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Understanding what to look for in a facility that may pose a risk of falling is key to mitigating risk and avoiding potential lawsuits. Beyond handrails in bathrooms, hallways, and rooms, there are several additional precautions that facilities can take to reduce falls. Below, we explore the top 5 ways to reduce falls in a care setting.

1. Ensure appropriate call light distance

Although this is standard protocol for most facilities, a call light within reach of a patient bed or sitting area increases the likelihood that a patient will ask for help getting up instead of trying to on their own. That said, timing is especially sensitive if a patient is in the bathroom, so it is imperative that a staff member stay close and ready to respond while the patient is toileting. Patient falls often happen with toileting even after using the call light because patients are eager.

2. Remind staff members to maintain safe walkways at all times

Staff members must be trained on being completely aware of their patient’s surroundings, whether that is in their room or outside of it. Anything from a freshly cleaned floor to an uneven surface cannot go unnoticed. Poor lighting and perhaps cluttering of materials must be addressed and taken care of to ensure no one is at risk of falling. Facilities should take extra care to properly train and re-train employees on the importance of maintaining safe walkways.

3. Visitor Protocol Communication

Oftentimes a family member or friend visiting will bring a seemingly harmless object into a resident’s room. Although many objects do not directly cause a fall risk, it’s crucial that it’s explained and understood that whoever’s visiting must not put any object in the way of a walking path.

4. Keep hospital bed brakes locked and routinely checked

Bed brakes must be locked and routinely checked to make sure there is nothing structurally wrong with the bed. This is another crucial piece of employee training that should be emphasized as daily routine.

5. Close monitoring of residents’ medications

Certain medications can increase fall risk, and caretakers should have training around what those are and which patients are at risk. Even with this knowledge, setting up routine programs like hearing and eye exams further determine whether or not a patient is at higher risk for injury.

It’s evident that the COVID-19 pandemic has thrown enormous hardships and obstacles into our everyday lives. As a result of this, the decline in mental wellbeing has been profound in many settings. Whereas certain industries have suffered through layoffs and lack of employment, the healthcare field has endured the opposite: increased demand for workers, longer hours, and sacrificing their personal lives in order to help those who are in need. Therefore, it should come as no surprise that healthcare workers, who bear witness to the atrocities of this virus every day, are in dire need of resources to cope with the new strains on their daily life.

As we have seen a resurgence in COVID cases, we must take into consideration how long our doctors and nurses have been overworked. What can your hospitals and healthcare facilities be doing to address the needs of staff members during these tough times? We explore how crucial it is to invest in the mental wellbeing of healthcare employees now more than ever.

The need has always been there

Historically, healthcare workers have always been at a higher risk for suicide and depression. According to a study by Frédéric Dutheil and colleagues, physicians and nurses are 2-3 times more likely to commit suicide than the general population, with female physicians especially at risk. This is only expected to rise during the strenuous conditions brought on by COVID.

Medical University of South Carolina psychiatrist Constance Guille wrote in an editorial that accompanied a JAMA Psychiatry article, “[these findings are] “particularly concerning” [because the pandemic exacerbated] “two well-known risk factors for suicide among health care workers: work-related stressors and mental health problems.” It is now well documented that the need for support systems for physicians and nurses should’ve been implemented long before the pandemic. As frontline workers provide care and treatment with no clear end in sight, now more than ever there is a need for facilities to address the mental health needs of their staff.

During the COVID pandemic

Wesley Boyd, staff psychiatrist at the Cambridge Health Alliance says, “Historically, in medical training, having a patient die is seen as a failure.” If you factor in a deadly pandemic of a new virus, assessing patients confronted with a condition they don’t necessarily know how to treat, and witnessing multiple deaths on a single shift, it’s a mental health crisis for the frontline workers.

We interviewed Washington-based Mental health professional Greg White who notes, “who’s taking care of the people, who are taking care of the people?” Beyond the struggles seen in hospitals and facilities, there is no smooth transition to their life outside of work. As healthcare workers return home, whether it be to their families or friends, they are overworked, overwhelmed, and are experiencing hopelessness. In some cases, they are seen as a health risk due to their exposure, which can create disconnection among their circles. This is all a recipe for a mental health crisis, and inevitably such factors contribute to depression and suicide risk.

Implications

Beyond the unimaginable implications a lack of mental health resources may have on frontline workers, the risks cannot be ignored. Patient safety errors and lawsuits may arise due to staff members working overtime and under high stress situations. Healthcare worker fatigue has always been widely noted, however, it must be addressed and evaluated.

What Can Hospitals and Healthcare Facilities Do to Mitigate Risk

How can we support facilities and ensure their staff is setting up protocols to mitigate suicide risk and mental health? Each facility is subjective, but there are many ways to begin implementing a strategy for the wellbeing of staff members.

Equip Workers with Knowledge

First and foremost, there are clear warning signs all staff members should be aware of. Investing in education or suicide prevention training is one way to start the conversation and ensure staff members are looking out for each other. In order for an organization to thrive, leadership must provide the support and a safe environment for workers to check in. Enlisting a mental health professional to come in for a seminar and providing digital resources for training are great starting points. Opening the door to destigmatize mental health issues allows those who may be suffering to empathize with one another and seek help.

Digitalize and Provide Resources for Check-ins

Beyond educating staff-members, and in an effort to lessen the load on staff, organizations should also create systems where workers can anonymously report someone who may be at risk for suicide, or anonymously come forward and ask for help. Greg White, a licensed professional counselor and suicide prevention specialist notes that “it is crucial for someone to be able to talk about what they’re experiencing… to realize they’re not alone. One of the single most critical factors for a person who could feel suicidal is to reach out.”

The rise of Telehealth services can greatly mitigate the risk of mental illness among healthcare workers. Beyond speaking with an outsourced doctor or therapist anonymously, there are many apps that provide therapy and safety plans for people. Compile a list of resources that workers can turn to if they feel like they need support.

Enact Programs Devoted to Staff Mental Health

If there is a high volume of staff and patients at your institution, you may want to consider a program completely dedicated to the mental wellbeing of staff members. Johns Hopkins Medicine created a confidential support program called Resilience in Stressful Events (RISE). During the past year, RISE team members provide in-person psychotherapy and support. They check in with workers on COVID floors, and have provided a great deal of emotional support for those frontline workers.

Conclusion

Mental health professional Greg White reflected: “when building something good… if you don’t lay that foundation, and take time to get everything right, you’re not going to succeed. Really make sure that individual organizations are laying a solid foundation for taking care of their own.” This is truer than ever given the circumstances of the ongoing global pandemic. In order to mitigate suicide and mental health risks, it’s imperative for facilities to come together and lay down a protocol that workers can turn to. There will always be contributing factors that affect the people who take care of us the most: our nurses and doctors. It is time to invest into their wellbeing once and for all.

In recent years, several high-profile sexual abuse and molestation cases have come to light including Boy Scouts of America, the Catholic Church, and many more allegations stimulated by the #MeToo movement. These cases have brought attention to the subject in general exposing more instances of sexual abuse and misconduct across industries, specialties, and organizations.

How do you address the risk of sexual abuse and molestation?

It’s important to know the patterns and vulnerabilities as well as warning signs of potential sexual abuse behaviors. Potential risk exposures can look different depending on the setting, but there are three common scenarios to be aware of.

Crimes of Opportunity

These are scenarios where a vulnerable party is exposed to a sexual abuser in a one-off situation. Think of a victim alone in a dark area or in an unusually vulnerable situation when an offender takes advantage of the opportunity to assault the victim. Warning signs of an abuser may not be as evident in this scenario. It’s important to prevent opportunistic abuse by using escorts, making sure all areas are well lit, using security officers, cameras, other security measures such as alarms or panic buttons and whatever tools may be effective in that setting to both deter and interrupt attempts.

Predatory Behaviors

Predators often choose to work, volunteer, or frequent settings where potential victims are especially vulnerable to grooming behaviors. Think youth-serving organizations, healthcare, religious institutions and non-profits, where staffing or budgets are often stretched or the organization is dependent on volunteers. Many of these are settings where there is a higher degree of trust. Often, victims are emotionally, physically, intellectually, or even financially vulnerable.

Organizations should be aware of the potential for sexual abuse in their setting and proactively prepare by setting up systems that prevent sexual harassment and encourage reporting of risky behaviors. This requires them to recognize situations where there might be a vulnerable person alone with a person in power and take steps to prevent that from happening.

Slippery Slope

This type of sexual abuse is more likely to occour in an existing relationship. Think of counselors with clients, teachers with students, clergy with parishioners. Conduct may seem harmless and even caring at first but becomes gradually more inappropriate until boundaries are clearly crossed and ethics are breached.

It is very important that employees know what warning signs to look out for in their peers. The more educated individuals are around the warning signs and avenues for speaking up, the less likely it is that a sexual misconduct case will occur. Education can be made available in the form of training, counseling, or even awareness campaigns like posters and educational materials.

OmniSure has developed a SEXUAL ABUSE LIABILITY RISK ASSESSMENT CHECKLIST as a general starting point for most organizations. As an underwriter, it’s important to know which scenarios an organization is vulnerable to and go deeper with setting specific checklists, guidelines and coverages.

Warning signs, education, and reporting best practices can vary by setting, but OmniSure can help. With a nationwide network of clinical experts, OmniSure can help your policyholders make the right decisions when it comes to protecting their organization and their patients. Reach out to a specialist to get started.

Ask OmniSure is a series that answers real risk and safety questions from policyholders and insurers all over the country.

Question: I came across a clinical service that a prospective insured organization offers called bioidentical hormone therapy. What risks should I be aware of when assessing this policy?

An emerging practice in medicine involves Nurse Practitioners setting up shops that offer bioidentical hormone, herbal, and alternative treatments. Physicians will occasionally even refer to the Nurse Practitioners when the patient is wanting alternatives; however, the prescribing doctor will typically continue to monitor the patient as well.

If you’ve found a policyholder in this situation, you should ask the Nurse Practitioner if they are collaborating with a primary care provider for each patient and providing progress notes to the primary care provider. To add another layer of “vigilance” or monitoring of the patient and decrease risk for the Nurse Practitioner. Even with this layer of coverage, there are a few things that you should be aware of.

Understanding compounding of bioidentical hormones

Some prescription forms of bioidentical hormones are pre-made by a drug company. Other forms are custom-made by a pharmacist based on a doctor’s order. This is called compounding. The US Food and Drug Administration (FDA) has approved a number of preparations of bioidentical estradiol and progesterone, which are molecularly identical to the structure of the hormones generated by the human body. They have been through testing for safety and purity and to be sure each dose has the same amount of hormones. The compounded forms have not been tested and approved by the FDA.

Safety of bioidentical hormones

Customized bioidentical hormones are often advertised as being a safer, more effective, natural, and an individualized alternative to conventional hormone therapy. However, these claims remain unsupported by any large-scale, well designed studies. Also, the lack of FDA oversight for compounded hormones generates additional risks regarding the purity and safety of custom compounded bioidentical hormones.

The bioidentical hormones that have been approved by the FDA have been tested for safety. They have passed the FDA’s very strict standards and have been shown to be safe for people to use.

The compounded hormones have not gone through the FDA’s testing. As yet, little research has been done on them. They have not been proven to be safe or unsafe. Many major medical groups do not support using them because not enough is known about their safety and long-term side effects.

What to ask your policyholder:

• Is your policyholder using compounded products?
• If yes, what due diligence have they done to assess the quality of the compounding pharmacy?
• What contractual language has the provider put in place to protect themselves from allegations about the compounded product?
• Website advertising: Is it inflammatory promoting safe care not supported by FDA?
• Is there informed consent clear in regard to risks, as it is well established any hormone replacement therapy increases risks for various cancers?
• Are there policies and procedures clearly in place for ongoing monitoring of the patient and their hormone levels, side effects, etc?

Ask OmniSure is a series that answers real risk and safety questions from policyholders and insurers all over the country.

Question: What should I ask when a licensed professional becomes a “health coach?”

Nurse Practitioners, Licensed Chemical Dependency Counselors, Naturopaths, Dietitians, Athletic Trainers, Teachers, Child Development Specialists, and professionals of many types are opting to pursue other passions or rewarding ventures as a break from or in addition to their chosen profession. Often this leads to questions about risk and insurance.

At present, there are no formal prerequisites to calling oneself a health coach. There are certifications and licenses available, but none are required to practice as a health coach in any state.

To help guide these professionals, OmniSure created a tip sheet addressing their FAQs. Read below to learn what common questions OmniSure specialists receive.

• What is the Definition of a Health and Wellness Coach?
• What Does It Mean to Be a Certified Health Coach?
• Does a Health Coach Need to Be Certified?
• What Are the Legal Ramifications of Being Certified?
• What Are the Limitations on a Health Coach’s Practice?
• Are Health Coaches Covered by the Health Insurance Portability and Accountability Act (HIPAA)?
• Do Health Coaches Need to Obtain the Client’s Consent Before Providing Coaching?
• Should Health Coaches Share Information with the Patient’s Health Team?
• Do Health Coaches Need Malpractice Insurance?
• Does All of This Need to Be Approved by Legal Counsel?

Learn the answers to these questions and more with our Health Coach FAQ download.

Increasingly, services by risk control consultants are being included in Professional Liability Insurance plans and for good reason. When policyholders have access to professional risk advice, they are better able to handle tough situations, resulting in dramatically lower legal fees for them and their insurance providers. Just as access to professional risk advice helps policyholders, access to expert clinical advice is key to underwriters being better equipped to select and write risks the risks they want, and avoid the ones they don’t. However, not all risk consultants are created equal. OmniSure experts are known industry-wide for going above and beyond to provide the best insight when it’s needed most. Here’s why policyholders and insurers continue to trust the OmniSure team year after year.

1. OmniSure Experts Handle the Tough Situations

We see time and time again that companies will call themselves risk advisors but are ill equipped to advise insurers during the moments it’s needed most. In a recent scenario, OmniSure stepped in at the request of the broker when their carrier’s contracted risk services team lacked the specialized expertise needed to answer the insured’s tough questions. In the end, the policyholder and their professional liability partner were able to avoid litigation and improve care due to the expert knowledge and quick response of the OmniSure team.

“I have never had to make a call like this and Laura Luck Martinez was fantastic. Answered my questions, took time with me and provided helpful sample letters and handouts.” 

Katherine Short, ND, On Sky Family Medicine

“It was very helpful to talk with Ms. Martinez. I had a difficult situation [and] Ms Martinez was very kind and empathetic and made herself very available. She encouraged me to call again if more questions should come up. I am very grateful to have access to this service! Thank you!”

Verena Socolar, PhD, PMHNP-BC, Psychiatric and Mental Health Nurse Practitioner

2. OmniSure Experts Have Years of Clinical Experience

Unlike other risk consultants, OmniSure is staffed with a team of experts with hands-on knowledge of the problems their partners face because they’ve been there themselves! We hear frequently from our partners about the value of our team members’ knowledge and professionalism.

“Diana Patten is an enormous help to our team. She is knowledgeable, intelligent, and easy to communicate with when we need her. 

Jennifer Broadway, Administrator, CC Young Hospice

3. OmniSure Experts Care About Your Business

The love for what we do and the support for the health of our industry is at the center of everything we do. At OmniSure, we know that we can only succeed when our insurance partners, brokers and their clients succeed as well. Our experts love what they do every day because it means more successful insurance programs, better run healthcare facilities, better equipped medical professionals, and healthier, happier patients. 

“My experiences have been very positive. Jeff is consultative and professional. I feel like a business partner and he is interested in our location’s well-being.”

Robert Todd, Legacy at Savannah Quarters

4. OmniSure Experts Know Tough Situations Require Personal Advice

When our customers call us, they are typically facing a complicated, personal, and nuanced situation. They don’t need the same regurgitated, cookie-cutter advice. They need an experienced clinical expert to help them solve their issue in real-time. OmniSure experts are empowered with the knowledge they need to solve even the most complex issues.

“Carol was great and had a lot of really good ideas.”

Gary DiPietro, Cedar View

There are so many benefits to working with an independent third-party risk management firm, but it’s important to pick a team like OmniSure’s in order to have a partner who can provide the right advice, on-demand, when it is needed.  Contact us if you’re ready to have an expert team on your side.

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.

Key Take-Aways 

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. 

1. Consider regulatory guidelines. Know which states provide guidelines for assisted living facilities and how those guidelines are regulated.
   
2. Consider immunities. Know when exposures are located in a non-immunity state or in less favorable venues.
   
3. 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.  

Ask OmniSure is a series that answers real risk and safety questions from policyholders and insurers all over the country. 

Question: Should underwriters consider state vaccination programs in their underwriting for skilled nursing facilities?

Across the US we’re seeing a dramatic drop in COVID-19 cases due to the distribution of the COVID-19 vaccines. Whether healthcare providers are leaving the vaccination decision up to individuals or they are implementing special programs to encourage staff to get vaccinated, the rollout plan of each state and municipality greatly impacts the level of risk for facilities. This is especially important in skilled nursing facilities where some of the highest-risk members of society reside.

This underwriter asks, should location and state vaccination programs play a part in the writing and reviewing of professional liability policies for skilled nursing facilities? To answer this question, we need to look at the effectiveness of these programs and how they impact patient health.

OmniSure specialists took a deep dive into the impact of vaccination rollout on COVID-19 cases in skilled nursing facilities. As of late February 2021, in 2/3rds of US states case numbers were on the decline. States with both national and local vaccine rollout support are experiencing the greatest decline in infections. In care facilities, this translates to a sharp decline in resident deaths in states that have the best rollout plans. 

To learn more about COVID-19 trends across the United States, read the full report here. 

Keeping this data in mind, it’s clear that vaccine programs can play an important role in the level of risk at the time of the underwriting process. Underwriters should pay attention to the location of their policyholders and decide whether to apply accompanying knowledge about pandemic preparedness and response in the area to their selection and pricing strategy. 

With mental health concerns and substance use on the rise, it is no surprise that OmniSure’s insurance partners are becoming more inquisitive about the risks associated with mental and behavioral health, most specifically Addiction Treatment.  Here is how OmniSure’s AVP of Risk Services has answered some of the underwriters’ questions. 

One of the most significant and frequent risk management and safety issues in addiction treatment facilities is associated with detox. Clients usually arrive and go through detox before beginning the center’s recovery program. This is a vulnerable time for clients, as they often suffer some level of withdrawal in the detoxification process. Their physical health is often compromised as well. Risk issues to screen for include:

• Inadequate assessment for types and amounts of substances used
• Inadequate monitoring and treatment for coexisting medical problems, such as Diabetes, Heart Disease, and Liver Disease
• Inadequate staff training
• Complications of detox, such as severe withdrawal and seizures
• Dual Diagnoses
• Infection Control; and
• Slips and Falls

Adequate assessment for amounts, types, and length of time the client has been abusing drugs and alcohol is important. Many facilities include comprehensive drug and alcohol testing as a key part of the assessment process. In addition, the assessment process should involve a physical exam to identify injuries, abscesses, and baseline vital signs. Equally important to the assessment process is the identification of psychiatric and medical conditions and medications prescribed.

Once identified, additional conditions must be documented and monitored. Rapid response to worsening conditions is critical. There is often a delay in detox, due to staff inattention and failure to monitor. Common medical problems in the detox period include abscesses, cellulitis, seizures and uncontrolled medical conditions. Severe withdrawal can also occur. While most clients go through withdrawal with minimal complications, for some withdrawal can be deadly.

Occasionally, there is inadequate staff orientation and ongoing training in treatment facilities leading to delays in recognizing and responding to a new or worsening condition related to their physical or psychiatric issues. It is easy for staff to become complacent in an addiction treatment center, as many clients don’t suffer serious detox or other complications.

Infection control is important in detox as well. During a recent risk assessment a nurse was observed carrying a urine specimen in her ungloved hand which she then placed directly on the desk in the nurses’ station. As in all healthcare facilities, handwashing is vital to infection control. Proper PPE must be used when handling all blood and body fluids. Clients with open wounds should have them regularly cleaned and dressed. 

Slips and falls are not uncommon in detox. General client debilitation and compromise can lead to falls. We recommend that as part of the comprehensive assessment, a fall risk be completed.

In today’s pandemic environment it is of even greater importance to make sure good things are offered for the mental health of both clients and staff, for example, self-care options, meditation and mindfulness exercises, journaling, more time outside, gardening, art, gym equipment, exercise programs. And, most importantly, having well developed policies and procedures for prioritizing transparency and communication with clients, staff, the community, and families about how the facility is managing COVID-19 are key reduction strategies. 

With the additional layer of complexity as it relates to COVID-19, Underwriters might want to ask some questions: 

• Does the facility require documentation from a doctor before the admission? If so, do they stress that a telehealth examination is sufficient so as not to overwhelm hospitals, emergency rooms, and urgent care clinics? 
• Is there a protocol for quarantine? 
• Does the facility have a Crisis Response Team and a plan for worst case scenarios? 
• How are they using online services such as Zoom for inpatient, outpatient and discharging clients?
• Are they assisting clients with group meetings online and relapse prevention resources? 

Resources for additional information:

naatp.org   National Association of Addiction Treatment Providers 

naadac.org   National Association for Alcoholism and Drug Abuse Counselors

thenationalcouncil.org   National Council for Behavioral Health

samhsa.gov   Substance Abuse and Mental Health Services Administration

cdc.gov   Center for Disease Control