This article was produced with Amwins.
Senior care facility operators must navigate an increasingly complex liability landscape marked by rising claim severity, increased underwriting scrutiny, and fluctuating carrier appetite.
From nursing homes and assisted living facilities to hospice care providers and home health agencies, these facilities present a significant challenge for retail brokers. Specialists at Amwins point to a fragmented market for senior care, as experienced carriers pull back or hold firm on rates, and less experienced capacity providers enter the space, often undercutting prices.
“Operators may find a cheaper premium, but with a carrier that lacks the underwriting depth or long-term staying power,” said Matt Wasta (pictured on the right), managing director of the long-term care facilities group at Amwins Program Underwriters.
Ryan Gillispie (pictured on the left, executive vice president and healthcare specialist at Amwins Brokerage, agreed. “There’s so much new capacity that it’s tough for carriers to push rate,” Gillispie said. “Many renewals are flat. In some cases, carriers have had to lower their prices to retain accounts.”
Across the board, carriers are recalibrating their underwriting posture to manage rising losses in the senior care space. That includes reduced limits, higher retentions, narrower coverage, and stricter underwriting standards.
What’s driving this dynamic? Both Amwins experts pointed to a sharp increase in the frequency and severity of claims. While claims frequency dipped in 2020 and 2021, they have rebounded and even surpassed pre-COVID levels, according to Wasta.
“Severity is rising even faster,” he said. “Slip-and-fall cases that used to settle for $150,000 are now landing in the $350,000 range.”
Gillispie echoed the concern, noting the rise of huge verdicts in high-risk jurisdictions like Cook County, Sacramento, and parts of Kentucky. “The plaintiff bar is emboldened, and carriers are leaning heavily toward mediation to avoid potentially nuclear jury awards,” he said.
A complicating factor is how recent loss runs covering the pandemic, when courts were closed, appear artificially clean, misleading some underwriters and investors into underestimating current exposure.
While the entire senior care sector faces increased exposure, memory care and dementia-focused facilities present unique underwriting challenges. They aren’t as heavily regulated as skilled nursing and deal with highly vulnerable residents. “Incidents here tend to be catastrophic when they do occur,” said Wasta.
Gillispie noted that operational realities at facilities paint a stark picture of their risks. “Elopements, aggression, and behavioral issues are common,” he said. “And with staffing shortages, it’s hard to maintain oversight. Underwriters are asking more detailed questions about locked doors, monitoring systems, and staff-to-resident ratios.”
Both agree that capacity for these facilities still exists, but with tighter terms, higher deductibles, and additional exclusions, especially in difficult jurisdictions like Florida or California.
“We’re seeing more sub-limits on abuse coverage, exclusions for class actions or punitive damages, and more scrutiny around excess liability,” Wasta said.
Gillispie added: “In some cases, we have to reduce coverage or introduce creative layering to get it done. It’s not one-size-fits-all anymore.”
In response to capacity gaps left by traditional insurers, new market entrants have emerged. A few are bringing fresh approaches to risk assessment, such as predictive analytics or alternative rating models.
While some are well-informed and innovative, Gillespie warned that success isn’t guaranteed. “This is a long-tail business,” he noted. “We won’t know for years if their models are working. Some of the most-respected carriers exited this space after suffering losses. It’s a cautionary tale.”
Wasta agreed, emphasizing that experience and longevity matter. “Just because someone is willing to write it today doesn’t mean they’ll be around tomorrow,” he added.
Given the complexities, how can retail brokers position their clients for success? Wasta and Gillispie point to a key theme: a complete and compelling submission.
“Tell the full story,” Wasta said. “Why is this operator different? Why should they be expected to outperform their peers? A detailed submission leads to better terms.”
Beyond financials, brokers must articulate operational strengths. This should include up-to-date census data, survey results, tech implementations like fall detection, EMRs, and details on risk management practices.
Ownership transparency is another critical factor. “We see a lot of private equity or REIT money in the space,” Gillispie explained. “It’s essential to identify who’s really running the show and their experience in senior care. Underwriters want to see a mission focused on care, not just real estate.”
Despite the stakes, some blind spots continue to hinder underwriting evaluations. According to the Amwins experts, the biggest gaps in submissions for senior care facilities revolve around ownership, organizational structure, and documentation.
For Wasta, not being able to understand who’s making care decisions constitutes a “red flag.” At the same time, poor or late documentation also weakens claims defensibility. “Operators need to show that they can maintain thorough, timely records,” he said.
For Gillispie, historical loss data remains a hurdle. “Facilities change hands frequently,” he noted. “Some buildings have had two or three owners in five years. Underwriters still want to see the full loss history, regardless of ownership. If we can’t get it, assumptions are made—and they usually lean conservative.”
While new technologies to mitigate risks have drawn attention, underwriters emphasized that proven systems matter more.
“Everyone claims to have fall prevention protocols, but few implement them effectively. What really stands out is high-quality, real-time documentation—like robust MDS systems and EMRs.”
Senior care liability is an increasingly challenging terrain for retail brokers and insureds. However, with clear communication, detailed submissions, and informed strategy, brokers and operators can still achieve favorable outcomes.
Wasta and Gillispie stressed the importance of collaboration between brokers, underwriters, and insureds. As a leading wholesale broker and program administrator, Amwins is uniquely positioned to offer support, resources, and expert guidance.
“We use publicly available and proprietary data to highlight areas of concern and offer insights to brokers. That feedback loop helps the broker advise the client on ways to improve and secure better terms over time,” Wasta said.
Gillispie added: “From our side, we help with budgeting, pro formas, and realistic expectations, especially for brokers who don’t work in senior care often. We may say, ‘This is California; you’re probably looking at a $50K retention.’ The more data we can gather, especially from onsite clinical teams, the better we can advocate for the insured. It’s a collaborative process to get the best result.”
Learn more about Amwins’ healthcare insurance expertise and capabilities here. For more information about Amwins Program Underwriter’s long-term care program, click here.
