How to Avoid the Biggest Homecare Risks

What are the biggest dangers to your in-home care business? HomeCare recently held an online panel session with homecare insurance experts to find out and learned that most dangers fall into one of three large categories.

1. Automotive-Related Risks

The top risk tends to be automotive accidents. According to statistics based on claims managed by Philadelphia Insurance Companies, which sponsored the event, the average auto incident requires a payout of about $125,000.

“I think that not only speaks to homecare agency operations, but just in this life as human beings—voluntarily putting ourselves in a vehicle and hurling ourselves down the road at 60, 70-plus miles an hour, really bad things can happen and very severe things,” said Brett Jones, president of West Insurance, Inc. “The largest claims
that we’ve seen in my agency have been auto-related.”

Those costs may be climbing, especially in cases that go to court, said Jeffrey Mancill, vice president of claims for Philadelphia Insurance Companies. That’s because since COVID-19, there has been a trend across the board for juries to give out more money in all kinds of cases, he said.

“It definitely affects the values of cases and claims settlements that we’re paying out,” he said. “You could have a very minor accident, and the next thing you know, it’s manufactured into some seven-figure case. And the plaintiff’s attorneys are very aggressive.”

He and the others had suggestions for how to mitigate the risk, including:

• Ensure everyone who works for you has a valid driver’s license.
• Confirm that employees who are driving and any personal vehicles being used in relation to a job have a personal auto policy, because your liability as an employer often kicks in once their limits have been exhausted.
• Run a motor vehicle report on employees to see their driving records.

“It’s not an option in this day and age, it is an expectation,” West said. “Any judge that you would appear in front of is going to expect that you are looking at people’s driving records to make sure you’re putting responsible people behind the wheel.”

Those checks shouldn’t just be run once when an employee is hired; rather, they should be conducted at least annually, if not more often. The good news is some state motor vehicle departments allow you to set up record monitoring and will alert you if an employee driver has a moving violation or lets their driver’s license lapse.

2. General/Professional Liability

This area is a catch-all that can involve most components of patient care and the risks that it brings, including:

• patient falls
• transfers
• scalding
• choking/food-related issues
• medication errors
• shift coverage and client matching

Falls can be one of the most frequent causes of insurance-related losses, said Tony Canci, vice president of underwriting at Philadelphia, and they can quickly escalate beyond a simple fall injury.

“It’s probably no surprise—we’re dealing with mostly elderly, oftentimes frail individuals,” Canci said. “And it’s also no surprise that the severity a lot of times can be very high.”

One of the best ways to moderate fall risk and other injuries is to be vigilant about training caregivers and ensuring they are performing all required monitoring responsibilities around a client. For example, the panel said, often a client will request—or even insist upon—toileting alone when they really need to be supervised.

A solid employee training and onboarding program can also reduce inappropriate assumptions on the part of caregivers. Jones, for example, said he had in one case at a nursing facility had a client with a do not resuscitate (DNR) order who choked on some food, and the caregiver thought the DNR prohibited from doing the Heimlich maneuver. Additionally, having policies and procedures you can document in writing—in an operations manual or some other format—is critical, especially if a claim goes to court.

Training and the consistent use of best practices can also help prevent your staff from being harmed in transferring or otherwise working with clients—and protect you from workers’ compensation claims. One option is to have a “lifting lab” where your caregiving team can demonstrate their knowledge of mobility and transfer equipment and learn how to use it properly. Some home medical equipment providers are willing to offer up their showrooms as training centers as well.

Also important is ensuring that clients aren’t being left alone—say, when one caregiver wraps up their shift and leaves before the next one has arrived—and that care teams are documenting everything stringently, which can provide protection if a claim goes to court.

3. Abuse & Theft

These are scary scenarios for business owners—and also difficult to discuss in some cases. Prevention, again, comes down to training, said Jake Darcy, senior risk management consultant at Philadelphia. That means having a formal policy in place to lay out required policies, procedures and red flags for staff. Screening during the hiring process is also critical, he said.

“It’s more than just running background checks on your employees,” Darcy said. “You really need to have good procedures in place for checking references and making sure that the people that you’re hiring to come into your organization are not potential abusers and that they’re the type of people that you’re comfortable working in a one-on-one scenario with your clients.”

The situations most at risk for abuse are those in which a single caregiver is staying in a home 24 hours a day, because potential abuse might go unnoticed, Canci said. In those cases, it’s important to have routine check-ins, or even better, swap caregivers every 48 hours.