Memory Care Unit Has Unique Legal Risks

Many of the risks seen in Memory Care are the same risks that arise in skilled nursing and assisted living.  However, there are unique legal risks inherent in the provision of memory care services that leadership should not ignore.  While this article is not an exhaustive list of those risks, some of the often-overlooked enhanced risks are identified below.

By: Karen Davila

Memory Care in the CCC

The existence of a Memory Care Unit allows residents to remain in the CCC longer, but the risks of caring for those individuals increases substantially.  Memory Care services are generally provided in a secure (“closed”) unit with staff with specialized trained to understand the unique needs of residents with dementia.  Risks are different from those elsewhere in the CCC in part due to (a) the geographic and physical isolation (restricted ingress/egress) that are common for Memory Care Units; and (b) the unique capabilities and vulnerabilities of residents, rendering them unable to comply with safety guidance and participate meaningfully in analysis of any adverse event.  Because of this, leadership should recognize and attempt to mitigate risks associated with falls, elopements, aggressive/disruptive behaviors, infectious disease, adequacy of staff training, and 24/7 staff supervision, among others.  Additional thoughts and considerations on each of these are discussed below.Continue reading

Reducing Risks in CCCs with Personal Caregiver Handbooks

Developing a Personal Caregiver Handbook that spells out expectations and accountabilities of both the resident hiring the caregiver as well as the caregiver is one of the best defenses to issues of liability that may arise.  But where do you start in building out the Handbook?  Here are some key considerations as well as areas that should be covered in the Handbook:

Prior to Developing Handbook

Because the CCC’s relationship with its residents is governed by each resident’s agreement and any move-in documents that accompanied that agreement, it is important first to review those documents to determine if there are any barriers to implementation.  Because each resident contract might be different, this process might require review of all versions in effect for any current residents.

Assuming the resident contracts do not require any additional steps before rolling out such a program, the CCC can move to the drafting of the Personal Caregiver Handbook.Continue reading

Real Risks of Caregivers on Continuing Care Community Property

Providing a high-quality and safe environment and care for vulnerable seniors is a top priority for continuing care communities (CCCs).  Senior communities that provide a full continuum for seniors aging in place (including independent living, assisted living, skilled nursing, and memory care) often focus their safety concerns and resources on the licensed areas of the community, where falls and skin breakdown are the subject of lawsuits.  Sometimes overlooked are the risks that arise when independent living residents bring their own personal caregivers into the community to support their needs.

Growing Use of Personal Caregivers

More and more seniors are finding safety and security in CCCs throughout the country.  And, as they age in place, maintaining that independence often involves the use of personal caregivers who come into the CCCs and create additional risks.  Each time a personal caregiver is allowed admittance to the CCC, real risk is created- and that risk can lead to legal liability, including:

  • Injury to other residents
  • Injury to the resident that hired the caregiver
  • Injury to the caregiver caused by other residents
  • Slip, trip and fall (or other general liability claims) by the caregiver against the CCC
  • Theft/damage to property

But there are a few basic steps that a CCC can do to reduce those risks, while still allowing residents their independence.  Here are some simple considerations:Continue reading

Mitigating the Risk of Personal Aides in Continuing Care Communities

continuing care community law personal aid liability risk managementMore and more seniors are finding safety and security in continuing care communities (CCCs) throughout the country.  And, while they want the increased safety and security, they do not want to lose their independence.  Aging in place and maintaining that independence often involves the use of various personal service providers (PSPs) who come onto the CCC campus and create new risks.  PSPs go by many names and perform many functions, including housekeeping, meal preparation, assistance with activities of daily living (bathing, grooming, eating), grocery shopping, dog walking, and driving the resident to various offsite appointments.Continue reading

Importance of Communication During Care Transitions

care transition doctor patient

Over nearly the last two years, nothing has become more evident that the importance of clear and concise communication during care transitions.  As health care facilities struggled to manage the burgeoning demand for inpatient beds, and in particular ICU beds, care transitions were fast and furious.  To facilitate care delivery and expedite care transitions, CMS issued numerous 1135 COVID-19 Emergency Declaration Blanket Waivers.  Examples (not an exhaustive list) of those blanket waivers related to required communications that may have affected the quality or safety of care during and immediately after care transitions include:

  • Allowance of audio-only telehealth for certain services.
  • Waiver of the requirement to authenticate verbal orders within 48 hours.
  • Restrictions on patient rights regarding visitation, particularly where an outbreak of COVID exists.
  • Limitations on detailed information sharing for discharge planning for hospitals and critical access hospitals.
  • Extension of time within which to complete medical records following discharge.
  • Expansion of role of allied health professionals, reduction in physician supervision requirements in certain settings, and
  • Waiver of requirement to develop and keep current a nursing care plan for each patient.

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