| Medication Management |
Administering, dispensing, or monitoring medications (e.g., opioids, anticoagulants) for residents with multiple comorbidities. Errors can trigger overdoses, interactions, or preventable hospitalizations. |
+30–40% PL increase; refusal possible if audit error rates >5%. Carriers expect pharmacist oversight and e-prescribing double-checks. |
| Care Transitions |
Moves between IL, AL, SNF (or external referrals). Handoff gaps and missed orders cause delayed treatment or deterioration. |
+25%+ PL surcharge; non-renewal risk if >10% transition-related incidents. EMR-linked checklists reduce loadings. |
| Infection Control Protocols |
Breakdowns in hygiene, isolation, or outbreak response (e.g., influenza/COVID) leading to cluster events and regulatory citations. |
+20–35% GL/PL if outbreak history or poor survey results. Exclusions possible for non-compliance with documented protocols. |
| Mobility & Fall Prevention |
Transfers, ambulation, and therapy sessions; falls are the top cause of injury and claims among older residents. |
+40–50% GL/PL surcharge if fall rates exceed benchmarks. Credits for sensor alarms, non-slip flooring, and PT fall-reduction programs. |
| Nutritional & Dysphagia Management |
Diet errors, unsafe textures, or inadequate supervision during feeding can cause choking or aspiration pneumonia. |
+15–25% PL; carriers review dietitian oversight and swallowing assessments. Sublimits or exclusions without protocols. |
| Wound Care & Basic Treatments |
Dressing changes, catheter care, and skin integrity management; improper technique increases infection and sepsis risk. |
+20% PL; refusal risk if performed by unlicensed staff. Credits for certified wound-care programs and audit logs. |
| Emergency Response Procedures |
On-site CPR/AED use, seizure management, and evacuations; delayed responses escalate severity of outcomes. |
+30%+ if no 24/7 RN coverage or documented response times. Premium relief for drills, telemetry, and clear escalation pathways. |