Many senior living residents can benefit from services provided by third-party providers. These can include hospice, home health, physical therapy, occupational therapy, dieticians, masseuses, sitter services and many others. It is important to have a good relationship with these providers and for everyone to understand the expectations.
The community is ultimately responsible for the coordination of care and services for each resident. As such, the community still has the obligation to ensure provision of quality care and services regardless of third party involvement. Third-party services can present a significant risk to residents if the third party does not understand how the community operates or does not adhere to the quality protocols for resident care.
To manage expectations for third-party providers we recommend the community meet with each agency, and have them sign a third-party agreement which "spells out" the community's rules for outside entities when entering the facility and providing services to residents. Your agreement should include a sign-off form for each agency to acknowledge they have received and understand the community's rules of conduct, insurance requirements, necessary background checks, and communication/ documentation expectations. Click here for a sample 3rd party agreement to be signed by the 3rd party provider.
An example of a potentially litigious third-party service is wound care. As a reminder, one out of every 10 claim dollars for the THOMCO Senior Living Program is for pressure sores, with an average cost of $270K. In order to avoid claims, the charts should note the resident is receiving wound care by a home health nurse, and that the process is monitored by the community staff. If there is no corresponding documentation that the community staff are still monitoring the wound and coordinate preventative measures with the home health nurse, they could be defenseless during the litigation process. The home health nurse is generally only with the resident long enough to assess and complete treatments. That means community staff is responsible for the care of the resident's wound and wound prevention throughout the day and night. It's imperative that individualized
interventions are accomplished and included in the resident's service plan. The community should show nursing tasks performed by third-party providers are being monitored, with staff documentation, ideally on a weekly basis, in the resident's chart. It's also important that the third-party's documentation reflects the coordination of services. This is done by requiring third parties to provide progress notes after each visit.
In summary, to improve a chart's defensibility in the event of a claim related to third-party services, it is important to show coordination of care through documentation. This should include: notes from each third-party provider visits; weekly documentation by the community's staff regarding third-party services; and individualized service plan interventions in the resident's record.
If there is a claim related to a negative outcome to a resident involving a third-party provider's services, your community will almost certainly also be included in the plaintiff's claim. Therefore, there is important indemnification and hold harmless language in the TPPA. Additionally, the TPPA helps to make it clear that the Provider is not an employee of the community and contains expectations for insurance requirements. One-million in liability limits are recommended whenever possible.
Utilizing third-party providers can improve resident's quality of care and quality of life. They may also increase your referral base and residents' length of stay. It's important to utilize third-party provider agreements to ensure a positive relationship with clear understanding of the expectations.
Click here for a sample agreement residents should sign when utilizing 3rd party providers. Sample third-party provider agreements are also available on www.thomcouniversity.com .
If you need further information on risk management and loss prevention for senior living please contact Bill Coons at 1-888-546-4042 or by e-mail to Bill.Coons@thomcoins.com.
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