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:
- Develop a program of expectations and accountability and require residents to acknowledge their shared responsibility in implementing the program. Consider having residents indemnify the CCC for any wrongdoing on the part of their caregiver.
- Develop a Caregiver Handbook and require all caregivers allowed access to the CCC to comply, including acknowledging receipt of the handbook.
- Consider a “credentialing” process for all caregivers. This may be more appropriate for larger CCCs, but could be as simple as requiring background checks.
Developing a Caregiver 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 to first review those documents to determine whether a Caregiver Handbook and related protocols can be implemented without a revision to the resident agreement. Assuming the resident agreement provides sufficient flexibility, the CCC can develop its processes that should lay the foundation for mitigating the risks whenever a new caregiver enters the community.
Residents with established caregiver relationships likely will want to maintain those despite any additional requirements. Effective communication, transparency and education of existing residents on the importance of various new requirements will be critical to assuring compliance and providing for the safety and security of your residents moving forward.
Communicating the caregiver requirements to new residents and caregivers is equally important. Once the Caregiver Handbook is published, the CCC should provide a copy to all new residents when they move in as to their obligations with respect to employing a caregiver and the requirement to adhere to the handbook.
A simple credentialing process that requires all caregivers to complete and submit a background check that meets certain requirements can further reduce risks in this regard. The CCC can offer a list of agencies through whom caregivers can be credentialed and hired, but if the resident intends to contract directly with a caregiver (i.e., no agency is involved), the background check process would have to be completed by the resident at the resident’s expense. This “credentialing” should be completed prior to allowing a caregiver to access the CCC property (and in the case of existing caregivers, as a condition of continued access). Written confirmation that the background screening was completed and raised no red flags is essential to a successful program.
Minding Your Business: Real Risks of Caregivers on CCC Property
Examples of the real risks of caregivers on CCC property are described below and should be considered when implementing a Caregiver Handbook.
- Background screening- Caregivers enjoy a unique position of trust with the residents they serve. Seniors may be vulnerable to theft or other criminal conduct within their homes. Moreover, caregivers have access throughout the community to other seniors on which they may prey if they are criminally inclined. As a CCC, if you do nothing else, implement a mandatory background screening for all caregivers as a condition of access and entrance to the CCC property.
- Caregiver insurance/indemnification- Do you require caregivers to have insurance for injuries while on the premises? Many caregivers are independent and do not have workers’ compensation insurance, raising the risk that if a caregiver is injured on CCC property, the caregiver might file a claim. Requiring each caregiver to have his/her own insurance and further requiring the caregiver to indemnify the CCC in the event of injury may mitigate this risk. Regardless of whether the caregiver is employed directly by the resident or through an agency, the CCC should consider requiring copies of certificates of insurance with the CCC listed as an additional insured.
- Caregiver pets- Are caregivers allowed to bring their pets on site? While resident pets may be allowed, the CCC may choose to prohibit a caregiver from bringing his/her own pets on the property. When the caregiver acknowledges and agrees to the specific limitations of the access granted by the CCC, this should be one of the prohibited activities. Additionally, the indemnification by the caregiver should cover any liability created by the caregiver’s actions.