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Lessons Learned from Recent Incidents

Have you ever wondered if an incident at your community has the potential to turn into a large claim for damages complete with litigation? If you have, you are right to be concerned. If you haven’t given it much thought perhaps its time to think again. The following are very brief descriptions of several claims we have seen over the past few years and a comment or two about why the otherwise innocuous incidents ultimately resulted in claims with settlement values between $150,000 and $500,000.

Case 1: The Inappropriately Accepted Resident
Incident: A resident was inappropriately accepted at an assisted living community post hip surgery. During her less than two months total residency, an outside home health agency also provided some care. She was inappropriate for ALF care due to complicated medical conditions, but the family wanted to try to avoid a skilled care facility. She left owing a balance of slightly over $1,000. A year after the resident left, the community sought to recover the owed money using the services of a collection agency. After the collection efforts started the family filed a claim alleging abuse and neglect.

Lesson: Although there is no specific incident such as a fall, this case resulted in a payment of more than $300,000 because a visiting home health agency suggested to the community administrator the resident was inappropriate for assisted living and should be transferred to a skilled facility. If this type advice is not diligently evaluated for accuracy and acted upon it paints a picture of “profits over people” which is the formula the plaintiffs’ attorneys use to make a case. The resident’s health deterioration over the next month and a half in essence “creates” her claim for damages by proving she was inappropriate for an ALF setting. A more thorough admission assessment might have avoided this case altogether.

Case 2: Honoring A Wish On Poor Judgement
Incident: A resident of an assisted living community from April 2003 until October 27, 2005 passed away on December 6, 2005 at the age of 94. She entered the community as an independent resident and received home health care. As the aging process progressed she was moved into the assisted living portion of the community where her health continued to decline. Throughout the lengthy report of the two and a half years the resident lived at the community the family kept mentioning the resident wanted to REMAIN at the community and NOT transfer out to skilled care. The community, acting on poor judgment, attempted to honor her request.

Lesson: The community could not retain the resident through end of life hospice care because the medical complications became too great. The deterioration of the health of the resident gave rise to the claim for several reasons which combined to make the claim one to settle rather than defend. The records failed to document “turning” the resident to reduce the occurrence of bed sores. As her health declined she reached a point where, despite her desire to remain at the community, she was no longer appropriate for assisted living – regardless of hospice. To a jury it might have looked like the community was more interested in keeping her as a resident so they could continue billing her. This resident should have been appropriately discharged, or she should have been required to hire outside home health agencies to handle the higher level of care. This may become a recurring theme as more communities utilize hospice in their locations.

Case 3: A Joke Gone Wrong
Incident: A 57 year old resident took another resident’s medicine as a practical joke. He later passed away after being given medicine by the hospital E.R. to subdue him. There is no clear evidence as to whether the wrong meds caused the death or the medicine given to “calm” him down in combination with the wrong meds caused the death.

Lesson: The community has a policy to watch the residents take their medicine and for staff to not take their sight off the resident until the medicine is consumed. The general standard of care dictates that staff should observe residents consuming their medicine. Employee training on medicine policies and procedures is extremely important to the defense of a case like this. It is of vital importance to always follow your written policies!

Several Conclusions Can Be Made From Looking At These Three Claims

First of all, it is extremely important to thoroughly document the care your community is providing. This includes the care of PT / OT, home health and hospice agencies. Too often PT / OT and Home Health records are not made part of the resident’s chart. The community must assure records generated by outside providers are made a part of the resident’s medical record.

Another important lesson learned is to make sure your employees understand your policies and procedures and are capable of following them. It is ALWAYS better to have policies, procedures and training instead of NOT implementing policies for fear they will not be followed. Even though you cannot always control your employees you are more likely to have success in meeting the standard of care/best practices for the Senior Living industry if policies are in place.

Finally, you run a business as an assisted living community. Even though you love your residents there may come a time when you need to decide if you are the best place for them. If you cannot meet the clinical needs of the resident, you are not staffed to meet their ongoing needs and/or third party resources are not available, then a move to a higher level of care is necessary. This eventual transfer is better to sell on the front end by properly managing expectations.

Visit Thomco University for Senior Living Loss Prevention and BEST PRACTICES training. Thomco University is a free education and training program for our clients in Senior Living Programs.

Bill Coons, Loss Control Director

For senior living risk management assistance send an e-mail to BillC@thomcoins.com
or call 1-888-546-4042

For more information on Senior Living Programs or Risk Management topics, please call us at 1-888-514-3167 or visit us on the web at www.thomcoins.com.