Risk control and research drive Arrowhead's new
program for safety-minded nursing homes
By Elisabeth Boone, CPCU
Carole Fleischman, president of Arrowhead General Agency's Managed Insurance Programs Division, developed Silver Lining, a risk management and insurance program for the nursing home industry.
Do you want to hear the sound of a door slamming? Just pick up the phone, call one of your standard carriers, and say these two words: "nursing home." As the property/casualty industry seeks to retrench amid a sea of red ink, one thing it's definitely not looking for is risky business, especially in the form of nursing home applicants. Open any newspaper or popular magazine and you can read the horror stories of abuse, neglect, incompetence, and painful death in poorly run facilities. Even for reputable and conscientious nursing homes, obtaining insurance coverage is sometimes an almost insurmountable challenge.
That's the bad news. The good news is that among these clouds, there's now a silver lining. In fact, Silver Lining is the name given to an insurance program that was recently introduced by the Managed Insurance Programs Division of Arrowhead General Agency, Inc., of California. Initially launched in California and available exclusively through independent agents and brokers, the Silver Lining program is the brainchild of veteran underwriter Carole Fleischman, president of the Managed Insurance Programs Division. Tough risks are like Happy Meals to Fleischman, who brings to her craft years of specialized underwriting experience and a keen ear for the concerns of prospective insureds.
Silver Lining promotes the use of the Tempur-Med mattress as part of a comprehensive pressure management program. Silver Lining also implements proactive risk control techniques that empower nursing staff managers to turn safety into a profit center to track effectiveness.
In designing the Silver Lining program, Fleischman says, "I wanted to put a bell or whistle on the program to make it different and to help make the risk acceptable, especially in light of the fact that the nursing home industry is having such great difficulty." She started by visiting the Internet. "I went on line to see what I could find that would contribute to a nursing home's success, and what I found was Tempur-Med, which is a division of Tempur-Pedic, the Swedish mattress manufacturer," she explains. "I contacted them and found that they partner with nursing homes to supply mattresses that are designed to either improve or prevent pressure ulcers, which are the leading cause of injuries and lawsuits in nursing homes today."
Continuing her research, Fleischman satisfied herself that Tempur-Med and Tempur-Pedic had earned a solid reputation for quality and integrity. "From what I could determine, they do a very good job," she says. "Not only do the mattresses prevent and/or heal the pressure ulcers, but they go beyond that to incorporate a built-in electronic fall system so an attendant can tell when a patient is moving before he or she falls. The fall system can be transferred to a wheelchair and wherever else a patient might sit, so he or she is protected throughout
the facility." Each mattress carries a 20-year warranty.
The material in Tempur-Pedic's mattresses originally was developed for NASA to help distribute astronauts' body weight during space flight. The material also is used to make airplane seats, boardroom seats, pillows, pet beds, and other related products.
Another discovery pleased Fleischman: Tempur-Med offers educational programs for nursing home staff to help them meet the certification requirements of the state in which they work. "Tempur-Med has designed courses that are approved by the states and that can be taken for certification by the nursing home staff via Internet," Fleischman explains. "All in all," she comments, "I thought Tempur-Med's program was very good. They go beyond what I think other suppliers do. When their mattresses are used in a facility and the facility is compliant with their wound prevention and treatment program, they guarantee to pay indemnity for any loss resulting from a pressure sore if they are found legally liable, up to $250,000. They're really putting their money where their mouth is."
Partners in prevention
Already impressed with Tempur-Med's comprehensive approach to comfort, health, and injury prevention, Fleischman was delighted to discover that the organization was seeking a partner with whom it could develop an insurance program that would incorporate its products and services.
In terms of both supplies and support, what Tempur-Med provides goes a long way toward meeting Fleischman's goal of finding a way to help nursing homes improve their risk profile. "Research shows that when people rest better, they eat better, so Tempur-Pedic's mattresses can promote health from a nutritional standpoint," Fleischman remarks. "Comfortable sleep, reduced pain, and good nutrition also improve residents' attitudes toward their surroundings and enhance their interactions with staff members." These findings, she notes, are supported by the results of published studies by, among others, Yale University's nursing school and the Marriott organization, which owns a group of nursing homes.
A reduced incidence of injuries, claims, and lawsuits is a big piece of the risk management initiative that is the foundation of the Silver Lining program. For that reason, Fleischman's unit encourages nursing homes to purchase and install Tempur-Pedic mattresses in their facilities. "We work to help nursing homes understand the need for the mattresses. They cost approximately the same as other mattresses, but if the facility owns the mattresses it's currently using, it would have to incur the expense of replacing them with Tempur-Pedics," Fleischman says. "That can be a stumbling block, but it's far outweighed by the benefits."
"They [nursing home staff] need something tangible that can assist them in controlling losses ... If a nursing home doesn't use state-of-the-art equipment, it really doesn't have much of a defense today."
--Carole Fleischman
In addition to the mattresses, Tempur-Med also supplies all the topical skin products that nursing home personnel need to administer wound care. "They'll supply any kind of skin care product the facility needs, whether it's for wound care or not," Fleischman continues. "Also, if a facility has a stage 3 or stage 4 pressure ulcer issue, Tempur-Med will send out, at no extra cost, a power mattress that shifts the body continuously. A nursing home that didn't have Tempur-Pedic mattresses would have to rent a power mattress." The Tempur-Pedic program provides a comprehensive data management program, where the information on every resident with a wound is reviewed at least once a week by a certified wound specialist. These specialists are also available for consultations as needed, Fleischman adds. This extra support and oversight, in combination with unlimited access to the mattresses and other tools and supplies needed, is what makes the overall program so strong.
For nursing homes and similar facilities, Fleischman points out, just trying to do things correctly and hire the right personnel aren't enough. "They need something tangible that can assist them in controlling losses, especially in light of the Elder Abuse Act and the Patients' Bill of Rights. If a nursing home doesn't use state-of-the-art equipment, it really doesn't have much of a defense today," she says.
Clearly Fleischman believes the Tempur-Med approach is a giant step toward giving nursing homes the equipment and techniques they need to prevent and control losses. Although Silver Lining applicants aren't required to purchase the mattresses, those that choose not to do so are scrutinized very carefully. "If an applicant has never had any kind of pressure sore loss and it already has a pressure sore program, even though it might not be what we think it should be, we would probably look at the risk," Fleischman explains. "But if the facility has had this problem, we wouldn't go forward with binding coverage unless the administration was willing to use the mattresses and the Tempur-Med support services."
What's inside the Silver Lining?
The Silver Lining program provides general liability and medical malpractice coverage on a nonadmitted basis through Lloyd's of London with limits of $1 million per occurrence and $3 million aggregate. The self-insured retention is $50,000, and the minimum premium is $50,000. The program is available to skilled nursing facilities with between one and six locations; also acceptable is a multi-location entity that operates a mix of nursing homes and assisted living facilities. Currently offered only in California, Silver Lining will be made available nationally based on the program's results. If a prospect is domiciled in California and has one or more locations out of state, however, Arrowhead will entertain the risk, as long as it's not in Texas or Florida.
WorkSafe, which has trained nursing home consultants, handles loss control for the program. "They begin with the pre-underwriting inspection and go on to review documentation, assess management attitudes, talk with patient advocates and visitors, and make recommendations," Fleischman explains. WorkSafe also administers an ongoing loss control program once a risk has been accepted. Claims are handled by ProClaim, 85% of whose business is nursing homes. "They're dynamite," Fleischman says admiringly.
The boomers are coming
The elders of the generation that once said, "Never trust anyone over 30" are now, however reluctantly, beginning to think about nursing homes, first for their aging parents and second for themselves. Given this reality, Fleischman predicts a significant increase in demand for nursing homes of the highest caliber. Boomers, she says, are far more vocal and assertive than their parents, and they'll settle for nothing less than the best. For facilities that want to attract boomers, the pressure will only intensify to provide five-star surroundings and services. "Nursing homes are dealing with human emotions and human lives, and they need to hold themselves to the highest standards," Fleischman declares.
Not coincidentally, that's exactly what Arrowhead's Silver Lining program is designed to do. *
For more information:
Arrowhead Managed Insurance Programs
Phone: (626) 844-2464
Web site: www.silverliningins.com