New Study Finds Nursing Homes are Overdoing High Intensity Care
A new study published in the Journal of the American Medical Directors Association found that near dying nursing home residents are receiving high to ultrahigh intensity rehabilitation therapy in the weeks leading up to their death. This practice raises the question of whether the services are needed or being performed as a revenue source. It could also mean that some residents are being denied hospice care, where they would be better suited to spend their final days. The study found this was twice as prevalent at for-profit nursing homes as at nonprofit ones.
“Some of these services are being provided in the last week and sometimes on the day of their death,” said Dr. Thomas Caprio, one of the study’s authors and an associate professor at the University of Rochester Medical Center.
Rehabilitation services, including occupational, speech, and physical therapy, are “a potential revenue source for these facilities,” he added. “And when the plan of care shifts to hospice care and palliative care, that revenue stream disappears.”
The study examined the level of intensity related to rehabilitation therapy provided to nearly 55,700 long-term residents at 647 skilled-nursing homes in New York State in the thirty days before they died from October 2012 to April 2016. An estimated 14 percent of those residents got some rehabilitation in the month before they died, and of that group, 2,667 received therapy at high to ultrahigh levels. Medicare often covers rehabilitation therapy for long-term patients, and nursing homes can bill Medicare at the highest rate for ultrahigh levels of treatment. Among nursing home residents who got therapy, those receiving “ultrahigh levels” jumped 65 percent from 2012 to 2016.
Helena Temkin-Greener, the lead author of a University of Rochester Medical Center study that took a closer look into this issue, posed the question, “If ultrahigh therapy is good for patients at end of life, why are only for-profits using it? These people are using high-intensity services without justification.”
A spokesperson for the New York State Department of Health said, “If actions taken by a nursing home were to cause patient harm. the department would investigate and take appropriate actions.” However, rehabilitative therapy in nursing homes has been found to provide significant benefits, even for patients not expected to live for very long.
The study did not analyze the results of the therapy provided, but researchers said their findings suggested that the “dosage” might be excessive. Richard Mollot, executive director of the Long Term Care Community Coalition said the study’s findings were troubling.
“Residents should receive therapy and other services that can help them attain, and maintain, their highest practicable well-being,” Mollot said. “However, these services must always be tailored to the personal needs, goals, and wishes of the individual.”
“We need to be able to keep both perspectives,” said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy. “Nursing facilities are providing more therapy than needed in order to increase their reimbursement, and nursing facilities are not providing appropriate maintenance therapy to residents who need it — at the same time.”
“I think this is just tip of the iceberg, really,” Caprio said.