The document discusses the need for culture change in long-term care facilities away from an institutional model that strips autonomy and freedom. It outlines a person-centered model that recognizes residents' need for choice, relationships and engaging in meaningful activities. Facilities that have implemented culture change through physical transformations, organizational changes and personal growth report higher satisfaction rates, lower turnover and improved health outcomes compared to traditional facilities.

1. Keeping the Promise : Inventing a New Long-Term Care Nancy Fox, Pi ñon Management

12. Customer Satisfaction Surveys Source: Pinnacle Quality Insight - 2010 Source: My Innerview – 2010 * Based on a subset of Colorado Homes that contract services with My Innerview Scale (1 – 5) Piñon National Range Overall Quality 4.3 4.2 4.08 – 4.66 Individual Needs 4.4 4.3 4.17 – 4.61 Recommend Homes 4.5 4.4 4.2 – 4.8 Percent “Excellent” and “Good” Responses Piñon Colorado* Range Overall Satisfaction 91% 87% 81% -98% Recommend Home 89% 86% 81% - 100%

13. Occupancy Rates Comparison

14. Denver Occupancy Rates Based on cost report data 2010

15. Financial Outcomes As an example of financial impact of culture change, year-to-date figures from one home are given. These numbers reflect the financial changes that occurred after Piñon took over management of this home and brought in a knowledgeable administrator in March 2009 who implemented culture change practices. Net Operating Income Net Income December 2008 ($27,955) ($240,879) December 2009 $309,998 ($31,353) December 2010 $503,509 $407,178

16. Turnover *Source: American health Care Association 2007 AHCA Survey Nursing Staff Vacancy and Turnover in Nursing Facilities Piñon 2011 (All Homes) Colorado* United States* Nursing Admin 15% 37.4% 28.7% Nursing - RN 23% 48.4% 41% Nursing - LPN 14% 44.7% 49.9% Nursing - CNA 8% 66.4% 65.6% Overall Staff Turnover 10%

17. Staff Turnover – Rowan Community *Source: American health Care Association 2007 AHCA Survey Nursing Staff Vacancy and Turnover in Nursing Facilities Piñon Management Employee Data Department Turnover Colorado U.S. Nursing Admin - ADON 0% 37.4% 28.7% Nursing - RN 0% 48.4% 41% Nursing - LPN 0% 44.7% 49.9% Nursing - CNA 11% 66.4% 65.6% Nursing - Restorative Aide 0% Activities 0% Resident Transportation 50% Social Services 0% HIM - Medical Records 0% Accounting - Business Office 50% Dietary 36% Housekeeping 0% Laundry 50% Plant - Maintenance 0% OVERALL TURNOVER 14%

18. Clinical Outcomes Source: CMS Quality Measure/Quality Indicator Report – 2010 Quarter One Piñon Average National Average Colorado Average Prevalence of Falls 14.4% 13.1% 16.9% Residents with a UTI 7.6% 13% 16.3% Residents Who Lose Weight 8.4% 8.6% 8.8% Residents Who Were Physically Restrained 1.3% 3% 3.5%

35. Old Nurses Station Christopher House

36. New Nurses Station Christopher House

40. Old Dining Room North Star

41. Remodeled Dining Room North Star

52. The Residents deciding on Dining Room Décor

53. Flattening the Hierarchy

55. Daily Community Meeting

56. A Neighborhood Team in Learning Circle

58. Downhill Skiing

59. Join the local swim club

60. Put childcare in your home

61. Adult Enrichment Programs at Local College

62. Have a Resident Sales Team!

63. They come here to live

64. And continue to enjoy their simple pleasures..