Private duty transport: Know where your agency stands with insurance

Should your agency provide patients with transportation?

One home care agency reports that its private duty agency transports patients on a variety of errands, from visits to the doctor’s office to the grocery store and the barber. These trips might be made in the client’s car or the home care nurse’s vehicle.

If it’s the employee driving his or her own vehicle, the agency requires a copy of the employee’s license as well as proof of liability insurance. If the trip is made in the patient’s car, the client must prove that he or she has up-to-date car insurance. An agency staff member admits to being uncomfortable with the arrangement, but is at a loss for how to handle it. The clients want it and the agency feels, accordingly, it is a service it must provide.

There are consequences for an agency that fails to limit its liability. Failure to keep tabs on staff driving records or otherwise limit liability can force an agency’s insurance premiums to skyrocket. In a worst-case scenario, insurers may refuse to provide coverage for some staff drivers. Needless to say, that can spell not only layoffs and transfers, but can place a severe strain on already short-staffed home health care agencies.

Private duty transport is a Catch-22 in many ways and one that plenty of agencies find themselves in. Should home health care extend to taking patients on errands and to medical appointments? It depends on whom you ask.

To drive or not to drive

Neil Drucker, RN, president of Omni Healthcare Consulting of Moore, OK, says that all his private duty agency clients "provide transportation for their patients." Omni Healthcare Consulting also obtains a vehicle release from liability from the client upon admission.

It’s an entirely different story for Kathy Kieke, RN, MSN, care center director of St. Cloud (MN) Hospital Home Care and Hospice. "Staff are not allowed to transport clients, but they can accompany them on public transportation, taxis, and so forth," Kieke says.

Sometimes the decision whether to transport clients may not be left to the agency but comes under the rubric of state regulations. One such state is Tennessee. Vicky Tataryn, RN, BS, quality improvement consultant of Nashville-based Healthcare Consultants, says that under Tennessee state law, "people who transport someone for payment . . . must have a special chauffeurs license." Putting state regulations aside for a minute, Tataryn comes down on the side of prudence when it comes to transporting patients. It’s her opinion that the risks far outweigh the gains. "I know the patients want it but . . . take them in a taxi or not at all."

Tataryn is not alone in her opinion. Merridee Hansen Farr, MPA, director of regulatory affairs/compliance at Rocky Mountain Home Care of Salt Lake City, notes that her agency recently wrestled with the same problem, but when all was said and done, decided against private duty transport. "We decided that the risk is not worth any possible benefit," she says.

Hansen Farr’s advice: check with your insurance broker or carrier regarding a hired and non-owned liability clause, which provides auto liability coverage for vehicles that are leased, hired, rented, or borrowed from anyone other than an agency employee or partner. These policies typically provide auto liability coverage for vehicles that are not owned, leased, hired or borrowed but that are used in connection with a particular business. An example: employees using their vehicles for company business.

This provision was "never meant to cover employees transporting patients during the scope of their employment," she explains. "Our carrier indicated this provision was not intended for that kind of service, and we would not be covered in case of an adverse event. Also, if any of [an agency’s] employees’ insurance providers found out they were using their vehicles for business purposes, they may cancel the policy since it probably would not cover this particular employment duty.

"We called three major insurance carriers — Allstate, Farmers, and State Farm — and they all stated that they would not cover someone to do this as part of [his or her] job. We felt we had a responsibility not to put our employees at risk with their insurance providers. If an accident did occur, the investigation by the insurance company could very well reveal the circumstances of the trip, i.e. transporting a patient while working for an employer."

For the moment, Rocky Mountain Home Care offers company-owned vehicles to those offices that provide a substantial amount of private-duty transport and who can "demonstrate it is a profitable’ service. Otherwise, we do not transport at all."

Also, says Hansen Farr, if agencies decide to go ahead with private-duty transport, either with the employee’s or client’s vehicle, "it would probably be in their best interest to have extensive policies in place that would govern employee driving record reports, background and drug-screening checks, defensive driving and safe driving in-services, etc. Of course, you could also have the patient sign a waiver, which would attempt to hold the agency harmless in the event of an accident, although these often do not hold up in a courtroom setting."

Limiting liability for drivers

Regardless of your agency’s policies on private duty transport, insurance agencies are taking a closer look at liability factors related to on-the-job driving. Raymond Helms, MPH, executive director at Pathways Home Care of Concord, NC, says that the liability firm for his hospital-based home care agency recently asked for the drivers license numbers all of the agency’s employees — nearly 300 in all.

"Subsequent to that request," he says, "we received notice from them that several members of our staff are to be placed in non-driving’ positions, based on items on their driving records from the state [Department of Motor Vehicles] DMV. They have not disclosed to us which items they consider to meet their elimination criteria, but indicate that prior accidents, whether the employee was at fault or not, are part of the criteria. They did say that if we could provide proof that they were not at fault in prior accidents, they would consider removing them from the nondriving restriction.

"This could lead to job losses at the worst, or transfer into other nondriving’ positions in our hospital for some of our very talented staff members. Our hospital risk management is immediately soliciting other vendors for our liability insurance, but says they hear that this is a growing trend across the country."

John Beard, CEO of Alacare Home Health and Hospice of Birmingham, AL, says his agency has worked to minimize such risk management problems by working proactively with the carrier. For starters, he notes, his agency screens new hires for driver safety records and conducts an annual in-service on driver safety. Alacare also mandates that any driving accident, be it personal or job-related, be reported along with any tickets an employee might receive. His agency takes it a step further, Beard says, by conducting an annual check with the Alabama DMV on all staff that drive in connection with their jobs. And for those employees who fail to follow Alacare’s driving policies and procedures, a system of progressive discipline is used.

[For more information, contact:

• John G. Beard, MBA/JD, CEO, Alacare Home Health and Hospice, 4752 U.S. 280 E, Birmingham, AL 35242. Telephone: (800) 524-7773.

• Neil Drucker, RN, President, Omni Healthcare Consulting, P.O. Box 7325, Moore, OK 73153. Telephone: (405) 412-6877.

• Merridee Hansen Farr, MPA, Director of Regulatory Affairs/Compliance, Rocky Mountain Home Care, 5681 S. Redwood Road, No. 24, Salt Lake City, UT 84123-5322. Telephone: (801) 288-1616.

• Raymond Helms, MPH, Executive Director, Pathways Home Care, 487 Lake Concord Road N.E., Concord, NC 28025-2934. Telephone: (704) 784-7114.

• Kathy Kieke, RN, MSN, Care Center Director, St. Cloud Hospital Home Care and Hospice, 48 29th Ave. N., Suite 15, St. Cloud, MN 56303. Telephone: (320) 240-3265.

• Vicky Tataryn, RN, BS, Quality Improvement Consultant, Healthcare Consultants Inc., One Vantage Way, No. C-210, Nashville, TN 37228-1529. Telephone: (615) 259-2772.]