Nursing home trends

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.