Risk tips for home healthcare organizations
Running a home healthcare business can be a rewarding experience, but it comes with its own set of unique risks. Unlike traditional healthcare facilities, home healthcare providers can be faced with an assortment of challenges related to working in the client's home and regularly interacting with the client's family. And those challenges are in addition to the risk posed by marketing your services, providing non-contracted services and more.
Recent claim activity has highlighted some general risk management considerations that every home healthcare business owner or operator should be aware of. From conducting a root cause analysis of an incident to monitoring employees' social media activities, these tips can help you minimize your exposure to risk and help keep your business running smoothly so you can continue to provide quality care to your clients without putting your business, employees or clients at risk.
General risk management considerations
- Many errors in healthcare settings are found to be process issues when a complete incident analysis is performed. When reviewing events, ask the question: Do you want to fix the person, so they do not do this again, or do you want to fix the process, so no one does this again?* A root cause analysis of an incident will help to determine what processes played a role in the incident. When processes are thoroughly examined, changes can be made to prevent future incidents.
- Firing staff after an incident is often a knee-jerk reaction. If an incident occurs, perform a preliminary investigation before initiating any disciplinary actions. This should be done to determine if the incident occurred due to employee malice, or if the processes should be reviewed. It is wise to not create an adversarial relationship with employees especially if the incident is caused by process issues. If an incident evolves into a claim, remember that employees will most likely need to be deposed by both sides. During depositions, we have found that angry staff do not make good defense witnesses. They may decide to air their employment grievances, whether they are pertinent to the claim or not. When a claim has been made, reach out to your claims adjuster or your Hanover risk associate as they may be able to provide guidance regarding disciplinary actions you are contemplating.
- Do not release videotapes without authorization. It is important to maintain patient privacy, especially for those who are not involved in the incident. Most, if not all, healthcare organizations will only release videos with a properly executed subpoena. Recorded information should only be disclosed in compliance with federal and applicable state laws.
- In the event police are called due to an incident, it is important to be mindful of body camera equipment. What is seen and heard can be used during potential litigation. It is important to remain professional and to refrain from making statements in the heat of the moment.
Risk considerations when marketing your services
- Review marketing material to ensure what is being advertised is indeed what you can provide. If you provide homemaker services, do not refer to it as skilled care. Additionally, do not state that you can prevent falls.
- Be realistic with potential clients. Patients are individuals with their own history and ways of living life. They will be impulsive; they will get up despite knowing they need assistance; smokers may sneak cigarettes which can lead to fires; dementia symptoms may become more frequent leading to wandering. If the patient ultimately requires more care than what you can provide, be honest with the family. Unfortunately, you may not be able to accept the patient or you will have to discharge them to a safer setting.
- Provide realistic material regarding what services you can and cannot provide. Include information regarding your employees’ training and limitations, and only have trained employees perform the aligned tasks. For example, if an employee is not trained on getting compromised individuals in and out of the bath, do not have that employee provide that service. If a patient needs a gait belt, staff the visit appropriately with employees who are competent in that type of assist.
Risk considerations for non-contracted services
Do not provide services outside of the contracted scope of work. Remember the adage that "no good deed goes unpunished." You may think you are being helpful when providing extra services not specified, but that can get you into trouble. Actual claim examples include volunteering to pick up children from the bus stop, picking up medications from the pharmacy and placing medications in a pill counter. These acts were done with the best of intentions; nevertheless, incidents occurred, and the agency was brought into the suit.
Leverage opportunities to help prevent future risk
- Inquire often with clients as to how the employee is working out. This may provide insight into any potential issues that could arise down the road. For example, if a family member states, “Please instruct the employee to always have the patient use the walker or have nasal cannula on,” follow up on those types of statements. Does this indicate that something in the care plan is not being done, or does it mean the patient is unwilling to do those things? Ensure documentation occurs that addresses these concerns. This documentation may need to be produced at a later point should questions, or claims, arise.
- Perform periodic on-site assessments of staff while at the client’s home. This will allow you to monitor the quality of care being provided by employees as well as how they engage and speak with the client. By observing the employee's interaction with the client, you can identify any areas where improvements can be made, such as communication, bedside manner or adherence to protocols.
- Monitor what employees are writing on social media. Establish clear guidelines for social media use by implementing a social media policy to ensure that employees are aware of the potential risks and consequences of posting inappropriate or unauthorized content on social platforms. A policy can help prevent breaches of patient confidentiality, protect the provider's reputation and avoid legal liability.
- Address and document risks in the home. Considerations include the following: Does the bathroom need a raised toilet seat or a grab bar? Are the stairs a fall hazard? Are the rugs trip hazards? If the patient/client wants to go outside, is the environment safe? If a wheelchair or rolling walker is used by the client, will it be on a flat surface? Has the family modified medical equipment in the home that staff may be asked to use?
Establish clear expectations and monitor them for all staff
- Provide employees with employment expectations regarding interactions with clients and monitor their performance. Are staff establishing relationships beyond professional? Are they doing things with family or patients outside of employment hours? Are they providing information not authorized by the company? Any of these activities could potentially put your organization at risk of legal liability if something goes wrong.
- Establish competencies and re-verify them on a schedule set by your organization. Establishing standard procedures for your staff will help to avoid inconsistencies in the service provided. For example, if you are providing meal preparation, have you verified the employee knows how to do those activities? If the patient has a specific diet, is the employee aware of it and any restrictions it may include?
Provide staff with a clear reporting structure
- Establish ways for staff to communicate incidents and provide that information to all staff. For example, if the patient suddenly goes to the hospital or has a change in level of care, is the expectation that the agency is made aware? Do you follow up to try to obtain details? Clear incident reporting and timely follow-up may alert you to a potential claim, whether you think there’s validity to the potential claim or not. For example, if a patient fell while your staff was present that could potentially be a claim regardless of what led to the fall.
- Establish policies that staff should follow in the event a client is making a claim. Do you continue to service that case? In some situations, continuing to provide care can help maintain the relationship with the client and their family, potentially reducing the likelihood of the claim escalating or leading to a lawsuit.
By identifying areas of potential risk and implementing risk management strategies, home healthcare organizations can stay ahead of challenges and be better protected if circumstances don't go as planned. With the demand for home healthcare businesses growing, it's even more important to be properly insured and ready for the unexpected. Contact your Hanover agent to learn more.
*Mark Galley. Think Reliability. April 2023. Re-thinking 'Procedure not followed'.