Highland Risk Services
In addition to providing information to our agents, we seek information our agents can use when serving the needs of their clients. With that in mind, this article will look at elopement in elder care facilities – who is most likely to do it, and what can be done to prevent it.
One of the primary risks for seniors residing in elder care facilities is their ability to put themselves in harm’s way by leaving the facility unaccompanied and unobserved. Referred to as elopement, this risk primarily affects those with dementia, who may be looking for someone or something familiar. What can an elder care facility do to prevent elopement of its residents?
Understand the Reasons
It is important to understand why a person wanders, so the facility can take appropriate steps for prevention. Many elderly individuals with cognitive issues may wander for reasons, which, on the surface, may not be clear. They may be trying to meet an elemental need such as using the bathroom or getting a drink of water. They may be reacting to something they do not like in the facility’s environment. Or, there may be medical conditions behind their wandering.
Home health care provides some unique challenges for those working in this environment. Not only are many of the same risks associated with hospitals and nursing homes present, but household related hazards such as poor air quality, toxic substances, and aggressive pets may also be issues. Additionally, the homecare health setting cannot be controlled. Finally, many home health care providers may have limited training and experience in providing patient safety and there is no direct supervision of their daily activities.
Some of the risks associated with home health care are:
General security/personal safety hazards:
- Unsafe neighborhoods
- Violence from patients or family members
- Potentially dangerous household pets
When it comes to home healthcare, fraud and theft are major areas of concern. Every effort must be made to prevent fraud and theft, as occurrences not only affect the well-being of patients, but can also harm a client’s reputation.
Health care fraud occurs when false information is represented as truth. Perpetrators exploit patients by entering into their medical records false diagnoses of medical conditions they do not have, or of more severe conditions than they actually do have. Then bogus insurance claims can be submitted for payment.
Home healthcare fraud claims also involve intentional incorrect billing of Medicare. According to the Senior Medicare Patrol (SMP), “An estimated $250 million is lost to purposeful health care fraud each year.” Examples of fraud that may occur include:
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.
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.
When an occurrence happens that puts your facility at risk, is not the time to begin to be concerned about risk management. The best protection for your facility considers three areas: 1) good management 2) up-to-date, reviewed personnel policies and 3) well-designed insurance coverage.
All the efforts taken to manage a facility well contribute to sound risk management. Fully attentive administrative staff with a wide range of skills may be the most important guard against major risks.
Careful strategic planning and effective supervision helps ensure organizational resources is closely aligned to accomplishing the facility’s mission, and that staff and volunteers are treated fairly and comply with rules and regulations.
Management skills needed for nursing home supervision include:
Facilities for seniors have some unique security challenges. Residents require protection along with the care and comfort they are provided. As a broker who provides service to agents addressing the coverage needs of elder care facilities, it is important for you to understand the security problems and requirements these facilities must address.
Violence has increased in our society. This has increased the challenge to provide a safe and secure environment for elder care facility residents. Additionally, technological advances have allowed facilities to employ sophisticated monitoring equipment, alarms, and security systems. Litigation also has had an impact on the security functions of personnel in elder care facilities.
Senior care facilities present some unique security challenges. When the elder care facility is establishing security, the following areas must be addressed to meet these challenges:
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.