Risk Management - Care and Compliance Group, Inc.

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RISK MANAGEMENT
How to Protect Your Community
INTRODUCTION
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Assisted living and residential care has become an
increasingly litigious environment.
Outcomes from recent lawsuits have given a wakeup call to the industry about the importance of
maintaining quality risk management programs.
This course will explore the fundamental
components of risk management that should be in
place in your community.
INTRODUCTION
We will focus on practical strategies to address
causes of lawsuits, responding to incidents, falls,
documentation, compliance with CCL requirements,
and insurance requirements. The session will wrap
up with a deep-dive into three case studies adapted
from actual lawsuits against providers in California.
COURSE OBJECTIVES
By the end of the course, you will be able to:
1. Describe how recent judgments against assisted living
and residential care providers have ramifications for the
entire industry.
2. Identify the most common causes of lawsuits in assisted
living and residential care.
3. Implement five critical steps that should be included in
every incident response.
4. Describe the key principals to include in a falls program.
COURSE OBJECTIVES
5.
6.
7.
8.
Describe the records that must be maintained in any
RCFE or ARF.
Implement ten steps for better documentation.
Describe the type of insurance coverage assisted living
and residential care providers should have/consider.
Apply critical thinking to real-world case studies to identify
ways to improve risk management and prevent the same
types of outcomes in his/her community.
Lawsuits in Assisted Living
and Residential Care
RECENT LAWSUITS IN THE NEWS…
Emeritus – $23 million
A California jury has awarded $23 million in punitive damages
against Emeritus Corp., a nationwide chain of assisted living
communities, following a wrongful death lawsuit brought by
the family of woman who died in one of the company’s
communities.
See more at: http://www.aboutlawsuits.com/emeritus-nursinghome-lawsuit-punitive-damage-award42915/#sthash.dfmS2Cgk.pdf
RECENT LAWSUITS IN THE NEWS…
Mariner Health Care Inc – $400,000
Despite the assisted living community’s arguments, a jury
found negligence for failing to properly treat pressure ulcers
and awarded the family $80,000 for past mental anguish,
$20,00 for past medical expenses and $300,000 for past
disfigurement and impairment damages.
http://www.nursinghomesabuseblog.com/litigation/settlementreached-with-hospital-assistedliving-facility-in-case-involvingamputation-of-womans-legs/
RECENT LAWSUITS IN THE NEWS…
Santa Clara Special Care Community LLC
- $3 million
A north Eugene assisted living community, cited by
state officials earlier this year for failing to protect a
woman with Alzheimer’s disease from being sexually
abused by another resident, now faces a $3 million
lawsuit filed by the victim’s family.
http://www.opb.org/news/article/assisted-livingcenter-hit-with-lawsuit/
CNA CLOSED CLAIMS
CNA HealthPro Ins. released their Reducing Risk in a
Changing Industry study, which revealed:
1. The severity of closed claims has increased at an
average rate of 7.6 percent per year.
2. Assisted living facilities have the highest average
severity within the for-profit business segment, followed
by skilled nursing facilities.
3. The most frequent allegation is resident fall, which
comprises approximately 44% of not-for-profit and 38% of
for-profit open and closed claims.
4. Injuries with high severity include amputation, sexual
assault, death, head injury, loss of organ and pressure
ulcer.
WHY DO RESIDENTS AND FAMILIES SUE?
1.
2.
3.
4.
5.
To recover damages
To punish or to get even with the provider
Usually when there is poor communication
between provider and family/resident
Need for an explanation as to how and why this
occurred
How to prevent a similar event from occurring in
the future
What Happens When You Are Sued?
WHAT HAPPENS WHEN YOU ARE SUED?
They go fishing:
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Attorneys can submit questions to both the
plaintiff and the defendant, called
“interrogatories”
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Must be answered truthfully under oath
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Also, “requests for admission”, which require the
both parties to say which allegations they affirm
and which they deny
WHAT HAPPENS WHEN YOU ARE SUED?
Request for Production of
Documents:
• Demands for production of
documents by the parties
involved
• Resident records
• Employee records
• Health/medical records
• Licensing reports
WHAT HAPPENS WHEN YOU ARE SUED?
Depositions:
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The parties may be required to appear in the
opposing attorney's office to answer questions
under oath in front of a court reporter.
•
Depositions can also be taken from third parties,
such as disgruntled former employees.
Responding to Incidents
TYPES OF INCIDENTS
Falls:
• Those 75 yrs and older who fall are four to five times more
likely than those 65 to 74 yrs to be admitted to a long-term
care facility for a year or longer
• Rates of fall-related fractures among older women are more
than twice those for men
• Over 95% of hip fractures are caused by fall
• Men are more likely than women to die from a fall
• Many people who fall, even without an injury, develop a fear
of falling. This fear may cause them to limit their activities,
which leads to reduced mobility and loss of physical fitness,
and in turn increases their risk of falling again and a change
of condition.
TYPES OF INCIDENTS
Changes in Condition:
• Can occur quickly or slowly over a long period of
time
• May be difficult to detect in those with cognitive
impairment
• May be due to infection, metabolic changes,
medications, cognitive diseases, physical
impairments, or emotional upset, etc
• Triggers a service plan change and a visit to the
doctor
TYPES OF INCIDENTS
Aggression:
• Resident on resident
• Resident on staff
• Resident on visitor
• If a cognitive deficit is present, it is usually an
attempt to communicate a discomfort or unmet
need
• May trigger an eviction
• Must be reported to the LPA/CCLD
TYPES OF INCIDENTS
Wandering/Elopement:
• Cognitively impaired residents
• Monitoring whereabouts
• Technology can help but is not a guarantee
• Notify CCL, responsible party, etc.
• Update service plan
TYPES OF INCIDENTS
Sexual Inappropriateness:
• Sexuality has no age limit
• Often occurs with cognitive decline / dementia
• Can be difficult to redirect when between two consenting
adults
• Cannot allow one person to sexually assault another;
• Sexual advances towards staff must be addressed if
resident is cognitively intact
• If resident has dementia, staff must be trained to re-direct
the inappropriate behavior; change of face
EVERY RESPONSE MUST INCLUDE
1.
2.
3.
Appropriate follow up care: doctor appointment,
ER visit, Urgent Care, etc.;
Resident Monitoring: visual checks every 15
minutes, visual checks every 30 minutes…every
hour…
Communication: notify family, primary care
physician, licensing, Ombudsman, your
insurance. Schedule a service plan meeting with
the family to discuss the incident and what you
are going to do from here.
EVERY RESPONSE MUST INCLUDE
4.
5.
6.
Documentation: Medical Emergency response
protocols, updates to service plan, resident
monitoring, elopement protocol, fall assessment
and response, state reports, etc.
Root Cause Analysis: who, what, when, where,
how and why?
Debrief your staff.
Falls
FALLS
Comprehensive Falls Program
• Falls Risk Assessment
• Staff Education / Training
• Exercise Program
• Vit D/Calcium Supplementation
• Increased Sunlight Exposure
• Environmental Audit
• Observation
• Footwear Interventions
• Medication Review
FALLS
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Definition of a Fall:
An unexpected event in which a resident comes to
rest on the ground, floor or lower level.
CALCULATING FALL RATES
Number of resident falls
x 1000
Number of bed days
FALLS
Interventions:
• Exercise program
• Good nutrition and hydration
• Appropriate footwear
• Use of grab bars and night lights in bathrooms
• Review of medications
• Audit of environment for hazards
• Eye exam
• Encourage to call for assistance and/or use of DME
FALLS
A Team Approach:
• Requires “buy in” of the residents to work, i.e., eye
exams, appropriate footwear, use of DME, exercise,
calling for assistance, reporting unwitnessed falls;
• Ongoing and thorough training of caregiving staff to
monitor for and report accurately all witnessed and
suspected falls;
• Activities that encourage, entice and enable the
residents to remain active and speak to their specific
interests;
• Family involvement in reducing clutter and promoting
the residents’ participation in activities.
FALLS
The Environment:
• The location of falls remain the highest in the
bedroom
• The majority of falls occur between 6 am and 9 pm
• Encourage the resident to recreate the bed to
bathroom door orientation he/she is accustomed to
• Reduce clutter on the floors, stairs and in doorways
• Place often used items on lower shelves
• Remove throw rugs and extension chords
• Use of grab bars and even lighting
FALLS
Post Fall Follow-Up:
• Receiving appropriate care
• Call 911
• Communication
• Investigation
• Education
FALLS
Assessments
• A fall assessment should be conducted post fall by
an appropriately skilled professional to determine if
an injury requiring medical intervention has
occurred.
• Ideally, a licensed nurse is in the community and
can assess the resident.
• If not, 911 can be called and a paramedic can
perform the assessment.
• Follow up with the primary care physician should
occur as quickly as is feasible.
Document, Document, Document…
HOW IMPORTANT IS IT?
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The old adage, “If it wasn’t written, it didn’t happen” applies
to assisted living as much as to any other care setting.
With the number of lawsuits being filed in California alone,
we cannot afford to not document in both a resident chart as
well as a staff file.
Who documents in which is going to be determined by your
specific company and policy, however, do remember that
once it is written, it cannot be altered. It is a permanent part
of that record.
Your documentation is also your proof of the care and
service provided to your residents.
TYPES OF RECORDS
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Resident Records
Medication Records
Incident Reports
Staff Records
Volunteer Records
RESIDENT RECORDS
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The licensee shall ensure that a separate, complete, and
current record is maintained for each resident in the facility
or in a central administrative location readily available to
facility staff and to licensing agency staff.
Each record shall contain at least the following information:
(1) Resident's name and Social Security number
(2) Dates of admission and discharge
(3) Last known address
(4) Birthdate
RESIDENT RECORDS
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(5) Religious preference, if any, and name and address of
clergyman or religious advisor, if any
(6) Names, addresses, and telephone numbers of
responsible persons to be notified in case of accident,
death, or other emergency
(7) Name, address and telephone number of physician and
dentist to be called in an emergency
(8) Reports of the medical assessment and of any special
problems or precautions
(9) The documentation required for residents with an
allowable health condition
RESIDENT RECORDS
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(10) Ambulatory status
(11) Continuing record of any illness, injury, or medical or
dental care, when it impacts the resident's ability to function
or the services he needs
(12) Current centrally stored medications
(13) The admission agreement and pre-admission appraisal
(14) Records of resident's cash resources
RESIDENT RECORDS
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(15) Documents and information required by the following:
(A) Section 87457, Pre-Admission Appraisal
(B) Section 87459, Functional Capabilities
(C) Section 87461, Mental Condition
(D) Section 87462, Social Factors
(E) Section 87463, Reappraisals
(F) Section 87505, Documentation and Support
RESIDENT RECORDS
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The licensee shall be responsible for storing active and
inactive records and for safeguarding the confidentiality
of their contents. The licensee and all employees shall
reveal or make available confidential information only
upon the resident's written consent or that of his
designated representative.
All resident records shall be available to the licensing
agency to inspect, audit, and copy upon demand
during normal business hours. Records may be
removed if necessary for copying. Removal of records
shall be subject to the following requirements:
CCL REMOVING RECORDS
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Original records or photographic reproductions
shall be retained for a minimum of three (3) years
following termination of service to the resident.
CCL REMOVING RECORDS
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Licensing representatives shall not remove the following current records for
current residents unless the same information is otherwise readily available
in another document or format:
(A) Religious preference, if any, and name and address of clergyman or
religious advisor
(B) Name, address, and telephone number of responsible person(s)
(C) Name, address, and telephone number of the resident's physician and
dentist
(D) Information relating to the resident's medical assessment and any
special problems or precautions
(E) Documentation required for allowable health condition
(F) Information on ambulatory status
(G) Continuing record of any illness, injury, or medical or dental care
(H) Records of current medications
(I) Current emergency or health-related information
CCL REMOVING RECORDS
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Prior to removing any records, a licensing
representative shall prepare a list of the records to
be removed, sign and date the list upon removal of
the records, and leave a copy of the list with the
administrator or designee.
Licensing representatives shall return the records
undamaged and in good order within three
business days following the date the records were
removed.
MEDICATION RECORDS
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When requested by the prescribing physician or
the Department, a record of dosages of
medications which are centrally stored shall be
maintained by the facility.
PRN AUTHORIZATION
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Resident can determine and clearly communicate
his/her need for prescription and nonprescription
medication on a PRN basis.
Resident cannot determine his/her own need for
nonprescription PRN medication, but can clearly
communicate his/her symptoms indicating a need for a
nonprescription medication.
Resident cannot determine his/her need for
prescription and/or nonprescription PRN medication
and cannot communicate his/her symptoms indicating
a need for nonprescription medication. (Must contact
physician before each dose)
PRN ORDERS
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For every prescription and nonprescription PRN medication
there shall be a signed, dated written order from a
physician, and a label on the medication.
Both shall contain at least all of the following:
(1) The specific symptoms which indicate the need for the
use of the medication.
(2) The exact dosage.
(3) The minimum number of hours between doses.
(4) The maximum number of doses allowed in each 24-hour
period.
PRN RECORDS
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A record of each dose is maintained in the
resident's record
The record shall include:
Date and time the PRN medication was taken
Dosage taken
Resident's response
MEDICATION ORDERS
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For every prescription and nonprescription PRN
medication for which the licensee provides assistance
there shall be a signed, dated written order from a
physician, on a prescription blank, maintained in the
residents file, and a label on the medication. Both the
physician's order and the label shall contain at least all
of the following information.
(1) The specific symptoms which indicate the need for
the use of the medication.
(2) The exact dosage.
(3) The minimum number of hours between doses.
(4) The maximum number of doses allowed in each 24hour period.
CENTRAL STORAGE RECORDS
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The licensee shall be responsible for assuring that a
record of centrally stored prescription medications for
each resident is maintained for at least one year and
includes:
(A) The name of the resident for whom prescribed.
(B) The name of the prescribing physician.
(C) The drug name, strength and quantity.
(D) The date filled.
(E) The prescription number and the name of the
issuing pharmacy.
(F) Instructions, if any, regarding control and custody of
the medication.
MEDICATION DESTRUCTION LOG
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Title 22, Reg. 87465 Medication Destruction Log
(i) Prescription medications which are not taken with the
resident upon termination of services, not returned to the
issuing pharmacy, nor retained in the facility as ordered by
the resident's physician and documented in the resident's
record nor disposed of according to the hospice's
established procedures or which are otherwise to be
disposed of shall be destroyed in the facility by the facility
administrator and one other adult who is not a resident.
Both shall sign a record, to be retained for at least three
years, which lists the following:
(1) Name of the resident.
(2) The prescription number and the name of the pharmacy.
(3) The drug name, strength and quantity destroyed.
(4) The date of destruction.
HOSPICE MEDICATION RECORDS
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Prescription medications no longer needed shall be
disposed of in accordance with Section 87465(i).
The licensee shall maintain a record of dosages of
medications that are centrally stored for each
resident receiving hospice services in the facility.
REPORTING CHANGE OF ADMINISTRATOR
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The licensee shall notify the Department, in writing,
within thirty (30) days of the hiring of a new
administrator. The notification shall include the
following:
(1) Name and residence and mailing addresses of
the new administrator.
(2) Date he/she assumed his/her position.
(3) Description of his/her background and
qualifications, including documentation of required
education and administrator certification.
REPORTING CHANGE IN CHIEF CORP OFFICER
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Any change in the chief corporate officer of an
organization, corporation or association shall be
reported to the licensing agency in writing within
fifteen (15) working days following such change.
Such notification shall include the name, address
and the fingerprint card of the new chief executive
officer, as required by Section 87355, Criminal
Record Clearance.
EMPLOYEE RECORDS
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The licensee shall ensure that personnel records
are maintained on the licensee, administrator and
each employee. Each personnel record shall
contain the following information:
(1) Employee's full name
(2) Social Security number
(3) Date of employment
(4) Written verification that the employee is at least
18 years of age, including, but not necessarily
limited to, a copy of his/her birth certificate or
driver's license
EMPLOYEE RECORDS
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(5) Home address and telephone number
(6) Educational background
For administrators this shall include verification that
he/she meets the educational requirements in
Sections 87405(b) and (c).
(7) Past experience, including types of employment
and former employers
(8) Type of position for which employed
EMPLOYEE RECORDS
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(9) Termination date if no longer employed by the
facility
(10) Reasons for leaving
(11) A health screening
(12) Hazardous health conditions documents
(13) Criminal Record Clearance or exemption
STAFF TRAINING RECORDS
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Documentation of staff training shall include:
(A) Trainer's full name
(B) Subject(s) covered in the training
(C) Date(s) of attendance
(D) Number of training hours per subject
HOURS WORKED
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In all cases, personnel
records shall demonstrate
adequate staff coverage
necessary for facility
operation by documenting the
hours actually worked
VOLUNTEER RECORDS
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Personnel records shall be maintained for all
volunteers and shall contain the following:
(1) A health statement
(2) Health screening documents
(3) Criminal record clearance or exemption for
volunteers that are required to be fingerprinted
RECORD RETENTION
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All personnel records shall be
retained for at least 3 years following
termination of employment.
Incident Reports
INCIDENT REPORTS
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Each licensee shall furnish to the licensing agency
such reports as the Department may require,
including, but not limited to, the following:
A written report shall be submitted to the licensing
agency and to the person responsible for the
resident within seven days of the occurrence of any
of the events specified.
This report shall include the resident's name, age,
sex and date of admission; date and nature of
event; attending physician's name, findings, and
treatment, if any; and disposition of the case.
INCIDENT REPORTS
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Death of any resident from any cause regardless of
where the death occurred, including but not limited to a
day program, a hospital, en route to or from a hospital,
or visiting away from the facility.
Any serious injury as determined by the attending
physician and occurring while the resident is under
facility supervision.
The use of an Automated External Defibrillator.
Any incident which threatens the welfare, safety or
health of any resident, such as physical or
psychological abuse of a resident by staff or other
residents, or unexplained absence of any resident.
INCIDENT REPORTS
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Occurrences, such as epidemic outbreaks, poisonings,
catastrophes or major accidents which threaten the welfare,
safety or health of residents, personnel or visitors, shall be
reported within 24 hours either by telephone or facsimile to
the licensing agency and to the local health officer when
appropriate.
Fires or explosions which occur in or on the premises shall
be reported immediately to the local fire authority; in areas
not having organized fire services, within 24 hours to the
State Fire Marshal; and no later than the next working day
to the licensing agency.
Documentation Fundamentals
DOCUMENTATION FUNDAMENTALS
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Accurate and objective statements. (objective means
‘not influenced by personal feelings, interpretations, or
prejudice; based on facts’.)
Do not assign blame.
Do not use abbreviations.
Leave no blank spaces.
Write, and sign your name, legibly.
Use blue or black ink – colored ink does not copy.
Do not document what you have not done yourself.
Correct any errors by using a single line to mark
through the error, initial, and write the correct word or
phrase.
Sign your name and date in ink.
THE GOOD EXAMPLE
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On June 30, at 0830, I entered Mr. Smith’s
apartment, #3, to find him lying on his back on the
kitchen floor. His walker was across the room.
There was no visible blood. He was awake and
stated, “Oh Thank God. I fell and think I am hurt.”
I called for assistance from my co-worker, James,
who called 911. I remained with Mr. Smith, on the
floor, until the paramedics arrived. He was taken
via ambulance to the emergency room at
approximately 0900. His daughter, Margie, and his
primary care physician, Dr. Bell, were both notified
by phone once he was on his way.
THE BAD EXAMPLE
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Today at 8:30 I went into Mr. Smith’s apartment
and he had tripped over that stupid cat again and
fallen on his floor. I had James call 911 while I
stayed with him. They came and took him to the
emergency room because he was hurt. I called his
daughter and his doctor.
THE UGLY
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That resident in #3 went to the ER because he fell
or something. I think he was hurt real bad. Why do
ya’ll let people live here if they can’t take care of
themselves, anyway? I thought this was supposed
to be a assisted living, not a nursing home. And
don’t think I’m gonna take care of that nasty cat
while he’s gone, ‘cause I ain’t.
Insurance
IMPORTANCE OF INSURANCE
Besides being required by Licensing, what is the
importance of having insurance?
• Transfers financial risk from your company to the
insurance company
• Protects your property against damage by allowing
you to have your property replaced or repaired if
some type of damage occurs
• Business liability insurance covers accidents that
occur on the business premises and mishaps that
occur during normal business operations on and off
premises
IMPORTANCE OF INSURANCE
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Replacement insurance protects a business in the
event equipment is stolen, replacing the missing items
and paying for repairs from damage caused by the
theft.
We live in a litigious society. Even the most frivolous
lawsuit can be costly to defend; and in the event your
community is on the losing end of a lawsuit, the
awarded damages could exceed the business's
capabilities to pay. Depending on the business entity
structure, not only the business assets, but also the
owner's personal assets could be at risk. Business
liability insurance will cover at least part, if not all, of
any damages.
TYPES
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Vehicle / Automobile Insurance
Health Insurance
Worker’s Comp Insurance
Casualty Insurance
Life Insurance
Structural / Property Insurance
Liability Insurance
PARTNERSHIP
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Many insurance companies offer risk management
services, audits and self audit tools to assist you in
mitigating the risk to your community.
Some will offer safety resources, such as fact
sheets, checklists, sample protocols, and best
practices on topics such as documentation,
management issues, property safety, resident
safety and transportation safety.
Many are offering online training topics accessible
to clients for training staff as well.
Case Studies
INFECTED PRESSURE ULCERS
What Happened
• In 2006, a 51 year-old woman, Darletta Dean, who
had trusted two of her local health care facilities
passed away. The woman, who had cerebral palsy,
died from multiple infected pressure ulcers on
different parts of her body. The assisted living
resident was being provided weekly medical
treatment from a home health agency and roundthe-clock care from Totally Taxing Assisted Living.
Nonetheless, she suffered such significant
pressure ulcers that ultimately caused her death.
INFECTED PRESSURE ULCERS
The Lawsuit
• The wrongful death lawsuit alleged that the home
health agency and the assisted living community
were only treating one of the victim’s pressure
ulcers. They were negligent in providing the
appropriate level of care for this resident and
ensuring she received the proper medical care.
INFECTED PRESSURE ULCERS
The Evidence
• Dean was 51 years old when she died from 3
avoidable pressure ulcers that had become
infected. The jury found substantial evidence that
Dean died from multiple infected pressure ulcers
on different parts of her body.
• The documentation from neither the home health
agency nor the assisted living community
described more than one decubitus ulcer.
INFECTED PRESSURE ULCERS
The Outcome
• The jury awarded $4 million to Dean’s family for
pain and suffering and $5.5 million for the wrongful
death claim. The jury also awarded $2,683 in
funeral expenses.
INFECTED PRESSURE ULCERS
Discussion
• What Could Have Been Different?
MULTIPLE FALLS
What Happened
• 88 year old Mary Pace, with a history of dementia
and recurrent urinary tract infections, is moved into
an assisted living. Within a year, staff are no
longer assisting her with ADLs, claiming it is
because she is combative. She suffers multiple
falls. Her daughter requests she be checked for a
UTI, which is not done. She falls and fractures
both her shoulder and hip on the left side. Once in
the hospital, she is also found to have a severe
UTI, becomes septic and dies.
MULTIPLE FALLS
The Lawsuit
• The family filed a lawsuit alleging gross negligence
resulting in Mary’s death.
MULTIPLE FALLS
The Evidence
• Documentation by staff of Mary’s combative
behaviors with no follow up with her physician.
• Documentation of multiple falls suffered by Mary
with no physician follow up.
• Depositions of staff members that they were told to
leave her alone because she had dementia.
MULTIPLE FALLS
The Outcome
• The community was found to be at fault for Mary
Pace’s death and a judgment of $10 million was
awarded to her family.
MULTIPLE FALLS
Discussion
• What Could Have Been Different?
SEXUAL RELATIONSHIP
What Happened
• Two residents with dementia living in an assisted
living community, both without spouses, were
engaged in an intimate relationship. Jim and
Teresa told their adult children they were “in love”
and wanted to marry. Jim’s family was not
bothered by the relationship, however, Teresa’s
daughter was “horrified” and moved her mother out
of the community, claiming her mother was
sexually abused by Jim.
SEXUAL RELATIONSHIP
The Lawsuit
• Teresa’s daughter sued the assisted living
community claiming her mother was sexually
abused by Jim and the assisted living allowed it to
occur, citing her mother’s inability to consent based
on her diagnosis of dementia.
SEXUAL RELATIONSHIP
The Evidence
• Teresa was conserved by her daughter due to her
diagnosis of dementia.
SEXUAL RELATIONSHIP
The Outcome
• The assisted living was found to be at fault for
allowing the sexual relationship to occur between a
consenting and non-consenting adult. The jury
awarded Teresa’s family what amounted to the cost
of her rent and care for the 5 years she resided at
the assisted living, cost of bringing the suit, and
suffering, for a total of $1.8 million.
SEXUAL RELATIONSHIP
Discussion
• What Could Have Been Different?
Quiz
QUESTION #1
Why do resident families sue?
a.
b.
c.
d.
e.
To lose
To make a point
To recover damages
For notoriety
B&C
QUESTION #1
Why do resident families sue?
a.
b.
c.
d.
e.
To lose
To make a point
To recover damages
For notoriety
B&C
QUESTION #2
You are required to carry life insurance.
a.
b.
True
False
QUESTION #2
You are required to carry life insurance.
a.
b.
True
False
QUESTION #3
An example of objective information is:
a.
b.
c.
d.
Color of hair
Feelings for your spouse
An opinion
None of the above
QUESTION #3
An example of objective information is:
a.
b.
c.
d.
Color of hair
Feelings for your spouse
An opinion
None of the above
QUESTION #4
Educational background is included in personnel
records.
a.
b.
True
False
QUESTION #4
Educational background is included in personnel
records.
a.
b.
True
False
QUESTION #5
Medication records include:
a.
b.
c.
d.
Central Storage Record
Destruction Log
PRN Authorization Form
All of the above
QUESTION #5
Medication records include:
a.
b.
c.
d.
Central Storage Record
Destruction Log
PRN Authorization Form
All of the above
QUESTION #6
A comprehensive falls program includes a
medication review.
a.
b.
True
False
QUESTION #6
A comprehensive falls program includes a
medication review.
a.
b.
True
False
QUESTION #7
The resident record contains:
a.
b.
c.
d.
Mother’s maiden name
Favorite color
Last known address
Neighbor’s shoe size
QUESTION #7
The resident record contains:
a.
b.
c.
d.
Mother’s maiden name
Favorite color
Last known address
Neighbor’s shoe size
QUESTION #8
Workman’s Compensation Insurance is a required
insurance in California for businesses.
a.
b.
True
False
QUESTION #8
Workman’s Compensation Insurance is a required
insurance in California for businesses.
a.
b.
True
False
QUESTION #9
When documenting in the resident’s record:
a.
b.
c.
d.
e.
Use blue or black ink
Write legibly
Sign your name
Don’t leave blank spaces
All of the above
QUESTION #9
When documenting in the resident’s record:
a.
b.
c.
d.
e.
Use blue or black ink
Write legibly
Sign your name
Don’t leave blank spaces
All of the above
QUESTION #10
“Interrogatories” must be answered as if you are
under oath.
a.
b.
True
False
QUESTION #10
“Interrogatories” must be answered as if you are
under oath.
a.
b.
True
False
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