What does risk management mean to you, your leadership, and your team? In the assisted living facility (ALF), risk management has different meanings to different people. Insurance brokers, attorneys, long term care staff, patients/residents and family members all view risk from very different perspectives.
Risk management is defined as the process of identifying, assessing and controlling threats to an organization’s capital and earnings. That doesn’t sound like it’s focused on residents and providing resident-centered care, so why is it important in the ALF? Here is why. Residents and staff make up the facility community. If the facility is not identifying risks for residents and staff, risks can become too great. This process should start before hiring staff and before admitting residents.
Helping staff lower risks
Start with looking at your hiring process. How are staff members interviewed when they become a candidate for your facility? It is true that some people do well in the interview but don’t become that shining star you had hoped for in an employee. Who is doing the interviews and what questions are they asking? It is helpful to have consistent questions that are specific to the positions for which you are hiring. Sometimes staff is needed sooner than later, but hiring people who are not qualified won’t help with managing risk.
There is no question that a facility should maintain sufficient, qualified staff members capable of meeting scheduled and unscheduled resident needs at all times. The facility should have ongoing training for staff on how to monitor changes in residents’ physical, cognitive, and psychosocial conditions. In facilities serving residents with dementia, direct-care staff should receive dementia-specific training each year. These educational trainings should help the staff meet the needs of the residents while keeping the residents and themselves safe.
Managing risk through the admissions process
Resident screening should occur before move-in. Reviewing a completed 1823 health assessment for health, psychosocial, and cognitive status is best practice prior to accepting a resident for admission. A face-to-face meeting with the resident and family, although not always possible, is best practice. This ensures the facility is able to meet the resident’s needs and serves as a basis for the development of a comprehensive service plan.
Information from the resident’s physician and documents such as guardianship papers, powers of attorney, living wills and do-not-resuscitate orders also should be obtained at the time of admission.
The service plan, or some form of communication when a service plan is not required, should be developed with the help of the resident and/or designated agent. The plan should include the scope, frequency, and duration of services and monitoring, and it must be responsive to the resident’s needs and preferences. The plan should be reviewed at routine intervals after move-in and annually thereafter, or as the resident’s needs or preferences change. Turning down a prospective resident is not bad marketing; it is recognizing your facility’s strengths and weaknesses to best manage the risk for the facility and the resident.
Risk is the greatest during the initial few days of residency. Take this opportunity to show what a great facility you are by going above and beyond to make the transition as easy as possible for the resident and family. At the same time, learn as much as possible about the new addition to your facility family.
Resident contracts should contain all the facility’s commitments and actual practices, including the criteria and procedures for admission, on-site transfers and discharge. Payment information should be comprehensive and should include: rate structure and payment provisions for both covered and noncovered services; an explanation of billing, payment, and credit policies; criteria for determining level of service and additional charges; fees and payment arrangements for third-party providers; provisions for payment during absences; and the facility’s policy for residents who can no longer pay for services. When a person becomes a resident, the reality of increased costs as service needs increase may not be taken into consideration. Financial issues can occur, creating a risk for the resident.
When a resident wants to engage in potentially risky behavior, such as service refusal, a risk agreement should be negotiated. This should be followed by open discussions with management and family members about the consequences of the resident’s choice. If the resident’s mental or physical condition changes substantially, the risk agreement should be reviewed. Providers must be careful to avoid using the negotiated risk or shared-risk process as a means of retaining residents who are beyond the scope of care that can be provided in the setting.
According to 429.23(1-4 & 6-10) FS; 58A-5.0241 FAC, internal risk management and quality assurance program; adverse incidents and reporting requirements:
(1) Every facility licensed under this part may, as part of its administrative functions, voluntarily establish a risk management and quality assurance program, the purpose of which is to assess resident care practices, facility incident reports, deficiencies cited by the agency, adverse incident reports, and resident grievances and develop plans of action to correct and respond quickly to identify quality differences.
(2) Every facility licensed under this part is required to maintain adverse incident reports. For purposes of this section, the term, “adverse incident” means:
(a) An event over which facility personnel could exercise control rather than as a result of the resident’s condition and results in:
- Brain or spinal damage;
- Permanent disfigurement;
- Fracture or dislocation of bones or joints;
- Any condition that required medical attention to which the resident has not given his or her consent, including failure to honor advanced directives;
- Any condition that requires the transfer of the resident from the facility to a unit providing more acute care due to the incident rather than the resident’s condition before the incident; or
- An event that is reported to law enforcement or its personnel for investigation; or
(b) Resident elopement, if the elopement places the resident at risk of harm or injury.
(3) Licensed facilities shall provide within 1 business day after the occurrence of an adverse incident, by electronic mail, facsimile, or United States mail, a preliminary report to the agency on all adverse incidents specified under this section. The report must include information regarding the identity of the affected resident, the type of adverse incident, and the status of the facility’s investigation of the incident.
(4) Licensed facilities shall provide within 15 days, by electronic mail, facsimile, or United States mail, a full report to the agency on all adverse incidents specified in this section. The report must include the results of the facility’s investigation into the adverse incident.
For more about reporting and liability claims, please click here.
Risk management cannot be just reporting the requirements to the State. It must be a part of every aspect of your facility. Risks exist with every resident and staff member, but if managing risk is part of your everyday actions, it’s easier to keep risk down.