The average cost of insurance liability claims was lower for skilled nursing settings by more than $20,000 when compared to assisted living in a new national analysis.
For SNFs, the average claims cost was $245,559 in 2021, while average costs reached $267,174 for assisted living. The findings were reported in the annual Aging Services Claim Report released this week by Chicago-based insurance company CNA. The analysis provides insight into the claims and potential risk factors aging services organizations face.
The study also found the most frequent allegations in skilled nursing settings were related resident falls, which made up 36.1% of closed claims. Pressure injuries, improper care, failure to monitor and delay in seeking medical treatment were also among the most frequent claims at SNFs.
More than 59% of fall-related closed claim allegations in both skilled and assisted living settings involved a resident with a prior history of falls, data showed. Experts encouraged providers to conduct and document a comprehensive falls assessment upon admission, including a history of prior falls, and include additional monitoring considerations for their care plan requirements.
“Closed claims involving residents with a history of falls resulted in a higher average total incurred of $242,232 in the 2021 dataset,” the authors said. “Knowledge of a previous history of falls may result in a higher expectation being placed upon the facility to implement additional measures in order to prevent recurrence.”
In regards to pressure injury claims, CNA researchers found that 94.7% of closed claims allegations occurred in a SNF. Approximately two-third of pressure injury closed claims involved a resident’s death with an average total incurred loss of $261,828.
“Develop written admission criteria to determine if available services meet the needs of the resident; document referral of residents with non-healing wounds to an appropriate provider in a timely manner,” researchers suggested. “Determine if the resident has a change in condition and transfer to a higher level of care if indicated.”
Full findings from the analysis can be found here.
