John Atkinson
Senior Living & LTC Industry Practice Leader
Nearly fifty providers of senior living and long-term care services submitted data for this analysis. Our analysis focuses on paid and closed claim data comprised of nearly 10,300 closed claims with approximately $1.87 billion in paid indemnity and expense over the past ten years. In total, this analysis includes the exposure associated with approximately 243,000 senior living and long-term care units. Using ten years of claims experience through December 31, 2023, we project 2023 outcomes and forecast results for 2024.
Per our previous report, we’ve separated claims and exposure data into senior living — those exposures related to independent living, assisted living, and memory care providers — and long-term care — those exposures related to skilled nursing facilities. We took this additional step in our analysis as we recognize the importance of understanding the unique exposures and claim treatment in each setting. Underwriters bifurcate these risks so it’s important for providers to see this distinction in the data. Further, jurisdictions can treat these settings differently which impacts the claim trends as well. For example, Kentucky has the highest loss rate for long-term care providers which is likely in part a result of the available causes of action and recoverable statutory damages specific to long-term care providers.
It is also important to understand the unique challenges to each setting. This helps providers identify the high-risk claim areas when looking to tailor and enhance their risk management processes. Future studies showing these distinctions will be interesting to monitor as consumers continue to look to age-in-place.
The principal findings in this study are developed on a countrywide basis over the past ten years along with projected 2024 experience. State-level findings can be found in our full report. The charts below depict:
It’s no surprise that falls continue to be the primary loss driver for both senior living and long-term care providers, or that wounds are the second primary loss driver for long-term care providers given the acuity of the residents admitted and retained in that setting. What is concerning, however, is the significant number of wound claims shown for senior living providers. This result emphasizes the importance of understanding these claims and implementing proactive risk management processes to identify and manage residents who develop (or are admitted with) wounds. This is particularly important as we continue to see the growing utilization of home-and-community-based services (HCBS) in senior living. Also, it’s notable that “abuse” is the second highest cause of loss for senior living. It is important for providers to have admission processes to identify individuals with pre-existing behaviors or conditions that contribute to behavioral issues. Further, providers should have strategies to manage resident behaviors and processes to recognize when discharge is appropriate because the environment may be inappropriate and staff are not able to manage the resident’s behaviors.
Also addressed in the report are the current claim trends observed with COVID-19 claims. While many of the COVID claims are closed, many continue to be litigated in courts with an aggressive defense since the impact of available federal and state liability protections is still uncertain.
Explore our full report to learn more including indemnity and expense statistics, cause of loss analysis, and the impact of close lag.
Our specialists work with operators and equity partners to develop clinical and risk management support tools and diagnostic risk assessments to substantially impact the claim trends observed from this report. In addition to these tools, we host webcasts and provide educational risk insights gleaned from the study, along with recommendations for effective solutions that can provide real, long-term reductions in causes of loss.
Senior Living & LTC Industry Practice Leader
Senior Living & LTC Industry Practice Leader
Managing Director, Marsh Senior Living & LTC Industry Practice