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Adopting A Cultural Risk Management Approach in Senior Living that Focuses On Compassionate Care, Dignity

Featuring Bryan Baird, President, K&B Underwriters, LLC

Posted on 30 Jul 13 by Annie George

Senior living providers are increasingly feeling the pressure to mitigate risk and reduce losses while at the same time deliver quality care to residents. These issues will only become more prevalent as health care reforms come into play and an aging population requires even more services from these providers. Many senior living providers look to our industry to help protect their facilities, assets, staff and residents and stem the losses that contribute significantly to their operational costs. Most risk-mitigation and loss control processes involve an analytical, clinical approach where the caregivers and residents themselves are not necessarily front and center in the equation. Bryan Baird, president of K&B Underwriters, takes a different approach when it comes to risk management, expanding the goal to engage the caregiver and foster an environment of compassion among the staff that will also translate to those for whom they care.

We spoke to Bryan about this approach and his vision to help senior living providers through intensive adaptation and adherence to a cultural risk management program, which focuses on two key components: building an engaged compassionate staff; and creating an experience of care that reduces fear of death and suffering. In so doing, Bryan tackles some difficult issues. He not only sees this approach as fundamental in restoring dignity for the elderly within our society, but also as having a positive impact on the operating profit for senior living providers. At the same time, this approach will also provide relief from the financial stress for many other industry stakeholders, including liability and workers comp insurers, residents and their family members, Medicare/Medicaid, taxpayers and future consumers of the long-term care industry.

K&B Underwriters is a national program administrator known for its innovative insurance and risk management solutions through its DigniCare program, specifically designed for assisted living facilities, independent living facilities, nursing homes, and continuing care retirement communities (CCRCs).

Annie George (AG): Tell us the backstory on the genesis behind “cultural risk management”.

Bryan Baird (BB): “I was involved in a risk management session with a nursing home located in an urban area and reviewing changes from a clinical perspective to be implemented. During my visit I witnessed an incident between a caregiver and resident that illustrated a total lack of respect and compassion for the individual being cared for. This isn’t an isolated incident…the frequency and severity of incidents may be different from one location to the next, but in varying degrees, unfortunately, disrespectful – even aggressive and abusive treatment – does take place. We see it when we review state inspections during the underwriting process, and you hear about incidents as they make headline news.

“It became very clear that unless we first help the caregivers, any clinical assistance we provide is going to fall short. The key is in investing the time and resources in building and nurturing the caregivers themselves. Employee engagement is the single biggest driver of quality care, resident satisfaction, and ROI. Management needs to understand that the caregivers must come first in order to transform the type of care given to residents. And that means going beyond providing a one-time seminar or training session. When I left the facility, I began to think about what could be done to change the culture, to make a real transformation.”

Bryan explained that as he focused on how a cultural shift could be achieved he was inspired by the work done by the Little Sisters of the Poor, a faith-based organization founded in the 1800s, which today operates numerous nursing homes around the world. He read and studied the life of their founder, Sister Jeanne Jugan, who was canonized by the Catholic Church in 2009. What he found was that Saint Jugan in her care for the poor and elderly put everything into the people who were the caregivers. When Bryan visited a Little Sisters of the Poor nursing home, he saw that her teachings resonate today in how the staff was treated and he was “completely blown away.”

“The staff is not comprised of only nuns, but also individuals who come from the same pool of talent that other nursing homes have access to,” explained Bryan. “But when you experience their environment, you immediately see the difference. I asked them how they impart this culture of caring to the staff. They explained that it takes daily contact, reinforcement and an understanding of a sense of purpose through a program they have implemented, based on Saint Jugan’s teachings, in addition to support from the community. Caregivers need support from others in the face of human suffering, which is why this type of care was first started from religious orders. The burnout and turnover is high so you have to be grounded with strong support and sense of purpose.”

Bryan also saw what is being done with hospital caregivers through the Schwartz Center for Compassionate Care in Boston. He attended CNA’s HealthPro Leader Board Business Meeting where they announced a partnership with the nonprofit Schwartz Center in which the insurer is helping to offset the cost to hospital clients that participate in the Center’s programs. The mission of the Schwartz Center is to promote compassionate care so that patients and their caregivers relate to one another in a way that provides hope to the patient, support to caregivers and sustenance to the healing process. “It’s this type of initiative and approach we need to look at for senior living providers,” said Bryan, “where there is support therapy for caregivers and staff.”

“In looking at successful models of care from faith-based senior living providers and entities such as the Schwartz Center, for-profit providers can integrate the same principals in their own organizations. They can utilize training and delivery models similar to those from organizations with a proven track record in building employee engagement and organizational culture change,” said Bryan. 

AG: Let’s discuss the second component to adopting a cultural risk management approach, which involves creating an experience of care that reduces fear of death and suffering.

BB: “We want to foster an environment where we provide the elderly with the strength and motivation to accept and embrace the natural process of death. In learning from the Little Sisters of the Poor’s spirit of “accompaniment” (how they walk with the dying), we can help remove the fear of death, help the individual understand the purpose behind their suffering, and embrace this stage of life. With engaged caregivers supported by the community, including faith-based organizations and nonprofits that come in and listen to those that are dying, individual fears can be diminished and they can make decisions for themselves sooner rather than later. This not only helps the individual who is suffering and nearing the end of his or her life to gain acceptance and a sense of peace, but also the family members and the caregivers to achieve the same understanding.”

“What’s more, it will have the added effect of helping caregivers and society as a whole to recognize the immense contributions and value of the elderly. There was a time when the elderly were revered in our society for their wisdom and their experiences. This is no longer the case. In helping the elderly go through the dying process, understanding their purpose in life, even during their final days in a nursing home bed, and bringing dignity back to their lives, we will also learn to value them and their contributions once again. The suffering elderly provide an immense value to society that we all need to recognize. The most obvious, but certainly not the biggest one, is that they give us the opportunity to visit the sick and the dying. This not only helps the elderly resident, but also provides opportunities for others to show and give love.  Without that ingredient, we become a cold and practical society that makes choices based on the bottom line.”

“We have a moral obligation to participate in this effort, particularly as our population ages with longer life expectancies and spiraling medical costs (40-50% of healthcare costs in one’s life take place in the last 24 months). If we don’t, the stage is set where we will find ourselves making a pragmatic case to view euthanasia or assisted suicide as not only an efficient way to reduce expenses but frame it as the ‘compassionate’ choice instead of palliative care.”

“We need to begin to have a conversation about how we change our views as a society when it comes to the elderly, how we care for them and how we approach the end of life. These are big issues, and they’re not only for the senior living providers to address, but also for society as a whole, our communities and our industry. The changes in healthcare law, an aging demographic and fewer dollars compel us to look for an approach based on compassion, respect and dignity.”

For more information about K&B Underwriters and their programs for senior living, please visit You can also contact Bryan at (888) 760-3194 x101.