Currently browsing Blog

Medical workers have been working endlessly throughout the COVID pandemic. Last month, we reported on the rising suicide rates among healthcare workers. Another epidemic facing these staff members is the rise of violent behaviors among clinic and hospital visitors. We explore the causes and implications of this surge of aggression in care settings below.

Staff Shortages in Clinics and Hospitals

According to a recent study, nearly one in five healthcare workers have quit their jobs. This can be attributed to several factors such as pay cuts, longer hours, and employee burnout. Whatever the reasons may be, an understaffed healthcare environment inevitably leads to aggression.

Longer wait times cause irritability. Whether someone is waiting to be seen or cannot see someone in a specific time frame, there tends to be backlash. In a healthcare setting, it is imperative to try to avoid this as much as possible. A solution to this can be strategic appointment setting or perhaps investing in online and mobile waiting rooms. If people can reserve a time slot and be notified when to come in, they do not have to wait to be seen.

Medical scheduling software can also reduce the cases of no-shows and create more time to get patients through the door at their convenience without crowded waiting areas. This helps both the patient and healthcare practice plan accordingly and avoid inpatient aggression or conflict.

Employee Conflict Management

Another negative implication of staff shortages involves internal aggression between healthcare workers. An environment of smaller, overworked staff members is a recipe for irritability and lack of patience among peers. This video by OmniSure discusses the importance of conflict management in a work setting.

Now more than ever, clinical settings must invest in mental health resources for their staff members so that they can do their job effectively and without conflict. In order to mitigate the risks of overworked and distracted staff members performance, investing in mental health resources mitigates the risk of malpractice. This is the sole responsibility of leadership in medical organizations.

Mitigating Harm During Extreme Instances of Violence

While we have explored some of the ways healthcare facilities can ease the tensions of a stressful atmosphere, the signs are not always clear when an extremely violent event unfolds. CEO of OmniSure Michelle Foster Earle explains, “…when preparing for aggressive acts, step one in an effective plan is prevention. A good place to start is with a security risk assessment by a qualified expert who will determine what the vulnerabilities are and make recommendations to reduce risk.” Now more than ever, this is absolutely necessary in clinical settings. Recommendations to mitigate violence will be specific to setting, staffing, and patient demographics but might include extensive training, panic buttons, metal detectors, security cameras, strategically placed mirrors, and prohibiting firearms.

Conclusion

The unfortunate reality of increased violence is something medical staff, patients, underwriters, and insurance carriers must keep in mind moving into the future. With awareness, proper education, and training, mitigating risk of violence is easier.

The COVID pandemic inevitably highlighted the ways in which we define the doctor-patient relationship, and what healthcare looks like. Physicians had to remain connected with their patients in new ways, and thanks to state and federal governments rewriting telehealth regulations, patients were able to access providers from the comfort of their homes.

While there are a plethora of benefits telehealth creates in a post-pandemic world, some states are rolling back regulations around telehealth licensing and requirements. We have received many calls related to whether or not a provider is allowed to offer services beyond state lines. Unfortunately, due to federal and state laws, there is not a “yes” or “no” answer or as OmniSure’s Laura Luck Martinez BSN, RN, MS, ARM, CPHRM, FASHRM puts it, “there is no one-size-fits-all solution. The one consistent thing we can say is that the pandemic changed things significantly.” We explore the implications of this below.

Each State is Different

As of summer 2021, states are rolling back many telehealth pandemic workarounds. Because these laws were issued under state emergency declarations, they were never meant to be permanent. This means that updated legislation should be communicated to patients. An article published in the Atlanta Journal Constitution (9/7/21) explains how Johns Hopkins Medicine in Baltimore, “recently scrambled to notify more than 1,000 Virginia patients that their telehealth appointments were ‘no longer feasible,’ said Dr. Brian Hasselfeld, medical director of digital health and telemedicine.” Virginia’s emergency order has been rolled back. Although the demand for telehealth service is still high, the state by state licensing requirements complicate physician’s abilities to provide care beyond state borders.

Martinez also explains how she often gets calls because patients who were seeing their provider have since moved and are still wanting the same doctor. It’s important to note that the law does not change during these circumstances. If you are not in the state and they have rolled back their telehealth legislations, you cannot continue the same patient/provider relationship.

State licensing basics

State medical boards oversee a myriad of moving parts to ensure patient safety and provider credibility. While these systems are in place for great reasons, they vary by state. It must be considered that additional licenses in out-of-state territories require application fees and adhering to certain continuing education programs.

Another factor with state medical boards rolling back regulations has financial implications as well. Part of a state’s revenue comes from licensing, and these are not minor fees. Kaiser Health News notes that “different state requirements make it cumbersome and expensive for doctors, nurses and other clinicians to get licenses in multiple states….” Therefore, while the convenience of telehealth for patients is accessible, the out of state licensing is not financially accessible for providers.

Telehealth makes more options available

The benefits of telehealth and telemedicine are very clear. For many, going to a doctor’s appointment is not easy. People have transportation issues, disabilities, or perhaps live in rural areas or challenging to access settings, and these are huge considerations for lawmakers in telehealth legislation.

According to the American Medical Association, “telehealth use by physicians jumped from 25 percent in 2018 to almost 80 percent in 2020, while almost 85 percent of psychiatrists connected with the patients via video visit or telephone during the height of the pandemic.” There is no debate on the growing use of telehealth, and it’s benefits for patients and providers alike.

Current outlook

The value of telehealth and telemedicine expands the breadth of healthcare access. Lawmakers are hard at work trying to make healthcare more accessible for Americans. This past June, The Protecting Telehealth Access Act was introduced in the Senate in order to expand telehealth access and advocate for this coverage beyond the COVID-19 pandemic.

US Rep David B. McKinley (R-WV) who helped introduce the bill explained in a press release how “the pandemic has proven the value of telehealth… particularly in rural areas, where access to care is a challenge, telehealth has provided a much-needed lifeline and improved care for millions of Americans. We need to take the lessons learned over the past year and a half and ensure we provide flexibility to meet the needs of patients and health care providers.”

As of the time of this publication, we expect much of the legislation will pass, making telehealth and telemedicine accessible for all Americans. In the meantime, the landscape remains difficult to navigate, but you and your insured partners don’t need to go it alone. OmniSure specialists are available to provide guidance and advice for your specific situation when it comes to telehealth. Speak to an expert to get started.

This October, we celebrate National Physical Therapy Month, an annual opportunity to raise awareness around the importance and impact of physical therapy. As of 2021, there are 484,540 people employed in the Physical Therapists industry in the United States alone. Here’s what PT facilities need to do in order to ensure the success of their clients’ recoveries, while also mitigating the risk of potential lawsuits.

It is well known in the world of physical therapy that improperly treating a patient is the biggest, and likely the most obvious risk. Of course it is highly unlikely that malpractice is intentional, but it carries unimaginable consequences. Beyond the seemingly obvious risk of improper treatment, there are quite a few overlooked risks to consider.

1. Financial incentives can lead to overtreatment.

According to marketresearch.com, there are currently 38,800 clinics in America providing physical therapy, occupational therapy, speech therapy and audiology and no standardized method of compensation in the field which can lead to care related issues when compensation is based on patient time. OmniSure’s Carol Marshall explains how “often…physical therapists want to work a full 8 hours today, so they end up treating people they really shouldn’t. There are 7 hours of treatment they can bill to Medicare, but they receive an 8 hour a day paycheck.”

This can be particularly concerning in facilities that provide bonuses to therapists based on productivity. Unfortunately, this is a common practice in physical therapy facilities and it leads to incorrectly reporting time. It is easy for a problem to go unnoticed due to a therapist’s schedule being packed full. Individualized attention to detail must always be managed over possible financial incentives within clinics.

2. Shortage of therapists can lead to billing errors.

Marshall explains how OmniSure repeatedly sees a shortage of therapists across all settings. “Often we find that a PT is working at an acute care hospital and they have 12 or so people to see in 8 hours. Each patient would have one hour of treatment ordered.” The possible result? Patient care gets shortened. This is an extremely tough predicament, because in some cases there are simply not enough therapists to give patients the time prescribed by their doctors. Beyond the disadvantages this creates for a patient, a shortage of time can lead to accusations of payor fraud. Patient health plans might get billed an entire hour, though they were only seen for a 45 minute session (or less).

3. The lack of clear and thorough instructions for the Patient Home Regimen can put recovery at risk.

Physical Therapists must provide clear and thorough instructions to their patients. If a patient doesn’t adhere to the treatment plan established by the therapist and approved by the physician, this puts their recovery at risk. According to physical therapist Jenni Ribbens, “…attending physical therapy 2-3 times a week but failing to do exercises at home is a common reason patients do not achieve the results they hoped for.” This prolongs the healing process and does not help the patient nor therapist achieve their goals. Along with clear instructions regarding the exercises themselves, there must be instructions administered or communicated to the participant.

Accountability and trust are key components in the relationship between physical therapists and participants. Even if the patient is adhering to the exercises but not performing them as often as prescribed, they are not adhering to the treatment plan. This is easily avoided if the instructions provided are clear and thorough.

4. Physical Therapy Assistants practicing outside their scope of practice can put patients at risk.

Many physical therapy clinics have assistants who are in the residency phase of their programs. While these assistants are there to shadow a therapist, there are times when they’re given a task or assignment they’re under qualified to administer, and they do it regardless. Carol Marshall explains how this happens because “perhaps the student doesn’t want to look like they don’t know what they’re doing, so they go ahead with what they think is right.”

This is particularly dangerous in a care setting, because this could lead to further injury. A patient needs to know who’s treating them, and additionally, their therapist must have the skills in order to do so. Certified physical therapists need to practice certain protocols to ensure they are not leaving a patient unattended. Routine training and/or assessments are sometimes delegated to mitigate the risk of malpractice with PT assistants.

5. Equipment and devices used improperly or poorly maintained can result in harm.

The luxury of technology in a physical therapy setting has revolutionized the way therapists can take care of their patients. While there are a myriad of benefits that come from medical gear, this equipment also requires close attention. Like a medical device in any setting, employees must establish a routine maintenance check on all gear.

OmniSure’s Carol Marshall explains this using equipment with electronic stimulation as an example of a risk: “how often are those machines calibrated is a risk… if you have a shortage in that piece of equipment or voltage hasn’t been regulated or gone through regular maintenance this can result in malfunction.” Another example of this are hot packs, which could potentially harm anyone with a skin condition or an elderly patient on certain medications. It is essential that every physical therapist knows exactly what and how the tools they are using work, and the potential risks involved in using them.

Conclusion

Closely adhering to a patient safety, risk reduction and harm prevention strategy is vital for any PT clinic. There is always a potential for injury if employees are not paying close attention to detail. Clear communication between the providers and patients is always the greatest way to ensure positive outcomes throughout the recovery process. If you are looking for patient safety or risk mitigation advice, OmniSure is here to provide you with the insight you need. Contact us today.

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.