Silverado, Other Providers Roll Out New Program to Address Costly Issue of Worker Injuries

Staff injuries sustained while transferring residents* have always been a top concern for senior living providers, and the issue has become more severe and costly in recent years — with memory care facing some of the toughest challenges. 

With this in mind, Irvine, California-based memory care pioneer Silverado is among the first group of providers implementing a newly created program from global advisory, broking and solutions company Willis Towers Watson and products and solutions provider Direct Supply.

The Safe Resident Moving & Positioning Program (SRMPP), first announced late last month, is the only program of its kind specifically tailored for senior living providers — not just memory care, but across the continuum. 


While similar protocols are well developed for hospitals and skilled nursing facilities, the needs of senior housing providers are unique, Silverado Senior Vice President of Risk and Legal Affairs Frank Russo told Senior Housing News. Silverado operates about 20 standalone memory care communities across six states.

There are numerous reasons why such a program is urgently needed in senior living. For one, not only are workers commonly injured in the process of moving and positioning residents, but residents are at risk of falling if best practices are not followed. Falls compromise resident well-being and can lead to hospitalizations — outcomes that all quality providers strive hard to avoid.

“The financial impact associated with moving and positioning residents incorrectly can also be significant, particularly given the increase in both the frequency and severity of liability claims stemming from resident falls,” Willis Towers Watson stated in a press release announcing the SRMPP.


Out of 267 closed assisted living claims from insurer CNA in 2018, 49.4% involved allegations of a resident fall. At $224,300 per claim, fall-related claims in assisted living were more costly, on average, than fall-related claims in other senior housing and care settings.

For its 2018 report, CNA for the first time examined the presence of dementia in relation to falls, finding that nearly two-thirds of all fall claims across all levels of care involved a resident with dementia. And, these claims are more expensive on average.

These figures reflect that preventing falls in memory care settings is of paramount importance. But, it is particularly thorny problem in these settings, with resident transfers bringing particular risks to both residents and workers.

“Our residents may not be able to articulate, to speak, to follow commands,” Russo said. “So, working with and transferring a resident … you may not know if they’re in pain or they’re not in pain, or they’re not helping you.”

This can add up to a “volatile situation” that results in injuries to both parties, he said. And these situations are not addressed in existing safe transfer and lifting protocols, which assume that the patient has some level of cognizance or ability to cooperate.

The issue is only growing more serious. As early-stage dementia is diagnosed more routinely than in the past, providers like Silverado are caring for younger, fitter, stronger residents who have the ability to overpower caregivers who are assisting them, Russo noted.

Furthermore, the staffing crunch in senior living may put providers in the situation where they are only receiving applications from less skilled and experienced caregivers, or are seeing their workers turn over more frequently, both of which could increase the risk of fall-related injuries.

In addition to the serious and concerning toll that fall-related injuries take on people, they also lead to a slew of costs and operational issues from a business perspective.

For example, a worker injury could pull an experienced caregiver out of rotation for an extended period of time. These are difficult workers to replace, particularly those who had earned dementia certifications and gone through significant training and education. And — especially in memory care — some residents form an attachment to particular caregivers, making them irreplaceable, Russo noted.

Fall-related costs have gone up for Silverado and across the industry in the last several years simply due to growth in medical costs and an increasingly litigious atmosphere. A litigated claim is around 10- to 12-times more expensive than a non-litigated claim for the same back injury, Russo said.

To alleviate all these costs and concerns, Silverado is eager to pilot the new safety program developed by Willis Towers Watson and Direct Supply.

The program consists of guidance related to determining the amount and type of assistance a resident may need and safe techniques for providing that assistance, including what type of equipment is recommended. Resources include a library of seven videos, which are part of a larger Willis Towers Watson collection of 25 videos providing senior living-specific training in a variety of areas.

In a case study prior to the formal rollout, a provider achieved roughly a 45% reduction in caregiver strain injuries by adopting the program, according to data provided to SHN by Willis Towers Watson.

Participating providers receive some potential pricing incentives from Direct Supply on products, and the Milwaukee, Wisconsin-based company also can provide product selection services to help providers get their fall reduction efforts implemented.

There are also potential financial incentives on the insurance side.

“Because of the outcomes shown in the data from Direct Supply and Willis Towers Watson, we’re providing a credit in pricing to anticipate future improved outcomes for resident safety, translating into less injuries for senior workers,” Katie Sebastyan, regional underwriting manager, risk management services for PMA Companies, told SHN.

Although it’s still early days for Silverado, the provider plans to roll it out across the entire portfolio. Russo has high hopes for the program and no doubts that it will bear positive results.

“It’s a no-brainer, absolutely,” he said.

*Editor’s Note: An earlier version of this article described the new program as focused on fall reduction. The article has been updated to clarify that the program is focused primarily on how to safely transfer and move residents to prevent worker injury, and that preventing resident falls should occur as a result. SHN regrets the error.

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