Ask OmniSure is a series that answers real risk and safety questions from policyholders and insurers all over the country.
Question: Is Assisted Living less safe than Skilled Nursing Facilities? How should COVID’s impact on Assisted Living facilities be considered in the Underwriting process and/or guidelines?
While they both care for seniors, Assisted Living Facilities and Skilled Nursing Facilities present stark differences when it comes to level of risk, but is one really safer than the other during a pandemic? To answer this question, we have to look at a few key differences in regulations, acuity and environment that create discrepancies between these two types of facilities.
1. Regulatory Differences
It is generally perceived that Skilled Nursing Facilities (SNF) are more regulated than Assisted Living facilities (ALF), and thus more prepared to manage the COVID pandemic. However, while ALFs are not federally regulated like SNFs, each state has unique regulations for infection management in the assisted living setting to varying degrees.
What makes accountability different and perhaps more difficult from the professional liability underwriter’s perspective is that there is not a federal database similar to the Centers for Medicare & Medicaid Services (CMS) on reporting requirements for assisted living facilities like there is for skilled nursing facilities. In response to this, OmniSure developed a state-by-state resource for underwriters to view the guidelines for an assisted living facility. The resource includes what the COVID infection rate is in the state, and what the reporting requirements are in the state.
2. Differences of Acuity
The senior population is already acutely at risk for COVID-19, but the more frail, higher acuity and comorbidities a resident has, the higher risk for negative outcomes. The acuity in skilled nursing facilities is typically much higher than that of assisted living facilities and total care needs are more common meaning more interaction with staff and increased opportunity for virus exposure.
Assisted living resident acuity can vary greatly however, rarely does the assisted living resident require total care. Most states don’t allow total care residents in the assisted living setting unless the resident is on hospice services. The higher acuity skilled nursing facility residents require more staff interactions in the form of med passes, treatments, feeding assist, etc., increasing possible staff virus exposure.
3. Environmental Considerations
Being able to control the environment is a key aspect of managing COVID in assisted living and skilled nursing facilities. By nature, assisted living facilities can actually have more minimal exposure between residents.
Skilled nursing facilities typically have two, and sometimes three or four-bed units. This increases the challenge of infection control. By the time a skilled nursing facility resident is found to be COVID positive, their roommate(s) are also likely positive. Meanwhile, an assisted living resident generally has their own room or apartment, providing an element of separation to minimize exposure.
A type of care environment with similarities between the two is memory care (MC), where there can be two beds to a unit in both assisted living facilities and skilled nursing facilities. Memory care units in both SNFs and ALFs have had COVID outbreaks that are more challenging to manage. This is due to the “open” concept of these units, the residents’ wandering behavior, and residents not understanding compliance with infection control practices.
Because there are fewer interactions with medical staff and the general public in an assisted living facility and because they’re medically less complicated, they can actually be less risky than a skilled nursing facility when it comes to infection control. But there are a few considerations that underwriters can use in their overall strategy to select better risks.
- Consider regulatory guidelines. Know which states provide guidelines for assisted living facilities and how those guidelines are regulated.
- Consider immunities. Know when exposures are located in a non-immunity state or in less favorable venues.
- Consider Memory Care. Even if licensed as Assisted Living, memory care communities might be better evaluated using higher standards or skilled-nursing-facility-like guidelines.
Underwriters can utilize OmniSure to conduct Pre-bind reviews to assist in risk selection. In addition to compiling resources to help you select better risks, OmniSure’s team of experts can help you in a one-on-one conversation. Get in touch with our team today.