Inspire Daily Serve With Compassion Advocate Together

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1 2012 Fall Conference Fall Conference & Awards October 8-9, 2012 Marriott East, Indianapolis

2 2 Conference Welcome Dear Friend, Our conference theme this year has been Inspire, Serve, and Advocate. These are attributes that define those who are in our profession this is what you do every day! Our Fall Conference has been planned to further develop and refine these attributes for the attendees. The wide range of session topics follow five tracks: Administration, Clinical, Transitions of Care, Hospice, and Assisted Living. These will be coupled with outstanding opening and closing speakers who will inform, inspire, and motivate. One of the beautiful aspects of our profession is the camaraderie and leadership that our members embody. Our conferences are designed to provide many opportunities for you to catch up with old friends, make new ones, and share what has been successful for you. So join us for this wonderful opportunity for renewal, learning and sharing. Regards, Jim Leich Jim Leich, President/CEO LeadingAge Indiana conference schedule Time Assisted Living 1A Hospice 1B Administration 1C Clinical 1D Transitions 1E CEUs Monday, October 8, :45-9:00 AM Registration & Continental Breakfast 9:00-10:15 AM Opening Session 1.25 CEUs 10:30-11:45 AM 1A 1B 1C 1D 1E 1.25 CEUs 11:45 AM - 1:15 PM LeadingAge Indiana Awards Lunch 11:45 AM - 1:15 PM INALA Awards Lunch & Annual Business Meeting 1:30-2:45 PM 2A 2B 2C 2D 2E 1.25 CEUs 3:00-4:30 PM 3A 3B 3C 3D 3E 1.5 CEUs 4:30-6:30 PM Networking Reception Tuesday, October 9, :30-8:45 AM LeadingAge Indiana Business Meeting & Breakfast.5 CEUs 9:00-10:00 AM 4A 4B 4C 4D 4E 1 CEU 10:15-11:15 AM 5A 5B 5C 5D 5E 1 CEU 11:30 AM - 12:45 PM Closing Session 1.25 CEUs conference welcome

3 Conference Welcome Fall Conference & Awards October 8-9, 2012 Marriott East, Indianapolis 3 conference sponsors contact us Platinum Sponsors Gold Sponsor Health Management Advisors, Inc./ Gatlin & Co. Silver Sponsors Healthcare Therapy Services, Inc. Samaritan Alliance, LLC Exhibitors Advantage Billing & Consultants, Inc. All Med Medical Supply Creative Health Solutions Healthcare Therapy Services, Inc. Hospital Purchasing Service (HPS) Lee Agency, Inc. PharMerica Proactive Medical Review & Consulting Samaritan Alliance, LLC Senior Care Pharmacy Varsity P.O. Box 68829, Indianapolis, IN P (317) F (317) Jackie Brewer, Westminster Village North, Inc. Jerry Cripps, InterDesign Mary Drews, The Towne House Retirement Community Jillian Everett, Peabody Retirement Community Deb Freeland, CliftonLarsonAllen Amanda Green, Healthcare Therapy Services, Inc. Butch Gross, Theracare, Inc. Kim Hoppe, Plante & Moran, PLLC Doug Kafoure, GuideOne Insurance Kevin Kleva, Senior Care Pharmacy Jeff Kunce, Neace Lukens Insurance & Risk Management Amanda Lobb, Calderon Textiles, Inc. LeAnn McCrum, In Touch Pharmaceuticals Amy Page, Pines Village Retirement Communities, Inc. Mark Prifogle, Grandview Pharmacy, Inc. Melissa Russell, Friends Fellowship Community, Inc. Greg Whitehead, Young at Heart Pharmacy education committee LeadingAge Indiana LeadingAge Indiana is an association representing not-for-profit services and facilities for the elderly. LeadingAge Indiana members are non-profit organizations, providing high quality health care, services and housing for over 25,000 seniors throughout Indiana. The mission of LeadingAge Indiana is to assist members to provide the highest quality of life for those they serve. Hoosier Owners and Providers for the Elderly (HOPE) advances the interests of Hoosier owned and operated providers of health care, housing, and assistance services for the elderly by: Establishing working relationships with legislators, regulators, advocates and other providers of services to the elderly; Leading in planning for the future delivery, regulatory and payment systems; Providing effective education and training programs at a reasonable cost; Providing members with timely information; Exercising fiscal responsibility in use of member dues. Indiana Assisted Living Association (INALA) The mission of INALA is to promote the interests of the Assisted Living industry in Indiana and to enhance the quality of life for the population it serves. To accomplish this, INALA is committed to providing: Information Leadership Expertise Representation Guidance Public Education Responsiveness Indiana Hospice & Palliative Care Organization (IHPCO) is the leader in end-of-life care in Indiana; celebrating over 30 years of service to terminally ill Hoosiers, their loved ones and the professionals working for them. IHPCO s mission is to educate the people of Indiana about end-of-life choices. This mission is acheived in a number of ways. about the partners

4 4 Education Sessions Keynote: Do it Well. Make it Fun. Monday, October 8 th 9:00-10:15 AM Sponsored by Grandview Pharmacy, Inc. Good enough is not really that good. Success, even in tough times, comes from showing up and doing an excellent job. It's not rocket surgery! But most people do just enough to get by and then miss the opportunities that come from doing a great job with a great attitude. This hilarious presentation addresses the common sense philosophy of Do it Well, Make it Fun. Ron shows staff and managers how to become successful by seeking excellence while at the same time making their work experience more enjoyable. By creating an organizational culture in which excellence and fun coexist, you will attract great employees, develop excellent leaders, and deliver extraordinary products and services. Ron Culberson, MSW, CSP; Do it Well. Make it Fun. 1A Finding Heroes to Help the Elderly Hiring Safe vs. Hiring Fast Monday, October 8 th 10:30-11:45 AM The key ingredients of outstanding resident care customer service and staff retention are center stage in turbulent times. In this fast paced and informative presentation, participants will look at several new ideas that can help a community hire and keep good employees that will both result in good resident care and in a safe and operation with good risk managment. It is hard to deliver outstanding long term care with short term staff. Karl Ahlrichs; Gregory & Appel Track - Assisted Living 1B Indiana Palliative Care Models Monday, October 8 th 10:30-11:45 AM The mission of the Research in Palliative and End-of-Life Communication and Training (RESPECT) Center is to build a collaborative, interdisciplinary scientific community of researchers and clinicians to work together to advance the science of communication in palliative and end-of-life care across the lifespan. Three faculty members will share what they have learned regarding Palliative Care in the community, Palliative Care in the long term care setting and Palliative Care for dementia patients and family caregivers. Greg Sachs, M.D., Greg Gramelspacher, M.D., and Kathleen Unroe, M.D., MHA; IU School of Medicine Track - Hospice 1C Managing to Be a Great (and Fun) Leader Monday, October 8 th 10:30-11:45 AM Leadership success comes from creating confidence in those you lead while creating an environment that attracts and keeps good people. In order to accomplish this success, you must manage yourself, manage the culture, and manage the people. You create confidence by what you do and how you do it. The what refers to the skills you need to do your job well. The how refers to the values or manner in which you lead. Great leaders are not only skilled but embrace values that are respected by those around them. Next, you must create a culture that attracts the right staff and supports them so they stay. You can do this by making sure there is quality in all the processes that occur and that there is an element of fun as well. A work environment that is enjoyable is one that will be more productive. Finally, a great leader must manage the workforce by recruiting the right people and then motivating and inspiring them. This leads staff to want to work rather than to feel that they have to work. Ron Culberson, MSW, CSP; Do it Well. Make it Fun. Track - Administration 1D Beyond Forgetting: Making an Impact on the Quality of Life for the Cognitively Impaired (Part I) Monday, October 8 th 10:30-11:45 AM A two part session that will focus on the overall challenge of behavioral symptoms in the cogntively impaired. Part I will focus on the why of how the disease effects the person's ability to communicate and comprehend and the process of retrogenesis and how this affects their ability to function. We will also cover therapeutic communication approaches and understanding what the messages are behind certain types of behavioral symptoms. See Session 2D for Part II of Beyond Forgetting. Debbie Carriveau; IU Health Laporte Hospital Track - Clinical

5 Education Sessions Fall Conference & Awards October 8-9, 2012 Marriott East, Indianapolis 5 1E LeadingAge Indiana Clinical Quality Report Card Pilot Study Monday, October 8 th 10:30-11:45 AM Hospitals are increasingly asking long term care providers for more clinical outcomes data as well as how long term care providers will reduce hospital readmissions. As a result, LeadingAge Indiana and Sawgrass Partners initiated a Clinical Quality Report Card (CQRC) Pilot Study in order to help members prepare for accountable care organizations and increase awareness among not-for-profit providers about the importance of measuring clinical outcomes. The LeadingAge Indiana membership CQRC Pilot Study outcomes will be reviewed and discussed during the presentation. Session attendees will gain an understanding of the long term care provider and hospital relationship as it relates to the emergence of ACOs. More importantly, attendees will learn how to market their clinical outcomes data to their local constituency in order to promote the "Not-for-profit Difference" within their primary market area. Mike Logan; Sawgrass Partners, LLC Track Transitions Special Events LeadingAge Indiana Awards Luncheon Monday, October 8 th 11:45 AM 1:15 PM Sponsored by Health Management Advisors, Inc. Join LeadingAge Indiana as we celebrate the successes of our members. This event recognizes those who make a difference on behalf of Indiana seniors. Awards to be given include Excellence in Service, Care and Volunteering. All nominees will be recognized. Come celebrate with fellow members at this highly anticipated event. INALA Awards Luncheon Monday, October 8 th 11:45 AM 1:15 PM The INALA Awards Luncheon was established to recognize and honor those people that have positively affected the lives of those being served in Assisted Living. Nominees and winners will be recognized in the following categories: Angel Award, Outstanding Community Director award, Creative Idea of the Year Award, Outstanding Marketing Director Award, Outstanding Caregiver Award, and Outstanding Food Service Director Award. We invite you to celebrate with your peers! INALA Annual Business Meeting The INALA Annual Business Meeting will be held in conjunction with the INALA Awards Luncheon at 11:45 AM. All members are invited to attend. The meeting will include Board Member elections, a review of the financial report, and a report from the board chair. 2A Veterans Benefits in Assisted Living Monday, October 8 th 1:30-2:45 PM Although the Veterans Administration Aid & Attendance pension has been widely used as a marketing tool for assisted living communities, there are a lot of misconceptions about this benefit and frustration about getting approvals. We will unravel some of these mysteries and help communities understand their limits in talking about this benefit and who can help their clients. Important changes to this benefit are coming that you'll want to know about. Carlotta Katra; Aging Avenues & Veterans Care Advocates Track - Assisted Living 2B POST-Physician Orders for Scope of Treatment How and Why Monday, October 8 th 1:30-2:45 PM Oregon was the first state to pass laws implementing POLST to improve end-of-life decision making for its residents. In this session, you will hear how POLST was eventually implemented in Oregon, what it means for EOL decision making and how Indiana is working towards passage of a similar POST bill. Susan Hickman, PhD; IU School of Nursing; Fairbanks Center for Medical Ethics Track - Hospice 2C Continuing Care In the Home Setting: Entry Into Home Health Care Monday, October 8 th 1:30-2:45 PM This presentation will explore home health care and provide an overview of services, reimbursement, market entry, certification and regulatory oversight. The session will conclude with a questions and answers period. Regina Loncaric; Plante Moran Track - Administration

6 6 Education Sessions 2D Beyond Forgetting: Making an Impact on the Quality of Life for the Cognitively Impaired (Part II) Monday, October 8 th 1:30-2:45 PM Part II will focus on the use of purposeful and therapeutic activity as a non-pharmacological intervention for behavior symptoms. Multiple demonstrated examples of things to use for specific types of behaviors will be shared. Participants will have the opportunity for handson experiences as they participate in many of the activities as a dementia individual would. There will be video of affected individuals and group work towards planning purposeful interventions for these individuals, so participants leave with a solid basis to begin implementing their own programs. See Session 1D for Part I. Debbie Carriveau; IU Health Laporte Hospital Track - Clinical 2E Bundled Payments - The Implications to Post Acute Care Monday, October 8 th 1:30-2:45 PM This session will provide an overview of the bundled payment models resulting from changes in healthcare payment reform. In addition, we will discuss how bundled payments operate in a post-acute care environment and key opportunities to create financial success in an episodic payment world. We will also discuss the implications of bundled payments to care delivery models, define how post-acute providers will be impacted and the implications to older adults. Deb Freeland; CliftonLarsonAllen LLP Track - Transitions 3A Home and Community Based Services/Waivers Monday, October 8 th 3:00-4:30 PM The setting for the delivery of care in Indiana continues to be moved out of the institution and into Home and Community Based settings. This session will discuss the state s goals and financing mechanisms available for community based care and in which locations. Participants will also learn how to tap into these programs and how they work for our residents and potential residents. Specific programs addressed include the Aged & Disabled Waiver and Money Follows the Person. Kristen LaEace; Indiana Association of Area Agencies on Aging & Susan Waschevski; Division of Aging Track - Assisted Living 3B Ethics in Hospice Monday, October 8 th 3:00-4:30 PM Many hospice organizations do not have formal ethics committees and yet face difficult dilemmas and situations in end-of-life-care. Dr. Hickman has conducted extensive research on ethical issues in EOL care. Participants will also be able to discuss experiences from their own hospice organization. Susan Hickman, PhD; IU School of Nursing; Fairbanks Center for Medical Ethics Track - Hospice 3C Claim Catastrophe Stories - Are You Covered? Monday, October 8 th 3:00-4:30 PM As an Executive Director, Administrator and Decision Maker, you wear many hats! Come to this entertaining seminar to get a better understanding of the insurance needs of your facility and how they apply to your situation. We will use some true, funny, entertaining and even scary stories of claims that have happened to facilities just like yours. These examples will help you understand the types of coverages needed. Samples of catastrophic claims that could cost you your business and livelihood will be shared as well. This session will specifically highlight Professional Liability, Property, Sexual Misconduct and Workers Compensation. Rob Schmidt; Lee Agency, Inc. Track - Administration 3D Panel Discussion: A Practical Approach to Reducing Psychotropics in Your Facility Monday, October 8 th 3:00-4:30 PM Dr. Lisa O Hara will present and moderate a panel discussion on practical approaches to reducing psychotropic medications. The panel will include a variety of practitioners that currently practice within long-term care, making their input relevant. The panel will discuss actual resident cases and what resident characteristics and medication characteristics draw them to use a specific antipsychotic, anxiolytic, mood stabilizer, antidepressant, or hypnotic. Starting, changing, reducing, and stopping psychotropic therapy will also be addressed by the panelists. Audience participation will be encouraged, making this session as realistic and rewarding as possible. Lisa O'Hara; GrandView Pharmacy Track - Clinical

7 Education Sessions Fall Conference & Awards October 8-9, 2012 Marriott East, Indianapolis 7 3E Pay for Performance - Reducing Hospital Admissions Monday, October 8 th 3:00-4:30 PM The importance of reducing hospital readmissions has been recognized by the Centers for Medicare and Medicaid Services (CMS), managed care organizations, and insurance companies, not only for quality of life, but controlling costs. Consider the facts: Almost 1/5 of Medicare beneficiaries are rehospitalized within 30 days Readmissions account for 18% of Medicare hospitalizations and $15 billion in annual Medicare spending The 30-day readmission rate in the U.S is 17.5% 70% of 30-day readmissions are for a different diagnosis than the original diagnosis. It is critical providers position themselves now as a leader in this domain, establishing a track record of minimizing hospital readmissions. This session will discuss the multi-discipline approach needed, and how to implement a program that analyzes and provides solutions to this process. Jane Belt; Plante Moran, PLLC Track Transitions Special Events Networking Reception Monday, October 8 th 4:30 6:30 PM Sponsored by: Samaritan Alliance There is no other industry where sharing among peers is more imperative! Don't miss this opportunity to enjoy an evening with old friends and maybe even some new ones. This year's reception is free for all conference attendees (Exhibitors and Associate Members/Industry Partners will be required to pay a fee) and will take place at the Marriott East. LeadingAge Indiana Annual Business Meeting & Breakfast Tuesday, October 9 th 7:30 8:45 am The Business Meeting Breakfast will be held from 7:30 to 8:00 am prior to the Business Meeting. Individual tickets may be purchased for $15 to attend the breakfast, but they must be purchased in advance when attendees preregister. There will be no tickets available at the door. take place, as well as a review of the financial and business reports, and an update on all major association initiatives. Each facility will designate one voting representative for the meeting. 4A Brand Makeover, Part I Tuesday, October 9 th 9:00-10:00 AM This session will focus on the building blocks of redefining yourself through brand development. Attendees will learn a step-by-step process to systematically clarify their branding strategy so that it resonates with their staff, board of directors and consumers. We will share examples of organizations that successfully completed this process, along with the marketing results they experienced. See session 5A for Part II. Matt Bekelja; Varsity Track - Assisted Living 4B Fraud in Hospice: Key Areas of Concern Tuesday, October 9 th 9:00-10:00 AM Hospice is an industry, like many others in the healthcare realm, that is constantly changing in regulatory, operational and other matters. Along with change comes the opportunity for fraudulent activities, whether intentional or not. This session will explore the key areas of concern and how an organization should address this matter with the proper overall risk assessment analysis, structuring internal controls, and performing testing and reporting. Jim Ridenour; Crowe Horwath Track - Hospice 4C Corporate Compliance Mandate Tuesday, October 9 th 9:00-10:00 AM By March 23, 2013, all Skilled Nursing Facilities are required to have in operation a compliance and ethics program that is effective in preventing and detecting criminal, civil and administrative violations. Is your facility ready? This program will provide the Essentials of Corporate Compliance for skilled nursing providers and how to develop your Corporate Compliance program in line with your current Quality Assurance program. Sherri Robbins; BKD, LLP Track - Administration The Annual Business Meeting will be held from 8:00 to 8:45 am, and is open to LeadingAge Indiana members. Elections of various Board of Directors positions will

8 8 Education Sessions 4D Hospital-SNF Regional Collaboration: Creating Minimum Care Standards; Improving Hospital to SNF Verbal Communications Tuesday, October 9 th 9:00-10:00 AM This session will provide an overview of a regional collaborative approach between hospitals and SNFs to improve care transitions for Heart Failure (HF) patients to prevent patient readmissions. Results include: 1) development of minimum care standards for HF patients, 2) initiation of a pilot program to improve RN to RN verbal hand off communication between Hospitals and SNFs. Carol Birk, Indianapolis Coalition for Patient Safety; Becky Bartle, HOPE; & Arif Nazir MD CMD FACP, Indiana University Track - Clinical 4E Working With the Medicare QIO to Safely Reduce Hospitalizations Tuesday, October 9 th 9:00-10:00 AM The QIO s Role in reducing hospitalizations includes the six priorities of the National Quality Strategy: making care safer; promoting effective coordination of care; assuring care is person and family centered; promoting the best possible prevention and treatment of the leading cause of mortality, starting with cardiovascular disease; helping communities support better health and making care more affordable for individuals, families, employers, and governments by reducing costs of care through continual improvement. The 2013 goals for the partnership are keeping patients from getting injured or sicker (decrease preventable hospital acquired conditions by 40%) and help patients heal without complications (decrease preventable complications during transitions of care so all are reduced by 20%). Join us to hear how the QIO can help you in meeting these goals. Nancy Meadows, RN, BS; Health Care Excel Track - Transitions 5A Brand Makeover, Part II Tuesday, October 9 th 10:15-11:15 AM This session will feature an organization for which Varsity developed and performed a brand makeover. Attendees will witness the entire process described in the session Brand Makeover, Part I as it was applied to this organization. We will share with them the key strategic issues that informed our approach, as well as the results experienced by their peer organization. See session 4A for Part I. Matt Bekelja; Varsity Track - Assisted Living 5B Uganda: A Model for Palliative Care in Developing Countries Tuesday, October 9 th 10:15-11:15 AM Through a screening of the short documentary film, Okuyamba, the Lugandan word meaning 'to help,' this session focuses on describing the common mission shared by a small band of palliative care nurses working tirelessly to ease the pain and suffering of AIDS and cancer patients, dying deep in the rural villages of Uganda. From the training of traditional healers in the Buyija Forest to that of nurses and clinical officers at Hospice Africa Uganda, the film explains the interrelationships between traditional and western medicine, as well as the manner in which they complement one another in the identification and care of dying patients. Michael Wargo; Center for Hospice Care: Hospice Foundation Track - Hospice 5C Will Your Rehab RUG Levels Be Found Supported Under Medicare Audit? Tuesday, October 9 th 10:15-11:15 AM Rehab is the primary skill service for over 80% of SNF Part A stays. The OIG is increasing reviews of rehab RUG levels in This course focuses on strategies to advocate together for interdisciplinary team clinical, communication and documentation practices to meet or exceed the Medicare coverage guidelines for justification of rehabilitation skilled services. Specific documentation strategies for common Medicare Part A Rehab RUG level billing scenarios will be discussed with a focus on medical record compliance to improve the provider s ability to withstand a complex review of claims by the MAC, Recovery Audit Contractors (RAC), Zone Program Integrity Contractors (ZPIC) or other Medicare review entities. Amie Martin; Proactive Medical Review & Consulting LLC Track - Administration

9 Conference Information Fall Conference & Awards October 8-9, 2012 Marriott East, Indianapolis 9 5D 2-Gram Sodium Tuesday, October 9 th 10:15-11:15 AM Heart failure is a condition in which the heart has lost the ability to pump enough blood to the body's tissues. With too little blood being delivered, the organs and other tissues do not receive enough oxygen and nutrients to function properly. Heart Failure prevention is complicated but doable. One of the important measures in treating heart failure is limiting sodium intake. Come learn the part diet plays in the management of Congestive Heart Failure and how to provide a diet that your residents with CHF need. Stacey Wiseman, MS RD; Meadowood Retirement Community Track - Clinical 5E Issues Regarding Healthcare Reform Tuesday, October 9 th 10:15-11:15 AM This session will explore Accountable Care Organizations and the inter-relationship with long term care providers. Gregory L. Pemberton, Esq. & Kevin Woodhouse, Esq.; Ice Miller LLP Track - Transitions Closing: Surviving & Thriving Amidst Adversity Tuesday, October 9 th 11:30 AM - 12:45 PM Sponsored by Omnicare Pharmacies of Indiana Jane Hoeppner is certainly inspiring. Many of you know her as the wife of IU s extraordinary football coach Terry Hoeppner who tragically died of a brain tumor in early His passion culminated in the coaching job of his dreams at Indiana University. The enthusiastic reception of the entire IU community and the hard work of the football team provided Terry with all he needed to lead them to huge success falling only one game short of qualifying for a bowl game in While success came quickly, so did the devastating diagnosis of a brain tumor. After a battle which ran from 2006 into 2007, Terry died leaving Jane a widow. Her continued involvement at IU cheering on her beloved husband s team, as well as her support in the Coach Hep Cancer Challenge has all helped her cope with her loss. In reflection, Jane has written a book titled Never Ever Quit: Surviving and Thriving Amidst Adversity. Her words, both written and spoken to various audiences since Terry s death, have helped thousands cope with life s struggles putting faith at its core. Please join us for this inspiring Closing Session as she shares her story of healing, surviving and thriving. Jane Hoeppner Conference Information Location The full conference will take place October 8-9, 2012 at The Indianapolis Marriott East, which is located at 7202 East 21st Street, Indianapolis, Indiana The hotel is holding a block of rooms until September 14, 2012 at the discounted rate of $99 plus tax per night, for a single or double room. You must mention you are with IAHSA Conference and make your reservations by September 14th to receive the special discounted rate. Please call The Indianapolis Marriott East at to make reservations. We suggest that you make reservations soon, even if you are unsure about attending the conference. You can always cancel the room later. Staying at the Host Hotel offers great networking opportunities to meet your colleagues and make new friends and helps the associations reduce the overall costs associated with producing the conference. Explanation of Conference Rates The Samaritan Rate is for LeadingAge Indiana members who are also members of the Samaritan Alliance. If you are unsure if your facility is a member, please call the LeadingAge Indiana office at The Facility Rate is for LeadingAge Indiana, INALA, IHPCO and HOPE members from one facility in one location. Members may choose the Facility Rate up to 7 to register 1-7 individuals for the full conference or the newly created Facility Rate up to 10 if you plan on registering 1-10 individuals from one facility location. Student Rates are available for individuals enrolled in a health facilities administration course. Retired Administrator Rates are also available for former LeadingAge Indiana Administrators who served the long term care community for at least 15 years and are currently not employed. Please call the LeadingAge Indiana office for these special rates:

10 10 Conference Information Conference Information Continuing Education Credits The Indiana Professional Licensing has approved 9 continuing education credits for Health Facility/Residential Care Administrators for attendance at all sessions (Monday is worth 5.25 depending on your session choices, and Tuesday is worth 3.75). Approval has also been requested from the Certifying Board of Dietary Managers, and the American Dietetic Association for Registered Dietitians. The Indiana Social Worker, Marriage and Family Therapist and Mental Health Counselors Board has approved this organization to provide Category 1 Continuing Education for LSWs. However, licensees must judge the program's relevance to their professional practice. Registration To guarantee that your registration reaches LeadingAge Indiana by the deadline of September 28, 2012, please fax a copy of your completed registration form along with all participants' names, session numbers, and any special meal requests to We will hold a registration space once we receive the fax. Mail the original along with payment when your corporate check becomes available. LeadingAge Indiana also offers on-line registration at All preregistered attendees will receive a confirmation letter. If you do not receive a confirmation, do not assume that you are preregistered. Name badges are required for admittance into all conference events. Name badges, meal tickets and conference packets may be picked up at the LeadingAge Indiana registration desk at the conference. Special Needs and Conference Attire Persons requiring special assistance or menus are encouraged to note their needs on the registration form or attach a letter providing details. We encourage casual attire for the entire conference. Don t be caught unprepared. Everyone responds differently to climate-controlled environments and the hotel does its best to provide a comfortable climate for our event. However, sometimes it is warmer or cooler than you prefer. We hope that you will take this into consideration when preparing for this conference and wear clothing that can be layered. Conference Special Events This year the Fall Conference will feature several special events which require pre-registration. You must pre-register for the following events: Awards Lunch, Welcome Reception and the Business Meeting Breakfast. There is an additional fee to attend the Business Meeting Breakfast, but all other conference events are included in the price for all facility members. Exhibitors and Associate Members will be required to pay a fee for both events. Cancellations Cancellations received prior to September 28, 2012 will be refunded. Due to the need for reproducing handouts and having accurate meal counts, we will be enforcing a deadline to register. Substitutions are always welcomed. No-shows will be billed. General Information For general information & registration questions, please contact Ann Sullivan: asullivan@leadingageindiana.org or call You can also find more information on the 2012 Fall Conference at or or Our national partner, LeadingAge, is an association of 6,000 not for profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that supports, enables and empowers people to live fully as they age. P.O. Box 68829, Indianapolis, IN P (317) F (317) contact us

11 General Information: Complete this form, and fax to , then mail a copy to LeadingAge Indiana Fall Conference, P.O. Box 68829, Indianapolis, IN You will receive a confirmation letter after your registration is processed. We suggest that you fax your registration before the September 28, 2012 deadline. Please make checks payable to LeadingAge Indiana and register EARLY! 1 Facility: MEMBERSHIP: LeadingAge Indiana INALA HOPE IHPCO Non-Member Mailing Address: City: State: Zip: Phone: Fax: Educational Session Choices Write the number of the session you will attend & whether you plan to attend special events. TUESDAY Closing TUESDAY Session 5 TUESDAY Session 4 TUESDAY Busns Brkfst ($15 fee) MONDAY Reception (no fee*) MONDAY Session 3 MONDAY Session 2 MONDAY Awards Luncheon (no fee) MONDAY Session 2 MONDAY Keynote Address This is required for important reminders. 3 First & Last Name Please type or print your name as it should appear on your name badge. 2 2D 3D Yes Yes 4A 5C Yes INALA -or- LA IN Sample: Indiana Inspire i.inspire@serve.org Yes 1B Yes Registration Fees/Payment: All fees are priced on a per person basis, unless otherwise specified. The Member Fee is available to all LeadingAge Indiana, INALA, HOPE, & IHPCO members. The Samaritan Fee is for members who are also members of the Samaritan Alliance. Once you have completed this form, please fax it to to confirm your reservation. 4 Total Amount Due: $ The amount due is the total from that column under the Registration Fees. Four Ways to Register/Pay: by FAX: by MAIL: LeadingAge IN, P.O. Box 68829, Indianapolis, IN by WEB: register on-line at by CREDIT CARD: [ VISA MASTER CARD AMEX ] Member Samaritan Non-Member Amount Due Individual: Monday, Tuesday $249 $125 $349 $ Individual: Monday Only $189 $95 $265 $ Individual: Tuesday Only $129 $65 $180 $ Facility Rate up to 7 $999 $ $ Facility Rate up to 10 $1499 $ $ Individual: Executive Breakfast $15 $15 $20 $ Exp: Signature: Tabletop Vendor: Reception $25 $25 $25 $ Tabletop Vendor: Exec Brkfst $20 $20 $20 $ * Trade Show Vendors will be required to pay a fee to attend the Networking Reception & Breakfast. 11 Registration Form

12 P.O. Box Indianapolis, IN please route to: CEO/President CFO/COO Hospice Director Administrator DON/Clinical Staff Marketing Director HR Director Assisted Living Platinum Sponsors Gold Sponsor Health Management Advisors, Inc./Gatlin & Co. Silver Sponsors Healthcare Therapy Services, Inc. Samaritan Alliance, LLC Exhibitors Advantage Billing & Consultants, Inc. All Med Medical Supply Creative Health Solutions Healthcare Therapy Services, Inc. Hospital Purchasing Service (HPS) Lee Agency, Inc. PharMerica Proactive Medical Review & Consulting Samaritan Alliance, LLC Senior Care Pharmacy Varsity Fall Conference & Awards October 8-9, 2012 Marriott East, Indianapolis