Carnage at Our Hospice: One Year After Buyout

Strange Tony,

Our hospice is unrecognizable on the one year anniversary of our latest buyout.  We went from time efficient technology that met Medicare regulations to garbage in-garbage out Homecare Homebase.

An important element of Healthcare Services also is Kindred, and it's important that we invest in Kindred for the long term. And so for example, implementing Homecare Homebase, while an expense for 2019, it's a decision that the Kindred board made recently because we thought it would position us better for the future and enable us, as Humana, to attain the clinical outcomes and the clinical measures that we're striving to do.  So we thought that was a smart investment to make.--Humana CFO Brian Kane

Additionally, Kindred at Home has selected Homecare Homebase as the electronic medical record and practice management system for both home health and hospice. And we’ll begin implementing this system in 2019. This will accelerate our ability to proactively identify key clinical interventions while improving revenue capture and business and quality reporting.--Humana CEO Bruce Broussard

Humana made an investment in Homecare Homebase as part of its big data, artificial intelligence plans.  Who knew big data and AI were a euphemism for not paying employees for hours worked and miles driven?

On the clinical side Homecare Homebase is a time eater for nurses who say the system does a poor job of documenting decline and how the patient continues to meet hospice eligibility.  The system can't do anything without orders and scheduling.  Home health is scheduled.  Hospice happens.

Few experienced hospice nurses remain.  Some recall Kindred's effort to predict a patient's decline and death.  The predictive service index score was so inaccurate clinicians stopped looking at it.  On-call staff laughed at it and said, "that number is worthless." 

Who trashed our hospice?  It's been a group effort led by financial rapscallions who own 60% of our company and Humana, which owns the other 40%.  Kindred at Home executives will have a lottery level payday when Humana acquires the other 60%.

Kindred at Home President David Causby and Hospice President Larry Graham foisted Curo's bad technology and miserly staffing models on our once great hospice.  This wobbly platform harmed customer service levels.  Dedicated hospice professionals could not get the attention of anyone in the company.  Their issues and concerns went unheard despite repeated requests. 

Humana considers the home a whole new ecosystem, a distribution platform that no other insurer has today.  Kindred at Home provides the opportunity for Humana to bring integrated technology into the home.  Humana plans to use big data/AI to personalize care for those it insures.  I don't believe it after seeing how executives used our hospice data.

Data showed an employee drove too much, therefore management cut the mileage reimbursement rate (lower than the rate paid to other employees) as an incentive for the high mileage employee to pay Kindred at Home for a company car.  Translation:  The company (which gave patient assignments) no longer wanted to pay staff mileage to drive to fulfill those assignments.

Data showed our hospice had too much square footage, too many computers, too many phones, too many parking spaces and too many bathrooms.  The aforementioned areas were cut 50 to 75%.  They did add cameras to spy on the few employees left.

Data showed it cheaper to take away company provided cell phones so employees could pick up and pay for that personal expense (over $800 pay cut in my case).  Staff who desire a clear boundary between work and personal phones are unreasonable and not team players.  Company apps for employee personal phones have tracking/monitoring capabilities.

Humana's data mining has proven harmful and offensive to Kindred at Home employees.  If someone wants to personalize my care then talk to me.  Ask me about my dreams, my desires, my gifts, my faith and my heart. 

Data mining already produced impersonal decisions that benefit our greedy owners.  Heartless artificial intelligence will reduce hospice headcount past the point of no return.  When that happens, when the Kindred/Curo combination becomes the least preferred hospice provider, God will strike Broussard, Kane, Causby, Graham and our 60% owners where it hurts the most, in their pocketbooks.

Recall that as a 40% owner in a highly leveraged business in Kindred, there's a lot of debt impacts there that get consolidated below the EBITDA line.-- Humana CFO Bryan Kane

Retribution will come for the harm executives have done to our once great hospice.  They are responsible for the deep drop in customer care and destroying teamwork at our site.  It may be in this life or when executives meet their maker. They will atone for their grievous sins.

Anonymous

Moody's Reveals KAH Executive Selfish Greed

Strange Tony,

Moody's issued an update to its rating of Gentiva (Kindred at Home) debt.  It noted improvements from a financial standpoint that lessens investor worry for holding Gentiva debt. 

Moody's Investors Service ("Moody's") upgraded Gentiva Health Services, Inc.'s (dba Kindred at Home, or KAH) Corporate Family Rating (CFR) to B1 from B2

While Gentiva's debt rating improved it is still considered junk.  Kindred at Home plans to spend $487 million to replace $475 of second lien term loan.  Financial rapscallions charge deal fees for such debt exchanges.  It's one of the ways they rob funds from companies they own.

The upgrade of the CFR follows the successful separation from Kindred Healthcare, Inc. and merger with Curo Health Services, LLC in July 2018. KAH has performed well since completing these transactions, and is ahead of plan with respect to realizing benefits of cost saving initiatives. As a result, the company has deleveraged meaningfully over the last year and generated over $100 million of free cash flow since the separation. Additionally, the proposed refinancing transaction will modestly reduce leverage and result in about $18 million in annual interest expense savings. 

My hospice coworkers helped generate Kindred at Home's over $100 million of free cash flow since July 2, 2018.  $77 million of KAH cash will be used to give WCAS and TPG Capital another payday (more deal fees).

A hospice coworker informed me that her first raise in years was a mere 12 cents.  That's a wage increase of $249.60 per year before taxes.  I know how hard she works and the love she shares with patients.

Kindred at Home offers a miserly 1% retirement benefit according to Fidelity.  It's 401(k) match declined under Gentiva from 3%.

This decrease prepared us for Humana's cutting two holidays for 2019 and reducing holiday pay.   It's clear none to a mere pittance of the $18 million in interest expense savings will go to employees.

Earnings before Interest, Taxes, Depreciation and Amortization (EBITDA) soared over the last twelve months according to Moody's.

Moody's recognizes that adjusted debt/EBITDA has declined from 7.5x at the time of the separation transaction, to 6.3x for the twelve months ended 3/31/2019. Moody's believes that adjusted debt/EBITDA will decline to the mid-5.0x range by the end of 2019.

Gentiva/KAHDebt did not change during the period.  That means EBITDA soared 19%.  Moody's understands income statements and balance sheets but has no clue when company cuts turn into poor care and bad customer service, eventually eroding revenue.

The stable outlook reflects Moody's view that the company will continue to de-lever as it realizes continued cost saving benefits, while maintaining very good liquidity and solid growth. 

Moody's also does not know when company technology robs employees of pay for hours worked and miles driven.  Homecare Homebase is complex and cumbersome on the clinical side but even worse for payroll and expense reimbursement.  Fellow employees were shorted pay and mileage during the period cited by Moody's.  Management and corporate have ignored employee concerns.  It's called wage theft.

Moody's expects Gentiva/Kindred at Home to have "organic revenue growth and further realization of cost savings."  I believe cost savings have harmed customer service and further cuts will harm revenue at our hospice site.  Customer service is already far below our historical standards.  How far will our hospice shrink to fund a giant executive payday (based on a multiple of EBITDA)? 

Shrink, Shrank, Shrunk.

Anonymous (from KAH/Gentiva with its unstable, greedy executives, clearly unwilling to share)

Executive Fireside Chat: Hot Air

Strange Tony,

Kindred at Home CEO David Causby and Hospice President Larry Graham spoke to employees via audio.  I asked my hospice co-workers about the company update.  They said:

• It had no meat, no substance.  It sounded like a political speech
• They talked about how great things are going and how management is doing great
• There was nothing for me in their talk
• The talk of excellence and making a great company is nonsense, given what they've done to our hospice, harming our service levels and quality of care

CEO David Causby said he achieved very strong financial results for the company by growing ADC (average daily census) and instituting very strong cost controls.

I believe my coworkers busted their backsides to serve our hospice patients while severely handicapped by a garbage-in/garbage-out Homecare Homebase (HCHB) and Curo's unreliable technology.  We waived goodbye to five co-workers who'd worked hard to serve our patients.  Local management promised merit raises during Q1 but they never arrived.

Causby talked about spreading the Homecare Homebase virus throughout the company.  It is infecting 15 home health sites with plans to make it epidemic at all 360 home health locations.  Causby said it would help with administrative and clinical operations.  Somehow he believes it will help with employee retention and recruitment.

Hospice President Larry Graham is of the same delusion.  He stated HCHB would "enhance the work-life balance of clinical staff and lead the industry in compliance and clinical excellence.

A nurse case manager in Florida wrote this on Indeed three days ago.  "The charting will take over your life. You spend all day in the field seeing patients then have to go home and spend hours charting. There was no real training on the documentation either, you just learn as you go. Every form requires an additional form which ultimately requires an addendum.. it’s never ending. On your days off you are expected to catch up on charting and are getting phone calls, texts and emails. It’s non stop." 

Two days ago a North Carolina nurse wrote about her Kindred at Home employment.  "NO ONE tells you that you will work from home the moment you get home until you fall asleep charting, wake up and chart more. There is no work life balance."

CEO Causby touched on benefits, that have only deteriorated under his watch, and our long promised merit raises.  The company administered a benefit survey that asked about benefit trade offs and possible new benefits, most of which were nonsense, like maid or handyman.  

Hospice President Larry Graham mentioned "enhanced benefits" in his talk but those words made no sense to my hospice coworkers.  In the real world Causby and Graham took away our Employee Appreciation Day and Floating holiday for 2019.  

David Causby said he wanted to "improve the benefit structure for all of our employees."  If Causby, Graham, Humana CEO Bruce Broussard and our 60% financial rapscallion owners meant that then employees would have equity stakes in Kindred at Home and something other than a pittance for a retirement match.  These executives are well aware of Kindred's miserly benefits package vs. Humana's.    

Long promised merit raises remain a distant vision.  Causby said executives are "looking at salary structure and plan to address merits in upcoming months for our company."  Apparently raises remain under the vise grip  of strong cost controls.

Graham dangled a golden future with Humana as our employer where executives would go above and beyond for patients and staff.  Through redesigning for excellence opportunities will be created for employees.

Causby tempered Graham's lofty future by informing us executives did the heavy lifting in standing up our company up over the last ten months.  He noted this transitional year had the company fully implementing HCHB in hospice which caused "a lot of stressful times."  Causby said "hopefully there will be more opportunities within the organization for individuals to grow, but it wouldn't be right of me to say this is not going to be a bumpy year.  I hope all of you can stay with us as go through this transition."  Causby and Graham bumped five co-workers out the door via the Curo model.

Causby said Kindred at Home is a good company that wants to be great.  "It starts with employees, feedback to us and how we can get better."  Here's one answer.  It starts with real relationship. 
Quit bullshitting us.

Anonymous

Humana Execs Toy with Kindred

Strange Tony.

Humana hosted its Q1 earnings call last week.  Humana President Bruce Broussard did not mention Kindred at Home directly in his opening remarks but CFO Brian Kane did.

Healthcare Services is performing in line with expectations, and our adjusted EBITDA guidance remains unchanged for the full year at $1 billion to $1.05 billion. Our home business, including both Kindred at Home and Humana At Home, is outperforming our initial expectations primarily reflecting higher-than-anticipated volume and increased deal synergies relative to expectations.

My hospice coworkers helped deliver those higher than expected volumes and we directly bore the brunt of increased deal synergies with the loss of experienced staff.

As it relates to Healthcare Services, we are seeing really nice performance in our Kindred business, in our Humana At Home businesses. Homecare Homebase is being implemented. That's going well. We're committed to getting on Homecare Homebase. That's one of the investments, as you point out, that we made this year. We think that will create a better clinical model ultimately for us as we continue to integrate with Humana. 

Homecare Homebase has made delivering higher volumes problematic with its overly complex, home health oriented clinical side.  It's business operations side made it difficult for employees to be paid for the full amount of time they work and miles they drive.  

Kindred at Home Hospice President Larry Graham told employees they rolled out Homecare Homebase "to enhance the work-life balance of clinical staff and lead the industry in compliance and clinical excellence."

Enhanced work-life balance means staff are free to document from home and not be paid for it.  The only place for nurses to document continued hospice eligibility is in the narrative.  Some nurses added a qualifier to address Homecare Homebase's garbage in-garbage out clinical rabbit trails.

Humana made $39 million in Q1 from its complex holdings in Kindred at Home.  My hospice coworkers received nothing from executives for their efforts.  President David Causby has long advocated not giving employees raises and turning a tin ear to their voices.

Hospice President Larry Graham knows his customer is Humana and its financial rapscallion partners.  Since its founding Curo has been owned by financial rapscallions.

Here's how Causby and Graham have impacted a key work-life measure, whether an employee would recommend their employer to a friend.  Less than half of Kindred/Curo employees would recommend a friend work for the company.  That's a stinging management rebuke.

Humana President Bruce Broussard did address Kindred with one Wall Street analyst.  

We have invested in Kindred based on a reimbursement change that would have some impact on lowering the impact from a therapy. But in addition, we see a great opportunity in being able to assist us in what our core business, and that is really driving down the cost of care through preventing hospital admissions.

Kindred at Home is a toy for Humana executives and Kindred at Home's abysmal duo, David Causby and Larry Graham.  As a result my hospice co-workers have much to bear.

Anonymous

We Can Give the Heart of Hospice Away

StrangeTony,

My heart grieves for the way my hospice coworkers have turned on their brethren after the Humana buyout.  Not long ago we stood united against sick, unethical management.  When management attacked we would surround a coworker with support and encouragement.  That has changed.

Fear set in after five coworkers received pink slips.  Longtime employees must believe the favor they curry with ignorant, arrogant managers will give them the upper hand in the next round of reductions.  It won't. 

Our management doesn't know the heart of hospice and cannot discern its beat.  But staff who've lived it, some for decades, know. 

Former hospice disciples turned Judas against dedicated coworkers.  Those who once surrounded peers in support have jointed management jackals in taunting "the weak." 

Management's insider club offers cruel words and dismissive jokes to the scorned. Mean Girls Management can't take the heart of hospice from us.  But we can give it away and I'm afraid that is happening. 

This is my prayer at this time:

Lord, protect us from evil imposed by those pretending to lead us to greener pastures.  Soften all of our hearts so that we may appreciate one another.  Provide us a mirror so we can see what is in our eyes, in our hearts when we speak ill of the other.  Even the scales so all people can be seen for the good they do, not just the favored few.

Lord, show our leaders that the pasture is for all, not an exclusive reward for being in authority.  Catch the victims of management cruelty should they plummet.  Hold them closely in your palm so they may rest and be renewed in mind, body and spirit.  Guide them to the next opportunity to do your will in this difficult world. In Christ's name we pray.  Amen

Wishing the peace that passeth all understanding to you and yours,

Anonymous

Stand Against Management's Selfish Wind

Anonymous,

I retired from hospice at the right time.  Corporate toxicity was bad enough my last several years.  The poem below gave me solace during stressful times caused by executive whimsy, mendacity and greed.  I share it with you in the hope it serves as a balm.

The Oak Tree
by Johnny Ray Ryder Jr

A mighty wind blew night and day
It stole the oak tree's leaves away
Then snapped its boughs and pulled its bark
Until the oak was tired and stark
But still the oak tree held its ground
While other trees fell all around
The weary wind gave up and spoke.
How can you still be standing Oak?
The oak tree said, I know that you
Can break each branch of mine in two
Carry every leaf away
Shake my limbs, and make me sway
But I have roots stretched in the earth
Growing stronger since my birth
You'll never touch them, for you see
They are the deepest part of me
Until today, I wasn't sure
Of just how much I could endure
But now I've found, with thanks to you
I'm stronger than I ever knew

Distorted executive priorities and inhumane behavior are the damaging wind which feels unceasing.  Sick leadership eventually collapses from the unnecessary weight it imposes on others.  Stand strong until that day.  Listen for the voice of God for his peace and mercy are always available.  Rest in his palm when the burdens seem too great.

Strange Tony

Margin Matters Over Customer Service

Strange Tony,

Customer service at our hospice continues to deteriorate.  Regional VP's and local management are well aware of the numerous ways our care is coming up short.  Their response is not the corporate tagline, "Our Care Matters."  Bone cutting staffing models, garbage-in/garbage-out technology and robust financial margins are more important.  To their credit our hospice staff have hung in there thus far.

Humana, despite making the home one of its top five strategies, considers Kindred at Home a management distraction.  While they don't care enough to pay attention our hospice is breaking under the weight of layers of aloof and disturbing management.

Cracks are growing in the dike.  I'm not sure how much longer staff can hold back the abusive tide.  Humana/Curo's cookie cutter mantra is growth.  Our hospice is to grow by shrinking. Staff, holidays, health care coverage and mileage reimbursement are all smaller.  What will the company shrink next?  Kindred at Home is synonymous with widespread management malpractice.  The chaos continues.

Anonymous