When home healthcare workers enter clients' homes, they bringmore than medical care and help with daily living. They also bringthe risk of liability. Whether clients slip out of their grasps inthe showers or they administer the wrong medicines, home healthcare workers and their employers confront potential claims andlawsuits every day.

That risk is expected to increase as the home healthcareindustry booms, propelled by the aging of the Baby Boomers. Therewill be many more home healthcare workers on the frontlines,potentially facing allegations of wrongful death, sexual abuse,medical error, negligence and inadequate monitoring.

The financial consequences of a lawsuit can be devastating,particularly for owners of smaller agencies. Right now, agents andbrokers have an opportunity to educate home healthcare agencies ofall sizes about insurance coverage that is relevant to them.

Home healthcare workers cover a broad spectrum, includingregistered and licensed practical nurses; physical, speech,respiratory and occupational therapists; hospice workers; homehealth aides and personal care assistants.

They provide essential care to millions of people. According toa March 2009 article from TheMedica.com, which publishesinformation on the healthcare industry, of the people receivingcare at home, 75
percent of those receive skilled nursing care, indicating a highlevel of need. Also according to TheMedica.com, while the majorityof people requiring home care services are 65 and older, a full 30percent are disabled, undergoing rehabilitation, recovering fromsurgery or living with chronic conditions.

In light of these trends, home professional caregivers face amyriad of risks, which can lead to potential costs for a homehealthcare agency. For example, a negligence claim was filed afteran elderly woman fell and broke her hip. The claim resulted in a$195,000 indemnity loss. In another, a caregiver's physical abuseof a mentally challenged person resulted in $50,000 in defensecosts.

Sicker and quicker

As a result of the recession, cost containment has been a keystrategy for survival and has contributed significantly to patientsbeing discharged from hospitals and nursing care facilities morequickly and in a more precarious condition. Also, advanced medicaltechnology has made it possible to accommodate sicker people intheir homes.

The number of people 65 years and older will increase to 55million in 2020 from 40 million now, according to the U.S. Dept. ofHealth and Human Services. Add in the number of people 80 years andover–one of the fastest-growing segments of the population–and it'sclear home healthcare workers are treating increasingly frail andsick patients.

There also are significant risks and liabilities beyond homevisits. Worker and patient transport is a major issue. In oneexample, a patient in a wheelchair was being carried up a flight ofstairs when the hand grips slipped off. The patient fell out andtumbled down the stairs, suffering serious back and neckinjuries.

Many agencies that provide home healthcare workers also work ona contract basis with nursing homes, assisted living facilities andsenior housing centers, providing allied healthcare workers asneeded. These workers need coverage as well.

Further, agency administrators, medical directors and otheragency staff must also be protected. Finally, many alliedhealthcare workers are independent
contractors. While such workers are sometimes required to providetheir own coverage, there is a trend among agencies to cover themunder their policies.

Typically, a home healthcare agency's owners or top managementwill make the buying decision. Larger agencies often have riskmanagers, who are also integrally involved, and may be an agent orbroker's initial point of contact.

To be effective, insurance coverage must be comprehensive,including professional liability and general liability (GL)coverage. While these policies can be purchased separately, it'sgenerally a good idea to work with a single insurance provider totry and avoid gaps in coverage.

Wanted: comprehensive coverage

Policies for home healthcare workers can generally cover:

o Professional liability and general liability of allied medicalprofessionals and facilities

o Medical directors, leased workers, volunteers and students asinsureds

o Products/completed operations coverage (included in GL)

o MedPay (included in GL)

o Punitive damages (where insurable by law)

o Personal injury.

Like any other insurance buyers, home healthcare agency ownersand managers should expect their operations to be scrutinizedcarefully. Insurance agents and brokers can also play a role here,working with home healthcare agencies to make themselves moreattractive to insurers and underwriters. For one, insurers want tobe satisfied that a claim would not shut down the business. Amongother factors, insurers look at:

o Claims history, paying particular attention to repeated claimsfor the same types of errors or negligence, indicating thatpersistent issues have not been addressed or mitigatedeffectively

o Staff training to ensure that employees have the skills andknowledge they need to deliver services and treatment in a safe andcompetent manner

o Hiring procedures and employee background screening, includingcriminal record and past employment checks

o Ratio of caregivers to patients at a level that enablescaregivers to have enough time to provide quality care that is freeof mistakes

o Employee licensing and credentials to ensure staterequirements are met.

Given that there will be more and sicker people being cared forby home healthcare workers, the need for home healthcare agenciesto realize and identify potential liabilities will only become moreimportant in 2010 and beyond. Agents and brokers should beproactive about educating home care and hospice agencies on therisks they face, ensuring that they are protected and able tocontinue providing care to America's elderly population.