Taking a close look at the type of professional liability insurance claims skilled nursing homes and assisted living facilities are reporting to carriers provides us with additional insight into the top risks that these operations face – from falls to improper care and elopement. Last year, CNA shared findings from its claims files between 2011 and 2015 for the senior care sector, which includes nursing homes and assisted living facilities. Following is a summary of the findings:
- The leading causes of claims paid regardless of the facility were resident falls (42.7%), pressure ulcers (18.6%), and improper care (excluding falls) (14.7%).
- The highest average paid claims for all facility types were elopement ($325,561) followed by failure to follow physician orders ($323,325), and delays in seeking medical treatment ($245,783).
- The average paid per closed claim for assisted living facilities ($221,496) was higher than the average paid for skilled nursing facilities ($212,766).
- More than one-half of elopement claims (54.3%) were from assisted living facilities.
- Assisted living facility elopement claims were very costly, averaging $388,048 per claim, and they were more costly than elopement claims for skilled nursing facilities ($251,172).
- While 94% of pressure ulcer-related claims arose from skilled nursing facility residents, the average claim paid for pressure ulcer-related claims for assisted living facilities ($236,562) exceeded the average pressure ulcer claim paid for skilled nursing facilities ($231,732).
- Almost 76% of the fall related claims involved skilled nursing facility residents, but the average claim paid for fall-related claims for assisted living facility residents ($196,571) exceeded the average claim paid for fall-related claims involving skilled nursing facility residents ($188,009).
Other professional liability claim allegations involve delay in seeking medical treatment, medication error, failure to follow physician orders, violation of resident rights, failure to move the resident to a higher level of care, failure to treat, and failure to diagnose, among others.
Although the information is here based on CNA-insured aging facilities, it can serve to help nursing homes and assisted living facilities to mitigate their exposures to professional liability risks by understanding where problem areas exist and implementing stronger, more effective programs. This includes, for example, having a fall program with a strong emphasis on prevention, adopting a skin integrity program in which all disciplines are actively involved in the risk assessment and care planning process for prevention of pressure ulcers, and other measures which we will review in future articles.
About Caitlin Morgan
Also important is the Professional Liability insurance program a nursing home or assisted living facility has in place, including the scope and extent of coverage and policy limits. The professionals at Caitlin Morgan are specialists in insuring the senior care industry and can provide you with tailored solutions for your clients. Give us a call at 877.226.1027 to find out more about our programs, including our Professional and Medical Malpractice Liability risk retention group for Indiana nursing homes and assisted living facilities.