A "silver lining" for the nursing home industry

Rough Notes, Feb 2003 by Boone, Elisabeth

Risk control and research drive Arrowhead's new program for safety-minded nursing homes

Do you want to hear the sound of a door slamming? Just pick up the phone, call one of your standard carriers, and say these two words: "nursing home." As the property/casualty industry seeks to retrench amid a sea of red ink, one thing it's definitely not looking for is risky business, especially in the form of nursing home applicants. Open any newspaper or popular magazine and you can read the horror stories of abuse, neglect, incompetence, and painful death in poorly run facilities. Even for reputable and conscientious nursing homes, obtaining insurance coverage is sometimes an almost insurmountable challenge.

That's the bad news. The good news is that among these clouds, there's now a silver lining. In fact, Silver Lining is the name given to an insurance program that was recently introduced by the Managed Insurance Programs Division of Arrowhead General Agency, Inc., of California. Initially launched in California and available exclusively through independent agents and brokers, the Silver Lining program is the brainchild of veteran underwriter Carole Fleischman, president of the Managed Insurance Programs Division. Tough risks are like Happy Meals to Fleischman, who brings to her craft years of specialized underwriting experience and a keen ear for the concerns of prospective insureds.

In designing the Silver Lining program, Fleischman says, "I wanted to put a bell or whistle on the program to make it different and to help make the risk acceptable, especially in light of the fact that the nursing home industry is having such great difficulty." She started by visiting the Internet. "I went on line to see what I could find that would contribute to a nursing home's success, and what I found was Tempur-Med, which is a division of TempurPedic, the Swedish mattress manufacturer," she explains. "I contacted them and found that they partner with nursing homes to supply mattresses that are designed to either improve or prevent pressure ulcers, which are the leading cause of injuries and lawsuits in nursing homes today."

Continuing her research, Fleischman satisfied herself that Tempur-Med and Tempur-Pedic had earned a solid reputation for quality and integrity. "From what I could determine, they do a very good job," she says. "Not only do the mattresses prevent and/or heal the pressure ulcers, but they go beyond that to incorporate a built-in electronic fall system so an attendant can tell when a patient is moving before he or she falls. The fall system can be transferred to a wheelchair and wherever else a patient might sit, so he or she is protected throughout

the facility." Each mattress carries a 20-year warranty.

The material in Tempur-Pedic's mattresses originally was developed for NASA to help distribute astronauts' body weight during space flight. The material also is used to make airplane seats, boardroom seats, pillows, pet beds, and other related products.

Another discovery pleased Fleischman: Tempur-Med offers educational programs for nursing home staff to help them meet the certification requirements of the state in which they work. "Tempur-Med has designed courses that are approved by the states and that can be taken for certification by the nursing home staff via Internet," Fleischman explains. "All in all," she comments, "I thought Tempur-Med's program was very good. They go beyond what I think other suppliers do. When their mattresses are used in a facility and the facility is compliant with their wound prevention and treatment program, they guarantee to pay indemnity for any loss resulting from a pressure sore if they are found legally liable, up to $250,000. They're really putting their money where their mouth is."

Partners in prevention

Already impressed with TempurMed's comprehensive approach to comfort, health, and injury prevention, Fleischman was delighted to discover that the organization was seeking a partner with whom it could develop an insurance program that would incorporate its products and services.

In terms of both supplies and support, what Tempur-Med provides goes a long way toward meeting Fleischman's goal of finding a way to help nursing homes improve their risk profile. "Research shows that when people rest better, they eat better, so Tempur-Pedic's mattresses can promote health from a nutritional standpoint," Fleischman remarks. "Comfortable sleep, reduced pain, and good nutrition also improve residents' attitudes toward their surroundings and enhance their interactions with staff members." These findings, she notes, are supported by the results of published studies by, among others, Yale University's nursing school and the Marriott organization, which owns a group of nursing homes.

A reduced incidence of injuries, claims, and lawsuits is a big piece of the risk management initiative that is the foundation of the Silver Lining program. For that reason, Fleischman's unit encourages nursing homes to purchase and install Tempur-Pedic mattresses in their facilities. "We work to help nursing homes understand the need for the mattresses. They cost approximately the same as other mattresses, but if the facility owns the mattresses it's currently using, it would have to incur the expense of replacing them with Tempur-Pedics," Fleischman says. "That can be a stumbling block, but it's far outweighed by the benefits."