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 organization 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. It is 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. Pricing depends entirely on HOW it is bought: as an endorsement on a general liability policy we write, HNOA often costs a few hundred dollars; as a stand-alone (monoline) policy it runs $2,500 to $5,000, and association practitioner programs (CPH, CM&F and similar) generally cannot take the endorsement, so "add HNOA to my existing policy for $300-$800" is usually not a real option. A package carrying GL, professional liability and HNOA together is typically cheaper than the monoline.

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.

Can a brand new facility get covered, with no history?

Yes, and the file will be judged on the operators rather than the entity, because the entity has no record yet. Underwriters ask for owner and administrator resumes on a new venture in this class: licensure, the settings worked in, years of hands-on experience, any facility previously run. Where staff transport residents or use personal vehicles, expect two standing conditions as well, both of them yours to keep up: the facility pulling motor vehicle records on its drivers annually, and staff maintaining their own personal auto policies, since hired and non-owned auto sits above the driver’s own coverage rather than replacing it.

The same requirements, in the regional center context

Why is abuse and molestation coverage 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 coverage 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 coverage 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 programs as well as residential?

Yes. Adult day health and day programs 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.

What does a assisted living and residential care insurance application ask for?

The applications for assisted living and residential care businesses ask about 4 things above all: how long have you been operating under your current ownership or management; briefly describe what your facility does and how you run it; do you assess all new residents for mobility limitations, prior injuries, skin breakdown, disorientation, wandering risk, medications, and other health factors; have you or any employee ever faced licensing board investigations, suspensions, or revocations related to prescribing or dispensing narcotics. Have your licenses and accreditations and your last five years of claims history from your current insurer, with details on all open claims and closed claims over $25,000 ready and a quote takes a day instead of a week.