SIC CODE: 8051 Nursing Homes - Skilled

8052 Nursing Homes - Intermediate Care

8059 Nursing Homes (except skilled & intermediate care)

NAICS CODE: 623110 Nursing Care Facilities

Suggested ISO General Liability Code: 44430, 44429

Suggested Workers Compensation Code: 8829

Description of operations: Nursing homes are facilities that provide all varieties of care for those unable to care for themselves, including the elderly, those recovering from illness, and those with long-term or chronic illnesses or disabilities.

There are several types of nursing homes. "Skilled care" is the designation given for those homes that provide around-the-clock physician and nursing care for patients who reside on the premises. Homes that have available medical facilities and services, but whose patients are able to provide a degree of care for themselves and do not need around-the-clock attention are called "intermediate care." The third type, "personal care," provides boarding facilities and access to medical attention for patients who are ambulatory. Nursing homes must be licensed by the state in which they reside.

Property exposure can be extensive if flammable gases such as oxygen are used on premises for patient care. Adequate controls must be in place for patient safety. Smoking must not be permitted on premises. Kitchens are required to provide three meals a day to resident patients. All grills and deep fat fryers must have fire extinguishing protection, hoods and filters. There should be automatic fuel shut off valves and adequate hand-held fire extinguishers. Other fire concerns may center on the home’s heating plant and laundry operation. If the nursing home has been converted from other occupancies, it must meet current codes for its current occupancy, including electrical wiring, heating, and plumbing systems. Theft is a concern as large quantities of drugs may be stored on premises. Tight controls must be in place including, but not limited to, inventory control and limited access to the drug room. Business income and extra expense losses can be severe due to the cost of equipment, the time it may take to repair or replace a damaged item, and unavailability of backup facilities

Equipment breakdown exposures are high as operations are dependent on medical equipment being available and the property meeting requirements for elderly or disabled occupancy.

Crime exposure is from employee dishonesty and money and securities. Pre-employment checks, including criminal background checks, should be required of any employee with access to drugs or money. Inventory must be reviewed regularly and the drug areas must have limited access. Regular monitoring with cameras can be helpful in deterring employee theft and monitoring patient treatment. All ordering, billing and disbursements must be handled as separate duties. Regular audits must be conducted. Money and securities can be a concern if payments are accepted on premises. Deposits should be made regularly and no money kept on premises overnight.

Inland marine exposure comes from accounts receivables, computers, medical equipment and valuable papers and records (employees’, patients’, and vendors’ records). Most medical equipment is now run by computers and should be covered on a computer form. Some medical equipment may be shared with other facilities or be kept in mobile care units, requiring separate coverage as it is transported between locations. Equipment in transit must be adequately secured to prevent movement during transit. Duplicates should be made and kept off site. Some homes may have extensive fine arts and statuary that should be covered under a fine arts coverage form. There may be a bailees exposure if the nursing home takes custody of the goods of others.

Premises liability exposure is extensive due to the large number of visitors to the premises and the impaired physical ability of patients. Public and life safety code compliance is very important. Excellent housekeeping is required to reduce the number of trips, slips and falls. Hallways, rooms, and recreational areas must be orderly and well maintained. .Adequate lighting, marked exits and egress are mandatory. Steps must have rails, be well-lighted, marked, and in good maintenance and repair. There should be a temperature-monitoring device in all bathing and showering areas to prevent scalding. Parking lots should be maintained free of ice and snow. Inappropriate touching and sexual misconduct must be considered. Background checks should be conducted before hiring any employee. Security at the facility, as well as in the building, corridors, and any owned parking area, needs to be carefully checked and reviewed. Emergency evacuation procedures are important and should be reviewed on a regular basis.

Environmental impairment exposure is significant due to the potential for improperly disposing of medical waste, including contaminants such as hepatitis B or the AIDS virus. Disposal must be documented and meet all FDA and EPA standards.

Professional liability, medical malpractice, and directors and officers exposures are high. Nursing homes should be part of an accreditation organization and subject to regular inspections by that organization. It should also be licensed and staffed based on the requirements of their license. The staff/patient ratio should be sufficient to provide adequate care for patients. Supervision is essential along with regular training, monitoring, and well written and followed procedures. Patients must be informed of their rights to obtain or refuse medical care as described by state and federal law. Access to patients’ records must be restricted to those having a legitimate reason for viewing them. Patients’ records must be duplicated and stored off site. Both on-site and off-site records must be safeguarded to protect patients’ right to privacy. Patient plans should be in place and followed by all staff members. Only patients who are within the appropriate level of care within the nursing home’s license should be admitted and allowed to remain in the facility. A process should be in place to confirm that professionals attend continuing education classes to maintain their credentials.

Automobile exposure is high if there is any transport of patients and residents. Training and prior record of drivers, as well as condition and maintenance of vehicles, are the main items to consider. All drivers must have appropriate licenses to transport patients. Any transport for non-ambulatory patients must include supervision.

Workers compensation exposure comes from contact with patients, from infections, and from communicable diseases such as hepatitis, HIV, AIDS, or MRSA. All CDC recommended procedures for handling bodily fluids must be followed. Constant cleansing with disinfectants can result in dermatitis to exposed skin. Gloves and masks should be worn at all times when working around any bodily fluids. Accidental piercings from needles are common. Back injuries, sprains and strains can occur when assisting or lifting patients. Slips and falls can occur from tripping over objects or slick floors. Procedures should be in place for safely handling unruly or violent patients to minimize injury to both the patient and the employees.

Building, Business Personal Property, Business Income and Extra Expense, Equipment Breakdown, Employee Dishonesty, Money and Securities, Accounts Receivable, Computers, Mobile Equipment, Valuable Papers and Records, General Liability, Directors and Officers, Employee Benefits, Environmental Impairment, Medical Malpractice, Professional, Umbrella, Business Auto Liability and Physical Damage, Hired and Nonownership Auto, Workers Compensation

Earthquake, Flood, Computer Fraud, Forgery, Bailees Customers, Fine Arts, Cyberliability, Employment-related Practices, Stop Gap Liability