SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
Hebrew Rehabilitation Center
 
Employer identification number

04-2104298
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    171,111   171,111 0.120 %
b Medicaid (from Worksheet 3, column a) . . . . .     77,045,305 74,641,186 2,404,119 1.690 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0   0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     77,216,416 74,641,186 2,575,230 1.810 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     1,829,473 393,961 1,435,512 1.010 %
f Health professions education (from Worksheet 5) . . .     1,239,388 27,163 1,212,225 0.850 %
g Subsidized health services (from Worksheet 6) . . . .     582,020 417,354 164,666 0.120 %
h Research (from Worksheet 7) .     16,322,406 12,763,329 3,559,077 2.500 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     0 0   0 %
j Total. Other Benefits . .     19,973,287 13,601,807 6,371,480 4.480 %
k Total. Add lines 7d and 7j .     97,189,703 88,242,993 8,946,710 6.290 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     1,829,473 393,961 1,435,512 1.010 %
9 Other            
10 Total     1,829,473 393,961 1,435,512 1.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
214,434
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
20,129,912
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
21,079,093
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-949,181
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Hebrew Rehabilitation Center
1200 CENTRE STREET
BOSTON,MA02131
WWW.HEBREWSENIORLIFE.ORG
License # 2290 		X X   X   X        
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
HEBREW REHABILITATION CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): SEE PART V, SECTION C
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
HEBREW REHABILITATION CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
SEE PART V, SECTION C
b
See Part V, Section C
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
HEBREW REHABILITATION CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21   No
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
HEBREW REHABILITATION CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
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Schedule H (Form 990) 2018
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
FORM 990, SCHEDULE H, Part V, line 3e Hebrew Rehabilitation Center's (HRC) 2019 CHNA provides a prioritized description of the significant health needs of the community identified in the CHNA. FORM 990, SCHEDULE H, Part V, line 5 In support of our mission to honor our elders, Hebrew rehabilitation center (hrc) is focused on the most vulnerable and under-served seniors, e.g. the medically underserved, low income or minority populations in the community. Of special importance to HRC are seniors at risk for elder abuse and neglect. The primary vehicle for gathering community input was the Boston CHNA-CHIP Collaborative survey. Over 100 groups and organizations were involved in data gathering across sectors, including representatives from housing, transportation, faith community, education, public health, and health care; organizations that work with specific populations; focus groups with community members not typically represented in these processes (e.g., LGBTQ youth, low-wage workers, family members affected by violence, specific immigrant populations, etc.). We leveraged several community partnerships to complete the survey, e.g., former members of the Multicultural Coalition on Aging, which represented Boston and its immediate suburbs, 2Life Communities, local churches, senior centers, and the like. Members of these groups included senior health focused governmental agencies and other organizations that serve and represent members of the medically underserved, low income or minority populations in the community. These include low- income seniors, disabled seniors, seniors with memory health challenges, seniors with chronic diseases such as diabetes and heart diseases, and seniors with mobility challenges and fall risks. Also represented were seniors of underserved ethnic minorities for whom English is not their first language, many of whom are challenged by low health literacy, cultural barriers, and limited English proficiency. The surveys were in the field for one month. In addition to the survey, HRC also took into account publicly available data sets in conducting its 2019 CHNA, including: - 2019 Boston CHNA - CHIP - Boston Public Health Commission - Health of Boston 2016-2017 - 2018 Massachusetts Healthy Aging Community Profile - The Massachusetts DPH West Suburban Community Network Area (CHNA 18) that consists of Brookline, Dedham, Dover, Needham, Newton, Waltham, Wellesley, and Weston. In addition to the survey, HRC also took into account publicly available data from the Public Health Departments in conducting its 2019 CHNA. FORM 990, SCHEDULE H, Part V - CHNA Line 7a https://www.hebrewseniorlife.org/sites/default/files/2019-11/Community_Hea lth_Needs_Assessment_2019.pdf FORM 990, SCHEDULE H, Part V - CHNA Line 10a https://www.hebrewseniorlife.org/workfiles/HealthCare/Outpatient/Community _Health_Needs_Assessment.pdf FORM 990, SCHEDULE H, Part V - CHNA Line 11 The HRC 2019 CHNA identifies the following significant health needs of seniors in our community: - Access to geriatrics specialists - behavior health - financial security - housing affordability - closing racial and ethnic disparities that exist in health care Details on how HRC is working to increase the availability, accessibility, and visibility of specialized geriatric care are detailed extensively in the HRC 2019 CHNA implementation plan. In determining priorities, the CHNA committee considered the degree of community need for additional resources, our ability to meet that need through our experience, expertise, and programming, and the capability of other medical and hospital organizations to meet that same need. There are not any needs identified by the CHNA that are not being addressed. FORM 990, SCHEDULE H, Part V, Line 13h Hebrew Rehabilitation Center also uses Medicaid eligibility to determine eligibility for financial assistance. FORM 990, SCHEDULE H, Part V, Line 16a https://www.hebrewseniorlife.org/sites/default/files/2019-12/HRC_Financial _Assistance_Policy.pdf FORM 990, SCHEDULE H, Part V, Line 16b https://www.hebrewseniorlife.org/sites/default/files/2019-12/HRC_Financial _Assistance_Application_0.pdf FORM 990, SCHEDULE H, Part V, Line 16c https://www.hebrewseniorlife.org/sites/default/files/2019-11/HRC_Financial _Assistance_Policy_Summary.pdf FORM 990, SCHEDULE H, Part V, Line 16j In addition to having the FAP listed on the website, Nursing Unit Coordinators have copies of the FAP and application in their offices where they admit patients. For the Long Term Chronic Care Unit, Financial assistance is discussed by the fiscal staff at meetings with patients and families.staff at meetings with patients and families.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Page 9
Schedule H (Form 990) 2018
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address Type of Facility (describe)
1 HSL Medical Group HRC (Dedham)
7000 Great Meadow Road
Dedham,MA02026 		outpatient clinic
2 Hebrew Seniorlife Medical Group at OC
one del pond drive
canton,MA02021 		outpatient clinic
3 Hebrew Seniorlife Medical Group at CCB
100 Centre Street
Brookline,MA02446 		outpatient clinic
4 GREAT DAYS FOR SENIORS (BOSTON)
1200 CENTRE STREET
ROSLINDALE,MA02131 		ADULT DAY HEALTH
5 GREAT DAYS FOR SENIORS (BRIGHTON)
30 WALLINGFORD ROAD
BRIGHTON,MA02135 		ADULT DAY HEALTH
6
7
8
9
10
Schedule H (Form 990) 2018
Page 10
Schedule H (Form 990) 2018
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
FORM 990, SCHEDULE H, PART I, LINE 7G The reported subsidized health services include costs of HRCs adult day clinic in Roslindale and Brighton. The service is funded by Medicaid and self-pay. The Medicaid loss is included with Medicaid in line 7b. The service is priced for affordability and operates at a loss when total costs are included. FORM 990, SCHEDULE H, Part I, line 7 column (f) Bad Debt provision expense of $0 was included in FORM 990, Part IX, line 25, column A and was excluded for purpose of calculating the percentage in this column. FORM 990, SCHEDULE H, Part I, line 7 The costing methodology used is based primarily on the standard cost accounting methods of the Massachusetts State Center for Health Information and Analysis (CHIA) Cost Report which follows the standard Medicare cost accounting principles of the Medicare Cost Report. To cost some specific programs, a cost to charges ratio specific to each program was developed. FORM 990, SCHEDULE H, PART II Founded in 1903 with the promise to honor our elders, Hebrew Rehabilitation Center (HRC) is an essential member of the Greater Boston health care community. The HRC Roslindale campus, a long-time cultural touchstone in the area, opened in 1963. HRC opened a satellite in Dedham at NewBridge on the Charles in 2009. At HRC patients and families receive industry-leading care, and our staff do incredible work that reverberates globally. HRC is committed to caring for the underserved, as 90% of the seniors served here are low-income. As a chronic care hospital that primarily serves a community of seniors, it is always our priority to keep seniors healthy, safe and independent in their homes for as long as possible. HRC puts a lot of emphasis on educating seniors and their loved ones on the necessary steps and care needed to remain independent. HRC does this through outpatient care at its satellite clinics supporting senior housing, adult day health programs that help at-risk seniors stay at home, outpatient rehabilitative care designed to prevent re-hospitalizations, and by offering many supportive programs and services that improve the physical and mental health and lives of seniors As such, HRC community activities are designed to improve the health of our in-patients and ambulatory patients, as well as seniors in the communities in which we operate. HRCs community activities are also designed to teach the next generation of caregivers, which includes our own staff and external learners across Boston. HRC contributed $85,721 to Workforce Development through career development programs for Certified Nurse Assistants (CNAs) and other staff and a Nursing Scholarship Program. The PCAs enrolled in the career development programs must be certified nursing assistants and be recommended by their managers in order to be considered for the workforce development program. The program includes costs of onsite remedial classes in math, English as a Second Language (ESOL), and reading for our employees. An outside vendor provides classes for 10 months of every year with the students meeting two times per week for two hours each class. For each class, HSL pays for one hour as release time and the employee attends one hour on their own time. The students also receive progress reports. These classes help prepare employees to pass the College Placement Test (CPT) so they are able to move on to degree programs. The Hebrew SeniorLife Scholarship Program provides employees with the opportunity to increase their nursing education and skills at area nursing programs. HRC serves as a primary training facility for 45 affiliate academic institutions in the Greater Boston area, including: Harvard Medical School, Northeastern University, Simmons University, among others. HRC trains over 900 students annually in a wide variety of health professions including; medicine, nursing, pharmacy, dentistry, physical, occupational, speech, and expressive therapy, clinical pastoral and social work. HRC seniors actively participate in the education of 185 Harvard Medical School students annually during role-playing sessions that allow our seniors to provide important and vital feedback to the next generation of doctors on how to effectively communicate and treat older adults. HRC annually trains 32 dental students from Harvard School of Dental Medicine and Boston University School of Medicine on geriatric dental medicine. HRCs Department of Medicine has 12 physicians and 7 NPs devote 2,637 hours and $238,267 to teaching geriatric medicine while an additional 66 allied clinical and specialty support educators provide 17,100 hours and $813,820 in teaching. HRC has partnered with a Boston area high school to train 60 students annually to become CNAs. Other economic development, physical improvements, and environmental benefits were identified but not specifically costed in Part II.
Text of bad debt expense footnote FORM 990, SCHEDULE H, Part III, line 2 HRC records provision for doubtful accounts as the amount needed to adjust the reserve, which is based on estimated percentages of accounts receivable by payor and aging category. If not already adjusted by contractual allowance, the charge figure is adjusted to cost using HRC's overall cost to charge ratio. FORM 990, SCHEDULE H, Part III, line 4 HRC estimates an allowance for uncollectible patient accounts. Generally, no finance charges are assessed on receivables. Once an account has been determined to be uncollectible, it is charged-off. Form 990, Schedule H, Part III, Line 8 Medicare revised its reimbursement methodology for LTCH hospitals in FY16. The hospital continues to adapt, but continues to incur a significant loss of revenue each year. In addition, HRC LTCH patients often exhaust their Medicare benefit days, resulting in un-reimbursed care. FORM 990, SCHEDULE H, Part III, line 9b Patients found to be eligible for assistance through Massachusetts Medicaid (known as MassHealth) or other program are not pursued through collection efforts but rather are assisted free-of-charge with the MassHealth application and eligibility process through to completion, including any necessary appeals.
FORM 990, SCHEDULE H, PART VI Supplemental Information Hebrew Rehabilitation Center (HRC) operates a 725-bed licensed chronic care hospital consisting of a 505-bed facility in the Roslindale section of Boston, MA and a 220-bed satellite facility in Dedham, MA (also known as the NewBridge Health Care Center, on the campus of the continuing care retirement community operated by NewBridge on the Charles, Inc.). HRC leases space from NewBridge on the Charles, Inc., an affiliated entity, to operate the 220-bed satellite. HRC also operates three outpatient clinic satellites on Hebrew SeniorLife campuses: NewBridge on the Charles, Dedham, Mass.; Orchard Cove, Canton, MA; and Center Communities of Brookline, Brookline, MA. Services provided by HRC include long-term chronic care, medical acute care, post-acute rehabilitative care, primary and specialty care, outpatient clinics, outpatient therapy services, and adult day care. HRC is accredited by CARF (Commission on Accreditation of Rehabilitation Facilities), and is the only geriatric specialist affiliated with Harvard Medical School. HRC is part of the Hebrew SeniorLife health care continuum, which includes home health care and hospice services, private care services, and community palliative care. Hebrew SeniorLife, Inc., is HRCs sole member and also provides management services to HRC. Hebrew SeniorLife is a Harvard Medical School affiliate and a national thought leader in senior health care, senior living, research and teaching. HSL is governed by a large and active community board comprised entirely of independent persons from the community. HRC, as a subsidiary of HSL, has a board comprised of three employees (President, CEO, CFO) and two independent directors who are also members of HSLs Board of Directors (including the Board Chair). Surplus funds, should they exist, are reinvested in HRC as capital investment, for upkeep of the facility and for growing patient medical equipment and technology needs.
FORM 990, SCHEDULE H, PART VI - SECTION 2 Needs assessment In 2019, HRC updated its 2016 Community Health Needs Assessment (CHNA). This 2019 Community Health Needs Assessment (CHNA) and Implementation Plan provides a comprehensive review of unmet health needs of the HRC community, including negative health impacts of social and environmental conditions. The CHNA Committee analyzed community input, available public health data, and an inventory of existing programs. Additionally, this year, HRC also took part in the first ever Boston CHNA-CHIP Collaborative, a group initiative to develop a Boston-wide CHNA and Community Health Improvement Plan (CHIP). Initiative members include hospitals, health centers, community organizations, the Boston Public Health Commission, and others, all working together for sustainable change in the health of the residents of Boston. Key learnings and research from our participation in the CHNA-CHIP Collaborative factored in prominently in the HRC CHNA and related Implementation Plan. HRC is focused on the Attorney Generals (AG) efforts to support health care reform, reduce barriers to access, improve quality, and reduce costs in health care for patients of the HRC community. We considered four focus areas as identified in 2017 by the Executive Office of Health and Human Services (EOHHS) and the Department of Public Health (DPH) including: - Chronic Disease with a Focus on Cancer, Heart Disease, and Diabetes - Housing Stability/Homelessness - Mental Illness and Mental Health - Substance Use Disorders
FORM 990, SCHEDULE H, PART VI - SECTION 3 Patient Education of Eligibility for Assistance All patients admitted to HRC are counseled by an admissions coordinator about services rendered, billing procedures, patient rights and responsibilities, insurance coverage, and eligibility for assistance as required by guidelines established by the federal Centers for Medicare and Medicaid Services and the Commonwealth of Massachusetts Department of Public Health. In addition to the admissions coordinator, a fiscal agent for HRC also provides education on eligibility under federal, state and local programs. All admissions documentation is reviewed and signed by the patient or responsible party on behalf of the patient at the time of admission and retained on file. HRC has provided financial assistance to selected adult day care participants since August 1999, covering the costs of transportation (in prior years) and some daily programs. The financial assistance has been essential to those participants who cannot afford to pay privately, but who have periods of ineligibility for MassHealth or other financial subsidies (given that the services are not covered by Medicare or private health insurance plans).
FORM 990, SCHEDULE H, PART VI - SECTION 4 Community information HRC honors diversity and provides health care services to all without regard to race, religion, culture color, national origin, class background, gender, sexual orientation, gender expression, marital status, political persuasion, or qualified handicap. HRC provides patient care and services in Roslindale, at the HRC satellite on the NewBridge on the Charles campus in Dedham, and at the outpatient clinics in Dedham, Canton and Brookline. 95% of the patients of Hebrew Rehabilitation Center and its satellite medical clinics are on Medicare and are older than 65. Our primary community is seniors and low income seniors, 65+, in certain neighborhoods of Boston, and the towns of Dedham, Canton, Brookline, Needham, Newton and Westwood.
FORM 990, SCHEDULE H, PART VI - SECTION 5 Promotion of Community Health In addition to its direct inpatient and outpatient care services, specifically long-term chronic care, medical acute care, post-acute rehabilitative care, primary and specialty care, outpatient clinics, outpatient therapy services, and adult day care, HRC promotes the health of the community in many other ways. With a senior population that grows every day, and longer life expectancies bringing increasingly complex medical needs, the senior care industry looks to HRC as a leader in advancing the standard of care. HRC hosts a number of programs designed to improve the quality of life for a growing number of seniors and their families not only in greater Boston, but seniors and their families across the nation and around the globe. HRC is committed to the continuous development, improvement, innovation and sharing of our best practice models in care, research, and teaching. The Center for Memory Health serves people living with dementia and as a leader in the country, also their families, caregivers, and other loved ones at all stages of the arc of memory loss, including those with no cognitive symptoms; early undiagnosed symptoms; moderate to severe cognitive symptoms; or advanced symptoms at end of life. The Center for Memory Health also offers the first and only evidence-based care management for Alzheimers and dementia in New England. The Center for the Prevention of Elder Abuse and Neglect offers emergency shelter, support services, education, and research benefiting victims and their families HRCs Volunteer department harnesses the energy of over 300 volunteers who provided over 20,000 of worked hours, helping seniors stay connected to the larger community. HRCs Chaplaincy department provides spiritual support, with weekly prayer services (Jewish and ecumenical), pastoral volunteer training, and weekly bible study class. HRCs Palliative Care program helps seniors, families and staff navigate difficult decisions and issues, helping seniors have dignity and comfort at end-of-life. HRCs Roslindale campus makes Kosher meals, an important service to many in the Jewish community, and its kitchen provides Kosher meals for Combined Jewish Philanthropies and Springwell as part of their Meals on Wheels program. Seniors and the professional community are served through sponsored events such as various support groups and healthy aging programs, and professional sponsorships (160 programs reached approximately 575,037 consumers in FY18). HRC collaborates with area providers to promote the health of seniors and is a preferred provider with Beth Israel Lahey Health for both its Beth Israel Deaconess Medical Center Hospital and its New England Baptist Hospital. HRC works with these hospitals to provide the highest quality, cost-effective hospital and post-hospital care. Driven by a commitment to reduce avoidable hospitalizations and readmissions, the goals of these agreements are to improve transitions of care for patients, access, communications, and information sharing, and ensure the best possible patient outcomes. HRCs Hinda and Arthur Marcus Institute for Aging Research described in general in the 990 Schedule O Part III Line 4A, is a worldwide leader in aging research, affiliated with Harvard Medical School. Marcus Institute and Brandeis Universitys Heller School for Social Policy and Management operate a joint Center to inform health care policy and practices in aging to address the impact of the nations unprecedented demographic shift as baby boomers enter retirement years, and to collaborate to translate clinical research into policy and practice recommendations for healthy aging. Marcus Institute researchers have several important findings that will directly improve the health of seniors, which include:
1. A video education tool for family members improved alignment between preferences for comfort-focused care and advance directives among patients with late-stage dementia. 2. Recognizing calcification of the abdominal aorta on bone density scans can be an important contributor to heart attack risk. Doctors should pay attention to this when receiving bone density scans 3. We have found abnormalities in brain networks associated with alterations in gait that can lead to falls and associated injuries. This information is leading to therapeutic interventions with transcranial direct current stimulation that stimulates these networks and improves gait and cognition. 4. We developed a practical model to predict fracture in nursing home residents. The model is comprised entirely from data that is already collected on every nursing home resident in the United States, and thus, it has the potential to be used to automatically introduce interventions to prevent fracture in high risk residents. 5. More than one-third of women and men age 65+ cohort members of the Framingham Heart Study had CT imaging evidence of new or worsening moderate-to-severe disc and facet joint degeneration over 6 years; the high frequency of degenerative findings in asymptomatic older adults suggests cautious interpretation of imaging results. 6. Both long-term and recent weight loss in older adults increase deterioration in bone microarchitecture, especially at the weight-bearing skeleton; attention to fracture risk in older adults with recent weight loss as well as in those with weight loss over adulthood is warranted. 7. Older adults with smaller size and lower density trunk muscles as seen on CT images have greater risk of excessive forward thoracic curvature (hyperkyphosis); strengthening mid-back musculature may improve muscle properties and prevent spinal deformity with aging. 8. Older adults with diabetes have deficits in cortical bone microarchitecture that may increase risk of fracture, whereas levels of bone mineral density are normal as defined by clinical DXA. 9. Promising new imaging method aids fracture prediction: Deterioration in bone microstructure is an independent risk factor for fracture in older women and men. 10. We have demonstrated that noninvasive electrical brain stimulation (i.e., transcranial direct current stimulation) may reduce the severity of gait disturbances associated with Parkinson's disease. 11. We have developed the Mobility Change Package which is available to download for free for those who want to implement a mobility program at their hospital in order to improve the care of older adults. Mobility is critical to maintain both cognitive and physical functioning throughout hospitalization. This package has been downloaded over 1,000 times to date. 12. National Academy of Medicine (NAM) Healthy Longevity Initiative: Dr. Inouye serves on the Steering Committee for the NAM Healthy Longevity Roadmap Project. This initiative will develop a comprehensive global roadmap report that will assess the challenges and opportunities of global aging with recommendations for action. Dr. Inouye also serves as the Chair of the Aging Interest Group for the National Academy of Medicine, with a goal of recommending policies to improve healthcare for older adults. 13. A study of older adults (average age 71) showed that knee hypermobility was linked up to 4-fold higher odds of ankle & foot pain, aching or stiffness as well as foot osteoarthritis. Knee hypermobility reduces the stability of the knee (and other lower body joints), and it is thought that this alters knee joint loads and contributing to joint pain. These data suggest that therapeutic interventions targeting mechanical factors, particularly for knee hypermobility, may be needed to prevent ankle and foot symptoms. 14. Caffeine intake is inversely associated with Parkinson's disease (PD) risk, and two genetic polymorphisms (GRIN2A and CYP1A2, both implied in other small studies) were examined to see if they accounted for, or modified, the protective effects. In a study of 829 people with Parkinson's disease compared to 2754 people without the disease, the protective effect of caffeine was seen but there was no caffeine-gene interaction with the polymorphisms, indicating that the relation between caffeine and PD risk is unlikely to be substantially modified by these genetic polymorphisms. 15. We evaluated the known risk factors for Parkinson disease (PD) as well as family history to examine how these factors may combine to determine overall Parkinson's risk. Additive interaction was present between no family history of PD and caffeine in men and between caffeine and physical activity in women. Having multiple known protective factors for PD had additive or super-additive effects, so that PD risk is very low in these individuals with multiple protective risk factors. 16. Higher protein intake is beneficial for maintenance of physical function in middle-aged Americans over the span of two decades. This association was particularly evident in women. 17. Men with higher intakes of milk, milk+yogurt, and milk+yogurt+cheese have higher trabecular and integral volumetric bone mineral density and vertebral compressive strength. Dairy intake seems to be most beneficial for older men irrespective of serum vitamin D levels. 18 HIGHER DIETARY FIBER MAY MODESTLY REDUCE BONE LOSS IN MEN AT THE HIP. 19. Among Puerto Rican adults residing in Boston, dairy food intakes were associated with higher bone mineral density, particularly those with sufficient vitamin D status. 20. A loss in home time is associated with decline in several patient-centered outcome measures in community-dwelling Medicare beneficiaries. 21. Frailty is associated with major respiratory complications, particularly respiratory failure after tracheobronchoplasty. Preoperative identification of frailty may help guide decision making for patients. 22. Deficit-accumulation frailty index provides better prediction of death or poor recovery than frailty phenotype in older patients undergoing aortic valve replacement. 23. Considering both multimorbidity patterns and frailty is important for identifying older adults at greater risk of mortality. Of the five patterns identified, the neuropsychiatric class was associated with lower survival across all frailty levels. 24. Older individuals treated with pravastatin could live free of coronary heart disease, on average, for an additional 18.7 days in 6 years, yet their overall survival was 33.7 days shorter than those who received usual care. 25. A 24-week multicomponent program had sustained beneficial effects up to 1 year on physical function, frailty, sarcopenia, depressive symptoms, and nutritional status in socioeconomically vulnerable older adults in rural communities. 26. In hospitalized individuals who underwent cardiac surgery, there are highly variable prescribing cultures of antipsychotics across hospitals, and a short-term use of typical antipsychotics was associated with risks of adverse events similar to those with atypical antipsychotics. 27. One in 3 older adults undergoing aortic valve replacement had depressive symptoms at baseline and a higher risk of short-term and midterm mortality.
FORM 990, SCHEDULE H, PART VI - SECTION 6 Affiliated Health Care System HRC is part of a group of not-for-profit affiliated entities whose sole member is Hebrew SeniorLife, Inc. HSLs coordinated system of care is based on the premise that research, training of geriatric health-care professionals, senior living and health care must be integrated in such a way to promote independence for all adults as they age. HSL is working to chart the course for senior life. Through our unparalleled combination of experience, optimism, vision and determination, we are working to improve the quality of life for people as they age and dispelling the notion that growing old has to mean growing frail. HRCs affiliates include senior supportive housing communities, which help keep seniors independent in their homes with supportive services including wellness and fitness programs, social service supports, access to health and home care, dining programs, and recreational activities. Coordinated services throughout the HSL network support seniors in their independence as well as provide for successful transitions between care settings. Examples of innovative programs include a grant-supported Depression Support service coordinating care of primary care and mental health providers and actively reaching out to monitor compliance and response. HSLs Chaplaincy Institute is one of the nations 50 most innovative Jewish non-profits in Slingshot for its work to train chaplains in issues related to aging and improving the quality of Jewish pastoral care nationally. It trains 16 graduate level students in pastoral care (Clinical Pastoral Education, accredited by the Association for Clinical Pastoral Education) over the course of a year. HSL also provides employee scholarships for Roslindale or NewBridge employees and/or a child/spouse of an employee who has been employed at HSL for at least 6 months. HSLs Employee Lifeline Program (H.E.L.P.) was created to help employees who, due to unexpected circumstances, are facing dire personal hardships that have negative financial consequences. The program provides some financial assistance to employees who meet the programs guidelines. Eligible beneficiaries include all staff who have been employed at HSL for a minimum of one year, are in good standing, and work a minimum of 1,000 hours on an annualized basis. HELP was designed by a group of employees and is funded through employee and Development efforts. Through the HSL web site, the Marcus Institute provides a wealth of free information on its latest findings in a series of guides that address issues faced by older adults and their families. These guides include Preventing Falls in Older Adults, the Delirium Guide, and Advanced Dementia, a Guide for Families. Through its Blogs, HSL provides a wealth of free information on healthy aging to the general public, covering topics such as Malnutrition in Seniors: What it is, why its bad, and how we can stop it; How Home Care Can Help Seniors Avoid Rehospitalization; and Understanding Alzheimers Disease and Dementia. FORM 990, SCHEDULE H, PART VI - SECTION 7 State filing of Community Benefit report This is not applicable as in Massachusetts only acute hospitals file community benefit reports with the state. HRC provides its Schedule H filing to the state via the Massachusetts Hospital Association.
Schedule H (Form 990) 2018
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