Louisiana Home Care Providers,

      I participated in a state emergency preparedness call this morning. Tropical storm force winds have arrived at the mouth of the Mississippi River and will be reaching those of us in the path of Isaac over the coming hours. You have all been busy preparing patients and their families, your staff and their families, and many of you are involved in preparing your own communities’ response teams related to the storm. DHH and the Office of Emergency Preparedness are well orchestrated and prepared to handle the challenges ahead.

     A few items were mentioned this morning related to post storm issues deserve repeating.

Home Oxygen dependent patients- Many of these folks will panic after the storm, particularly if power is out. Beware and prepare to assist them as much as possible to address this need.  

Home Ventilator dependent patients- The state is surprised that so few of these patients have requested assistance. Many have generators and feel secure but after the storm the availability of fuel may become an issue. Be prepared for that.

Length of Storm Duration- This storm is slow moving and will be over the state for perhaps three full days. This will result in more trees down, flooding, power outages, etc.

Fuel Shortages –Past storms have taught us that fuel will be in short supply, and power outages will impact gas stations’ ability to serve customers. Prepare accordingly.

Permission to Reenter Effected Areas – Connect with your Office of Emergency Preparedness now, before the storm hits, to make them aware that your home health nurses are often the first to get to patients after the storm. Find out if the nurses will need special identification, letters from the OEP office, or just their home health IDs to let them back into communities to check on patients.

    One last item is that communications are always a challenge post hurricanes. You will all recall that text messaging was the most reliable form of communication after Katrina. The office here in Lafayette will be closing to allow our staff to prepare their own homes and families for the storm. I will continue to be online checking email, participating in twice daily calls with the state’s emergency center, and responding to you in the event a need arises with which we might assist. You have all of my contact information below, except my cell number. Feel free to use that should the need arise. It is 337-380-4545. My home number is 337-406-8080. Thank you. Let’s prepare for the worst and pray for the best.

Home Health Colleagues,

       Hurricane Isaac convinced many of you to initiate your preparedness plans this past Friday, some over the weekend, and more of you on this very eventful Monday morning. The map below, updating the path of Isaac as of 10 AM CDT Monday, speaks for itself.  Evacuation orders have been issued by many parishes in low lying areas, outside of the levee systems.  Governor Jindal’s press conference yesterday recommended voluntary evacuation for other coastal residents.  Agencies began notifying those patients and their families to initiate their preparedness plans as early as Friday afternoon.

     The front edge of the storm is predicted to make landfall Tuesday AM with the center of the storm predicted to move ashore near the mouth of the Mississippi River around 8 PM on Tuesday. Most of us are aware that past storm models that have shown this track creates another dangerous scenario for New Orleans and coastal parishes. Current storm surge predictions are anticipated to reach up to 12 feet, potentially life threatening in low lying areas.

      Hurricane Katrina showed the vulnerability of those over 65 years of age. Provider plans include identification of patients who require assistance with evacuation. Home health agency personnel should have those lists updated and already sent to Parish Offices of Emergency Preparedness. Many providers have placed arm bands on patients, similar to those used in hospitals, with information related to the agency contacts in the event that they must be evacuated.  Remember that text messaging was the most dependable form of communication after Katrina. Phones were down, accessing email was difficult, but texting worked well. Also recall that home care providers had a difficult time accessing gasoline after Katrina. Plan accordingly. More information can be found in HCLA’s Emergency Preparedness Handbook online.

    Contact us at HCLA if we can be of assistance. As Hurricane Isaac approaches, below are some useful links for you, your family, and associates:

State of Emergency Declaration <http://r20.rs6.net/tn.jsp?e=0016AUCY2d93c5_7tmeWwpKcsW84_aoKR9Uapee32igxYnESLiwsoQUbPKnX2pEPJfWXktXOAtNwntrSAEN-qWvxdZqjVgaxl2QqbYmoE-Ls6pAdsxqXgue56A7hXb3Jw_GHI99Pb2X0HkKcvyGpkJ-VTQ6BJI0bNc1CK24wgMOvtroWzGV9titi1SlY7l1bSL5ojpoKngGjBI=> 

Governor’s Office of Emergency Preparedness www.gohsep.la.gov <http://r20.rs6.net/tn.jsp?e=0016AUCY2d93c4bpu2zFeZJElq81C13ubiws-mnxdqxUmlEXPR_3Hj7IlKOoJig8Y86xAirV2ADOHNO40P5mO34xRv6hp_mXPrMTr9j7YJN2njYGX7ECBFybg==>  

Louisiana Department of Insurance www.ldi.state.la.us <http://r20.rs6.net/tn.jsp?e=0016AUCY2d93c78ORMOzFHsL4RY0TspGktxDStClScRn0tSmRZ4PxdDr9KVuM_HAFihN3NfGkRZ5-fkP138neZEMp5tGZWSLnmaqMd9Dwq7Q5RP9bmZhE-deA==> 

National Weather Service www.weather.gov

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Warren Hebert, RN, CAE

RWJF Executive Nurse Fellow ’06-’09

Chief Executive Officer

Kindred Announces Agreement to Acquire Integra Holdings

      Discussions about the future have certainly included mergers and acquisitions within the current home care provider community. We also know there might be players who have not previously been in the home health arena seizing the opportunity present with ACOs, post-acute bundling, value based purchasing and other future programs aimed at reducing costs by achieving economies of scale. An example of that scenario item played out today as the article from the 4 Traders website illustrates.

     Kindred Healthcare has been in the post-acute market with LTACs, IRFs, and sub-acute units, but according to the story has not been in home care. Their acquisition of IntegraCare is an indication of a change in strategy. We will likely have the more predictable acquisitions of providers by large home care companies, hospitals being more active in home health, and mergers of large and small home care companies. But we will also see other entities, healthcare and perhaps those who have not been in our arena, seeking to acquire quality home health providers. This approach may assist them in removing barriers and silos that currently exist in our space allowing for a more efficient and effective operation in the post-acute part of the healthcare continuum. So we now have another variable to add for our strategic forethought. You can click on the title hyperlink or ‘the article’ to get the full story. But here are the first two paragraphs to give you a teaser.

       “Today, Kindred Healthcare, Inc. (NYSE:KND) announced it signed a definitive agreement to acquire IntegraCare Holdings, Inc. (“IntegraCare”), a portfolio company of private equity firm Flexpoint Ford, LLC, for a purchase price of $71 million in cash plus a potential $4 million cash earn out based on 2013 earnings. The Company expects to finance the transaction with operating cash flows and proceeds from its revolving credit facility. IntegraCare will have no outstanding long-term debt at closing.

IntegraCare is a high-quality provider of home health, hospice and community services which operates 47 locations across Texas. IntegraCare currently generates annualized revenues of approximately $71 million and earnings before interest, income taxes, depreciation and amortization of approximately $9 million. The Company expects to achieve annualized synergies of approximately $1.5 million once the integration of IntegraCare is fully completed in 2013. Kindred currently operates three nursing and rehabilitation centers, nine long-term acute care (“LTAC”) hospitals, three inpatient rehabilitation facilities (“IRFs”) and one hospital-based sub-acute unit within IntegraCare’s existing service areas and the transaction will provide a platform for organic expansion into additional markets throughout the south including the Houston market where Kindred has a large market presence.

Warren Hebert, RN, CAE

RWJF Executive Nurse Fellow ’06-’09

Chief Executive Officer