Practice Tips

Introduction

The healthcare industry, particularly long-term care facilities, is facing numerous challenges. Long-term care (LTC) involves a variety of services designed to meet the medical and non-medical needs of individuals with chronic illnesses and/or disabilities who are unable to manage activities of daily living (ADLs) adequately. Effective healthcare risk management is crucial to ensuring the safety, quality, and efficiency of services provided to these vulnerable populations.

Understanding Long-Term Care

Long-term care encompasses a range of levels of care and services that support individuals' health and personal care needs over an extended period. These services can be provided in various settings, including nursing homes, assisted living facilities, adult day care centers, and even within an individual's home. The primary goal of LTC is to help individuals maintain their highest possible level of functioning and quality of life.

The Importance of Healthcare Risk Management

Healthcare risk management involves identifying, assessing, and mitigating risks to ensure patient (resident) safety and reduce potential liabilities. In long-term care settings, risk management is particularly critical due to the vulnerable nature of the residents, the complexity of their medical needs, and the regulatory environment governing these facilities.

Key Components of Risk Management in Healthcare

• Risk Identification: Recognizing the potential risks that could harm patients (residents), staff, visitors, or the facility. These may include clinical, financial, legal, and operational risks.
• Risk Assessment: Evaluating the likelihood and potential impact of the identified risks. This can help the organization prioritize which risks need immediate attention and resources.
• Risk Mitigation: Implementing strategies to minimize the likelihood of risks occurring or reducing their impact. This can involve policy implementation and/or changes, staff training, and improving safety protocols.
• Risk Monitoring: Continuously monitoring the effectiveness of risk management strategies and adjusting as necessary. This ensures that risk management practices remain relevant and practical.

Challenges and Focus Areas for Long-Term Care Risk Management

Long-term care facilities face unique challenges in risk management due to the nature of their services and the demographic population. Some of the primary items include:

Staffing Issues

The quality of care in LTC facilities heavily depends on staff availability and competency. Challenges such as high staff turnover, staff shortages, and inadequate training can significantly impact patient safety and care quality. Addressing these issues involves implementing robust recruitment practices, providing ongoing training, and fostering a supportive work environment.

Medication Management

Medication errors are a significant risk in LTC settings, where residents often have multiple chronic conditions requiring complex medication regimens. Effective medication management involves accurately prescribing, dispensing, and monitoring medications to prevent errors and adverse drug events.

Infection Control

Infection control is a critical component of risk management, especially in LTC facilities where residents are more susceptible to infections. Implementing rigorous infection control protocols, such as hand hygiene practices, vaccination programs, and isolation procedures, is essential to prevent outbreaks and protect resident health.

Pressure Injuries and Skin Integrity

Pressure injuries are a significant concern in long-term care settings. They occur due to prolonged pressure on the skin and often affect individuals with limited mobility. Maintaining skin integrity involves regularly repositioning residents, using pressure-relieving devices, and ensuring proper nutrition and hydration. Effective management of pressure injuries includes early identification, appropriate wound care, and continuous monitoring to prevent complications, which can be achieved by implementing a skin integrity program.

Fall Prevention

Falls are the leading cause of injury and one of the leading causes of death among older adults in the United States. According to the JAMA article Trends in Deaths From Falls Among Adults Aged 65 Years or Older in the US, 1999–2020, more than 42,000 fall-related deaths occurred in 2020, with 86% involving adults aged 65 or older.

Implementing a fall program can ensure the safety and well-being of your residents. Some strategies you can use are risk identification and education of staff on practices and protocols. Assess your environment and make modifications to enhance lighting, remove obstacles and hazards, and install handrails. Implement an exercise program for your residents to improve their balance and strength. Continuously monitor and document incidents to identify a pattern and help with improvement.

See Medical Mutual’s Practice Tip Falls: Prevention/Reduction of Falls and Fall-related Injuries.

Strategies for Effective Risk Management in Long-Term Care

To address the challenges and ensure effective risk management, LTC facilities can implement several strategies:

Comprehensive Staff Training

Providing comprehensive training for staff on risk management practices, patient safety protocols, and regulatory requirements is essential. Continuous education and professional development opportunities can enhance staff competency and reduce the likelihood of errors. Implementing education for regular and temporary staff, such as travelers, is also essential.

Implementing Technology Solutions

Leveraging technology can significantly improve risk management in LTC facilities. Electronic health records (EHRs), telehealth services, and automated medication dispensing systems are some examples of technological advancements that can enhance patient safety, streamline operations, and reduce risks caused by human errors.

Resident-Centered Care

Adopting a resident-centered care approach involves tailoring care plans to meet each resident's individual needs and preferences. This approach fosters a supportive and respectful environment, improves resident satisfaction, and reduces the risk of adverse events. Through this process, collaborate with families through communication and care planning.

Regular Audits and Assessments

Conducting regular audits and assessments helps identify potential risks and areas for improvement. These evaluations can include reviewing incident reports, conducting safety inspections, and assessing compliance with regulatory standards. If you are uncertain of where to start, reach out to your risk manager at Medical Mutual Insurance Company of Maine.

Conclusion

Long-term care and healthcare risk management are integral to ensuring the safety, quality, and efficiency of services provided to these vulnerable populations. By understanding the unique challenges of LTC settings and implementing effective risk management strategies, facilities can create a safer and more supportive environment for residents, staff, and visitors. As the healthcare landscape evolves, continuous improvement and adaptation to emerging risks will remain essential.

Resources

Medical Mutual’s Practice tip Falls: Prevention/Reduction of Falls and Fall-related Injuries

Agency for Healthcare Research and Quality (AHRQ). (n.d.). Long-term care facilities resources. U.S. Department of Health & Human Services. Long-term Care Resources

ECRI. (n.d.). Developing an aging services risk management program. Retrieved from https://members.ecri.org/guidance/developing-an-aging-services-risk-management-program (Login required)

References

Santos-Lozada AR. (2023).Trends in Deaths From Falls Among Adults Aged 65 Years or Older in the US, 1999-2020. JAMA, 329(18):1605–1607. https://doi:10.1001/jama.2023.3054

SNF Metrics. (2024, March). Risk management in healthcare. SNF Metrics. https://snfmetrics.com/risk-management-in-healthcare/#:~:text=It's%20a%20fundamental%20aspect%20of%20healthcare%20quality