TL;DR
Comparison
What changes when we add memory care to an assisted living operation?
Whose decision: Assisted living operators opening or converting a memory care unit.
Last updated
| Factor | Memory care | Assisted living |
|---|---|---|
| Licensure | Frequently within assisted living, sometimes with a dementia endorsement | Assisted living |
| Defining exposure one | Elopement and wandering | Falls |
| Defining exposure two | Resident on resident altercation | Negligent admission and retention |
| Decisive wording | Assault and battery trigger language, and the professional services definition reaching supervision | Professional services definition and abuse sublimit |
| Staffing scrutiny | Unit-level ratios, not facility-wide | Facility-wide generally accepted |
| Underwriter evidence sought | Elopement risk assessment, egress testing, drill log, missing resident protocol | Assessment and care planning process |
| Relative cost per bed | Higher | Lower |
The recommendation
Behavioral expressions of dementia, including physical aggression, are clinically expected in this population. When one resident injures another, the claim against the community is about assessment, placement and supervision, which is professional liability in substance.
But many assault and battery endorsements apply to any claim arising out of assault or battery regardless of how it is pleaded, which pulls that claim to a sublimit that is frequently a small fraction of the main limit. For a memory care operator that is the single most important open item in the program, ahead of premium.
Then confirm the professional services definition reaches supervision and the provision of a safe environment, so an elopement claim is covered rather than argued about, and confirm no wandering or premises security exclusion has been attached at any layer.
Follow-up questions
Not for insurance purposes. The resident population is selected for conditions that produce wandering and sometimes aggression, which means the community has knowingly accepted a foreseeable risk it is staffed and secured to manage. That is a different underwriting proposition.
Unit-level staffing ratios rather than facility-wide, documented elopement risk assessment on admission and change of condition, secured egress testing records, a drill log, de-escalation training records, and a written missing resident protocol with evidence it has been practiced.
Go deeper
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