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By Cyril Tuohy

Bill Huggins, a former president of the Texas National Guard and U.S. Army Sergeant Major, spent much of his life giving orders.He used to be a pilot, built three grass runways, and even owned his own airport with as many as 70 hangars.

For Huggins, a strong, active man when younger, being reduced to dependency on caregivers as he aged evidently did not sit well with him.

Suffering from a condition known as "hospital psychosis," which left him disoriented, confused and angry, he lashed out and hit a nurse, according to a story in Silverado Senior Living's in-house newsletter and posted on Silverado's website.

His story ended peacefully. After his release from the hospital, his family found him an opening in a Silverado Senior Living community, which had recently opened its doors in Plano, Texas. He lived there without major incident for another 15 months until his death.

Residents like Huggins, described as "a giant of a man," aren't uncommon at Silverado. They are very often men and women who led active, professional lives. Some traveled the world, others made valuable contributions to their professions.

For much of their lives, the residents living at Silverado were mentally alert and physical fit. For some, it is the body that is gradually withering away. For many, though, their minds have left them long before their bodies.

Take the case of Don Doll, a retired defensive back for the Detroit Lions, Washington Redskins and Los Angeles Rams. Doll initially received home care provided by Silverado staff, but when Doll's wife, Diana, broke her arm and could no longer care for the professional athlete and his progressing dementia, Doll was admitted to Silverado's San Juan Capistrano, Calif., community in 2008.

He settled into his new life without incident; yet cases like those of Huggins and Doll illustrate the special challenges patients with Alzheimer's, Parkinson's and dementia bring to Silverado and its employees.

Left to deal day-in and day-out with patients living their final years are Silverado's professionals ? nurses, nursing aides, physical therapists, specialists, assistants and janitors who care for men like Huggins and Doll either through care at home, in assisted living communities or via hospice care.

There is the manual lifting, the bathing, the feeding, the repositioning of patients from beds into a chair, and the daily walks -- all of this falls on Silverado's employees.

Among employees at senior living communities, the worker injury risk runs high, particularly at Silverado, where residents typically suffer from severe Alzheimer's, said Frank Russo, vice president of risk management for Silverado Senior Living.

"Our world is a very high workers' comp driven industry," said Russo, who runs Silverado's workers' comp and risk management program. He gets help from risk management specialist Tatiana Williams.

Silverado sometimes has more than 100 Alzheimer's residents in any one of its 23 communities, and having carved out a niche for itself in the long-term care marketplace by catering to senior citizens afflicted with dementia, Russo and Williams are well aware that Silverado staffers are at even greater risk of harm than if they were employed by a regular long-term-care facility or even a hospital.

Many of the 2,800 employees who work for Silverado find themselves exposed to a gamut of risks, from burns due to washing dishes in the kitchen, to carpal tunnel syndrome from working on a computer keyboard.

But it's the Silverado employees working directly with patients, those responsible for the "heavy lifting," figuratively and literally, of the senior living company, that are most at risk.

Scores of workers' comp claims that come into Russo's office list lower-back injuries sustained from lifting and transferring patients, or even from helping patients who themselves have suffered a slip and fall.

While lower-back injuries are fairly typical among the workforce in this economic sector, no two claims are exactly the same, Russo said. Chartis reimburses Silverado for any single workers' comp claim of more than $350,000.

SAFETY STAR

Silverado, which has a high-deductible program, is willing to bet on itself, as Russo likes to say, because traditional insurance coverage covers you "for a cost that drives you out of business."

"We spend about $150,000 a month on losses," he said. To help control those losses, to in effect, prevent losses from ever turning into a claim in the first place, the company implemented its Safety Star program.

Safety Star is an incentive-based program designed to make the teaching of a safety culture fun and exciting for employees who may be getting their first dose of a corporate safety culture. Silverado's safety and prevention program is this year's winner of the Risk & InsuranceŽ PreVent National Employee Injury Prevention Award recognizing innovative organizations that embody an injury prevention philosophy and culture.

Silverado will be recognized at the 21st Annual National Workers' Compensation and Disability ConferenceŽ & Expo, Nov. 7-9, in Las Vegas.

Employees who teach safety to colleagues, assist them with a lift or demonstrate how to transfer patients earn points redeemable for gifts. Employees track their performance and their credits over the Internet.

Silverado's Safety Star program is "something that's very visible and rewarding and exciting," said Russo. Most important, it's supposed to be fun and engaging to employees, he said.

The company's safest communities are recognized monthly, and a "safety trophy" is bestowed on the community that has the best safety record at the end of the year. The company, which operates in seven states, has 23 communities and 13 at-home and hospice offices. Russo said that every safety and prevention program is run centrally from the company's headquarters in Irvine, Calif.

The program, grounded in Silverado's philosophy that love is greater than fear, is geared to giving employees reasons to stay with the company, and to shine a spotlight on employees who themselves may have never received much recognition in their lives.

Safety Star is, in fact, a retention tool to boost morale and cut turnover in an industry where many workers tend to be transient, and come from the nation's lower economic rungs.

"You are only as good as the individuals that work for you," Russo said.

With an eye to improving the experience of employees working for Silverado, the company's safety and prevention program includes a host of other benefits, including free flu shots, biometric screenings, and "lunch and learns" featuring speakers expert in stress relief and dieting.

Employees who participate in Silverado's light exercise -- Zumba, aerobics, walks and yoga accumulate Safety Star points.

More exercise makes Silverado associates more agile and less likely to injure themselves at work, and health screenings help reduce the risk of injuries unrelated to work -- injuries, which if they occur, are likely to affect associates at work.

"Caring for the whole person is an important loss control strategy," Russo said.

Paired with a wellness program offering biometric screenings, and a light and modified duty to 100 percent of company employees, the Safety Star loss-control and prevention strategy is meant to provide stress relief to Silverado's workers. The idea is to pre-empt a build-up of tension, which sometimes explodes into violence.

Silverado's "front-end" efforts at reducing loss costs by implementing better safety, wellness and prevention programs is turning up in much lower claims on the "back-end," said managers with the company's insurance partners.

Don Hurter, senior vice president, Medical Management Services, said Silverado was saving about 58 cents on every dollar on medical management payments, higher than the industry average medical bill savings of around 46 cents to 48 cents on the dollar.

Injury frequency has dropped from 192 in 2007 to 109 in 2011, according to figures supplied by the company, and total incurred cost per claims has dropped from $13,921 to $5,728 over the same period.

Frequency of claims in excess of $2,000 was slashed from 43 in 2007, to 25 in 2010, with a drop in total incurred losses from $1.78 million to $532,415 over the same period, according to Arthur J. Gallagher Risk Management Services, Silverado's insurance broker.

"They did a fabulous job with the experience modification," said John Berger, a claims specialist with AJG.

Hurter said the company's success has come from driving down claims costs at the local level in California. "After that, it's Texas, Utah, Arizona and Illinois," he said. "But really it's the success on the local level in California that has really driven down the claims."

ROI AND REGULATORS

Silverado's Safety Star program isn't being developed in a vacuum. Economic benefits aside, the company's safety program can also be considered as just one of the many responses put forth by a long-term care -acility to a more active regulatory agenda.

Under the Obama administration, the U.S. Occupational Safety and Health Administration has been more aggressive in enforcing laws around a safer workplace. OSHA's National Emphasis Program, which took effect April 5, encourages compliance with health and safety standards at nursing and residential care facilities through programmed inspections, according to the OSHA Law Blog published by Jackson Lewis, which practices in the safety and health area.

The National Emphasis Program directs compliance officers to focus inspections on ergonomic stressors associated with lifting patients, blood borne pathogens and workplace violence in nursing homes and residential care facilities, according Jackson Lewis Partner Brad Hammock, who runs the blog.

Russo and Williams, who run Silverado's risk management programs, have recently instituted random unannounced mock OSHA inspections with the help of an OSHA rep from Chartis and Arthur J. Gallagher.

At the end of the visit, Russo and his team issue the community an "OSHA score" of between 1 and 100. "We are trying to proactively address this new OSHA initiative," he said.

Regulatory matters aside, Russo, Williams and Silverado's broker and underwriters are aware of the economic benefits well-run safety and prevention programs bring to the company. It is a value that was recently demonstrated yet again, according to the American Society of Safety Engineers, citing a recent survey by Liberty Mutual of corporate executives.

For every dollar a company spent on workplace safety, executives reported they saved at least $3, the survey found. For every $1 spent on direct costs related to an accident, there were another $3 to $5 worth of indirect costs.

An accident with direct medical and compensation costs of $15,000, for example, ends up costing between $45,000 and $75,000 when indirect costs and lost-time equivalencies are factored in, the survey found.

For Russo, a former senior workers' comp adjuster and loss control specialist, and senior managers at Silverado, imbuing employees with the importance of safety at work and at home yields huge dividends: Claims are never filed in the first place, and there's no need to find ways to bring workers back to work since they're not out on injury in the first place.

Where companies often stumble is in implementing the package of measures in concert with a corporate workers' comp and disability program.

Building a unified thrust to have a panoply of programs working at once, backed by a consistent communications message throughout a dispersed organization, isn't easy.

Many corporate prevention initiatives go off half-cocked or simply fall on deaf ears. Department managers implement programs on different schedules, upper-management doesn't buy into one or more of the programs, budgets are slashed, or turnover means that promising initiatives die on the vine.

Large corporate mergers and acquisitions lead to further kinks. Mismatches among safety and prevention programs never fit as tightly as designed. Millions of dollars and hundreds of hours evaporate in frustration.

Silverado got a taste of how difficult integrating these programs can become. In early 2008, Silverado bought a community with a poorly performing workers' comp program in which a safety culture was nonexistent, Russo said.

"As you can only imagine, we suffered one of highest workers' compensation claims frequencies in the company's history," he said. "Several associates filed worker's comp claims in retaliation for being separated from the organization."

CYRIL TUOHY is managing editor of Risk & InsuranceŽ. He can be reached at ctuohy@lrp.com.

November 1, 2012

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