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Life Health > Long-Term Care Planning

Jumbo liability claims hit continuing care communities

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Consumers sometimes see continuing care retirement communities (CCRCs) — facilities that combine ordinary apartments with assisted living facility beds and skilled nursing home beds — as an alternative to long-term care insurance (LTCI).

Analysts at CNA Financial Corp. say U.S. CCRC facilities seem to have suffered in a big increase in the likelihood that a resident liability claim would be an extremely costly claim.

The analysts looked at closed professional liability claims at CCRCs and other types of long-term care (LTC) facilities.

CCRCs accounted now account for about 14 percent of the beds CNA insures, up from 11 percent in 2012, and they account for 7.5 percent of CNA’s closed LTC facility professional liability claims, down from 7.8 percent two years earlier.

But the average amount paid for a closed CCRC claim has soared to $317,741 this year, up from $168,422. The average for all closed LTC facility professional liability claims has held steady at about $211,000. The average fell about 9 percent at stand-alone skilled nursing facilities and rose about 10 percent at stand-alone assisted living facilities.

In 2012, the biggest claims CCRCs paid were for “elopement,” or cases of residents with dementia who left the facilities without adequate supervision. The highest award in a CCRC elopement case that year was for $554,144, and the next highest awards, in connection with allegations of gross improper care, were for three cases with an average award of $383,168.

This year, CNA has already paid a $1.1 million claim for a case involving allegations of gross improper care, and $984,749 in connection with a case involving allegations that a CCRC’s failure to follow physician’s orders led to a patient’s death.

The 2014 closed claim also includes nine claims involving allegations about pressure ulcers. “Seven of the nine closed claims involved the resident’s death,” the analysts report.

The share of closed CCRC injury claims involving the death of the resident has increased to 54 percent this year, from 41 percent in 2012.

See also: Housing


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