What Causes These Claims?
The National Center for Assisted Living (NCAL) estimates that there are about 30, 200 assisted living communities in the United States, with a total of one million licensed beds (and an average of 33 licensed beds per facility)
Within these facilities, there are several prominent risk factors…
- Resident falls make up a significant portion of claims. In 2016, resident falls accounted for 42.7 percent of the claims surveyed with an average payout of $186,589. Assisted living facilities, however, reported $196,571 in closed claims.
- Pressure ulcers and related maladies made up 18.6 percent of allegations. While skilled nursing operations saw a far greater frequency than assisted living facilities (a 15:1 ratio), assisted living facilities had a higher average value of closed claims ($236,562 to $231,732).
- Elopement saw the highest average total ($325,561), and 54.3 percent of elopement claims come from assisted living facilities.
- Errors in administering medication, failure to follow physician orders, improper care, failure to monitor, unsafe environment, resident abuse, and violation of resident rights were also prominent sources of claims.
Let the Games Begin in California with AB 1523 in
- Higher Acuity
- Higher Risk
- Higher Insurance Premiums
As of July 1, 2015
Operators of Residential Care Facilities for the Elderly (RCFEs) in California are required to have liability insurance in the event of elder neglect and other related injuries. The new law was sponsored by the Consumer Advocates for RCFE Reform (CARR).
Policy Coverage Amounts & Patient Risks
Under the new law, the mandatory coverage for RCFEs is as follows:
- $1 Million/Occurrence
- $3 Million/Aggregate
Impact of the AB 1523 in a climate of rising Inflation
Smaller Operators Leaving the Business
Insurance Carriers are exiting California & New Entrants are “Cherry Picking” risks to maximize profit leaving an unhealthy & non-competitive marketplace
The initial projection of $50 per month per resident for liability coverage was grossly underestimated