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Tip of the Week: What risk assessors are looking for

Contemporary Long-Term Care Weekly, December 6, 2007

Now more than ever, it is important to understand risk exposure as the number of insurance carriers offering liability coverage for skilled nursing facilities (SNF) is tapering off. If your facility is going to obtain coverage, you need to thoroughly evaluate the level of risk present at your facility.

Therefore, you need to know what risk assessors are going to be looking for when they come to your facility. Risk assessors, in partnership with an insurance carrier, may visit your SNF before they begin the underwriting process to determine what level of risk the facility represents. They gather comprehensive information about SNF operations and make recommendations to the insurance carriers.

Risk assessors will closely examine the following:   

• Policies and procedures. The insurance carrier is interested in how facilities do their jobs, so risk assessors will want to take a detailed look at your SNF's policies and procedures, ensuring that detailed protocols are in order for the delivery of care, says Tommy Gee, CIC, of Tucson, AZ-based insurance agency Mueller and Associates, a division of the Compass Bank Corporation. Risk assessors will analyze how a SNF works to respond to such problem areas as falls, elopement, medication administration, prevention and treatment of skin tears, and decubitus ulcers, says Gee.  

• Survey results. State surveys from the past two or three years and any deficiencies and plans of corrections will be on the risk assessor's list of things to examine. "We want to see that [a facility's] plan of correction is still working," says Carol Marshall, MA, regulatory specialist for Omnisure Consulting Group in Austin, TX.  

• Experience of the staff and management team. Assessors will compile a detailed narrative about the level of experience and qualifications of the owners, managers, and key staff members, says Gee. That narrative information should be supplemented with résumé details.  

• Marketing materials. This is an area in which long-term care facilities need to be particularly cautious. Risk assessors will examine a facility's marketing pieces to determine whether they may be problematic in court. Statements such as "Positively the best care in the state!" that have no quantitative basis are not going to impress risk assessors, as they're simply not true, Gee emphasizes.  

• Admissions and initial assessments. Risk assessors want to see how a SNF manages risk when a resident first enters the facility. It is also extremely important to document the residents' conditions when they arrive because you need to know what problems you are inheriting, explains Gee. Additionally, risk assessors will look to see whether SNFs find out what family members expect and manage those expectations.

Source: Briefings on Long-Term Care Regulations

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