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					   The New and Improved LTC
           Outlook

• MODERATOR: Theresa Bourdon, FCAS, MAAA,
      Managing Director & Actuary,
      AON

• Bryan A. Baird, President,
      K&B Underwriters, LLC

• Raymond E. Watts, Jr., Esq., Partner,
      Wicker, Smith, O'Hara, McCoy & Ford, PA
       Aon/AHCA 2006 LTC
     GL/PL Liability Study Data

• 60 LTC providers participated
    15 FP, multi-facility, multi-state
    12 regional, multi-facility, in 2 – 5 states
    33 small independents in only 1 state
• 290,000 licensed beds (255,000 occupied)
• 20,000 non-zero claims (over 7 year period)
• Loss development patterns for 77% of exposures
• Study participants represent 15% of the industry,
  measured by beds.
                   Key Findings

• Tort Reform is having a favorable impact on
  lowering both frequency and severity.
• Operational improvements focusing on effective
  defense strategies and quality of care initiatives are
  helping to stabilize and/or decrease loss costs, with
  most measurable impact on severity.
• Structural changes are evident as larger providers
  exit high cost states, leaving the market to smaller
  providers and limited liability corporations that
  typically have less capacity to indemnify claimants.
                  Tort Reform States*
                   Loss Cost per Bed

  6,000                      5,110 5,020
                                           4,520
  5,000
                         3,550                     3,730
  4,000                                                    3,460

  3,000          2,180                                        2,100
                                                                      1,750
                                                                              1,490
  2,000
           760                                                                        1,240
  1,000

     0
          1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006



* FL, GA, LA, MS, OH, TX, WV
Liability costs are dramatically dropping in states that have passed tort
reform in the past several years; As a group, the average loss cost has
              dropped from $5,110 in 1998 to $1,240 in 2006.
               Tort Reform States*
              Claims per 1,000 Beds

                                             18.1   18.7
                                                           17.5
   20.0                                                           16.3
                                      15.5
                               14.3                                      14.4
                                                                                13.4
                        12.4                                                           12.3
   15.0
                  8.9
   10.0
            5.6

    5.0

    0.0
          1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006


 * FL, GA, LA, MS, OH, TX, WV

Both frequency and severity are down in states that have passed tort
reform. The number of claims per 1,000 occupied beds for this group
    peaked at 18.7 in 2001 and has since dropped to 12.3 in 2006.
                      Tort Reform States*
                       Severity per Claim




                                          358,000


                                                    324,000
                                287,000
400,000




                                                              249,000
                      245,000
350,000




                                                                        199,000


                                                                                  197,000
300,000
250,000
            134,000




                                                                                            129,000


                                                                                                      122,000


                                                                                                                111,000


                                                                                                                          101,000
200,000
150,000
100,000
 50,000
     0
          1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006



    * FL, GA, LA, MS, OH, TX, WV

The average size of a claim has plummeted from $358,000 in
                 1998 to $101,000 in 2006.
                     All States Excluding Tort
                           Reform States
                         Loss Cost per Bed

                                                                                     1,710
     1,800                                                   1,560           1,580
                                                                     1,490
     1,600
     1,400                                        1,200
                                    1,060 1,120           1,120
                            1,010
     1,200
     1,000
      800
                          450
      600           280
              220
      400
      200
        0
             1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006



   In aggregate, the loss costs in states without tort reform have
increased substantially over levels in the late 1990s and early 2000s.
           All States Excluding Tort Reform
            States Claims per 1,000 Beds


                                                                                       10.7
    12.0                                                                         9.9
                                                                    9.2   9.1
    10.0                                                     8.0
                                         6.9   6.7     6.8
     8.0     5.5                 5.5
                   4.6     4.6
     6.0
     4.0
     2.0
     0.0
           1995          1997          1999          2001          2003         2005


Increases in frequency remain problematic in states without tort reform.
 Excluding the 7 tort reform states, frequency is increasing at an annual
                                rate of 9%.
                   All States Excluding Tort
                  Reform States Severity per
                             Claim




                                        181,000




                                                                      175,000
                                                            167,000




                                                                                          170,000


                                                                                                    163,000




                                                                                                                        160,000
                                                                                                              159,000
                                                  154,000




                                                                                141,000
 200,000




                               96,000
 150,000              61,000



 100,000
             39,000




  50,000


       0
           1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006



The 2006 average severity of the states excluding tort reform is 60%
  greater than the tort reform states ($160,000 versus $101,000).
              Countrywide Loss Cost
                     Per Bed

                                         2,030
                                 2,010
   2,250                                         1,930
                                                         1,790
   2,000                                                         1,630
                                                                         1,670
                                                                                                 1,610
                                                                                 1,550   1,550
   1,750
   1,500                 1,180

   1,250
                   770
   1,000
    750
             350
    500
    250
      0
           1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006



Countrywide, GL/PL loss costs are stabilizing at approximately
   $1,610 per bed after peaking at $2,030 per bed in 1999.
             Countrywide Claims Per
                   1,000 Beds

                                                                            10.7   11.1
                                                       10.1   10.5   10.3
    12.0                                   9.4   9.6
                                     9.0
    10.0                       7.7
                         6.5
     8.0     5.6   5.7

     6.0
     4.0
     2.0
     0.0
           1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006



  Frequency of claims continues to climb. Countrywide, the
number of claims incurred per 1,000 occupied beds has doubled
               from 5.6 in 1995 to 11.1 in 2006.
            Countrywide Severity
                 per Claim




                                         261,000


                                                   226,000
300,000




                                                             205,000


                                                                       186,000
                               182,000
250,000




                                                                                 162,000


                                                                                           159,000


                                                                                                     151,000




                                                                                                                         146,000
                                                                                                               145,000
                     135,000
200,000

150,000
            63,000




100,000

 50,000

     0
          1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006



Countrywide trends are driven by reductions in the average
severity from a high of $261,000 in 1998 to $146,000 in 2006.
           Percentage of Claims Reported by
         Size of Loss (AY 1998 – 2004 Reported
                        Claims)
         70.0%

         60.0%

         50.0%

         40.0%

         30.0%

         20.0%

         10.0%

           0.0%

                                50K -   100K -   250K -   350K -   500K -                  5M &
                      0 - 50K   100K     250K     350K     500K       1M 1M - 2M 2M - 5M     Up
AL, AZ, AR, CA, MS,
TN, TX, WI & WV       55.4%     8.6%    14.5%     6.4%     4.2%     6.2%   3.0%    1.4%    0.2%

FL                    41.8%     12.7%   19.9%     8.8%     7.1%     7.1%   2.1%    0.5%    0.1%

Remaining States      69.0%     10.0%   13.2%     3.8%     2.0%     1.5%   0.4%    0.1%    0.0%

Total                 58.4%     10.1%   15.2%     5.8%     3.9%     4.3%   1.6%    0.6%    0.1%
                        Distribution of
                        Compensation

                                                           More than
25%                                                        half of the
                                                          total amount
                                                    47%     of claims
                                                           costs paid
                                                            for GL/PL
                                                          claims in the
                                                          LTC industry
   28%
                                                             is going
                                                           directly to
Patient and/or Family Compensation                         attorneys.
Defense Costs (Defense Attorneys & Investigation)
Plaintiff Attorney Fees
              Average ALAE (Defense
                    Cost) Paid


   60,000                                                                                         52,754


   50,000
                                                                                         34,675
   40,000
                                                                                28,947
                                                              25,719   24,444
   30,000
                                                     18,946

   20,000                                   13,616

                                   7,376
   10,000            748
                           3,782
               131

      -
            1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                                           Year Claim Closed



The average amount spent to defend a GL/PL claim has increased
 more than sevenfold in the past seven years from approximately
                       $7,400 to $52,800.
          Average Indemnity Paid

                                                                                        143,829
  160,000                                                                                         140,747
                                                                    127,800                                 132,117
                                                                              123,039
  140,000
                                                          110,094
  120,000
                                                 91,647
  100,000
   80,000                              55,402

   60,000
   40,000                     23,699

                      4,568
   20,000     1,628

      -
            1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
                                                Year Claim Closed



The increase in defense cost spending appears to be contributing to
  stabilizing, and possibly lowering, average indemnity payments.
                  -
                                 1,000
                                           1,500
                                                   2,000
                                                            2,500




                       500
            WI        50


            TN        90


Excl. 10 States        220


   Excl. 7 Tort            280


            AR             290


            CA               540


            AL                    750


     All States                   770
                                                                             State




           WV                        860


            AZ                           910


           MS                            1,010


            TX                                             2,010


         7 Tort                                             2,180
                                                                    1996 GL/PL Loss Cost by
        2006 GL/PL Loss Cost by
                 State




                                                                                                                            9,880
9,000




                                                                                                                    5,430
7,500




                                                                                                            4,880
                                                                                                    4,300
6,000




                                                                                            3,180
                                                                                    2,600
4,500




                                                                     1,710
                                                        1,610
                                               1,240
                     1,120

                             1,130
3,000
               980
         550




1,500
  -
                     TX




                                                                                                                    MS
                                                                                                            TN
         WI




                             Excl. 10 States




                                                                     Excl. 7 Tort




                                                                                                    AZ
                                                                                            CA
                                                                                    WV




                                                                                                                            AR
                                                        All States
               AL




                                               7 Tort




Numerous states continued to experience dramatically high or increasing
GL/PL loss costs. Topping the list is Arkansas. The steepest jumps in the
     past five years have been incurred in Arizona and Tennessee.
              Arkansas Loss Cost per
                  Occupied Bed

                                                                       11,890
                                                              10,900            10,530
   12,000                                           10,160
                                                                                         9,710 9,880
                             8,990          9,110
   10,000

    8,000                             6,240

    6,000

    4,000
                     1,270
    2,000     290

       0
            1996    1997   1998      1999    2000   2001     2002   2003   2004     2005    2006


Estimates are based on approximately 19% of Arkansas providers
               measured by nursing home beds.
                Mississippi Loss Cost
                 per Occupied Bed

                                          13,810
14,000

12,000                                             10,010 10,180

10,000                                                             8,460
                                  7,150
 8,000                                                                         5,580 5,430
                                                                      5,200
 6,000            4,140
                          3,500
 4,000
          1,010
 2,000

    0
         1996   1997   1998   1999    2000     2001     2002   2003   2004    2005   2006


Estimates are based on approximately 11% of Mississippi
      providers measured by nursing home beds.
               Tennessee Loss Cost
                per Occupied Bed

7,000                                                       6,180

6,000                                                                                4,880
                                                                             4,350
5,000                                                               4,030
4,000
                       2,200 2,090
3,000                                               2,020
                                     1,540 1,380
2,000
                 350
1,000     90

   0
        1996   1997    1998   1999   2000   2001   2002   2003   2004       2005   2006


 Estimates are based on approximately 22% of Tennessee
       providers measured by nursing home beds.
                 Arizona Loss Cost per
                     Occupied Bed

                                                                                           4,300
  4,500                                                                           3,990
                                                                         3,580
  4,000
                                                                 3,020
  3,500           2,710
  3,000
  2,500
  2,000                                        1,240
           910                                          1,020
  1,500                                 700
  1,000                   260
                                  10
   500
     0
          1996   1997   1998    1999   2000   2001     2002     2003   2004      2005   2006



Estimates are based on approximately 20% of Arizona providers
               measured by nursing home beds.
                 Texas Loss Cost per
                    Occupied Bed

 7,000                                                     6,080
                                  5,740
 6,000
                          4,660
 5,000                                    4,150
                  3,550                            3,400
 4,000
                                                                   2,650
 3,000   2,010
                                                                           1,260 1,140
 2,000                                                                                 1,120

 1,000

    0
         1996    1997   1998   1999   2000        2001   2002      2003    2004   2005   2006



Estimates are based on approximately 9% of Texas providers
             measured by nursing home beds.
                  All Other States
               Combined Loss Cost per
                   Occupied Bed
                                                                                    1,130
1,200                                                                       1,030
                                                                     930
1,000                                                         840
                                  670            710 710
 800                                     590

 600                      450

 400      220     240

 200

   0
        1996    1997    1998    1999    2000   2001   2002   2003   2004   2005   2006



Estimates are based on approximately 15% of all other states’
        providers measured by nursing home beds.
       Preview of 2008 Study

• Similar participation to last study
• Tort states show continued favorable
  experience versus non-tort states
• Frequency stabilizing countrywide
• Severity stabilizing countrywide
• Increasing trends in several troubled
  spots
         2008 Medical
     Professional Liability
          Symposium
Selected Defense
Strategies Effecting LTC
Claim Trends
    Raymond Watts, Esquire
 Wicker, Smith, O’Hara, McCoy &
           Ford, P.A.

         Chicago, Illinois ~ March 11 & 12, 2008
         New Developments

• Changes in ownership and management of
  long term care companies.
• Implementation of effective arbitration
  provisions in admission contracts.
• Improvements in the quality of care and
  services delivered by LTC companies.
• Understanding and getting the defense
  themes across to the jury.
       Ownership/Management

• Reduction in large multi-state providers.
• Divestiture in litigation prone states.
• Introduction of investment firms providing
  capital to troubled industry.
• Real estate entities not involved in
  operations; contracted management.
• Increase in limited liability companies.
• Insurance unavailability.
      Ownership/Management

• All of the forgoing appear to have
  made long term care companies less
  attractive targets for lawsuits.
• Tort reform in litigation prone states
  has impacted select states.
• Understand the corporate structure
  and entities you are insuring.
              Arbitration

Pros:
• Less Expensive
• Quicker Resolution
• Greater Predictability
• Reduce/Eliminate Catastrophic Result
• Confidential
• Greater Input into Deciding Decision
  Makers
                    Arbitration

Less Expensive:
• Faster process costs less both in preparation time
  and actual length of proceeding.
• Discovery is usually limited.
• Expert witnesses can be reduced.
• Few hearings and usually done by phone.
• No appellate costs.
• Limited demonstrative evidence requirements.
                    Arbitration

Quicker Resolution:
• A case can get to the actual proceeding generally in
  a matter of months versus years.
• Closure for both sides on an expedited basis.
• Payment of any award often done sooner and
  higher net to plaintiff.
• Courts favor non-judicial arbitration (less burden of
  the system).
• Generally no appeal so ends with the ruling.
                Arbitration

Greater Predictability:
• Control over the selection of the
  arbitrator(s).
• More predictable outcome as to any case
  value.
• Hopefully an evidence based result.
• Choice of law clauses.
• Choice of venue clauses.
              Arbitration

Reduce/Eliminate Catastrophic Result:
• Evidence based versus sympathy/bias
  influenced.
• Punitive damages less likely if
  available at all.
• Improves actuarial/insurance renewal
  issues
                   Arbitration

Confidential:
• No media coverage.
• Privacy in airing ―dirty laundry‖ for
  defendant.
• No roadmap to other litigants.
• Privacy in medical information for plaintiff.
• Any award remains confidential.
                Arbitration

Greater input into deciding decision
  makers:
• You pick the arbitrator(s)
• You decide rules, procedures,
  formalities
• Parties can select an arbitrator with an
  expertise in a certain area.
                 Arbitration

Cons:
• Unlikely ―Defense Verdict‖
• Difficult to obtain a ―bullet proof‖
  agreement
• Limited Discovery (Plaintiff vs.
  Defendant)
• Limited Appellate Options
               Arbitration

Unlikely ―Defense Verdict‖:
• One to three lawyers (the arbitrators)
   deciding how much, if anything
   another lawyer (plaintiff’s counsel)
   will earn.
• Arbitrators underlying desire to make
   everyone happy.
                    Arbitration

Difficult to obtain a ―bullet proof‖ agreement:
• An agreement that accomplishes your goals and
   stands up to judicial scrutiny may be difficult.
• Unconscionability arguments; substantive and
   procedural.
• Waiver arguments.
• Defects in execution of the agreement.
• Over-reaching terms and conditions.
• Limitations on damages.
• Multiple defendants, admissions
• Voluntariness and opt-out provisions.
• Consideration.
                  Arbitration

Limited Discovery:
• Lack of full range of discovery if discovery
  available at all.
• Limited cross-examination of witnesses.
• More difficult to try the case effectively.
• Chance of not knowing full extent of case,
  for either side.
• Potentially limited subpoena power.
• Limited Appellate Options.
               Quality Care
              Improvements

• Care has generally improved in LTC.
• Many states now require higher staff to
  patient ratios.
• Facilities generally work hard for good
  survey results.
• Rather than excluding surveys in the
  defense, consider embracing them and
  using them as a sword to prove good care.
                  Explain the Scope and
                  Severity Scale


A,B,C =
Substantial
Compliance

D,E,G = Non
compliance
that is not sub
standard
quality of care
                       Sample Survey E Tag


Recertification
survey was
completed 3/14/05 -
3/17/05. Highest
S/S was E, Class III
deficiency, F253
and F332.
                      Sample Survey – G Tag



F 314 S/S = G
Quality of
Care:”…the
facility must
ensure that a
resident who
enters the facility
w/o pressure
sores does not
develop pressure
sores unless….”
                    Guidance to Surveyors
                    – Pressure Sores

(1) A resident who
 enters the facility
 without pressure
   sores does not
 develop pressure
  sores unless the
individual’s clinical
     condition
demonstrates that
     they were
   unavoidable
                  Guidance to Surveyors


  “Unavoidable” means
     that the resident
  developed a pressure
  ulcer even though the
  facility had evaluated
   the resident’s clinical
 condition and pressure
risk factors; defined and
       implemented
  interventions that are
consistent with resident
     needs, goals, and
recognized standards of
         practice…
                  Guidance to Surveyors
                  – Risk Factors

       Risk Factors
• Impaired/decreased
mobility
•Co-morbid conditions –
diabetes, renal, vascular
•Drugs such as steroids
that affect healing
•Impaired blood flow
•Resident refusal
•Cognitive Impairment
•Urinary and fecal
incontinence
•Malnutrition, hydration
deficits
               Resident Census Worksheet



Tracks Residents
   w/following
   issues:

•   Bowel/Bladder
    Status

B. Mobility

C. Mental Status

D. Skin Integrity
               Facility Staffing



A. Services
   Provided

B. Full Time
   Staff

C. Part Time
   Staff

D. Contract
                Current Issues/Ideas


• Surveyors can give favorable testimony, or be effectively cross-
  examined, in deposition or trial.
• Complaint Investigations are often ―unsubstantiated‖.
• Plaintiff/Decedent was often not a ―sampled resident‖.
• Surveys often irrelevant if resident was not in facility at the time
  of inspection.
• Surveys are subjective findings!
• Depending on state law, surveys may only be admissible in
  punitive damage phase.
• Effective motions in limine can still keep out bad surveys.
• Integrate defense themes into the case to deal with negative
  stereotypes, show good care to the resident, narrow the focus of
  the case, and put medicine in perspective.
             2008 Medical
         Professional Liability
              Symposium
LTC - Improving Trends vs.
Market Conditions.

Navigating in Rough Waters.

Bryan Baird, President/CEO
K&B Underwriters, LLC


               Chicago, Illinois ~ March 11 & 12, 2008
           Truth in Lending
              Statement


• While K&B Underwriters represents
  most insurance companies writing LTC
  business, it was recently appointed as
  the exclusive senior living MGA/MGU
  for a national professional liability
  underwriting insurance company.
           Are We Qualified?

• Program Underwriters with over 10 years
  experience in LTC;
• Underwritten 1,000’s of LTC submissions;
• Compared on a state by state/county basis
  K&B per bed ―Loss Cost‖ with same from
  two different LTC national databases;
• Developed a K&B underwriting experience
  mod to support K&B risk selection
  strategies.
          What You Will Learn
                Today:

• Softening market rates compared to rates
  developed with K&B data and 3rd party
  databases show: “Novice’s Need Not
  Apply”;
• Underwriting profit likely in only 7 states
  unless you have proven risk selection and
  pricing strategies;
• Will share our philosophy to risk selection
  and compare with a med mal actuarial case
  study performed in 2007.
             Rate Development
                 Methods

• Qualitative Method - Traditional Actuarial Study
  performed by Aon comparing K&B data to Aon
  national database approximately 15% of all US LTC
  beds, developing average loss costs and K&B
  underwriting modification factor;

• Quantitative Method - compared the loss histories
  from 1148 discrete facilities in 46 states and DC to
  various clinical characteristics;
           Qualitative Method

• Aon LTC Benchmark Data: exposure data
  used as the basis for a countrywide state
  specific loss rate analysis;
• Loss rates adjusted to reflect $1M per claim
  limit;
• Loss rates adjusted to reflect small
  providers under 5,000 country wide beds;
• K&B 5-year loss and exposure data
  compared to Aon loss rates to develop K&B
  underwriting mod based on superior risk
  selection criteria relative to general market;
             Quantitative Method

• 4-Year loss histories from 1,148 individual
  facilities all types and sizes in 47 states and
  over 4,000 claims;
• Compared Loss Data to the following
  Metrics:
      Facility Size and ownership
      Resident acuity
      Staffing
      Care indicators
      Survey results
         Can You Make Money?

• Given Loss Cost relative to market
  rates, it appears you need to know the
  following:

     Venue
     Loss Costs
     Definition of a ―good risk‖
              Market Definition of a
                  “Good Risk”:



• ―These days it seems like the definition
  of a ―good risk‖ has expanded to the
  point where a ―good risk‖ means
  anything you take the saran wrap off of
  and it doesn’t cause you to pass out!‖
     Alan Zuccari, Hamilton Insurance Agency, Inc.
          K&B “Good Risk”
     Philosophy “Culture of Life”
            Case Study


• In 2004 K&B formulated a hypothesis
  that there is a correlation between a
  physician’s adherence to what might
  be deemed a ―Culture of Life‖
  framework - respecting human life
  from conception to natural death - and
  improved quality of care and patient
  safety.
          “Culture of Life” Case
                  Study

• In 2007 K&B conducted a survey
  endorsed or supported by the following
  physician associations:
     Association of American Physicians and
      Surgeons;
     Association of Pro-Life Physicians;
     The American Association of Pro-Life
      Obstetricians and Gynecologists
     Catholic Medical Association;
     Christian Medical and Dental Association
        “Culture of Life” Case
                Study

• Over 500
  Physicians;
• 49 States;
• Over 100
  Specialties and sub
  specialties;
• 10 Years of Loss
  experience
      % of Physicians by # of Claims in 10 Years



100
 90
 80
 70
 60
 50
 40
                                           Physicians
 30
 20
 10
  0
         4       3       2       1    0
      Claims Claims Claims Claims Claims
      or Less or Less or Less or Less
      “Culture of Life” Survey
               Says:

• After accounting for self reporting
  errors, industry IBNR, trending factors,
  and adjusting to 100% credibility the
  result was a ―Culture of Life‖
  Experience Mod of .61;
• Or, ―Culture of Life‖ Physicians have
  loss ratios 39% better than their peers;
         “Culture of Life” Case
                 Study

• Why was there a difference?
• Several possible reasons, but K&B believes
  it main reason has to do with upholding the
  dignity and sacredness of human life;
• If a physician believes in the value of each
  human life, perhaps they can better
  establish trust with their patient?
• K&B doesn’t think this class will necessarily
  have less accidents, but we believe they will
  have a better outcome;
         Select Criteria to Define a
                “Good Risk”:


• Management respects dignity of the
  person as evidenced in treatment of
  staff and residents;
• Facility sets realistic expectations and
  has open and ongoing dialogue with
  the family members;
• Policies and Procedures consistently
  followed and implemented according
  to promises;
         Select Criteria to Define a
                “Good Risk”:


• Appropriate resident acuity relative to
  demographic mix;
• Overall survey reviews indicate facility
  is managed above average - scope
  and severity not always indicators;
• Care process & outcome indicators
  indicate management cares for dignity
  of human life;
          Select Criteria to Define a
                 “Good Risk”:


• Family and Resident Satisfaction Surveys;
• Care Driven vs. Profit Driven;
• Small vs. Larger & For vs. Not-for-profit;
• Marketing Materials adequately represent
  services;
• Prior Loss History;
• Financial Stability;
          Select Criteria to Define a
                 “Good Risk”:


• Adequate staff to resident ratio relative to
  resident acuity;
• Lower Staff Turnover;
• Lower percentages of contract staffing;
• Experienced staff at the DON/Administrator
  level;
• Employee Satisfaction surveys;
• Work Comp injuries;
          Select Criteria to Define a
                 “Good Risk”:


• Resident Assessments—completed
  regularly by appropriate party;
• Procedures for handling a change in
  conditions, family& physician notification;
• Medication controls and error rates;
• Entry and exit security measures;
• Incident reporting and physician reporting;
• Arbitration Agreements;

				
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Description: Arizona Nursing Home Attorneys document sample