The average cost of assisted living professional liability claims ($267,174) has outpaced such claims by skilled nursing facilities ($245,559) over the past few years, according to the 11th edition of CNA’s Aging Services Claim Report, released Wednesday.

The 2021 data set is based on 2,265 aging services professional liability claims that closed between Jan. 1, 2018 and Dec. 31, 2020. 

Falls-related claims are common in assisted living, making up more than half (54.8%) of all assisted living claims, according to the report. Falls-related allegations continue to be the most common allegation in skilled nursing, comprising 36.1% of all claims. 

Skilled nursing claims due to falls increased more sharply than did assisted living fall-related claims, “driven in part by allegations of improper care,” the report authors wrote. Staffing shortages may partially account for allegations of improper care and may lead to an increase in unwitnessed falls or delayed identification of pressure injuries, CNA noted.

More than half of the falls-related claims (59%) in both assisted living and skilled nursing involved residents with a prior history of falls. Dementia played a role in the assisted living claims, accounting for 72.9% of all assisted living falls-related closed claims. According to CNA, claims are more costly when they involve residents with a history of falls. 

Pressure injuries comprise a small part of assisted living claims, but when they happen, a death occurs two-thirds of the time. Elopement-related claims tend to happen more frequently in assisted living, as wandering often is associated with residents living with dementia.

Reducing assisted living and skilled nursing claims

CNA suggests the following for risk management :

  • Provide additional supervision and precautions when a resident has a history of wandering or dementia.
  • Comply with service plan directives.
  • Report all falls, per policy, in a timely manner.
  • Document actions taken that promote resident safety and service plan compliance in a timely manner.
  • Conduct chart audits to assess the quality of documentation on a routine basis.
  • Adopt a formal disclosure policy and procedure with documentation guidelines in order to consistently communicate facts pertaining to falls and changes in service plan, as well as effectively manage expectations of residents and families.
  • Obtain a physician statement that the resident’s status remains appropriate for assisted living if the resident is experiencing multiple falls.

The average total incurred for pressure injury-related allegations in assisted living claims has increased by more than 67% (up to $282,358) since the 2018 data set and has surpassed the total for pressure injury-related allegations in skilled nursing claims ($252,520).