Tuesday, October 9, 2018
The University of Rochester published a study finding that nursing home residents who received “ultrahigh intensity” rehabilitation increased by 65% from October 2012 to April 2016, some even in their last week of life. Medicare defines “ultrahigh” therapy as more than 12 hours per week.
The study analyzed data from 647 New York-based nursing home facilities and 55,691 long-stay residents that had died, with a specific focus on those who received very high to ultrahigh rehabilitation services—including physical, occupational and speech therapy—during the last month of their life. Treatments categorized as such receive the highest payout from Medicare and other insurers.
Helena Temkin-Greener, the lead author of the study and a professor at the University of Rochester Medical Center Department of Public Health Sciences says that the findings raise questions on whether there is a financial reason rather than a medicinal one for those types of treatments. For-profit nursing homes were more than two times as likely to use high to ultrahigh intensity therapy than were nonprofit homes.
On the other hand, the study could be indicative that nursing home staff are failing to recognize when a patient is nearing the end of their life. “It is important for [skilled nursing facility] providers and their care teams to consider the risk-benefit of potential therapy interventions and dosage relative to the resident’s current health status,” said Daniel Ciolek, associate vice president of therapy advocacy at the American Health Care Association, which represents most of the country’s for-profit nursing homes.
See Riley Griffin, Nursing Homes are Pushing the Dying into Pricey Rehab, Bloomberg, October 9, 2018.
Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.