1. Resident Directed Living Choice Dining Development STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION Resident Directed Living © Choice Dining Development STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION Execution – Evaluation – Measure – Adjust - Apply Teaching - Aligning Experiences - Expectations – Resources – Outcomes Spring Conference Helena, MT March 17, 2011

2. Agenda Program evolutions Execute Evaluate Measure 3/17/20112

3. "For every complex, difficult problem, There is a simple solution. And, it is probably wrong!" H.L. Mencken 3/17/2011 Slide 3 MHA Spring Conference

4. Environment & Constituencies Fiscal landscape transformation Emergence of non-traditional models Regulatory transition & interpretive inconsistency Deliberate seeking for “better” Competition Silver Tsunami Diversity of constituents and locations Expand servable constituencies 3/17/20114

5. Changing Demographics More Couples More Choice & Selection More Control More Flexibility Experience Consumers More Knowledgeable of CCRC Living Healthier – Wellness Important Seamless Experience Broader Constituencies 3/17/20115

6. Assumptions Thoughtful Culture & Service Change to Liberate Community Culture Envision the Future, Honor the Tradition Imposition of Dining Until the Dining Experience is Resident Directed, New Culture will not Take Deep Root What is Current Does Not Work As Well As It Can & Should 3/17/20116

7. Slide 7 Insanity – to continue to do the same things and expect different outcomes To liberate the culture of the community, it is increasingly clear that we need to change the environment, practices and service model of caring for and with residents. What we have been doing is not as effective as necessary or possible. 3/17/2011

8. MHA Spring Conference Slide 8 Self Directed Culture Residents, Leadership, Care Teams  Initiatives Must Contribute to Strategic Objectives  Choice Is The Vision for Community Dining Experience  What Is History of “Transformation” Projects?  What Were Expectations  How Defined and Structured  How was it trained & accepted?  Creating a Collaborative Evolution Process  Dining as the catalyst 3/17/2011

9. Resident Directed Living The core of RDL is the opportunity to exercise choice – residents’ for how they choose to live their day and staff choice for care delivery. This creates a collaborative coalition of residents and caregivers working together in a living environment. RDL facilitates the delivery of care, the experience of living and the dignity of self-determination. RDL is a management principle that aligns the natural rhythms of residents and the support they need. The organizing principle of RDL is that people should be able to make meaningful choices in their daily lives – on their own or with assistance. RDL relies on caregivers to help define and achieve outcomes that balance individual choice and system efficiency. 3/17/20119

10. Planning The only way to avoid mistakes is to gain experience. The only way to gain experience is to make mistakes. 3/17/201110

11. Planning Discovery Recommend Execute Evaluate Words to initiatives Consciously apply protocols Honest 3/17/201111

12. 3/17/2011 Slide 12 MHA Spring Conference

13. Assessment Points for RDL Implementation Stages are defined against the requirements of: Administration: fiscal, management and leadership considerations Regulatory: compliance criteria (grouped by clinical and operational considerations) Systems: software programs, forms, policy & procedures, protocols Personnel: staffing requirements, training, HR. The impact on each care disciplines is identified by department PP&E: Property, Plant & Equipment necessary to perform the tasks and functions Community: Communications, Resident & Family education; community collaboration 3/17/201113

14. Program Grid Strategic Objectives Community of Distinction Financial Enhancement Quality of Living Quality of Work Operational Effectiveness Step #1 Strategic Objective Benefit Step #2 Benefit Measure Measurement Tool Step #3AdministrationRegulatoryOperationsPersonnelPP&ECommunity Operational Resource Requirements Budget Impact $/FTE’s Slide 14 MHA Spring Conference

15. Program Grid Strategic Objectives Community of Distinction Financial Enhancement Quality of Living Quality of Work Operational Effectiveness Step #4 Collaborating Departments Nursing Resident Services TherapiesPastoralHousekeepingMaintenanceActivities Task Step #5 Task Implementation Nursing Resident Services TherapiesPastoralHousekeepingMaintenanceActivities Procedure Policy Resource Requirement Inform/Train Measure Slide 15 MHA Spring Conference

16. 3/17/2011 Slide 16 MHA Spring Conference

17. 3/17/2011 Slide 17 MHA Spring Conference

18. Alignment The appropriate positioning of systems and resources to attain a defined goal, mission, outcome or culture 3/17/201118

19. 3/17/2011 Slide 19 MHA Spring Conference

20. Execute Develop Implement Engage 3/17/201120

21. Evaluate Measures / KPI’s Analysis Adjust Re-apply Evaluate 3/17/201121

22. MHA Spring Conference Slide 22 The ROI Of A Dining Experience Dining establishes the daily quality of life for all members of a senior living community. The culture defined by the dining experience resonates with and dictates that of the entire community. The dignity and joy of making self-determined choices are at the core of any good dining experience. BAD DINING EXPERIENCE GOOD DINING EXPERIENCE High Staff Turn-Over/Contract Labor = High Costs & Poor Morale/Service High Staff Retention = Lower Labor Costs High Food Waste/Use of Supplements = High Food Cost Low Food Waste/Elimination of Supplements = Lower Food Costs Low Appetite/Unanticipated Weight Loss = High Care Costs Healthy Appetite = Lower Care Costs Poor Image = Higher Marketing Costs and Lower Income Great Dining Program = Lower Conversion Costs & Higher Occupancy

23. Key Performance Indicators Dashboard driven compliance leadership KPI’s developed from the recommendation process while mapping Best Practices Regulatory requirements Case/care management 3/17/201123

24. Impacts Team revised words – new vocabulary Team defined initiatives – new direction Team defined process – new means Project management – new process Resident Directed Care – new paradigm 3/17/201124

25. "The significant problems we face today cannot be solved at the same level of thinking we were at when we created them." Albert Einstein Slide 25 3/17/2011