Dying nursing-home residents in US pushed into rehab: Study

The proportion of nursing-home residents who received "ultrahigh intensity" rehabilitation increased by 65 per cent between October 2012 and April 2016, according to research by the University of Rochester. Some residents were found to be treated wit
The proportion of nursing-home residents who received "ultrahigh intensity" rehabilitation increased by 65 per cent between October 2012 and April 2016, according to research by the University of Rochester. Some residents were found to be treated with the highest concentration of rehabilitation during their last week of life.PHOTO: NYTIMES

Potentially unnecessary therapy can reap huge financial benefits, raising questions on motive

WASHINGTON • Nursing-home residents are increasingly spending time in rehabilitation treatment during the last days of their lives, subjected to potentially unnecessary therapy that reaps significant financial benefits for cash-strapped facilities, a study shows.

The proportion of nursing-home residents who received "ultrahigh intensity" rehabilitation increased by 65 per cent between October 2012 and April 2016, according to research published this month by the University of Rochester.

Federal insurance programme Medicare defines "very high" therapy as almost nine hours a week, and "ultrahigh" therapy as more than 12 hours a week.

Some residents were found to be treated with the highest concentration of rehabilitation during their last week of life.

The study analysed data from 647 New York-based nursing-home facilities and 55,691 long-stay decedent residents, with a specific focus on those who received very high to ultrahigh rehabilitation services, including physical, occupational and speech therapy during the last 30 days of their life.

Such treatments garner the biggest payouts from insurers.

The study sourced data from New York nursing homes' Minimum Data Set assessments, which track a patient's health status and socio-demographics, as well as the Centres for Medicare and Medicaid Services' Nursing Home Compare website.

The findings raise questions about financial motives, said Dr Helena Temkin-Greener, the lead author of the study and a professor at the University of Rochester Medical Centre Department of Public Health Sciences.

Medicare doles out lofty reimbursement cheques to nursing homes with patients facing the most complex and time-intensive rehabilitation.

Dr Temkin-Greener said for-profit nursing homes were more than two times as likely to use high to ultrahigh intensity therapy than non-profit homes.

"There's a possibility that nursing homes know a patient is approaching end of life, but the financial pressures are so high that they use these treatments so they can maximise revenue," she said.

The study of New York facilities does not bode well for how nursing homes throughout the United States are treating dying residents, given that most states have less stringent nursing-home regulatory oversight than New York.

There is one particular piece of data from the study, said Dr Temkin-Greener, that points towards nursing homes seeking to profit off of helpless residents.

"If ultrahigh therapy is good for patients at end of life, why are only for-profits using it?" she asked.

Rehabilitation therapy has proven to be incredibly beneficial to patients when properly prescribed, Dr Temkin-Greener noted, but with those approaching death, high-intensity treatment might be preventing staff from providing more appropriate end-of-life care, such as hospice or palliative care.

It may also be accelerating the residents' decline.

NYTIMES

A version of this article appeared in the print edition of The Sunday Times on October 14, 2018, with the headline 'Dying nursing-home residents in US pushed into rehab: Study'. Print Edition | Subscribe