Liberty Mutual Insurance and Ironshore Healthcare have released a 2025 benchmark study highlighting trends and providing insights into care giving claims in independent and assisted living communities as well as with skilled nursing facilities. The study analyzed 2,500 closed claims reported under Liberty Mutual/Ironshore policies resolved within the past 12 years.

Beyond increasing premiums and limited capacity, senior living communities also face growing costs from the share of claims filed. Key findings from the report include indemnity payments across all care/service settings more than doubling over the past 10 years, surging to $226,000 in 2024. Injuries related to falls have driven claim volumes higher in number and costs greater in amount. There are more claims associated with pressure ulcers and abuse; with the rising prevalence of wrongful death claims.

Now there are more falls...

Falls-related injuries (45% of all claims) consistently drove the overall volume of claims, whereas pressure ulcers and abuse claims — although less frequent — led to higher claims costs. In addition, 40% of closed claims contained wrongful death allegations, a large drive of claim frequency.

Failure to prevent falls in independent living facilities yielded an average claims costs of $49,000 across 75 claims; followed by an average cost of $137,000 across 209 claims; and skilled nursing, at an average cost of $183,000 across 557 claims. Comparatively, failure to treat/prevent pressure ulcers resulted in similar average claims costs for only one claim in independent living, 30 claims in assisted living and 331 claims in skilled nursing.

Providers need a root cause analysis to identify the cause of falls, including whether falls interventions were effectively implemented or if there were contributing factors — such as throw rugs in assisted living communities or the need to review resident medications in skilled care settings.

Although fewer claims were filed for care failures related to pressure ulcers, the report authors expressed that the data underscore the need for “consistent and meticulous” documentation regarding resident assessments for care plans, falls risks and wound care management, as well as the “critical” need for comprehensive safety plans.

The reporting also emphasized the importance of implementing resident monitoring systems, employee training on safety protocols and comprehensive care plan interventions to prevent elopements.

Care level costs vary...

There was a highlighted correlation between care level and claims costs. As the level of care increased, so did financial exposure, and the average indemnity payment in 2023 and 2024 surged to $226,000. That was more than double in relation to 10 years ago.

“Legal system abuse” also substantially increased average claim costs, driven by “aggressive legal strategies” used by plaintiffs’ attorneys.

Average claims costs in assisted living communities ($159,000) were twice as high as those in independent living settings ($74,000), whereas skilled nursing had the highest average claims cost, at $210,000.

Those costs often were doubled when indemnity was involved, due to the associated expenses to launch a “robust defense.”

The report writers attributed the cost disparities to the inherent vulnerabilities of residents in higher levels of care. In addition, as the level of care escalated, so did the complexity and expense of defending and settling claims, including the need for specialized expert witnesses, extensive medical records reviews and in-depth analysis of comorbidities.

Failure to protect residents from abuse led to the highest claims costs. Four claims in independent living had an average cost of $568,000, compared with 23 claims in assisted living at an average cost of $227,000 and 28 claims in skilled nursing settings costing an average of $286,000.

The writers emphasized a critical importance of regular staff training on the facilities' abuse policies, safety protocols, de-escalation techniques and thorough and better pre-employment screening to mitigate risks.