Reduce Nursing Home Professional Liability Insurance

Nursing homes provide assisted living and skilled nursing care to our nation’s most vulnerable citizens: the elderly who are not longer able to take care of themselves.  Managing a skilled nursing facility requires business acumen and compassion in equal measures because you must deliver high-quality care and maintain professional standards while you help residents and their families cope with the difficulties of living with chronic conditions and reduced independence.  This article will provide some basic strategies to help you establish an effective professional liability loss control program in your nursing home and maybe reduce your insurance costs.

Conduct a criminal background check on all job applicants, including professional staff.  Check professional and personal references, school and certification program transcripts, and status of licenses.  Ensure that all medical personnel (including physicians, RNs, LVNs, CNAs, pharmacists, etc) meet state licensing and registration requirements.  Establish your own hiring criteria for medical staff that includes required education or training, years of experience, and demonstrated skills.

Screen volunteers as well.  There have been cases of nursing home managers allowing volunteers to interact closely with residents only to find they had criminal backgrounds and were using their volunteer duties as an opportunity to prey upon the helpless elderly.  Conduct the same background checks on volunteers as you do for employee candidates and ensure they are thoroughly trained and carefully supervised before assuming volunteer duties.

Ensure adequate staffing levels and capabilities at all times. You are legally obligated to meet state mandated staff to resident ratios, but meeting the minimum will not defend you in a lawsuit if a resident suffers injury because you did not have adequate staff or personnel with appropriate expertise to accommodate resident’s needs. For example, if you are licensed to care for residents with dementia or Alzheimer’s you must have enough specially trained staff available on all shifts to handle reasonable anticipated care needs. If your medication policy indicates medicines may only be administered by an RN, then you must have an RN on site to fulfill these duties on all shifts. Consider contracting with an agency specializing in health care professionals to ensure you have adequate personnel if you have an employee staffing emergency.

Implement a thorough screening policy for prospective residents, especially if you accept persons with dementia or Alzheimer’s.  Learn whether an individual has a history of belligerence, aggression, or defiance.  Understand the training and capabilities of your staff and the mission of your facility.  If you do not have specific protocols that address disruptive residents (such as physical restraint methods or pharmaceutical treatments) then you should not accept such persons for care.

If you have a pharmacy at your facility, ensure your pharmacist is fully licensed by the state and that medicines are properly secured from residents and non-authorized employees.  If you use an off-site pharmacy or pharmacist consultant, require the use of a written contract with them that includes indemnification in your favor, and a requirement for general liability and professional liability insurance coverage.

Establish and enforce written protocols for dispensing and administering medicines. Include restrictions on who may dispense or administer any sort of prescription or non-prescription medication, procedures for dispensing and checking dosages, and procedures for matching the correct medications and dosages with residents.

Ensure you comply fully with the licensing requirements of your state and do not offer services not covered by your license.

Consider having an outside consultant audit your nursing home programs and procedures. Often times a fresh pair of eye can spot areas that need improvement.