Webinar Summary: Risk Management in Long-Term Care

We had the opportunity to attend this presentation by Beth Alford, RN, BSN, to the Ohio Health Care Association.  In addition to increased scrutiny by surveyors, she noted that long-term care facilities lose over 88% of the suits filed against them, and the average settlement amount is $406,000.  The overriding theme of her discussion on risk management and loss prevention was that timely and complete medical record documentation is essential in managing surveys, claims, and litigation.

Ms. Alford covered all components of an effective risk management program.  Best practices in documentation included:

  • Early Risk Identification: preadmission assessments, including history of falls and prior LTC facilities, and discussions with resident and family members
  • Averting potential liability: if the resident is injured in the facility, document all calls/meeting with family and any visits to the hospital if necessary
  • Policies: keep facility policies and procedures concise to ensure staff can easily interpret and follow
  • Staffing: although not part of residents’ medical records, maintain documentation of, and attendance for, all in-services/training provided to staff along with complete personnel records
  • Resident Rights: document verbal or signed consent of a resident’s refusal of treatment
  • Quarterly Care Plan: include notes, explanation of unchanged and new interventions, and evidence of family participation in the plan

She stressed that documentation must be complete, noting plaintiff attorneys focus on missing documentation concerning pain, pressure sores, lab results, interventions, family contact, and resident/family refusal of medications and/or treatments.  Documentation must be monitored daily, and full audits should be conducted on a regular basis.


Facilities should have clear record retention policies for all records, including, but not limited to medical records, 24-hour reports,  and assignment and scheduling sheets.  When records are requested, ensure proper authorization, only provide what is included in the specific resident’s record, and have requests reviewed by risk management.

Ms. Alford provided an in-depth review of the management of and the importance of documenting interventions and preventative measures in the following areas:

  • Elopement
  • Pressure injury prevention and treatment
  • Nutrition and hydration
  • Turning and repositioning
  • Medication errors
  • Significant condition changes
  • Sepsis
  • Falls (35% of lawsuits are fall related, with an average settlement cost of $350,000)
  • Use of lifts

This webinar provided excellent insight into the development of an essential loss control program.  Excelas has the tools and the expertise to assist long-term care facilities in conducting audits, assessing documentation quality and completeness, integrating facility policies and procedures with individual resident medical records, and preparing comprehensive analyses for facility administrators, risk managers, insurers, and counsel.  Contact Excelas today to discuss how we can support your risk management program.

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