012 to November 2012 2 non- profit hospitals 2 GOAL: Reduce unnecessary hospital readmissions within the first 30 days of discharge while improving patient self-reliance 30 patient pilot study Primary diagnosis: CHF (Heart Failure)/ COPD 30 Day Plan of Care

10. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Discharge Model Example 1 2 3 4 Discharge Planners completed risk assessments on each patient Home Instead Senior Care completed care consultations to determine patient specific home needs prior to discharge With the Discharge Planner, and based on these assessments, we determined the necessary level of care, which drove the required hours of care Prior to discharge we worked together to created Individualized Care plans that involved the patients own goals

11. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Care Plan focused on patient-centered goals with action plans – Functional goals: drive, grocery shop, wedding, garden Home Instead Senior Care was present at discharge – Helped to build trust, clarify discharge instructions, and understand the program Week 1: one hour of service for five visits Week 2: one hour of service for four visits Week 3: one hour of service for three visits Week 4: one hour of service for one or two visits Home Management with Patient Employment of a Teach Back Methodology instead of a complete care approach

12. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Patients only remember and understand <50% of what clinicians explain to them in a hospital setting The discharge plans must shift fromto

13. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. – Medication management reconciliation from discharge – Appointment with Primary Care Physician first week home – Diet and Nutrition low salt – Monitoring vital signs blood pressure, weight, fluid intake – Warning signs red flags – red, yellow, green zones – Organization of medical records in the home Critical Components for Success

14. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Outcomes Study 1 23.5% in readmission rate. Initial goal was to drop it 1% Reduction 97% Upon national readmission estimates for Medicare patients with CHF Improvement

15. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Outcomes Study 2 96% 93% 90% Of patients were discharged to their own homes Of patients remained out of the hospital 30 days post discharge Of patients remained out of the hospital 90 day post discharge

16. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Outcomes In both studies we were able to fill the discharge gap in education and compliance.

17. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Follow-Up Physician Visit Assistance Nutrition Management Warning Signs Monitoring and Notification Medication Self Management Care Management with Patient

18. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Best Practice Results Ensuring nutritious Groceries are in the home, reviewing the hospital diet instructions and providing mealtime socialization Physician appointment within 7 days post discharge, testing and therapy follow up completed when scheduled by providing transportation and assistance Disciplined, consistent discharge process Successful hospital to home transition

19. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Results (Cont.) Teaching patients to care for themselves instead of doing the care for them Developing the Returning Home Program Focusing on initial Admission Prevention Medication Management needs resulted in launching Simple Meds by Home Instead

20. Each Home Instead Senior Care franchise office is independently owned and operated. Each Home Instead Senior Care ® franchise office is independently owned and operated. © Home Instead, Inc. 2013. Home Instead Senior Care franchises provide only non-medical services. For medical advice, please consult your physician. Person-centered solutions to reduce hospital readmissions