Highland Risk Services
As a national insurance wholesaler for agents who serve allied health facilities, it is important that you understand the allied health field. One of the unique challenges faced by allied health facilities is significant and continuing growth.
Lead health professional of Public Health England, Linda Hindle, noted that allied health professionals might be the next major public health workforce in England, with more than 80,000 workers in private, government, education, and voluntary work. The growth has been significant in the United States as well, with more than 5 million workers providing 60% of the health care workforce in more than 80 different allied health professions. In addition, the number of US allied health professionals is expected to increase from 15-20% by the year 2020 according to the Bureau for Labor Statistics.
When we want to know something, we automatically do a Web search. It is quick, convenient, and provides current information. So, when a family needs to find assistance for an aging parent, or senior needs to make plans when they reach their golden years, they search the Web. They conduct searches for available options and the personal experiences of others. An Internet survey conducted by Pew indicated that 8 out of 10 caregivers have Web access, and 90% of those individuals use it for finding health information for someone else. Since seniors, their families, and caregivers utilize this resource, it makes sense for those providing elder services to create a professional, personal, and positive on-line presence.
A recent survey conducted by G5, a provider of services to senior living facilities, indicated that 75% of consumers do not trust what companies say about themselves; consumer reviews are twelve times more likely to be trusted. For this reason, a facilities website should not only include client’s positive comments and news articles related to the service you provide, but also objective informational content from external sources.
Owners of an assisted living facility that houses 17 or more unrelated individuals in Illinois must be licensed by the state. Additionally, 80% or more of the residents must be 55 years of age or older. The facility must also be providing personal and health services twenty-four hours a day with staff assisting with personal needs such as dressing, eating, and hygiene.
Generally speaking, assisted living facilities are not for individuals who require more than one caregiver assisting them in their daily activities. Assisted living facilities are prohibited from admitting residents who pose a threat to themselves and others. Also, residents must need only minimal assistance moving to a safe area during an emergency.
There are many stops along the aging path and independent living is only one of them. With an average stay of three to five years, independent living facilities are in a constant state of turnover. Independent living attracts seniors traveling along the care continuum, offering what residents desire, which means either affordable or increasingly upscale options. They also want health-care access when and where needed.
The aging of the independent living population presents some unique financial challenges. People are living longer, so the average resident is older now when they move into an independent living facility than they were five years ago. The average resident is more than 80 years old, more fragile, and has more health concerns. Over half live with some sort of assistive device – a cane, wheelchair, or walker.
Volunteers are a necessity in a successful hospice program. With this realization, Federal regulations actually require a specific level of volunteer activity at each hospice receiving Medicare and Medicaid funding. Although these dedicated and caring volunteers are important assets to a successful hospice program, they provide a unique area of risk management.
In addition to the liability for the acts and omissions of employees, hospices are also liable for acts and omissions of its volunteers. Not only does this liability affect the willingness of hospices to use volunteers, but also volunteers might be reluctant to assume liability. Fortunately, the Federal Volunteer Protection Act of 1997 promoted the idea of volunteer participation by attempting to immunize volunteers at charitable and nonprofit organizations from liability for their acts and omissions if performed within their volunteer duties. The requirements of the act are:
- If appropriate or required, the volunteer must have been properly licensed, certified, or authorized by the appropriate authorities in the state in which the harm occurred.
- The harm was not caused by the volunteer operating a motor vehicle for which the state requires the operator to possess an operator's license or maintain insurance.
- The harm was not caused by willful or criminal misconduct, gross negligence, reckless misconduct, or a conscious, flagrant indifference to the rights or safety of the individual harmed by the volunteer.
- The volunteer must have been acting within the scope of his or her responsibilities when the act or omission occurred.
However, the statute does not apply to misconduct which:
Many families are keeping senior members at home rather than choosing an assisted living or other residential health facility. However, families need to continue with their daily activities and need assistance caring for their elderly family member during a portion of the day. Adult care facilities provide this service. It is estimated that there are currently more than 4,000 of these facilities in operation and the number keeps growing. This is due in part to the increased life expectancy and better quality of life of our aging population. As the population of older Americans increases, so does the need for adult day care facilities.
Adult day care facilities provide meals and social activities for seniors. Additionally, medical and health services are available. The facility also administers medicine and provides necessary therapy. Of course, the variety of services increases the range of risk for both the senior participants and the employees.
Common risks associated with adult day care include, but are not limited to:
Since healthcare clinics treat a wide variety of conditions, including asthma, cardiovascular disease, diabetes, and hypertension, it is imperative healthcare clinics ensure that patients receive the appropriate level of care. Additionally, many healthcare clinics also provide obstetric care, a high-risk area.
Risk management for healthcare clinics includes any activity, process, or policy designed to reduce liability exposure. This involves all aspects of a healthcare clinics infrastructure and services, including clinical care, financial matters, facility maintenance, fire safety, and compliance with applicable laws and regulations.
Top risk management issues for healthcare clinics are:
Healthcare staffing agencies employ physicians, nurses, medical technicians, and healthcare professionals to work as contractors. Some major liability issues need to be taken into consideration due to a healthcare staffing agency’s operational dynamics.
- Contracts may transfer risk or responsibility to the agency.
- The agency ultimately lacks control over the day to day operations of the health care setting, which includes setting’s standards and policies; their coordination of services, and records; the quality of their other workers; and compliance with regulations.
- Maintaining a positive relationship with the contracted client can often influence not only the staffing agency’s ability to report or address areas of concern and adverse events; the ability to investigate; but also the agency’s ability to defend itself.
- If there are liability issues, it may be difficult to coordinate a defense because there are multiple defendants.
In order to meet the risk management needs of a healthcare staffing agency, there are some best practices for your healthcare staffing agency.
There are over four hundred long-term acute care hospitals (LTACH) in the United States that house critically ill patients. Sometimes unresponsive or in comas, patients may live there for months, or even years, sustained by respirators and feeding tubes. Some, such as those recovering from accidents, eventually will leave; other patients will be there for the rest of their lives.
About $26 billion a year is spent on critical care in acute care hospitals in the United States. Some estimate that the number of patients in these facilities has more than tripled in the past decade to 380,000.
The reason for this growth is two-fold:
- The increase in our aging population increases the chances of a catastrophic illness like blood sepsis or acute respiratory distress syndrome that eventually may send patients to acute care hospitals.
- Improved medications and medical technologies are keeping people alive longer requiring an increased need for intensive care.
The result is an increase in patients who require nearly constant care; they survive intensive care, but must remain on life-support. They cannot go home and a rehabilitation facility cannot meet their needs.
Medical imaging centers use technology to take images of the inside of the human body. Medical imaging is sometimes referred to as diagnostic imaging because it is frequently used to help doctors arrive at a diagnosis.
Medical imaging has had a tremendous effect on diagnostics and the treatment of disease. Consider the following:
- Mammography screening for breast cancer has resulted in better treatment options, improved survival rate, and a declining death rate.
- Coronary CT angiography performed to examine the heart vessels in patients with chest pain has helped guide treatment decisions with high accuracy, avoiding costly invasive procedures.
- Life expectancy in the United States has significantly increased due to incorporating advanced medical imaging procedures into healthcare.
Movement disorders, impaired mobility, and memory loss frequently require the services of a specialist. Traveling can be difficult for patients in skilled nursing facilities. Having direct access to a specialist from the skilled nursing facility or another easily accessible site is preferred.
This year, in a Wall Street Journal, an article discussed how hospitals are using interactive video to give patients better access to medical care. Skilled nursing facilities are an ideal environment to provide patient-centered care with a high standard for quality.
Seniors with chronic conditions who are not able to live independently and do not need constant care can use the services of an intermediate care facility. First established in the 1980s to help transition hospitalized elderly to their home within a few months, intermediate care facilities provide nursing care and rehabilitation. It is interesting to note that initially, only half of the elderly discharged patients were able to return home and nearly 25% stayed in the intermediate care facility for over one year.
Intermediate care facilities provide supportive care and nursing supervision under medical direction twenty-four hours per day. The goal is to use rehabilitation therapy to enable individuals to return to a home setting and regain/retain the functions of daily living if possible. To that end, a full range of medical, social, recreational, and support services are also provided. Intermediate Care Facilities are also known as Rest Homes with Nursing Supervision.
As an agent, your clients may be asking about their insurance rates: “Why did my insurance premium go up? , or “Since I have never had a loss, why didn’t my insurance rates go down this year?” Insurance rates, for the most part, have gone up anywhere from 6% to 15%. There are a number of reasons for this increase.
A “Hard” Market
After about five to six years of a “soft” market, we are starting to see the market turn “hard”. Mortgage rates and government bond rates have hardly ever been as low as they have been for the past few years. Previously, when government rates were in the five to seven percent range, insurance companies were able to offset the claims they were paying out by parking a percentage of their premiums in these bonds, which in turn, helped keep rates low. Now, with government bonds yielding barely one percent, insurance companies no longer has that cushion to help with insurance claims.