Risk Management Plan
Helpm31990
Chapter16.pptxChapter 16: Risk Management in Long-Term Care Institutions
Department Of Health & Human Services. (2011, February 10). A profile of older americans: 2011. Retrieved from Administration on Aging website: http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2011/4.aspx
Increasing Liability in Long Term Care Settings
General and professional liability insurance costs have been increasing with the number of lawsuits and awards.
Though frequency of claims may have actually decreased in the last several years, the severity of claims have increased resulting in a higher than average loss per paid claim.
Tort reform has also impacted long-term care liability lawsuits and paid claims.
What is Long Term Care?
Medical and non-medical care to people who have a chronic illness or disability.
Long-term care can be provided at home, in the community, in assisted living or in nursing homes
Most long-term care assists people with support services such as activities of daily living (ADLs).
Aspects of Long Term Care
Aging population coupled with longer life and multiple medical conditions
Long term care regulations
Various types of long term care providers
Institutional/Residential Care
Subacute Care
Community-Based Care
Home Care
Nursing Facilities
These facilities provide care to people who can't be cared for at home or in the community and provide a wide range of personal care and health services.
This care generally is to assist with support services for people who can’t take care of themselves due to physical, emotional, or mental problems.
Regulatory Enforcement of Nursing Facilities
Oversight is split between federal and state authorities
OBRA 87 established a Residents’ Bill of Rights
Quality of Care Initiatives
State Inspections
Statement of deficiencies and Plan of Correction is a detailed report of the facility’s perceived failures to meet CMS standards
Sanctions for unmet requirements
False or Deceptive Marketing
Marketing materials can be utilized in lawsuits as evidence of the high-quality care that the facility failed to provide.
There are substantial fines for falsely advertising services or the results of services as they may be settled as a deceptive trade practice.
Malpractice insurance does not cover this.
Physiology of Aging
Decreases or declines in:
brain weight - cognitive ability
immune response - thermal response
renal/pulmonary function - glucose tolerance
Changes in absorption, metabolism and clearance of drugs
Lower ability to detoxify alcohol
Changes in sight, hearing, taste, touch and smell
Nocturnal waking
Sundowning
Risks for the Elderly
Accidents: Fall and Nonfalls
Medication Errors
Infection Control
Pressure Ulcers
Dementia
Elopement/Wandering
Restraints
Therapy and Dietary Services
Disaster Planning and Fire Safety
Elder Abuse and Violence
Elder Justice Act of 2009
Elder Abuse consists of:
Physical abuse
Sexual abuse
Psychological abuse
Financial exploitation
Neglect
Employee Risks
Risks posed by employees may be avoided with appropriate and thorough hiring practices
Proper screening of applicants
Background checks
Credential verification
Risks posed to employees may include
Abuse or violence from residents
Ergonomics
Occupational Hazards
Subacute Care
Subacute care is considered a transitional phase designed to return patients to independent living quickly and at a lower cost.
It focuses on patient who need assistance after a serious illness or injury, but who do not require the full services of a hospital setting.
Subacute units/facilities may be subject to different licensing requirements than nursing facilities.
Home Health Care
Assistance at home from family, friends, volunteers or paid healthcare workers.
Some home care can only be given by licensed health workers
Home healthcare services must be ordered by a physician and are subject to regulation
Agencies receiving payment from Medicare or Medicaid must meet CMS requirements
Home Health Care Risks
Risks from the home environment
Informed consent
Termination of care
Incident Reporting
Falls
Use of Technology in the home
Home Health Employees
Negligence
Safety of Employees
Hospice Care
Palliative Care for patients who are within six months of death as determined by the physician
Performed in the home, hospital, nursing facility or other long term care facility
Risk mirrors those found in home health and long-term care facilities.
Summary
Population is getting older with increasing poor health
Family/friends care availability is very limited – therefore, methods of providing long term care other than family/friends is needed
Most long term care facilities/organizations are highly regulated though some of the newer agencies/services are not yet under as strict regulation
