The average cost of professional liability claims in the assisted living setting ($267,174) continues to exceed that of skilled nursing facilities ($245,559).
And while fall-related allegation claims continue to account for the majority of cases against assisted living operators, the severity of pressure injury claims has risen sharply since 2018 within assisted living, according to a new report published Wednesday by insurance giant CNA.
A total of 535 claims related to pressure injuries were recorded for 2021, with an average of total incurred damages of $254,108. Although pressure injuries predominantly remain an issue for skilled nursing, they also occurred in assisted and independent living facilities as residents in those settings age in-place.
The average total incurred cost for pressure injury-related allegations in the assisted living setting has increased more than 67% from 2018 up to an average of $282,358, and has surpassed the severity of claims tied to pressure injuries in the skilled nursing field ($252,520). Assisted living setting claims in 2018 were on average $168,446.
Both assisted living and skilled nursing settings saw nearly 66% of pressure injury closed claims result in death, with an average total incurred loss of $261,828 for claims involving a fatality.
Fall-related allegations continue to be the most common allegation in the assisted living setting, accounting for more than half (54.8%) of all claims.
Other than falls, the most common allegations in assisted living include:
- improper care (7.4%)
- resident abuse (6.8%)
- failure to monitor (5.8%)
- pressure injuries (5.8%)
Dementia was a contributing factor in 72.9% of all assisted living fall-related closed claims, data shows.
Overall the distribution of assisted living claims shifted 2.9% from 2018, with an increase from 18.7% of total claims to 21.6%.
Many factors appear to be contributing to claims.
Providing services to higher acuity residents in the assisted living or independent living settings may increase the potential for risk of legal action, the CNA report stated. That, coupled with resident populations aging in-place could cause some providers to market beyond their community’s service capabilities and face potential risk. Within the report, a CNA analysis of customer engagements found that less than a quarter of facility marketing materials convey realistic expectations regarding the ongoing risk of resident falls.
To reduce the risk of resident falls, pressure injuries, resident abuse and elopements, CNA writes that organizations must be willing to engage nursing care and ancillary staff. That means assisting with resident observation; being proactive to identify resident needs and communicate resident needs to care staff.