A new study reveals a growing trend of potentially unnecessary or harmful rehabilitation services for residents of nursing homes. The study finds that this trend, which may be driven by a desire to maximize profits, is particularly on the rise for patients in the last 30 days of life, indicating that these services could be interfering with appropriate end-of-life care.

The authors of the current study analyzed data from 647 nursing home facilities in New York State to better understand the patterns and growth of rehabilitation services. Specifically, they focused on residents who had received very high to ultrahigh rehabilitation services defined as 720 minutes or greater, or the equivalent of two hours of rehab per day.

They found that residents receiving ultrahigh rehabilitation was concentrated in the last seven days of life.
The study suggests this phenomenon is likely more pronounced in other states. A 2013 CMS study showed that nursing homes in at least 17 other states billed for ultrahigh intensity rehabilitation services at even higher rates than New York.

The authors acknowledge that some level of rehabilitation may be necessary and appropriate for patients approaching the end-of-life, such as speech therapy, which can assist with difficulties in swallowing. However, they contend that many of the goals of these therapies can be attained at low or intermediate levels of intensity and that ultrahigh levels for patients nearing end-of-life are generally unnecessary and, in many instances, could be harmful and interfere with appropriate care. This could also delay the timely introduction of hospice and palliative care.

Real Estate Attorney David Michael on Panel of Industry Professionals Discussing Environmental Due Diligence

May 16, 2016 – David Michael, an attorney at Lipson Neilson P.C., and the current Chair of the Oakland County Bar Association’s Real Estate Committee, will be on a panel of real estate industry professionals discussing “Avoiding the Abyss: Environmental Due Diligence in Real Estate”. Presented by the Energy, Sustainability and Environmental and the Real Estate Law committees of the Oakland County Bar Association, with the support of the Michigan Commercial Board of Realtors. This seminar is officially certified by CE Marketplace, Michigan’s Continuing Education Hub for Real Estate Professionals, for two CE Credits and will be held on June 15, 2016, at the WMU-Cooley Law School located at 2630 Featherstone, Auburn Hills, Michigan 48326.


Topics discussed by the panel will include:

  • The legal liabilities/risks associated with the purchase/sale of brownfields or properties with other environmental issues such as wetlands or endangered species.
  • Assessing the environmental condition of real property through ASTM Phase I and Phase II environmental assessments, natural resource assessments, hazardous building material surveys and environmental insurance and Brownfield Incentives/Tax Abatements.
  • Drafting transactional documents to minimize environmental liabilities and spread risk.

About David Michael
David Michael specializes in all aspects of real estate law and litigation, and he has extensive experience in commercial litigation and continues to practice in that area as well. He is the Chair of the Oakland County Bar Association’s Real Estate Committee, and a contributing author to Development Magazine, a publication of the Commercial Real Estate Development Association.

About Lipson Neilson P.C.
Founded in 1985, Lipson Neilson has offices in Bloomfield Hills, Las Vegas and Phoenix. The firm services clients in Michigan, across the U.S. and around the world. You can learn more about the firm by visiting


Contact: David Michael

Phone: 248-593-5000