Assisted living operators have good reason to recoil at results of a recent study revealing aging services insurance claims, researchers say. That’s because assisted living claims are paying out more than skilled nursing claims, on average — and there’s a high probability the trend is only going to get worse, they noted.
Although claims against skilled nursing operators are more numerous, assisted living facilities paid more per closed claim, on average, from 2011 to 2015. The gap was almost $9,000 — $221,496 to $212,766, according to CNA’s “Aging Services 2016 Claim Report.”
McKnight’s Senior Living first reported on the analysis of claims data in early November. See that article here: Elopement in assisted living: Not common, but costly. Researchers said they only recently have undertaken a campaign to spread the word further about the findings after first releasing study results on a limited basis in October.
Investigators said that higher-acuity residents, as well as greater expectations from residents and their family members, were key drivers of large assisted living claim totals. Assisted living close-claim payouts actually peaked from 2012 to 2014, at an average of $250,000.
Researchers emphasized falls and pressure ulcer risks in their 70-page report. Closed claims for falls issues in assisted living ($196,571) easily outpaced the overall average payout ($186,589) and the mean for skilled nursing claims ($188,009).
And although pressure ulcer-related allegations involving skilled nursing residents outnumbered those for assisted living residents by a 15:1 ratio, the average value of closed claims was still higher for assisted living ($236,562 compared with $231,732).
“The trend we’re seeing is the complexity of residents’ health is far greater today than before,” said Bruce Dmytrow, vice president of aging services and national programs at CNA. “With all the baby boomers coming up the pipeline, everything I’ve seen says they want to age at home, in place. Acuity is only going to continue to rise.”
This trend creates inherent risks for senior living operators that eventually end up housing such holdouts.
“The key point is if you’re going to take in residents with a higher acuity level and more complex medical and behavior types of needs, you need to have the staffing that specializes in ways to take care of them,” Dmytrow said.
Managing expectations of new residents and their loved ones also is critical, the CNA research team said.
“When you go into assisted living, you are somewhat mobile, maybe getting a better quality of life going in,” Dmytrow said. “But there’s not the realization and reluctance that there’s still going to be deterioration from a physical and cognitive standpoint.”