questions about their mental status, mood and preferences of daily routine, pain, long-term goals and overall satisfaction. While resident interviews may not appear risky at first glance, consider the following questions: ‘have you ever thought of hurting yourself?’ or ‘have you ever thought you’d be better off dead?’. Now, consider what happens when a resident answers with a ‘yes’.
Obviously, such questions open up a facility’s responsibility to
provide additional services, immediately. In this example, the facility would have a responsibility to report that event to the proper authorities, allocate additional mental health resources and make sure that the plan of care addresses this risk. Not asking these telling questions is not an option with MDS 3.0. Everything is documented and measured according to built-in severity scores. Of equal importance is the fact that this type of staff/resident interaction is entirely new, and proper training must be implemented so that the correct plan of action is taken every time.
The captive’s response For many facilities, the challenge of these new systems will be
in the change itself and the magnitude of these changes. As such, it’s critical for captives to understand underlying risk drivers such as communication between resident/family and staff, counselling on end-of-life issues, immunisations, handling of internal complaints, participation levels in resident surveys and the percentage of residents with advanced directives. These indicators speak volumes
about actual risk within the four walls of any facility. This is an opportunity to come alongside the membership and facilitate risk management initiatives. For example, if one facility has a 90 percent success rate in obtaining advanced directives, enquire as to its methods. Then, share the lessons learned, and provide a mechanism for facilities to share best practices and allow the entire risk pool to benefit. This is an ideal opportunity for captives to stand out from traditional insurance carriers by providing risk management services through an increased awareness of underlying risk drivers.
Invest in the future In order to maintain loss ratios in the midst of these changes, it is
important to invest in risk management practices. Leverage existing tools, such as MDS 3.0, to broaden and deepen your understanding of how each facility operates on a day-to-day basis. Learn to interpret, benchmark, track and trend available data to monitor the effectiveness of risk management programmes.
Mary Chmielowiec is the executive vice president of
insurance services at PointRight Inc. She can be contacted at:
maryc@pointright.com
Paola DiNatale MSN, RN, NHA, RAC-CT, is a national account
manager, risk services at PointRight Inc. She can be contacted at:
paola.dinatale@pointright.com
CAYMAN CAPTIVE 37
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