Assisted Living Incidents Lead to Costliest Senior Housing Insurance Claims

When it comes to professional liability insurance in senior housing and care, claims tend to be costliest for assisted living cases.

The average total paid for assisted living claims that closed between 2011 through 2015* was $221,496, according to a newly released report from Chicago-based commercial property and casualty insurance company CNA.

This is more than the average amount that CNA paid out for other senior housing and care claims, including in skilled nursing facilities (SNFs) and independent living. It also exceeds the overall average paid for this sector, which was $211,709.

Source: CNA's "Aging Services 2016 Claim Report"
Source: CNA’s “Aging Services 2016 Claim Report”

Still, the average total paid for assisted living closed claims decreased from the nearly $250,000 level seen between 2012 and 2014, the report shows.

The vasty majority of the claims that closed during these five years—80.7%—were related to SNF incidents. This higher acuity setting sees more falls and pressure ulcers than assisted living, and these are the most frequent allegations leading to closed claims.

However, rising acuity in assisted living has been observed for several years, and this is increasing the risks for providers in the sector, according to Bruce Dmytrow, vice president of Aging Services and National Programs at CNA.


“Families continue to have the expectation that residents will live safely in an assisted living community without declining and/or experiencing an injury,” Dmytrow told Senior Housing News. “Family and/or resident reluctance to acknowledge the need for a higher level of care and, in some cases, the refusal to permit transfer to a higher level of care create significant risk exposures and the potential for claims.”

Residents themselves have a desire to age in place despite increasing cognitive and/or physical limitations, further adding to complexities for assisted living providers, he noted.

The situation means that assisted living providers must delineate the scope of services they can safely provide, and determine how willing they are to invest necessary resources to provide a “safe and nurturing environment for this changing demographic,” he advised.

Elopement a Top Risk

Assisted living providers may want to review their measures to prevent resident elopement in particular.

More than half of elopement claims—54.3%—were associated with assisted living, versus 45.7% in skilled nursing.

Assisted living elopement claims also were extremely costly, averaging $388,048 per closed claim. That number was $251,172 in skilled nursing.

Comprehensive elopement risk assessments, placing new residents in rooms closer to nursing stations, and conducting elopement response drills are among the strategies CNA recommends in its report.

There were 429 closed claims related to assisted living beds in the time period evaluated, compared with 2,112 closed claims associated with SNF beds. These numbers include 391 claims associated with short-stay beds.

*Editor’s Note: This story has been corrected from a previous version, which stated that the data reflected closed claims only for the 2014-2015 time period.

Written by Tim Mullaney

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