Rising Storm in LTC How to Prepare for the Worst

Economic Squeeze Resource Shortage Workload Pressure Union Attack Government Interference

Economic Squeeze Medicaid/Medicare catastrophe Labor Costs & Turnover Access to Funding

Medicaid/Medicare Economic Squeeze

Economic Squeeze Medicaid/Medicare

Labor Costs: 70% Turnover rates: 40% - 166% CNA Turnover: 70% Costs: 25% of annual compensation Labor & Turnover Costs Economic Squeeze

Access to Funding Economic Squeeze

Resource Shortage Aging of America High-Growth Market Fewer Trained Workers Hospital Releases

Aging of America : 35 million 2010: 40 million 2020: 55 million 2030: 72 million 6.5% 65+ in residential care Resource Shortage Population Over Age 65 (in Millions)

High Growth Market Direct Care Workers 2 nd Largest Occupational Group New Job Growth: 1.Registered Nurses 9.Nursing Aides, Orderlies & Attendants Community Care Facilities: up 31% Nursing Care Facilities: up 28% Resource Shortage

1,113,000 needed 850,736 available Resource Shortage Fewer Workers NeededAvailable

Hospital Releases Resource Shortage

Workload Pressure Higher Acuity Staffing Litigation Pressure

Higher Acuity Diabetes Deaths in Nursing Homes Alzheimers ADL Dependence Workload Pressure

Staffing Shortage Workload Pressure

Litigation Workload Pressure

Union Attack Survival Requires Growth Markets Targeted Campaigns Political Influence

Growth Markets Union Attack

Targeted Campaigns Union Attack

Political Influence Union Attack

Government Regulation Specialty Healthcare DOL/OLMS Rule Changes NLRB Rule Changes

Specialty Healthcare Rehabilitation Center of Mobile Government Regulation

DOL/OLMS Persuader “Advice” Exemption Government Regulation June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) Persuader activities include drafting, revising or providing: 1.Materials for presentation, dissemination, distribution to employees 2.Speeches 3.Audiovisual, multimedia presentation 4.Website content 5.Planning, conducting one-on-one or group meetings 6.Employee attitude surveys concerning union awareness, sympathy or “proneness” Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406) Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406)

DOL/OLMS Persuader “Advice” Exemption Government Regulation June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) June 21, 2011 Notice of Proposed Rulemaking: The New Rules (proposed) Persuader activities include drafting, revising or providing: 7.Training supervisors to conduct meetings 8.Coordination or directing activities of supervisors 9.Establishing or facilitating employee committees 10.Developing personnel policies 11.Deciding which employees to target for persuader activity or disciplinary action 12.Conducting a seminar for supervisors 13.Other (must explain) Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406) Proposed Rulemaking Not a final rule 90 days to comment In effect after comment period Comment by web (regulations.gov), hand- delivery or by mail Reference 1215-AB79 and 1245-AA03 (29 C.F.R. Parts 405 and 406)

Watch Webinar and Get Other Resources Here: Comments Due September 21, 2011 DOL/OLMS Persuader “Advice” Exemption Government Regulation

NLRB “Quickie” Elections Rule Government Regulation Hearing suspended to post- election if issues effect less than 20% of unit Statement of Position Form (all future litigation limited to statement of position) Eliminate day waiting period to allow review of Regional Director decisions Provide voter phone numbers, , shift & departments within 2 days of direction of election (and immediately to Board) Key Changes

NLRB “Quickie” Elections Rule Government Regulation Key Changes Election can be held within 10 days of transmission of eligibility list (or earlier if union agrees) Use of electronic signatures to support a showing of interest Election Notices required (electronic posting required where possible) Review all individual voter eligibility issues post- election

NLRB “Quickie” Elections Rule Government Regulation Watch Webinar and Get Other Resources Here: elections Comments Due August 22, 2011

What Do I Do Now? Comment Political outreach Proactive ER Government Regulation

BOOM Right of BOOM Left of BOOM Situation Assessment Counter-Campaign Strategy Alert Legal, Consulting, Jump Team Vulnerability Assessment Positive ER, Engagement Hiring/Onboarding Tripwire Team Left of Boom

Frontline Focus

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