The exposure that ends a facility is the one most policies exclude.

Sexual abuse & molestation

Covers allegations of abuse by staff or volunteers. General liability usually excludes it outright, and any organisation working with children, patients or vulnerable adults will be asked to carry it by name.

Without it — Nearly every general liability form excludes it by endorsement, so the claim most likely to close a facility is the one most often uninsured.

Professional liability

Covers the advice, the drawing, the diagnosis — the work itself, rather than someone getting hurt on your premises.

Without it — Care decisions, medication administration and supervision are judged as professional acts, not premises accidents.

General liability

Third-party bodily injury and property damage — the line nearly every contract names by default.

Without it — Falls, wandering and visitor injuries are the highest-frequency claims in residential care.

Workers compensation

Required in almost every state the moment you have employees. Priced on payroll and class code, which is why the class code is worth arguing about.

Without it — Lifting and transfer injuries drive the loss ratio, and staffing ratios drive the lifting.

Hired & non-owned auto

Covers vehicles the business does not own but its people drive on the job — rentals, and employees running errands in their own cars. Their personal auto policy will not cover a business trip, and the claim lands on the business.

Without it — Staff driving residents to appointments in their own cars leaves the facility named and nothing responding.

Crime & employee dishonesty

Theft by your own staff, funds transfer fraud, and the dishonesty bond a home care contract will ask you for by name.

Without it — Resident funds handled by staff are the exposure licensing asks about, and a dishonesty bond is often named in the contract.

Employment practices liability

Wrongful termination, discrimination and harassment claims brought by your own employees. General liability specifically excludes these.

Without it — A large hourly workforce on rotating shifts, doing physically demanding work under supervision, produces employment claims at a rate few operators expect.

Why is abuse and molestation cover a separate thing?

Because the standard general liability form excludes it. For a provider whose staff work unsupervised with vulnerable adults it is simultaneously the cover most likely to be needed and least likely to be present — and licensing bodies and contracts increasingly ask for evidence of it by name. It has to be added deliberately, with a real limit rather than a token sub-limit.

How is assisted living insurance rated?

Per bed, which is the thing operators are most often surprised by. The rating unit is the number of lives in your care rather than your revenue or your square footage, so every bed you add adds premium directly and predictably. It also means an empty bed you are licensed for can still be costing you, and that licensed capacity and occupied capacity are worth stating separately when the policy is placed.

What do carriers ask about staffing?

Whether somebody qualified is on site at all times, and whether you can prove it. Full staff coverage with continuous on-site presence is close to a precondition in this class — it is the control that prevents the wandering, the fall and the unsupervised incident that produce the largest claims. Rotas, training records and incident logs are what an underwriter wants to see, and a facility that can produce them is a materially easier risk to place.

Why is employment practices cover such a big deal here?

Because the workforce shape produces claims. Residential care runs on a large hourly staff working rotating shifts, often with high turnover, doing physically demanding work under close supervision — and wage-and-hour, discrimination and wrongful termination claims follow that shape wherever it appears. Employment practices claims in this class are frequent and expensive, and operators consistently underestimate them relative to the resident-facing exposures they worry about.

Our premium jumped after a claim. Is that permanent?

No. We have taken facilities through exactly this: general liability placed after a serious claim, then premium brought back into line over roughly two years as the claim aged and the controls held. What moves it is documented staffing, training records, incident reporting and the reserves on any open claim — not shopping harder.

Is this the same as home health insurance?

No, and the distinction matters to underwriters. Home health sends caregivers into someone else’s residence; residential care means the residents live in your building, which brings premises liability, overnight supervision, resident funds and habitability into the picture. The two are rated differently and are not interchangeable on an application.

Do you write adult day programmes as well as residential?

Yes. Adult day health and day programmes sit in the same appetite and share the hard part — abuse exposure, transport, and supervision of adults who may not be able to report what happened to them.