Welcome! Managing Risk and Promoting Safety in The Work Place. Sophia Najjar and Sam Crudo May 24, Presented By:

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1 Welcome! Managing Risk and Promoting Safety in The Work Place Presented By: Sophia Najjar and Sam Crudo May 24, 2016

2 Sophia Najjar Faculty trainer in Leadership Development program Deep experience developing Insurance programs for companies in the Healthcare Industry Featured author in Leading Age Magazine titled: Reducing Turnover to Engagement Keynote speaker Comprehensive Risk Management approach Business Risk Advisor consulting clients on present and emerging risk Developing optimal resolutions that yield growth and successes for organizations Consultative expert to help reduce overall cost in an organization

3 Sam Crudo Over 25 years of experience in commercial risk management Forward thinker in the business world with extensive knowledge in what drives costs for a business and how to minimize their risks Believes in providing excellence to his clients by offering tools to achieve long-term stability and growth Holds the lead role in management of CIA Financial Group as CEO. Licensed for property, casualty, life, accident and health insurance products Earned the designation of Certified Insurance Counselor (CIC) and Certified Risk Manager (CRM) Teaches many industry-specific classes, including one of the most sought-after the Noise Reduction Executive Management training program Member of the Michigan Professional Insurance Agents Association, Michigan Association of Insurance Agents, National Association of Health Underwriters and Knights of Columbus

4 Agenda What is risk management Business challenges and trends Facts, exposure and risk management consideration 10 steps to managing risk in LTC

5 Risk Management LTC has become more competitive and regulated, risk management programs have taken on new importance. A comprehensive risk management plans is the first line of defense in guarding against claims or suits that, in the end affect the bottom line. It accomplishes three things: Helps facilities minimize losses Helps an organization meet federal and state regulations Sets a standard for quality of care

6 What is Risk Management? "Risk" is defined as the possibility of a loss or injury (i.e. the occurrence of a negative event) with the associated consequences. "Management" refers to the steps taken by an organization to prevent or mitigate any harm. Risk management is the responsibility of every staff person from the top administrator to the front line caregivers and everyone in between. It is the sum of every step taken to minimize the risk of harm.

7 Industry Growth and Forecast 80,000 Eldercare Facilities in the U.S. Demand for Eldercare will grow with an aging population: In 2012, 65+ individuals were 13.7% of population By 2030, this group will grow to 19% of population

8 Business Challenges Regulation Affordable Care Act (ACA) Federal & State Technology HIPPA and HiTech Assisted Living v. Nursing Homes Reimbursement Medicare, Medicaid, VA, Long-Term Care Insurance, Private Pay

9 Business Challenges Increased Need for Specialization Rehabilitation / Post Acute Care Increased Alzheimer s Care Specialized Care for Obesity High Labor Turnover Liability for Resident Care and Safety

10 Business Trends Low Industry Profitability Consolidation Managed Care Reduction in Reimbursement

11 Key Exposures & Risk Management

12 Think About Your Current Risks What do you think you should be concerned with? What issues are top of mind for you when you think about risk? What do you see as your top exposures?

13 Key Risk Management Considerations Hiring, Training, Retaining Employees, Contractors and Volunteers Resident Admissions Pre-Admissions Screening Dispute Resolution Arbitration

14 General and Professional Liability By far the biggest exposures fall under the General and Professional Liability lines of business. Key loss leaders in Eldercare: 1. Resident Falls 2. Wandering and Elopement 3. Pressure Ulcers 4. Abuse, Neglect, and Molestation

15 Resident Falls Fast Facts 50% of residents fall annually Leading cause of accidental death in individuals over 65 years of age Exposures Residents who have physical conditions or are prescribed medication that lead to balance, sensory or cognitive issues Residents who have unmet needs and are left unattended for an extended period of time Environmental conditions including poor lighting, wet floors, etc. Risk Management Assessment of fall risk at admission as well as quarterly assessments of residents to develop appropriate care plan Monitor residents closely following medication changes Staff Education on fall program Safety precautions including wet floor signs, grab rails, wheelchair and bed locks, call bell system, lighting etc.

16 Wandering and Elopement Fast Facts 30% of nursing residents wander at least once 70% of elopements result in a fatality Average loss of Elopement costs $300,000 to $350,000 Exposures Residents may wander when they have unmet needs, are confused, or have a change in routine Elopement is the most dangerous form of wandering, and a majority of attempts occur within 48 hours of admission or 12 months from date of admission Risk Management Assessment plan to identify needs and tendency to wander or elope Implement a wander guard or alarm system to prevent unauthorized exit Behavior logs and periodic check-ins Plan regularly scheduled activities

17 Pressure Ulcers Fun Facts Over 60,000 residents die each year due to complications related to pressure ulcers Average cost of a claim related to pressure ulcers is $275,000 to $315,000 Represent 16% of Eldercare claims Exposures Lack of movement can lead to circulation issues creating a pressure ulcer Residents face increased risk when they have conditions including incontinence, diabetes, immobility, swelling, poor nutrition Many organizations have poor prevention and screening practices Risk Management Full body assessment completed at admission and anytime resident is away from facility for period of time Identify risk factors and develop individual care plans If a wound is identified, have treatment protocol in place

18 Abuse, Neglect and Molestation Fast Facts 30%study of 2,000 nursing home residents reported that 44% said they had been abused Abuse claims cost an average of $150,000- $200,000 Exposures Harm can be physical, emotional, financial or sexual Act by a caregiver, trusted individual, guest, contractor or another resident Risk Management Resident rights and abuse prevention training as well as training for dealing with difficult residents and stress reduction Allegation investigation practices in place examples include physical assessment, monitoring, documentation, interviews

19 Property Fast Facts 30% $13.0 Million in property damage annually 2,840 nursing home fires per year Exposures Cooking equipment involved in almost two-thirds of fires Appliances other than cooking caused 30% of fires Smoking presents a fire exposure if allowed on premises as well Risk Management Prohibit smoking on premises, if possible. If smoking is permitted, implement policies to minimize risk Develop preparedness plan and evacuation drills Review white papers on kitchen and appliance safety guidelines (for example: dryer vent cleaning)

20 Workers Compensation Fast Facts Injury Rate: 8.6 per 100 full-time employees Over 50% occurred when handling residents Exposures Musculoskeletal problems are the leading cause of worker absenteeism and workers compensation claims Losses can also result from lifting or moving patients Risk Management Facilities should develop an injury prevention program focused on patient lifting, transferring & repositioning Establish clear incident reporting and investigation guidelines Implement a Return to Work Program

21 Auto Fun Facts 25% of all driving accidents are the result of excessive speed. 60% of van rollovers are the result of under-inflated tires 70% of driving accidents occur within 25 miles from home 1 out of 4 employees who drive as a part of their job experience an accident while at work Exposures High exposure if any transport of residents is provided Loading and unloading of residents presents risk Employee error including securing clips, wheelchairs etc. can impact resident safety Risk Management Confirm all drivers have appropriate licenses to transport residents and driver reviews are performed (i.e. physical exam, drug testing) Any transport for non-ambulatory residents must include supervision Start vehicle after all passengers are seated, seatbelts fastened, wheel chairs are secured Written protocols on loading and unloading of wheel chairs

22 Crime Fun Facts Thefts are not limited to personal items, but also prescription medication Usually committed by: Residents with dementia Visitors, housekeeping personnel, other employees Exposures Employee dishonesty, primarily related to the ordering, billing and disbursements of medication and money Wire transfer fraud Residents may also be the target patient trust funds Risk Management Inventory should be reviewed regularly, audits must be conducted, and the drug areas must have limited access All ordering, billing and disbursements should be handled as separate duties Pre-employment checks should be required of any employee with access to medications or money

23 Data Breach Fun Facts Exposures Risk Management According to an Experian report, the healthcare industry will be the most susceptible to publicly disclosed and widely scrutinized data breaches this year Eldercare firms have private data on residents and oftentimes business partners and are facing growing liability related to data security and privacy Healthcare breach cost $359/record Unlike some breaches, where a credit card company, for example, would simply issue a new credit card, healthcare breaches can disclose patients names, social security numbers, dates of birth, addresses, credit card information, medical and prescription history Much of this data is unique to each person and cannot be changed as easily as a credit card number Have your system checked for vulnerability Transfer risk via Cyber Security policy: make sure it includes costs associated with responding to a breach Costs of monitoring services provided to victims Cost of legal advice on how to respond to a breach Public relations expenses to restore resident and family s confidence Includes coverage for breaches under your control as well as for breaches of data managed by a third party Access to consulting services provided by Identify Theft 911

24 Employment Practices: Wage and Hourly Fun Facts Businesses are 3X MORE likely to be sued by an employee that experience a fire The average cost of an employment law suit rose 26% over the past 3 years Wage and hour cases filed in federal court rose to 8,871 for the year 2015 ending Sept. 30, up from 1,935 in That's an increase of 358 percent 7 out of 10 businesses don t buy EPLI or don t have the right coverage Exposures The financial damage of employee lawsuits can be dramatic; the cost of settling out of court averages $75,000, and the average jury award hits $217,000 if you go to court and lose Wage & hour litigation class action law suits are the "No. 1 exposure area in corporate America Risk Management Management training - termination, discrimination, harassment, pregnancy, etc. Review your wage and hourly current policy Develop and implement an overtime approval form Review your current EPLI policy for exclusions

25 Strategic & Business Risk What is the indirect cost associated when an incident happens in the work place? Dealing with media Reputational risk Human Recourses time spent managing claim Employee turnover Employee moral

26 Importance of a Comprehensive Risk Management Program The actual practice and implementing of effective risk management strategies does require a shift in mindset for many organizations, one that involves a change from a reactive response to a proactive approach

27 10 Steps to Managing Risk in Long Term Care 1. Name a risk manager 2. Review your recruiting and hiring system 3. Focus on the quality of employee training 4. Evaluate the patient needs before admission 5. Know your residents, Look for threats to residents and environment safety 6. Track standards of care 7. Target falls and lost valuables claims 8. Account for all medications 9. Review all business contracts 10. Review all insurance contracts Source: ASHRM

28 Comprehensive Risk Management Risk Analysis - four steps: Explore your risks Construct a plan of action Implement the plan of action Monitor and modify

29 Risk Management Key to important benefits: Fewer negative events Fewer survey deficiencies Improved reimbursement Lower costs for professional liability Improved public relations Controlling risk means more resources available for providing higher quality of care.

30 The Ball is in Your Court! Thank You! Sophia Najjar Sam Crudo