Reduce risk with protocols, good hiring practices
Risk management in hospice presents challenges not faced by most health care providers, but there are steps that agencies can take to reduce risk and provide protection from lawsuits and costly claims.
"A hospice's risk management needs will differ depending on the services provided," points out Marie F. Gaudette, CIC, CPIW, vice president of Smith Bell & Thompson Insurance in Burlington, VT. "Professional liability coverage differs if you provide services in your own facility and have control over people and equipment compared to services providing services only in the home," she points out. "If you are in the patient's home, you have no control over ease of access, cleanliness, or physical conditions, so you are at more risk of injury to patients and employees."
A hospice can ensure the right liability coverage and reduce premiums by addressing some key issues for home care services, says Gaudette. "Falls, positioning, and manipulation injuries represent the highest number of claims from patients and employees," she says. Minimize the risk of these claims by conducting an environmental safety assessment upon each admission, Gaudette says. (Editor's note: To see a copy of a safety assessment checklist developed by the New Jersey Department of Health and Senior Services, go to www.state.nj.us/caregivernj/documents/checklist.pdf.)
"If there are significant safety issues such as a lack of safety bars in bathroom, a need for a bed with rails, repairs made to access to house, be sure to document the items that the patient and family must address," she says. "If the patient agrees to make necessary changes but does not, then the hospice must explore other options such as moving the patient to a safer environment such as a nursing home."
Recommending a nursing home or other facility might also be the suggestion if the patient is in a setting that the hospice staff believe to be unsafe, Gaudette adds.
Minimize risk to employees by establishing protocols that ensure employees are able to handle their job responsibilities safely, suggests Sid Rockliss, chief financial officer of VNA of Chittenden and Grand Isle Counties in Colchester, VT. All of his employees undergo a pre-employment physical to ensure that they are capable of handling all aspects of their jobs, Rockliss says. "We have a job description for each of our clinical staff that is specific to their responsibility," he says. "A physical therapist has input on weight that employees can lift and provides training on lifting techniques to all clinical staff members."
"We are at highest risk for workers' compensation claims in the first six months of employment for our licensed nursing assistants, so we make sure they get lifting technique training and extra supervision during this time," says Rockliss. Not only are lifting techniques taught during orientation, but also each nursing assistant must pass competency assessments before beginning patient care, he adds. Equipment such as mechanical lifts are provided in homes where the patient's weight is more than an assistant can safely handle. If necessary, two assistants are assigned on some visits, Rockliss says. "It is easier to provide equipment than schedule two assistants," he admits.
The additional training and supervision have paid off for his VNA, says Rockliss. "Workers' compensation premiums are based on every $100 per salary paid by the agency, and over the past six years, our premiums have dropped, even though our work force and salaries have increased," he points out.
Increase supervision of home-based staff
Another challenge for hospices is the increasing charges of employee theft and abuse, says Gaudette.
"An agency can minimize the risk of employees stealing from patients or submitting fraudulent visit reports by taking steps before hiring the employee," she says. The following steps should be taken prior to any hire:
conduct federal and local criminal background check;
contact references and, if possible, ask for recommendations in writing;
require drug and alcohol screenings of every potential employee;
verify licenses to ensure they still are valid.
Even if you conduct drug and alcohol screenings prior to employment, be sure your policies state that you can mandate a screening at any point during employment as well, says Gaudette. "You should always have the option to screen if there is any suspicion of drug use," she explains.
To avoid liability, be careful not to ask your staff members to perform tasks that are outside the scope of their training, warns Gaudette. "Because of earlier discharge from hospitals and the increased complexity of care needed for patients in the home, some agencies are relying on aides and assistants to provide care for which they are not trained or licensed," she says. Not only is Medicare not paying for medical errors such as preventable bed sores, preventable infections, and injuries caused by falls, but also patients and families have valid claims against the agencies in these cases if the care was provided by an unqualified staff member, Gaudette points out. "Make sure that staff members are qualified to perform their jobs, and make sure employees have access to clinicians who can perform the tasks," she advises.
Because hospice home care staff work without regular supervision, communication between staff and supervisors is important, says Gaudette. "Supervisors should be talking with staff members regularly to ask about patients or job-related concerns," she says. Supervisors also should interact with patients and family members at a time they can talk without the regular caregiver in attendance to promote open communication, Gaudette says. Not only do those conversations give the supervisor a chance to identify strengths and weaknesses of employees, but it also gives the family a chance to express concerns they might not express to the day-to-day caregiver. "This should happen at the start of care, throughout care, and after care," Gaudette says.
Need More Information?
For more information about reducing risk, contact:
Marie F. Gaudette, CIC, CPIW, Vice President, Smith Bell & Thompson Insurance, Gateway Square, 40 Main St., P.O. Box 730, Burlington, VT 05402-0730. Telephone: (800) 735-1800 or (802) 658-4600. Fax: (802) 658-6191. E-mail: [email protected].
Risk management in hospice presents challenges not faced by most health care providers, but there are steps that agencies can take to reduce risk and provide protection from lawsuits and costly claims.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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