Curo Healthcare Glassdoor Flips to Gentiva

 

Strange Tony,

The former Glassdoor site for Curo Healthcare is now Gentiva.  That means a CEO change from Curo's Larry Graham to Gentiva's David Causby.  It's not clear Graham made the cut when our 60% financial rapscallion owners flipped from TPG/WCAS to CDR.

So far employees aren't rushing to rate Causby.  He has two ratings and a 7% approval.  Gentiva staff have the option to do so under the former Kindred Hospice Glassdoor site where Causby has a 75% rating.  That site was also recently rebranded for Gentiva.

While one can call Causby's low rating spurious there are other concerns for potential hospice employees.  Less than half would recommend their workplace to a friend and more than 50% have less than a positive outlook for Gentiva Hospice, now under Clayton, Dubilier and Rice.

The two lowest parameters are work/life balance and senior management.  A Virginia social worker echoed these sentiments on the former Curo Healthcare Indeed site saying:

I would like for the company to show more appreciation for those of us who have been loyal employees.

Causby and company ran off nearly all the talented, loyal employees at our hospice.  We would have loved to give him feedback as that was happening but management provided us no opportunities.  He would have been lucky to have gotten a 7% positive rating.  

Causby cut everything in half, including our census.  He's proven he can prioritize his personal wealth over employee satisfaction and quality hospice care.  The good news is his material gains are temporary and the day will come that he atones for his actions on this earthly plane.  

Anonymous

Tony Strange and Rod Windley Step Down

Strange Tony,

Aveanna Healthcare's CEO Tony Strange and Executive Chairman Rod Windley have been sent packing by financial rapscallion Bain Capital.  Bain and J.H. Whitney hold the vast majority (>70%) of Aveanna shares.  

Aveanna's stock price mostly sank in 2022 and is worth less than $1 per share.  It has traded like a company headed toward bankruptcy.  

COO Jeff Shaner will become CEO.  Shaner headed the hospice division under Gentiva while David Causby was over home health.  

Causby is currently CEO of Kindred Hospice, recently rebranded back to Gentiva, and under the ownership of financial rapscallion Clayton, Dubilier and Rice.

Bain and CDR expect huge profits, which bodes poorly for Aveanna and Gentiva staff.  Pay and benefits will remain as miserly as possible for regular staff.

The Tony Stranges and Rod Windleys get to exercise their grossly excessive separation packages that only exist at executive levels.  

They cannot take it with them and someday they will answer for their earthly deeds.

Anonymous

Financial Rapscallions Damage a Once Great Hospice

Strange Tony,

"Home Health Care News" ran a piece on how private equity firms think.  An operating partner at our new owner said:

"The simplest way I find to explain it is: if we’re successful, we take good companies, and we make them great companies.”

That's bull excrement in light of our hospice experience under majority private equity ownership.  TPG Capital and Welsh, Carson, Anderson and Stowe owned 60% of Kindred at Home from July 2018 to August 2021.  

The market will tell you right away.

It did.  Their greatness resulted into an over 50% drop in census.  Turnover went through the roof after they eliminated half the office jobs, cut two paid holidays, reduced holiday pay by 33% and installed crappy technology that stole pay and mileage reimbursement from dedicated hospice workers.  

Signature programs for hospice patients disappeared.  Financial rapscallions cut the many little things we did for patients in recognizing special days (birthdays, anniversaries) and honoring their service in the U.S. military.  

Before Humana et al we put much thought into our annual memorial service for grievers, planning a number of ways for families to remember and honor memories of their deceased loved ones.  Tight budgets eliminated nearly all of those personal touches.

Fortunately, our hospice's founding Medical Director missed financial rapscallion ownership as a board certified physician in hospice and palliative care.  That was a blessing, however he did experience it as a patient while the COVID-19 pandemic roared through our community and filling ICUs.  He'd watched the development of MRNA vaccines and strongly believed in their use.  Our hospice said his nurse had been vaccinated.  That was a lie.  

In addition, this nurse had been arrested for harming a family member,  A second arrest for the same crime occurred after our Medical Director's death.  Vaccine and family abuse information seems pertinent to a family intent on keeping their loved one safe.  That occurred under private equity ownership.

I don't recall anything close to these violations during my time with hospice prior to financial rapscallion ownership.

"Home Health Care News" would do better to interview hospice workers and learn how private equity firms damage care delivery and short shrift employees.  Sadly, courage is in short supply.

Anonymous

New Name: Gentiva Hospice

Strange Tony,

Our hospice's name is set for another change.  It's our seventh name change and most arose from corporate buyouts.  I thought the Gentiva name might return as it surfaced in a corporate office e-mail account.

The incomplete heart or odd shaped G above the Gentiva Hospice name symbolizes financial rapscallion and executive greed.  

I find it strange that executives happily and repeatedly  trash any brand loyalty our hospice earned in the community.  It may not be a bad thing given how badly Humana, TPG and WCAS bled us of cash and trashed what was once nationally recognized hospice care.

A toast to our new incomplete heart, G for greed logo.

Anonymous

Life Under CDR Sponsorship

Strange Tony,

Our Kindred Hospice site is now sponsored by Clayton, Dubilier and Rice.  Last time it took six months for TPG Capital, WCAS and Humana to gut services by slashing staff, reducing benefits and instituting complex, unreliable technology.  Customer service scores went into the toilet with not one word from above on this clear evidence of the carnage they'd imposed.

As we are in our honeymoon period I thought I'd look at other CDR affiliates and see what their staff said.  This is from a Healogics Vice President:

Every 6 months your job title will change, your boss will get fired and yet another restructure will occur. There is zero stability and always an evolving cut list. The strategy area is who is completely insane in constant restructuring and playing musical chairs with jobs, titles, department heads. The strategy is long time friends with CEO so unless your in their club look elsewhere. The culture is Toxic. They once made us tell everyone they were losing their job on 12/23. There is zero employee stability. You can work here for a short stint but keep that resume up to date because you will be on the quarterly cut list in short order. And steer clear of head of sales, strategy and ceo, that’s the boys club driving the bus. They do not care about employees.

A Healogics manager said:

You can guarantee every 2 years or less a major restructure in upper management. Decent work life balance. Not competitive pay. Not much opportunity for advancement.  

Agilon is another CDR healthcare affiliate.  A Utilization Management Reviewer said:

Great benefits. Poor management and upper management will not hear your concerns. This company is all about numbers/money. Lots of turnover. Very sad place to work. 

 A Review Nurse offered a similar assessment:

Very high turnover. If you have any issues like unfair treatment or hostile work environment and try to communicate that to management or corporate they will set you up to be fired instead of investigating the situation. Lots of discrimination and if you point that out, you will be fired.

Vera Whole Health is a new sister company for Kindred Hospice. 

When we all came over from other clinics and practices, we were told about some very grand ideas and concepts, such as communication and camaraderie, team work, and a close tight knit culture. In all reality, most of us never really saw that. Management does not really listen to the issues that were brought to them.

Vera Health leadership has this history:

Strange, almost "cult' like adoration given to, and expected from, the CEO. They talk a good talk, but the reality in the care centers does not live up to the hype. I would not recommend anyone to work for this company!

These assessments from nurses, managers and staff from sister CDR companies do not bode well for our hospice's future.  How far will we continue to fall from our award winning days?

Anonymous

Charlotte Buyer Borrowed to Fund CDR's 60% Stake

Strange Tony,

Humana's complicated sale of 60% of Kindred Hospice/Community Care to financial rapscallion Clayton, Dubilier and Rice has been consummated via a company named Charlotte Buyer Inc., which borrowed over $1.6 billion to fund the deal.

The Q4 2021 Annual Health Statement for Arcadian Health Plan (part of Humana) shows Charlotte Buyer to be an affiliate of Humana.  The filing showed numerous organizational charts for Humana's hospice and home health assets under the Gentiva umbrella.  .  

Charlotte Buyer is the intermediary company for Curo Health Services' hospice assets.  It is not the intermediary for other Gentiva/Kindred hospices that rose up under Integracare, Healthfield, Harden Healthcare, Odyssey, or VistaCare/Family Hospice umbrellas.  

Humana, TPG and WCAS borrowed under the Gentiva Health Services name to fund the deal in 2018.  Moody's most recent credit rating for Gentiva New said: 

Any divestiture of the hospice/ community care assets would trigger the requirement within the credit agreement to repay the debt and as a consequence could result in a different rating outcome. 

Oddly Humana went a level down to an entity that only covers a portion of the hospice assets.  I don't recall Curo having Community Care services.  They came from the Kindred at Home side.

Moody's rating of Charlotte Buyer noted:

The borrower under the credit agreement is Charlotte Buyer, Inc. There is a downstream guarantee from an intermediate holding company, but not from KAH Hospice Company, Inc., i.e. the future filer of the financial statements.

Borrowers need an upstream guarantee from Gentiva Health Services for multiple reasons. 

The credit agreement  permits the transfer of assets to unrestricted subsidiaries, up to the carve-out capacities, subject to "blocker" provisions which prohibit the transfer of intellectual property, that is material to the operations of the company, taken as a whole, by way of sale, conveyance, transfer or other disposition  to an unrestricted subsidiary.

Non-wholly-owned  subsidiaries are not required to provide guarantees; dividends or transfers resulting in partial ownership of subsidiary guarantors could jeopardize guarantees subject to protective provisions which only permit guarantee releases if such transfer is not done in connection with a non-bona fide transaction (as determined by the parent borrower conclusively and in good faith) and for the primary purpose to cause such subsidiary to become an excluded subsidiary and be released from the guarantee.

There are no express protective provisions prohibiting an up-tiering transaction.

I would not want to hold Charlotte Buyer debt as it represents a fraction of Gentiva Health Services hospice and community care assets.  

What kind of sleight of hand will executives and our new financial rapscallion owners use to take advantage of hospice staff? 

Anonymous

CDR Now Majority Owner of Kindred Hospice

Strange Tony,

Humana did it.  They sold our hospice down the river to yet another financial rapscallion.

Humana Inc. today announced that it has successfully completed its previously-announced transaction with private investment firm Clayton, Dubilier & Rice (“CD&R”) to divest a majority interest in the Hospice and Personal Care divisions of Humana’s Kindred at Home subsidiary (“KAH Hospice”). These divisions include patient-centered services for Hospice, Palliative, Community and Personal Care. Upon closing, the Hospice and Personal Care divisions have been restructured into a new standalone company.

...the new standalone company, soon to become Gentiva.

It's official.  The Gentiva name is coming back, just as I pondered last September.

It looks like Gentiva might be returning, especially as the Director of Corporate Communications for the company has a gentiva.com e-mail address. 

 A regulatory filing with the state of Oregon stated:

CD&R Falcon Holdings, L.P. (“Falcon Holdings”), the sole limited partner of Falcon Hospice, would acquire a 60% ownership interest in KAH Hospice Company, Inc. (“KAH Hospice”). KAH Hospice is currently owned by Gentiva a wholly owned subsidiary of Humana.

The Oregon analysis highlighted the negative impact Bain Capital's ownership had on Aveanna Healthcare,  

"caregivers were made to focus on profit maximization and overextend themselves...patient care ultimately suffered."  Bloomberg article 10-22-19

Former Gentiva CEO Tony Strange is CEO of Aveanna.  

Oddly, Humana's most recent SEC filing showing Q2 results has not one mention of their wholly owned subsidiary Gentiva.  

CDR borrowed $1.6 billion via a term loan from Goldman Sachs to help finance the deal.  It originally sought nearly $2.5 billion in loans but dropped a $400 million term loan A.

I was unable to find a debt rating for any of the possible entities associated with the deal, Falcon Holdings, CD&R Falcon Holdings, Kindred Hospice, KAH Hospice, or Gentiva (the name used for prior debt ratings).

There is a B3 debt rating for Charlotte Buyer, Inc. that covers Kindred at Home Hospice/Kindred Hospice.  It states:

The borrower under the credit agreement is Charlotte Buyer, Inc. There is a downstream guarantee from an intermediate holding company, but not from KAH Hospice Company, Inc., i.e. the future filer of the financial statements.

KAH Hospice is majority private equity owned, which could lead to an increasingly aggressive financial policy over time.  

Alternative sources of liquidity are limited as substantially all assets are pledged. 

 ...financial policies will be aggressive under majority private equity ownership including debt-funded acquisitions to drive growth.

Next level financial rapscallion ownership is upon us.  I expect it to be extremely painful.

Anonymous

Financial Rapscallions Harm More than Our Hospice

Strange Tony,

Financial rapscallions continue to harm hospice care.  Kaiser Health News reported:

According to a 2021 analysis, the number of hospice agencies owned by private equity firms soared from 106 of a total of 3,162 hospices in 2011 to 409 of the 5,615 hospices operating in 2019. Over that time, 72% of hospices acquired by private equity were nonprofits. And those trends have only accelerated into 2022.

My coworkers know the bane of private equity from three years of abuse under the hands of TPG Capital, and Welsh, Carson, Anderson and Stowe.  Humana will sell us down the river to yet another profit maximizer, Clayton, Dubilier and Rice.   

Kindred Hospice revenues were $399 million for Q1 and $382 million in Q2 or $781 million for the first six months of the year.  Pretax profits were $62 million for Q1 and $64 million in Q2 or $126 million for the first half of 2022.  

Humana's Q2 SEC filing is sparse on Kindred Hospice's financial operations and capital structure.  It provides even less for the home health operation it is keeping.  I don't understand how the SEC lets Humana get away with providing so little information on a company it acquired in full in August 2021 and still owns/operates.

Financial rapscallions want as little information in the public sphere as possible.  That way people won't see their greed and cruelty on paper.  Rest assured, their distorted priorities are acutely felt by hospice staff and patients.  The cuts just keep on coming.

Anonymous

Hand of Marcy Hospice

Strange Tony,

Our hospice met the new Regional-Local Assistant Vice President of Operations Minus Marketing Marcy Quarter. She shared her priorities as our hospice awaits sale to yet another financial rapscallion with multiple last names (Clayton Dubilier Rice).

Marcy wants to lever technology to cut expenses as it pushes a "one size fits all" hospice model.  She said:

The company used big data to find the average use of medications and supplies for each hospice diagnosis.  Any item exceeding company averages will not be allowed without extensive review and approval from the RLAVPOMM level. 

Similarly we data mined staff mileage and mileage above the company average will not be paid unless documented thoroughly.  Your tablet will no longer automatically calculate mileage to the patient's home for reimbursement purposes.  That is now your responsibility.  However, you should not fudge any mileage figures as your tablet will be used as a data validity check on any submissions.

Overtime has been banned for all hourly employees.  For all other key measures the former average is the new maximum.  That said, the executive team's expectations of increased census and revenues remain in place.  Customer service scores remain important but are secondary to expense control and revenue enhancement.  Any questions? 

A foolish new chaplain asked Marcy to clarify things for him should he find himself in a home with a dying patient as his clock hits forty hours for the week.

"You are to cease work when you hit the forty hour mark."  

He commented that his faith and assessment of the situation might require him to remain with the patient and family.

"That is not allowed."

It's but the latest insult to our once great hospice.  We're now under the Hand of Marcy.  Lord help us.

Anonymous

Kindred Hospice to be Eaten by CDR's Falcon

Strange Tony,

Kindred Hospice/Community Care is being acquired by Falcon Hospice which will be owned 60% by Clayton, Dubilier and Rice with Humana holding onto the other 40%.    

Kindred Hospice/Community Care is currently under Gentiva Health Services with Humana having a 100% stake.   Moody's said Gentiva's debt will be called and Falcon will have to issue debt at higher interest rates.  That may or may not happen given the structure of the deal.

Falcon Holdings will purchase 60% of the shares of KAH Hospice (the indirect owner of Kindred Hospices) that are owned by Gentiva (which is owned by Humana).  Upon consummation of the transaction, Falcon Holdings and Gentiva will own 60% and 40% respectively of Falcon Hospice and Falcon Hospice GP.   

The sole limited partner of Falcon Hospice is CD&R Falcon Holdings, L.P., a Cayman exempted limited partnership whose limited partners include investment fund entities of Clayton, Dubilier and Rice LLC.

Falcon Hospice will own 100% of KAH Hospice.  KAH Hospice is the parent to 441 subsidiary hospice, community care and palliative care agencies in 36 states.

Financial rapscallions using a Cayman Islands sub as a tax dodge is not a surprise.   

Unique features of falcons (birds of prey) include:

Falcons, use a combination of their talons and their beak to kill a prey animal

Falcons dramatically dive, or stoop, at birds with their wings nearly closed. Peregrine falconss are the fastest diving birds on the planet and can stoop at least 290 kph (180 mph) and have special adaptations in their nostrils that allow them to dive and breathe at such fast descents.

Falcons have a black "mask" of feathers around their faces. The black feathers may help to absorb light, thus reducing glare from the ground. This would help these birds to better identify prey below them.

Our local Kindred Hospice is the prey for CDR's Falcon Hospice.  Flesh tearing bears and talons, Lord help all of us.

Anonymous

Humana Leaves Mark on Kindred Hospice

Strange Tony,

In a high stakes poker game someone is always the mark.  It turns out our hospice was it.

“We have always been anticipating that we would divest a majority stake in hospice,” said CFO Susan Diamond. 

Never heard anything like that from our hospice line of chiefs until late 2021.  Word was we might be taken public in an IPO.  I don't think the financial media made that up.

Humana executives hit their mark by stealing wages/benefits from and lying to us from the start, so this isn't anything new.  Their multiple king's ransoms will remain on this earth when their soul answers for the damage they did to staff, patients and patients' families.

Anonymous

Broussard Cites Home Health Nurse Staffing Problem

Strange Tony,

Humana CEO Bruce Broussard spoke with CNBC's Jim Cramer yesterday.  Broussard said:

 "We do have a staffing problem in home health... we can get it, we're getting the help.."

Funny, CFO Susan Diamond said Humana was solving the nursing shortage problem by training more nurses and offering both sign on and retention bonuses.  

Training new nurses isn't a short term solution.  Sign on bonuses can actually increase turnover as extrinsically motivated nurses chase the next big cash bolus.

Cramer did not ask about hospice which Broussard plans to flip to yet another financial rapscallion.  How big with his bonus be for abandoning hospice staff to the next round of greedy owners?  

Anonymous

Humana Expands CenterHell

 

Strange Tony,

Humana converted Kindred at Home home health operations in fourteen states to its new brand CenterWell.  I call it CenterHell, a characterization reinforced by recent online employee reviews.

Those locations will get new signage and marketing materials as well as employee uniforms. apparel and other branded materials.

That brings back our original hospice conversion under Humana, TPG and WCAS.  Executives promised no changes, only to turn around and layoff key employees, cut the number of holidays as well as holiday pay and implement unreliable technology that purposely underpaid staff for hours worked and miles driven.

We got new signs and branded apparel but no raises.  I'll venture this conversion is similar.  Humana executives will get king's ransom bonuses for making it nearly impossible to deliver quality home healthcare.  Numbers matter to those at the top.

Anonymous

CDR to Buy Baby Formula Maker, Kindred Hospice

Strange Tony,

There's more information about our new hospice owners.  CDR is buying the baby formula division of Reckitt Benckiser.  Big's Matt Stoller writes:

Clayton Dubilier & Rice is one of the original gangsters of private equity, founded in 1978. It had classic pedigree; Jack Welch was an advisor. The firm is perhaps best known for shipping respiratory equipment out of the U.S. in the early days of the Covid pandemic, as well as the standard stripping of assets from companies it buys, and then letting them go bankrupt. So one can expect Clayton Dubilier & Rice, if it buys Mead Johnson, to attempt to raise prices on formula, or cut corners."

CDR can't raise prices on hospice so Kindred Hospice employees can expect more corner cutting.  As if Humana, TPG and WCAS didn't already expose our poor hospice's bones.  Lord, save us from financial rapscallions as they deliver evil.

Anonymous

Another Greedy, Tampering Owner for Kindred Hospice

Strange Tony,

Financial rapscallions TPG Capital and WCAS (Welsh, Carson, Anderson and Stowe) did not value employees at our hospice site after they took a majority ownership stake in July 2018.  Humana became the operating partner with 40% ownership.  Together they devalued our hospice employees.  It took a year for them to drive away experienced, talented, dedicated and caring hospice workers by implementing Curo Healthcare's sparse staffing models and complex, unreliable technology. 

Humana never equalized Kindred at Home benefits, even after buying out the rest of KAH from TPG and WCAS in August 2021.  They did improve the retirement match but it remains half of Humana's employee match.

The next round of abuse will come when Humana officially offloads the portion it just acquired to yet a different financial rapscallion, Clayton, Dubilier and Rice.  Consider what some CDR employees said on Glassdoor.

Management plays politics, associates + principles always look down at you, No rules for HR lady but all rules apply to all staff, partners expectations are ridiculous.  Fix up, stop playing political games, appreciate your staff 

Hostile environment within the administration team. Lack of professionalism and very much a cult like working environment. HR - a complete mess No new starters stay at this company...  Bad management.

They did not value the employees of the organization they acquired.  It's not all about money, people/employees matter.

CDR will continue President David Causby's "value add" to executive wallets and personal wealth accounts.  How does a hospice organization become an enrichment vehicle for greedy leaders and financial rapscallions?  The Senate Finance Committee is supposedly asking this question.  I'm afraid the answer will not come in time to save what is left of our once great hospice.

Anonymous 

Kindred Hospice's CDR Bids for Infant Formula

Strange Tony,

Financial rapscallion Clayton, Dubilier and Rice wants to buy a baby formula maker after winning 60% of Kindred Hospice/Community Care.  Greed from birth to death, it's the financial rapscallion way.

Anonymous

Humana Finally Reveals KAH Revenues

Strange Tony,

Humana has reported minimal information about Kindred at Home's finances since it became the 100% owner of the company in August 2021.  Today's Q1 earnings report had top line revenue of $726 million for KAH but not much more.   Assuming steady business throughout the year KAH would come in under $3 billion in revenue, i.e. less than when it acquired the company in July 2018.  Hospice has some seasonality so the number could come in over $3 billion.

Hospice had higher margins than Home Health when Humana closed last summer on the 40% it did not own.  Another sale of the hospice division to financial rapscallions should enrich CEO David Causby yet again.  He's on his __nth king's ransom?

Some may recall Causby's butchering of the Harden Healthcare integration (during the Gentiva days).  He combined Kindred Hospice with Curo Healthcare by keeping the brand salad and putting larger hospices under Curo's crappy technology and miserly staffing models.  

Anyone who remembers the torture TPG Capital, WCAS and Humana put our hospice through must be dreading Clayton, Dubilier and Rice.  

There has been no word on David Causby's response to the Senate Finance Committee's request for information on private equity ownership of hospice companies.  

I'd love to read a report before our hospice gets sold down the river yet again.

Anonymous

CDR Due Diligence on Kindred/Curo Hospice

Strange Tony,

Financial rapscallion Clayton, Dubilier and Rice conducted due diligence on Kindred Hospice and Community Care before agreeing to buy 60% from Humana for $2.8 billion in cash.  

Did they find the June 1, 2021 False Claim lawsuit against Kindred/Curo Hospice CEO Larry Graham before inking the deal? 

Thus, by knowingly submitting false claims or causing the submission of false claims, and knowingly concealing or knowingly and improperly avoiding Avalon’s obligations to repay overpayments, for hospice services provided to Medicare and TennCare beneficiaries in Tennessee who were not terminally ill from at least January 1, 2010 through February 20, 2020, Defendants are liable under the False Claims Act, 31 U.S.C. § 3729, et seq. (the “FCA”), the Tennessee Medicaid False Claims Act, Tenn. Code Ann. §§ 71-5-182 to -185 (the “TMFCA”), and common law theories of payment by mistake and unjust enrichment.

The lawsuit misses Kindred at Home's ownership of Curo, as well as Humana and its financial rapscallion partners (TPG Capital and WCAS) packaging the two companies in a summer 2018 buyout.

Humana was the operating partner of Kindred at Home from July 2018 through February 2020 and responsible for any fraudulent claims made to Medicare/Medicaid.

In approximately late 2018 or early 2019, at least two former Avalon nurses repeatedly raised concerns regarding ineligible patients to Avalon and Curo managers, including the Avalon Johnson City DOO, medical director, and the lead nurse, as well as the Curo Area Vice President of Operations, about patients who were not eligible for hospice. When these nurses informed the DOO that certain referred patients were ineligible, the DOO responded that “corporate” was requiring that the patients be admitted.

Similarly, in early 2020, Avalon Nashville terminated a former nurse after she repeatedly informed the current Nashville DOO that referrals or patients were not eligible for hospice, including numerous patients who were residents at Hillcrest Healthcare Center, a skilled nursing facility in Ashland City. For example, one Hillcrest patient who the nurse did not think was hospice appropriate informed the nurse that Hillcrest had told her the only way she could continue to stay at the facility was to elect hospice. When this former nurse did not believe a referred patient was eligible, the Nashville DOO sent a different nurse to evaluate the patient.

Humana pushed the Curo Health model on Kindred Hospice sites in 2019.  That's how Larry Graham became Hospice CEO.  It's not clear how much Graham profited from the multiple sales of Curo/Kindred at Home in 2018 through today?  How much more will he make when CDR acquires their controlling interest?  The public will likely never know.

Anonymous

Anonymous

Kindred Hospice Goes to Clayton, Dubilier and Rice

Strange Tony,

The winning financial rapscallion for a 60% stake of Kindred Hospice/Community Care is Clayton, Dubilier and Rice (CDR).  Humana will get $2.8 billion in the deal.  The press release said the whole deal was valued at $3.4 billion.  That makes no sense.  

A 60% stake for $2.8 billion translates to a $4.67 billion valuation for the whole company.  The difference between $4.67 billion and $3.4 billion is likely debt, which has to be refinanced at today's higher interest rates.  

Humana paid 11.5 times EBITDA for the rest of Kindred at Home in August 2021.  That deal valued the company at $8.1 billion.  Historically hospice has accounted for roughly half the revenue and half of the company's EBITDA.  

Humana is selling the hospice and community care divisions for a 12x adjusted EBITDA figure.  That means Humana will make money on the sale.  What's a few millions amongst greedy executives.

Not taking Kindred Hospice public means President David Causby's series of king's ransom paydays remain a secret.  CDR is excited to partner with Causby and the executive team.  

The rest of Kindred Hospice is an expense to be controlled.  Executive pay is allowed to soar.  Your's is not.  More pain lies ahead.  

Anonymous

Hospice Sales Talk

Strange Tony,

A Kindred Hospice employee wrote on "Indeed":

The hospice division is up for sale and yet another transition, more corporate speeches, more of the same.

Cue the key employee retention bonuses and promises of no changes.  Those no changes turned into massive hospice staff layoffs, reduced holidays, cuts in holiday pay and worse health insurance.

The July 2018 hope of receiving Humana level benefits never materialized for my coworkers.  Humana decided the hospice division was disposable for capital raising purposes.

Kindred Hospice executives David Causby and Larry Graham won't say how many millions they made when Humana bought the rest of Kindred at Home from its financial rapscallion partners.  

We will be sold to the next round of money changers.  Expect more abuse.

Anonymous

PE Stakeholder Project Confuses Kindreds

 

Strange Tony,

In searching for any information on the Senate Finance Committee's review of hospice company private equity ownership I ran across a report from the Private Equity Stakeholder Project.  

Generic Hospice readers know my disdain for financial rapscallions, who along with Humana trashed our once great hospice (nationally recognized).  However, I also value accuracy  in reporting and I found a error in their report table.  

July 2018 saw the take private split up of Kindred Healthcare.  Humana, TPG Capital and Welsh, Carson, Anderson and Stowe (WCAS) bought out the home health, hospice and community care parts of Kindred, now known at Kindred at Home.  TPG and WCAS took the hospital portions of Kindred Healthcare, long term acute care and rehabilitation hospitals, as well as outpatient rehab services.  

Humana purchased the rest of Kindred at Home from its financial rapscallion partners in August 2021.  WCAS and TPG monetized the post acute hospital division (Kindred Healthcare) to LifePoint in December 2021.  These were distinctly different deals. 

I looked for a way to submit this information so they could consider correcting their report but found no contact information.  

Last year I wrote:

How did Humana and Kindred at Home executives treat employees after the buyout?  They reduced headcount from 56.000 to 43,000.  They cut the number of holidays by 33% and holiday pay by 50%.  

After buying the rest of Kindred at Home Humana increased its employment number by 40,000.  That is why I submitted that number as a possible correction.  I hope the U.S. Senate report is more accurate in this regard.

 Anonymous 

Humana's CEO Earned 687 Times Hospice CNA

Strange Tony,

I just heard a guest on CNBC say the average worker will continue to fall further behind financially.  Humana released a report yesterday indicating how much it paid its board of directors and executive team.  

CEO Bruce Broussard made nearly $8,000 an hour with a total compensation of $16.5 million.  That does not include his board pay from HP ($190,000 in 2021) or KeyCorp, the parent company of KeyBank ($220.000 in 2020).  

Former CFO Brian Kane made nearly $5.6 million for working half a year.  CFO and the head of Humana's Home Division Susan Diamond took home $4 million.

They can't take it with them when they leave this earth and have to answer for the harm they caused hospice patients.

Anonymous

Crappy Corporate Hospices Change Hands for Executive Profit

Strange Tony,

Something odd happened while waiting for Humana to dump our hospice remnants to yet another financial rapscallion.  Jerry at the Death Nurse blog pondered if private equity firm Advent International might make a bid.  Advent owns AccentCare.  

I countered with an ironic alternative buyer, Bain Capital's Aveanna Healthcare headed by our former CEO Tony Strange.  

Those two names made a recent news report on Encompass' sale of its Enhabit home health/hospice division.

Private equity firms including Advent International and companies including Aveanna Healthcare Holdings Inc  have expressed interest in acquiring the home health and hospice business of Encompass Health Corp, people familiar with the matter said.

Jerry writes about crappy corporate hospice, a frequent topic at this blog.  DeathNurse linked to a September 2019 story about Caris Hospice firing a nurse while she was undergoing treatment for breast cancer. 

A Nolensville hospice care nurse was fired from her job after she was diagnosed and began treatment for breast cancer.

Chrissy Ballard worked for Caris Healthcare, a hospice care company headquartered in Knoxville but with offices in Middle Tennessee.

A Caris LPN included this in a 2020 review:

...over a million profit not enough, projecting more for this yr and stupid enough to tell us

A June 2021 story noted Caris' complete sellout to publicly traded NHC.

NHC acquired the remaining interest in Caris from its founder and managing director, Norman McRae, and McRae Investment Company. NHC already owned a majority stake in Caris prior to the purchase.

Caris CEO Norman McRae serves as Chair of the National Hospice and Palliative Care Organization's board of directors.  He also served as Chairman of Hospice Action Network, the lobbying arm of NHPCO.

NHPCO described the cancer-stricken nurse firing CEO as combining "a heart for mission-driven, community-based hospice with an entrepreneur’s drive for developing and nurturing outstanding teams, running efficient operations, differentiating on quality outcomes, and identifying and meeting community need."

Chrissy Ballard's husband Matt noted:

"The hypocrisy of being a company whose mission statement is Hospice with Compassion, Hospice with Grace," said Matt. "When you are on the flip side of that and you are an employee who is fired after their cancer diagnosis, it is devastating."

Heartless for sure.  There are over a million reasons.

Anonymous 

Humana Launches CenterHell in Seven States

 

Strange Tony,

Humana announced it would rebrand Kindred at Home Home Health offices in seven states to the CenterWell brand.  States where Humana will make the name change include Washington, Oregon, Idaho, Nevada, Arizona, New Mexico and North Carolina.

Months ago I offered the CenterHell name, complete with the green H often used by Humana.  I based this on how Humana tortured our once great hospice, turning it into a heartless cash machine for executives.  

When Humana et al purchased us in July 2018 my coworkers believed they were going to improve pay and benefits.  That did not happen.  Humana made nurse salaried and then overworked them terribly under sparse staffing guidelines.  They reduced the number of holidays and cut holiday pay rates 33%. 

Horrible technology added significant work hours and purposefully underpaid staff for miles driven and hours worked.   Talented, dedicated hospice staff were either fired or fled.  All these executive changes harmed patient care and as a result reduced our census over 50%.  

Executives sold us out on the cheap in 2018.  Their deal ensured they would make a 44% return on the stock they alone were allowed to buy.  However, that wasn't enough for David Causby and his C Suite companions.  Staff firings and pay/benefit reductions ensured they would get an additional 22% return.  How many regular employees received a 66% increase in take home pay over the last three and a half years?  Senior executives got just that from their exclusive stock holdings. 

Profit obsessed Humana will garner a big bolus of cash when it sells our hospice, yet again, to a financial rapscallion or group of greedy financiers.  Lord, hear our prayer for relief from the never-ending quest for profit.  Deliver us from the profiteers.

Anonymous

Goldman Sachs Shopping Our Hospice for Humana

Strange Tony,

Insiders leaked the status of Humana's planned sale of Kindred Hospice/Community Care.  "Axios" wrote:

A Goldman Sachs-run divestiture process aimed at private equity is underway, three sources tell Axios. The company last year explored a strategic sale of the hospice arm shortly after buying out its private equity JV partners, two people add.

• The company generates approximately $300 million in EBITDA, sources say.
• The sale aims to fetch 12x EBITDA for the assets, one person adds, which suggests a deal could be valued in the upper $3 billion range if that EBITDA is applied.

Between the lines: 12x is lower than recent private market trades for scale hospice companies. 

It appears our hospice will be once again saddled with financial rapscallion owners.  CEO Bruce Broussard's promise of a public listing turned out to be hollow.  

Humana will spin off Kindred Hospice/Community Care for 12x EBITDA, essentially the same price it paid TPG Capital and WCAS (11.5X EBITDA).

Debt rating agency Moody's rates Kindred at Home's debt under "Gentiva New":

Any divestiture of the hospice/ community care assets would trigger the requirement within the credit agreement to repay the debt and as a consequence could result in a different rating outcome. 

 The report indicates:

....at June 30, 2021, the company had a large cash position at around $200 million dollars, and consistently positive free cash flow. 

Moody's also notes that KAH has been paying down debt of roughly $125 million per quarter, which we expect would continue.

Humana, as operating partner, mobilized KAH's cash toward paying down debt of $500 million per year.  Hospice staff generate revenue from their hard work, yet received little in the form of raises or improved benefits.  

The financialization of our hospice continues with staff having no opportunity to have a stake in the company.  Going from financial rapscallion ownership to financial rapscallion ownership is not the least bit inspiring.  

Executives continue looking out for themselves.  Goldman Sachs is lining up their next king's ransom via a $3.6 to $3.9 billion sale.  

Greed is as greed does.  It's extremely grating and fatiguing for dedicated hospice professionals.   Lord, hear our struggles and comfort us.

Anonymous

Humana Ready to Reorganize Hospice Business

Strange Tony,

Humana's Q4 earnings call suggested our hospice may know about our new owners by April.  CEO Bruce Broussard said:

...we are committed to advancing our plans to divest a majority interest in our hospice business as we are confident we can deliver the desired experiences and outcomes for patients transitioning for restorative care to hospice through partnership models.

We have continued to explore various alternatives for the long-term ownership structure of the business and have initiated steps to reorganize the hospice business for stand-alone operations while also making investments to improve clinician recruiting and retention to position the business for further growth. While we're not able to share details today on a specific transaction structure or timing, we expect that we will be in a position to provide a meaningful update by our first quarter call. 

That means Kindred Hospice employees will not transition to Humana's richer benefits package.  Broussard did not mention causes for clinician turnover, like not paying staff fairly for hours worked and miles driven. He omitted sorry Homecare Homebase which added hours of extra work (often done at home and off the clock), sent clinicians down senseless rabbit trails and made it exceedingly difficult to find pertinent information (as it could be in numerous places or not charted at all).   

Humana purchased our hospice in June 2018 and promised no changes.  It then cut the number of holidays by 25% and holiday pay by 33%.   They jettisoned  administrative and clinical hospice staff and instituted time eating work processes for those remaining.  Our experienced hospice nurses left long ago.

Broussard admitted Humana had difficulty retaining hospice nurses they'd just hired.

We also reduced the number of nurses who attrit (quit) in the first 90 days of employment in the second half of 2021 for the first time since the pandemic began.

Before Humana destroyed our once great hospice we had nurses leave during the first 90 days of employment, mostly due to management painting a rosy picture and then not living up to what they'd sold.  

Turnover went into the stratosphere in 2019.  2020 brought the pandemic which isolated staff from one another, making them more susceptible to torture from Mean Girl management.  

What happens when management harms the quality of service while taking advantage of employees?  Census goes down and down and down.  In the earnings call Bruce noted hospice's declining volume for the last quarter and full year:

Fourth quarter 2021 home health admissions were up slightly while hospice experienced a low single-digit decline as compared to the fourth quarter of 2020. From a full year perspective, we have seen home health admissions up low single digits with hospice admissions down low single digits year-over-year. It is important to note that hospice volumes have been impacted by the higher mortality rates driven by COVID as well as lower post-acute facility volumes.

Hospice volumes have also been impacted by nurse turnover and lack of availability.  Our hospice continued to take patients and overload the few clinical staff left but that turns into poor service and bad word of mouth.  

Referral sources got the message that Humana did not care about serving customers.  Hospice staff felt how little management cared for us.  We saw executives focusing on enriching themselves while pretending technology would ameliorate the downstream impact of their greed.

While hospice volumes went down, margins remained robust.  That's the money that does not go to employees.  Humana's CFO said:

Hospice had slightly higher margins than the home health business, and those trends continue.

Four years ago a few of my hospice peers thought Humana and its financial rapscallion partners might make our hospice better.  Some looked at Humana's retirement match and wondered how long before they would have such a benefit. 

EMPLOYER CONTRIBUTION:  125% on up to 6% of employee 401(k) contributions

Humana dashed any misplaced hope.  I expect similar treatment from our new owners.  The question is how much money did Bruce Broussard make on our backs?  We may never know.

Humana has begun a divestiture process in collaboration with Goldman Sachs, Axios reported Monday, noting that the information came from three different sources. The process is supposedly targeting private equity interests.

Lord, deliver us from evil....that I pray.

Anonymous

Humana Reports Big Gain on KAH

Strange Tony,

Humana reported the following profit on its 40% ownership of Kindred at Home (KAH):

$1.13 billion gain recorded in the third quarter of 2021 associated with the company's previous minority ownership in Kindred at Home (non-taxable)

That's a doubling or 100% gain on its initial equity investment of $1.1 billion in 2018.  Contrast that with loyal employees who lost over 50% of the stock's value between Kindred's buyout of Gentiva and its sellout to Humana and two financial rapscallions.  

The big money does not go to the little person.

Transaction and integration costs associated with the Kindred at Home acquisition of approximately $128 million.

Fees paid to financial rapscallions are orders of magnitude higher than the paltry amounts KAH provided in its 401k match.  Has Humana harmonized benefits yet for KAH employees?  Likely not, as it plans to jettison the hospice and community care divisions.

Kindred Healthcare CEO and KAH President David Causby chose to enrich themselves and fellow executives.  They've received more than one king's ransom over the last three years.  Loyal employees got a kick in the teeth and many got kicked out the door.

Causby and Humana ruptured our hospice to the point it cannot be put back together.  Their giant gain is our significant loss.

Anonymous

Intentional Cruelty and Greed is Breier's Legacy

Strange Tony,

Ben Breier, the man who trashed his company's vision for integrated post-acute healthcare while making two king's ransoms, said of his new book Intentional Disruption:

"This is not a technical business book; it's an emotional leadership survival guide," Breier explained. "It encourages readers to be connected to a mission rather than just a salary. This book will hopefully help incumbent leaders, but was written with an eye towards inspiring emerging leaders of tomorrow."

Ben Breier is a jerk who sold our once great hospice down a river. While he counted his winnings Humana and financial rapscallions destroyed our hospice, harming employees and patient care.

Intentional Disruption is what Breier did to enrich himself multiple times.  He did not give employees an equity stake in the company.  Breier held that for fellow executives and his financial rapscallion partners.  

Breier disrupted employee trust when he abandoned us in summer 2018 for his first king's ransom.  Executives told us there would be no changes.  Yet, our new owners decimated staffing, cut the number of holidays and holiday pay (50%), drove away experienced hospice workers, and acted like everything was great when customer service scores plummeted and stayed poor.

Our leaders did not communicate with us, likely for their emotional survival.  They acted like there was no damage from the ongoing series of betrayals and reductions.  A management basic is paying people fairly for hours worked and miles driven.  Leaders failed abysmally in that regard.

Disruption should not mean stealing wages and mileage reimbursement from the people you supposedly lead.  Ben Breier will atone for his actions when he faces his maker.  I expect no insights into the distorted reality he created while enriching himself at the expense of the worker.   Rupture is a word I associate with Kindred Healthcare and Ben Breier.  That he did it all intentionally shows what a sorry person he is.  

Anonymous

Deals Drive Down Kindred Employment

Strange Tony,

Kindred Healthcare had 2,100 employees in Louisville, Kentucky in December 2017 when it announced its deal with Humana and two financial rapscallions to carve up the company.  Buyers said it would be unlikely that the local workforce would be impacted. 

As of December 2020 Kindred Healthcare had 1,185 employees in the Louisville area, a 44% reduction.  That's the portion of the company Humana did not buy.  

Oddly, there is no employment data for Kindred at Home in Louisville, Atlanta (Gentiva) or Mooresville (Curo Healthcare).  Humana reported an increase of 40,000 employees after buying out its KAH rapscallion partners.  That number should be at the top of any employment list.  It is missing.  

Our local Kindred Hospice experienced a 40% headcount reduction after Humana et al bought us.  That made Kindred at Home CEO David Causby's holdings far more valuable.   Yes, he profited handsomely from screwing over employees.

We are for sale again.  I don't think we can survive another greedy owner that partners with self-dealing executives.  Employees lose again.

Anonymous

Humana Drives Away Medicare Advantage, TPG Going Public

Strange Tony,

Our hospice waits for Humana to decide the method it plans to use to ditch us for a huge chunk of change (yet again).  Humana's stock is taking a beating today, down $80 per share due to Medicare Advantage enrollees dumping Humana coverage during Medicare's recent open enrollment period.  

For 2021, most Humana MA members will also have access to Go365, the insurer's health and wellness program that rewards users for improving their healthy behaviors.

Extrinsic rewards often demotivate people, the exact opposite of their intention.  Did that contribute to people switching away from Humana MA plans?

Eligible MA members will also have access to Humana at Home, a program in which they will be provided with a personal care manager who will reach out regularly with education and assistance in accessing resources to assist with medication, transportation and other needs.

How many of those who left Humana had the same personal care manager for the whole year?  Turnover in that position could motivate those with coverage to leave.  

Hopefully CEO Bruce Broussard will explain why so many insureds walked away from Humana's offerings in his upcoming earnings call.  A little color on that would be helpful.

TPG Capital, our former 30% owner, plans to go public.  Financial rapscallion founders will make billions from their equity stakes in the company, but that isn't near enough.

TPG's top dealmakers will force the buyout firm to pay them the cash value of tax savings it expects to receive, currently estimated to be worth $1.44 billion, in the years following its initial public offering (IPO)

These obscenely wealthy individuals pay taxes at a lesser rate thanks to the U.S. Congress.

Congress never passed into law proposed legislation that would have taxed payments made through tax receivable agreements as ordinary income. 

I know how TPG and Humana harmed our hospice after buying Kindred at Home in July 2018.   Our owners were quite skilled in driving away talented, dedicated hospice employees.  It is not surprising they did so with their customers as well.

Anonymous