1. Key Factors in Achieving Quality Neil Kurtz, M.D. President and CEO

2. Presentation Overview What quality means to our company –How we define it –How we measure it –How we maintain and improve it Challenges we face Quality initiatives to address the challenges Results

3. What is Quality? We define quality as: –“Skilled Compassionate Care” We look at quality in three basic ways –Process-based measures: these represent the actions of providers –Outcome-based measures: these represent the results of care processes –Best practices: these explain and define the nuances of best possible care

4. Clinical, rehab outcomes Quality Indicators Survey performance, 5-Star results Rehospitalizations Medication management Customer satisfaction, quality of life Employee engagement/retention Measuring Quality

5. Communicating Quality Discussion of quality results and outcomes starts every leadership meeting Publications focusing on quality –Quality Highlights Internal and external –Partners in Quality ED, DNS, physicians –First Monday For Medical Directors and attending physicians –Safety Caps Medication safety for nurses

6. Daily Clinical Start-Up Clinical Scoreboard Facility Performance Assessment “Stop and Watch” SBAR nurse/physician communication tool –Situation, Background, Assessment, Response Quality Assessment and Assurance process Quality Management Tools

7. Challenges More medically complex patients Shorter-term stays Varying approaches at multiple facilities Shortage of qualified staff Acceptance of change Funding

8. Addressing the Challenges Standardize care across multiple facilities –Ensure uniformity in approach Enhance measuring and monitoring tools Get better at managing transitions of care Reduce rehospitalizations Adjust staffing mix, scheduling approaches Modify and improve training Improve physician alignment

9. Key Initiatives Quality Improvement System utilizing Baldrige criteria Enhanced technology –Amalga for Daily Clinical Start-Up Increased Medical Director involvement Building a network of healthcare services Improving medication management –Golden Clinical Rx Solutions Improving the patient experience

11. Improved Survey Performance Average number of deficiencies5.955.48 Deficiency-free surveys1730 Surveys resulting in sub-standard2.8%1.8% Surveys resulting in IJ2.5%1.4% LivingCenters with 3 or less tags33%41% Overall HDI.97.92 20092010

12. Industry-Leading 5-Star Quality Results All Facilities Natl. Not For Profit Natl. For Profit Percent of Facilities January 2011

13. 5-Star Quality Improvement Golden Living Average 5-Star Quality Rating by Quarter

14. 5-Star Recognition NURSING HOMES 52 Golden LivingCenters named to the 2011 U.S. News & World Report List of America’s Best Nursing Homes

15. Golden Living