The average cost of liability claims across all aging services settings has increased since 2018, with assisted living claim costs continuing to exceed those in skilled nursing, according to a new report from Chicago-based insurance company CNA.
According to a recently released aging services claim report, the average liability claim cost in assisted living was $267,174 in 2021, up from $152,348 in 2018. Comparatively, the average skilled nursing facility claim cost for 2021 was $245,559, up from $216,428 in 2018.
In assisted living, the report noted an increase in severity resulting from allegations of failure to monitor — one of the top five allegations in the setting. The report authors noted that lack of appropriate staffing may contribute to or exacerbate those allegations, leading to an increase in unwitnessed falls or delayed identification of pressure injuries.
Falls
Resident falls and pressure injuries represented almost two-thirds of all claims across all settings, with improper care the top falls-related claim (51%), carrying an average cost of $229,934. Average costs for falls claims was highest in assisted living, but claim costs in skilled nursing showed a sharper increase over assisted living.
Falls-related allegations continue to be the most common in assisted living compared with other settings, making up 54.8% of all claims, with the average claims cost at $239,074, up from $224,300 in 2018.
Dementia is a contributing factor in 72.9% of all assisted living falls-related claims, averaging $242,269 in claim costs, according to the report. And more than 59% of all falls-related claim allegations in assisted living and skilled nursing settings involved a resident with a prior history of falls.
The top five fall-related injuries in assisted living and skilled nursing facilities were death (59.4%), fractures (30.7%), head injury (3.9%), laceration (1.8%) and muscle and ligaments (1%).
An analysis of customer engagements showed that less than 25% of facility marketing materials convey realistic expectations of the ongoing risk of resident falls, CNA said.
Other liability claims
Aside from falls, the most common allegations in assisted living were improper care (7.4%), resident abuse (6.8%) failure to monitor (5.8%) and pressure injuries (5.8%).
Across all settings, in addition to the increased severity of falls and pressure injuries, the report noted an increase in the severity of delays in seeking treatment, medication errors, resident abuse, elopements, improper care and failure to monitor.
Elopement-related claims made up only 1.8% of all claims, but they continued to be some of the most expensive, with an overall average cost of $360,840. Elopement-related claims occurred more frequently in assisted living, with an average cost of more than $400,000, according to the report.
Other claims seen more often in assisted living than in other settings include allegations of sexual or physical abuse, as well as failure to move residents to a higher level of care.
Although pressure injury claims are less prevalent in assisted living, about two-thirds of those claims involved the death of a resident. The average claim cost for pressure injury-related allegations in assisted living increased more than 67% to $282,358 since 2019, surpassing the average skilled nursing claim cost at $252,520.
Risk management
The ultimate effect of the pandemic on litigation, claim frequency and severity remains uncertain, according to CNA, but aging services organizations can limit their risk exposure by creating clear expectations of service capabilities and being transparent about their organization’s limitations.
The report authors noted that although aging-in-place arrangements are popular in attracting prospective residents, an organization’s willingness to accommodate residents and families presents some risk.
“While aging in place arrangement may be a beneficial marketing tool, retaining residents beyond the facility’s capabilities increase the potential for unanticipated events and adverse claim outcomes,” the report reads.
The report provided recommendations to help operators proactively manage resident and family expectations and limit risk, including a thorough pre-admission screening process, education on transition-related protocols and transparency around service capabilities.
The report analyzed 2,265 aging services professional liability claims closed between Jan. 1, 2019, and Dec. 31, 2020.
