Average cost of assisted living liability claims exceeds $267,000

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The average cost of professional liability claims in assisted living facilities ($267,174) continues to exceed that of skilled nursing facilities ($245,559).

And while claims of fall-related allegations continue to represent the majority of cases against assisted living operators, the severity of pressure injury claims has risen sharply since 2018 within assisted living facilities, according to a new report published on Wednesday by insurance giant CNA.

A total of 535 pressure injury claims have been recorded for 2021, with an average total damage suffered of $254,108. Although pressure injuries remain primarily a problem for skilled nursing, they have also occurred in assisted living and self-contained facilities as residents of these facilities age in place.

The average total cost incurred for assisted living pressure injury claims increased by more than 67% from 2018 to an average of $282,358, and exceeded the severity of pressure injury claims Skilled Nursing Pressure Injuries ($252,520) . In 2018, assisted living claims averaged $168,446.

Nearly 66% of closed pressure injury claims resulted in death in assisted living and skilled nursing, with an average total loss of $261,828 for claims involving death.

Courtesy of AIIC

Fall-related allegations continue to be the most common allegation in assisted living facilities, accounting for more than half (54.8%) of all complaints.

Besides falls, the most common allegations in assisted living facilities include:

  • improper care (7.4%)
  • resident abuse (6.8%)
  • lack of supervision (5.8%)
  • pressure injuries (5.8%)

Dementia was a contributing factor in 72.9% of all closed claims related to falls with assisted living, according to the data.

Overall, the distribution of assisted living claims changed by 2.9% from 2018, from 18.7% of total claims to 21.6%.

Many factors seem to contribute to the claims.

According to the CNA report, providing services to more acute care residents in assisted living facilities or self-contained residences may increase the risk of lawsuits. This, coupled with aging on-site resident populations, could cause some providers to market beyond their community’s service capabilities and face potential risks. In the report, a CNA analysis of customer engagements found that less than a quarter of facility marketing materials convey realistic expectations about the ongoing risk of residents falling.

To reduce the risk of resident falls, pressure sores, abuse and runaways, CNA writes that organizations must be willing to hire nursing and support staff. This means assisting with resident observation; be proactive in identifying residents’ needs and communicating them to caregivers.

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