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Being proactive in risk management by understanding resident and family expectations can go a long way for senior living operators in limiting losses, claims and grievances. That’s according to Rebecca Adelman, founder of Adelman Law Firm and Claims Management in Memphis, TN.

The goal of risk management, she said, is to manage expectations by addressing needs, feelings, the family system and goal of care through pre-admission communications. By having a formalized expectations management program, operators can reduce risk, and underwriting quality is improved, Adelman said during Argentum’s 2023 Senior Living Executive Conference in New Orleans.

The cost of not knowing what to expect

Staffing challenges have contributed to increased litigation expenses, she said. With staff turnover hovering between 24% and 42%, Adelman said, 80% of care is delivered by undertrained hourly staff. 

Senior living insurance expenses have risen 10% to 30% in the past two years, with overall claims severity increasing 8% to 12% annually, she said. 

Most claims, Adelman added, arise from care issues within the first two weeks after admission, when a resident is acclimating to the community, or in the last two months of residency. Frequently, claims are related to falls, medication errors, skin conditions and infections. 

Adelman said that she has found five areas where risk shows up the most: communication, the family system, goals of care, the aging process, and emotional and spiritual health.

When a community finds itself on the receiving end of a lawsuit, the costs to the organization are unquantifiable—there is an impact on recruitment, retention and training, as well as reputational damage and insurance premiums increasing by double digits.

“The key to risk reduction is having proactive management of residents and family expectations,” Adelman said. 

The value proposition of expectations management

The value proposition of expectations management, she said, is increased wellness; reduced expenses for claims, fines and monetary penalties; improvement in staff recruitment, retention and satisfaction; and reputation / differentiation.

“For residents and families, it means being that community that is seeking to understand needs, feelings and transitions of care, and helping them define and pursue quality of life, understand treatment options and care choices,” Adelman said.

The problem, she said, is that residents are moving in with more complex care needs. With the cost of senior care increasing 25% over the next 10 years, Adelman said, families are left with guilt and uncertainty and come to communities with unrealistic expectations.

Without effective family communication, Adelman said, senior living operators are setting themselves up for litigation and potentially pricey losses.

“Residents and families and these unmet needs—that really drive losses,” she said, adding that staffing challenges are adding to the problem. “It has to do with bridging the engagement between residents, families and our teams.”

Expectations management certification

Based on her research, Adelman has created a national certification program for senior living — Guide Path LLC — focused on resident and family expectations management. The curriculum covers culture change in senior living, expectations management, compassionate communication, empathic leadership in healthcare, trauma-informed care, quality of care / goals of care, palliative care, risk management and diversity, equity, including and belonging.

The goal, she said, is to help employees become better caregivers, which will encourage staff retention and recruitment.