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STAFFING AND SAFETY ISSUES
Facilities take on greater safety risk
due to higher frequency of patient
encounters. Patients can become
violent while detoxing or can threaten
safety if they relapse. Relapse situations
may grow more common as centers
adopt a ‘harm reduction’ approach.
“Harm reduction programs are
gaining more traction,” Storey said.
“Treatment centers won’t automatically
kick patients out of the program if
they relapse. The concept of safe
consumption sites and needle exchange
programs are also examples of harm
reduction. However, having an
individual relapse in a residential facility
Staffing ratios dictate the number
of patients each worker supervises.
Sticking to ratios can limit dangerous
encounters and reduce a facility’s safety
and liability risk, but the pressure of a
wait list may push organizations to relax
the ratios and increase the workload.
“Failure to meet supervision
guidelines is the biggest driver of
lawsuits and liability claims against
detox and counseling centers,”
said Paul Siragusa, vice president,
Philadelphia Insurance. “But an influx
of people seeking treatment combined
with high employee turnover in the
social service sector makes it tough to
To adhere to supervision guidelines,
these facilities might have no choice
but to turn people away, said Kevin
Glennon, VP of clinical programs,
“As long as the practitioner-to-patient ratio is maintained, organizations
shouldn’t have an issue. Similar to skilled
nursing or rehab facilities, it’s based on
bed availability,” he said.
IMPACT ON FOSTER CARE
Addiction epidemics coincide with
a rising population of children placed
in foster care. A 2015 study found two
out of every thousand children were
removed from their homes due to
parental neglect, constituting a 129
percent increase from 2012.
According to the U.S. Department
of Health and Human Services, the
number of children in foster care has
increased steadily since 2012. The
number of foster families has not.
“More children are entering the
system, but the state agencies aren’t
getting bigger budgets. In the claims
we see, it appears the agency tried to
cut corners, most likely due to a lack of
funding,” said Phil Hawley, president,
Hawley & Associates LLC.
“Social workers are burnt out.
They’re having a harder time …
properly vetting each situation before
placing children,” Siragusa said. “As a
result, we’ve seen instances of physical
or sexual abuse against foster children.”
According to Hawley, the cost of
care per foster child can range from
$100 to $400 per day, or $36,000 to
$70,000 per child per year. Costs are
higher for kids with special needs.
Siragusa said mistreatment claims
garner multimillion dollar verdicts.
They boil down to social services’
inability to evaluate foster homes.
Carrying professional liability
coverages for both medical
professionals and human service
providers can mitigate legal liability
for treatment facilities and foster care
agencies. Unfortunately, problems
like provider burnout, understaffing
and lack of bed availability can only be
solved with more funding.
In the interim, social service
organizations can implement thorough
screening protocols for employees,
staff, third party providers and patients
and foster families. Because not
every incident is preventable, “have a
response plan,” Konrad said. &
KATIE DWYER is an associate editor with
Risk & Insurance®. She can be reached at