Senior Care Facilities

Your team of ProAssurance advisors includes attorneys, healthcare administrators, registered nurses, clinicians, and quality/performance improvement professionals. We work with you to identify risks and develop goal-oriented solutions. You benefit from practical risk reduction strategies that help you improve patient safety and satisfaction while mitigating loss. Access our Risk Management staff via email or our helpline during regular business hours.

Q: How was my financial consideration distributed?
A: Financial consideration for most eligible policyholders was distributed via the U.S. Postal Service. For eligible policyholders receiving checks greater than $250,000, payment was distributed via Federal Express.

Q: To what address did you send my transaction documents and consideration payment and when were they sent?
A: The transaction documents and consideration payments were sent, as required by NORCAL’s Bylaws, California law, and the Amended and Restated Plan of Conversion, to the Named Insured’s mailing address on file with NORCAL at the time of mailing. Transaction documents were mailed starting February 26, 2021, and consideration payments were mailed starting June 7, 2021.

Falls

  • Each facility should have a fall management program in place. Fall management programs can be found at the Agency for Healthcare and Quality (AHRQ) and U.S. Department of Veterans Affairs (VA) websites, among others.
  • The facility’s protocols, policies, and procedures should include a post fall huddle (PFH) review. Consider developing a PFH template.
  • PFHs are confidential and are not included in the medical record; they provide a template to examine any unanticipated event.
  • A case scenario, along with an outline of components of a PFH, have been prepared to augment staff education.
  • The Joint Commission  recommends the PFH as a strategy to review fall and injury risk factors with the ultimate goal of prevention.

Suggested Post Fall Huddle Components

  • The first action is to determine if emergency care is needed and to act accordingly.
  • The team should convene within 15 minutes of the fall event, or in accordance with facility policy.
  • The staff member in charge of the resident, designated Post Fall Huddle Team Leader (TL), makes an announcement of an immediate huddle.
  • Involve the resident whenever possible.
  • Require individuals to gather and use “Group Think” (consensus of a group rather than a decision by an individual) to discover what happened.
  • Involve interdisciplinary team members whenever possible (such as RN, NP, MD, PT, members of nursing staff (LPN, CNA), who know the resident (no more than 3-4 people to not overwhelm the resident).
  • The TL completes the PFH form.
  • The appropriate clinician:
    • Modifies the resident’s plan of care to include identified interventions.
    • Communicates new interventions during resident hand-off reports.
    • Documents the fall event in the EMR per facility policy and guidelines.
  • After the post fall huddle, the Nurse Manager should follow-up with staff and the resident to ensure interventions are implemented, and the resident understands the interventions.
  • The Nurse Manager should be available to answer any questions or concerns voiced by resident or family.

Post Fall Huddle Scenario

A resident was admitted on day shift to the rehabilitation-nursing unit for post-operative hip replacement care. During the night shift, around 8:30 p.m., the nursing staff heard a loud noise in the resident’s room. When the CNA entered the room, she found the resident on the floor with her foot tangled in the bed sheet near an overturned walker. The CNA then called for assistance. The resident said she was not hurt, and the walker was too far away from the bed. As the resident was reaching for the walker, she lost her balance and fell. Her vital signs were within normal limits, including blood glucose. She denied any dizziness when she attempted to stand. 

The RN arrived and quickly assessed the resident. Together, they assisted the resident to the bed using a lift, placed the call light within reach and re-educated the resident on the use of the call light for assistance.

The RN called team members for a Post Fall Huddle.

Post Huddle Scenario

Post Fall Huddle Sample Form

 

Communication

Effective communication is integral to quality healthcare. You may have excellent clinical skills and a state-of-the-art facility; however, if communication is not a priority, you may increase your liability exposure. Consider incorporating the following guidelines to further enhance patient safety:

Communication Skills Checklist

Communication Skills Checklist

Limited English Proficiency Residents

We suggest first determining the need for language services. To help determine your obligation to provide meaningful access, consult HHS.gov for guidelines and answers to frequently asked questions.

The numerous options available may include, but are not limited to:

  • Employing bilingual staff
  • Enlisting community volunteers to interpret
  • Using telephone or video conferencing interpretation services
  • Hiring or contracting with qualified on-site interpreters
  • Using written transcription and translation services
  • Sharing the costs of resources or services with other facilities

The facility may also allow the patient to use family or friends to translate; however, the resident’s potential reluctance to disclose sensitive medical information in the relative’s/friend’s presence should be considered. In addition, the relative or friend may not convey the message objectively and effectively. In many cases, the family member may be a minor child who does not yet have the education or maturity to convey critical information.

The communication method(s) chosen should be accurate, effectively convey medical terminology, and maintain confidentiality.

Document in the medical record the communication method(s) agreed upon by resident and provider, or resident’s refusal of translator services.

 

Latest Resources

ProAssurance's informative newsletters offer a risk management perspective on topics of interest to physicians, hospitals and healthcare facilities, practice administrators, and office staff.

Vital Signs is intended to help physicians recognize common causes of malpractice claims by presenting actual case histories of malpractice claims.

Insureds, policyholders, and appointed agents can subscribe to Vital Signs by emailing
TreatedFairly@ProAssurance.com. Beginning in 2022, Vital Signs is distributed on a monthly basis.

Senior Care Vital Signs Newsletters

New vaccination requirements for long-term care workers who serve Medicare and Medicaid enrollees. The Biden administration unveiled plans requiring nursing home staff to get vaccinated against COVID-19, the requirement is expected to go into effect in September,

Hurricane Risk Mitigation and Preparedness Checklist 

Senior Care Risk Videos

The risks that senior living and long-term care facilities face are often broad, complex, and unique.  However, identifying and understanding common risks may help mitigate liability. The following Senior Care Risk Videos aim to enhance risk management programs by addressing these areas of liability: Institutional Claims, Tracking and Follow-up, Arbitration, Understaffing, and Policy and Procedures.

 

COVID-19

Mike Iovine, Assistant Vice President, ProAssurance Senior Care, shares his insight in this Risk & Insurance article on how the senior care market is responding to new risks presented by COVID-19.

Senior Care Seminars