美国A.M.Best保险风险管理全集-assisted_living

Assisted Living Facilities Original Date 4 99 LineBest s Hazard Index Underwriting Comments AUTOMOBILE LIABILITY 6Insureds generally transport patients AUTOMOBILE PHYSICAL DAMAGE GENERAL LIABILITY 5 PRODUCT LIABILITY AND COMPLETED OPERATIONS 3Lower if residents prepare their own food and snacks PROFESSIONAL LIABILITY 6Higher if facility houses Alzheimer s or dementia patients DIRECTORS AND OFFICERS LIABILITY 5 ENVIRONMENTAL IMPAIRMENT LIABILITY 4 WORKERS COMPENSATION 5 CRIME 5 FIRE AND E C 5 BUSINESS INTERRUPTION 7Difficulty finding replacement space INLAND MARINE 5 BOILER AND MACHINERY Low 1 3 Medium 4 6 High 7 9 Very High 10 SIC CodeSIC Classifications 8059Nursing and Personal Care Facilities NEC 8361Residential Care Homes for the Elderly NAICS CodeNAICS Classifications 6239Other Residential Care Facilities 62399Other Residential Care Facilities 623311Continuing Care Retirement Communities 623312Homes for the Elderly ISO CodeISO Classifications 44431Health Care Facilities 3 4 Homes for the Aged 3 4 Other Than Not For Profit 44432Health Care Facilities 3 4 Homes for the Aged 3 4 Not For Profit Only Related Classifications Hospice Facilities Hospitals General Care Nursing Homes Pharmacies Rehabilitation Facilities Physical Restoration Special Exposures Administration of drugs Lifting residents or heavy items Pets Pools whirlpools and exercise equipment Privacy Substandard facilities of care Unqualified personnel RISK DESCRIPTION A rapidly growing segment of the United States population is the elderly In 1996 there were 34 million people over the age of 65 representing 13 of the nation s total population By the year 2020 this age group is projected to nearly double in number and account for 20 of the total population This increase has produced a large and growing number of senior citizens requiring medical oversight and formalized care Assisted living facilities are designed to meet these increasing demands These facilities combine the advantages of independent housing supportive services and social activities They offer individual apartments or rooms meals housekeeping and laundry services transportation assistance with basic activities of daily living ADLs and instrumental activities of daily living e g bathing eating along with ongoing health and activity supervision Assisted living is an umbrella term for a wide range of new living settings where nursing home eligible people live and receive care However while some persons may refer to assisted living facilities as nursing homes they are not similar types of facilities they offer different services often to a different population While both facilities offer medical services nursing homes are designed to provide long term health care and social services to the elderly chronically ill or convalescent persons Assisted living facilities are designed specifically for elderly citizens whereas nursing homes may house both elderly and young persons i e those with chronic medical problems or severely injured individuals who are in need of 24 hour care The goal of nursing home care is to provide care and treatment to restore and maintain the patient s highest level of physical mental and social well being by providing round the clock health care services The goal of assisted living is to help individuals live as independently as possible This classification will focus solely on assisted living facilities For more information on nursing home care refer to the Nursing Homes classification Currently assisted living facilities are state regulated Facility providers are chosen to work with state agencies to help establish quality standard measurement and monitoring approaches Each of the 50 state departments of social services or public health responsible for licensing assisted living facilities has different parameters and restrictions as well as different names for the residences Currently there are 26 different terms commonly used throughout the United States including such designations as residential care personal care boarding facilities catered living retirement homes homes for adults and adult congregate living care While these various facilities may be referred to as assisted living facilities each often offers its own unique type of services The majority of states have existing licensing regulations using the term assisted living for the purposes of this classification all such residences will be referred to as assisted living facilities In 1996 people reaching the age of 65 had an average life expectancy of 82 7 years which is 3 4 years more than their expectancy in 1960 While such recent medical advances as new medications surgeries and life sustaining equipment have extended the human life span an increase in the elderly population has brought forth a need for a disproportionately large share of medical services and assistance with daily activities According to the U S Administration on Aging daily living activities include eating getting around in one s home dressing and bathing oneself These older individuals sometimes need help with ADLs and assisted living facilities are designed to provide the necessary support Diseases related to dementia i e ailments that affect the brain and alter memory thinking and actions such as Alzheimer s disease have affected life expectancies and those suffering from such illnesses require the sort of increased care that assisted living facilities offer Other factors contributing to the growth of such facilities include the fact that older persons now have higher incomes over 53 of the U S elderly have incomes topping 15 000 a year and nearly 35 have an annual income of 25 000 allowing individuals to afford living in these residences and the emergence of managed care and integrated delivery health care systems Additionally with more women entering the workforce the number of family members able to care for aging relatives has decreased It is estimated that more than 25 of seniors do not have relatives to whom they can turn for support in their later years Assisted living facilities debuted in the U S in the 1980s These institutions were patterned after Dutch and Scandinavian systems egularly by the facility and as the resident s condition indicates The resident his or her family or another party responsible for the resident play a role in the service plan s development by aiding the facility s personnel in determining what types of services and level of care the resident needs The resident may be placed in a particular level of care if the facility offers such distinct tiers Examples of these care tiers may include a level of minimal assistance where residents are only given direction on activities meals and medications a stand by assistance level where they are provided minimal hands on assistance with dressing 24 hour care medications meals and direction on activities and a hands on assistance level where they receive aid in activities of daily living help with incontinent care diabetic monitoring plus all other assistance from the previously mentioned levels Assisted living facilities typically do not provide continuous skilled nursing care The facility should assure that prompt and appropriate medical health and dental care services are administered when required The health care of each resident is under the supervision of the resident s chosen physician Residents suffering from temporary incapacity due to illness injury or recuperation from surgery may be allowed to remain in the facility if appropriate services can be provided or be readmitted to a hospital if necessary Many elderly citizens are turning to assisted living facilities because they find them more appropriate and cost efficient than other residences or facilities for the elderly such as nursing homes or adult daycares Compared to conventional nursing home care assisted living facilities are 20 to 30 less expensive More than 90 of the sector s revenues are generated from private pay In 1998 assisted living facilities comprised a nearly 17 billion industry which is projected to climb to over 23 billion by the year 2000 National expenditures for skilled nursing and home health care increased from 36 billion in 1985 to 106 billion in 1995 expenditures that accounted for 11 of all health care costs in the U S Assisted living facilities offer the appropriate level of care for seniors at 25 to 50 less than the cost of a skilled nursing facility Assisted living facility costs vary greatly depending on the type of residence room size and types of services required by residents Private funds pay for 90 of assisted living services the remaining 10 are covered by Supplemental Security Income SSI Social Security Block Grants and other entitlement programs In addition several private health and long term care insurance policies include assisted living residential care coverage In 1998 35 states reimbursed or planned to reimburse services in assisted living or board and care facilities as a Medicaid service According to the American Health Care Association 42 of all facilities receive state program assistance for residents Currently many states are experimenting with expanding assisted living to low income seniors through waivers to the federal Medicaid program The typical profile of an assisted living resident is a senior aged 75 or older the average age for women is 84 and for men is 81 who meets the entry criteria of having at least 25 000 in annual net income no combative or disruptive behaviors and the ability to pay monthly housing rental fees of 2 000 or more The average per diem rate for the industry is 72 it is approximately 91 for residents in an Alzheimer s disease facility Assisted living costs range from between 985 and 1 500 per month to 3 700 per month for a private 2 bedroom suite with minimal to moderate levels of personal care Residents generally have personal assets ranging from 100 000 to nearly 300 000 Conversely as needs change elderly people may relocate from assisted living residences According to the National Center for Assisted Living the majority of residents leave facilities because they are in need of a higher level of medical care In 1998 the following were leading reasons why residents moved out of assisted living facilities 43 went to a nursing facility 22 died 13 returned to their homes 11 went to a hospital 9 relocated to another assisted living residence and 3 went to other settings The average length of stay for an assisted living facility resident is three years Consolidation of assisted living facilities is one reason for the industry s increase This continuing trend is a result of dominant companies e g hotel chains and major corporations seeking to strengthen their presence in specific geographic regions Most of these acquisitions have been for individual properties and small clusters of properties Recently however there has been a growing number of acquisitions of entire public assisted living companies The majority of the largest multi facility providers are publicly held and managed as for profit businesses In 1997 54 of assisted living facilities were part of a larger multi facility organization with 10 or more residences 25 were part of multi facility organizations of 2 to 9 facilities and 20 were single or stand alone facilities According to the Assisted Living Federation of America in 1996 85 of assisted living residences were for profit while 15 were not for profit facilities Assisted living facilities are located in rural suburban and urban areas in all 50 states Facility developers have identified several locations as the highest selected regions due to favorable demographics and the relative absence of regulatory impediments in those states In addition to the District of Columbia these regions include Florida Texas New Jersey Pennsylvania California North Carolina Washington and Ohio Most assisted living facilities are freestanding however they may also be part of a continuing care retirement community seniors apartment complex or wing or floor of a nursing home The facilities may also be renovated schools or converted hotels motels or nursing homes Facilities vary in terms of size The average size of an assisted living residence is 43 units however facilities may range from 3 units to over 200 individual living quarters The average number of residents in a facility is 40 however small homelike facilities typically house 3 to 12 residents while large full service communities may accommodate 600 to 800 persons Assisted living facilities generally consist of a lobby kitchen administrative offices medical and treatment areas a common dining room employee lounges restrooms and a parking lot Common areas may include sun porches a veranda a library a billiards room television rooms gardens a beauty parlor barber shop and fitness rooms Individual units or shared rooms may be clustered in groupings of six to eight and they vary in size from one room to a full apartment Full apartments generally contain a bedroom bath closets and kitchenette These units often open in a suite like fashion into a common sitting area or small living room Assisted living facilities generally operate 24 hours a day 7 days a week however administrative offices are typically open from 9 a m to 5 p m Monday through Friday Most facilities place no restrictions on visitors who are generally allowed on the premises at any time In addition many insureds also allow residents to have overnight guests The number of personnel employed by assisted living facilities varies depending on the size of the organization Some states have requirements as to the number of staff needed in the facilities For example Alabama requires that there be one staff member per six residents in assisted living facilities at all times Typically a facility may hire anywhere from 10 to over 50 employees including administrators nurses direct care staff e g certified nursing assistants certified home health assistants food service personnel therapy consultants activities coordinators dietary consultants dietitians clerical staff billing personnel and housekeeping and maintenance workers The ages of the workers vary some may be as young as 16 while others may be over the age of 65 Some facilities hire temporary or part time employees such as students during the summer others have volunteers who assist personnel and aid residents in such areas as writing letters reading and providing companionship While assisted living facilities continue to prosper there are several primary concerns that plague the industry licensing delays scarcity of trained employees overbuilding in selected markets and the inability to manage costs Assisted living organizations and associations and the facilities states are working to combat these problems by establishing new regulations and re evaluating and creating new insurance and cost structures The assisted living industry which is still a relatively new sector of elderly care is anticipated to continue to grow as a viable alternative for long term care Factors that will aid in this upsurge include the continued number of people living to age 85 and over elderly persons seeking appealing alternatives to inappropriate nursing home placement e g being placed in a nursing home facility when they did not require that type of care and government agencies recognizing these lifestyle trends and the possibility that they will introduce entitlement programs to allow older people to choose a preferred assisted living setting To provide future services to all elderly regardless of income several states including Connecticut Illinois Louisiana and Rhode Island are currently establishing pilot programs to address low income residents needs Several associations serve the industry The organizations include the Assisted Living Federation of America ALFA which may be reached at www alfa org which is the largest trade association exclusively devoted to the assisted living industry and the population it serves Other associations devoted to these facilities include the American Association of Homes and Services for the Aging AAHSA which may be reached at www aahsa org and the American Health Care Association AHCA which may be reached at www ahca org MATERIALS AND EQUIPMENT Medical equipment and supplies rehabilitative and laboratory equipment hospital beds stretchers wheelchairs and other walking aids bathing equipment first aid kits wander guard sensors i e to keep dementia patients within the facility s premises Pharmaceuticals including oral medications subcutaneous injections e g the vitamin B12 insulin eye ear nose drops topical creams and ointments suppositories enemas inhalers etc Dietary and laundry equipment housekeeping cleaning and maintenance equipment recreational facilities and equipment arts and crafts supplies Furnishings tables chairs couches televisions VCRs Computer hardware and software fax machines copy machines Automobile Liability Because the majority of assisted living facilities will frequently transport residents to and from various locations the Automobile Liability exposure will be significant These facilities often transport residents to doctors appointments shopping malls grocery stores pharmacies restaurants theaters libraries and various other locations Most facilities will have at least one vehicle to transport residents although larger insureds may have a small fleet of vehicles Assisted living facilities may also own cars vans or pickup trucks to run errands or get supplies However some facilities may require employees to use personal vehicles for business use which would increase the exposure for this liability Depending on the circumstances travel may be done at night when there is low visibility and drivers may be tired What are the frequency of travel the radius of operations and the hazards of typical routes Most deliveries pick ups and resident transports will be intermediate Determine w