According to a recent New York Times article nursing home patients “on the verge of death” are being sent to receive ultra intense – and ultra expensive – therapy. This practice, of sending the dying for intensive therapy including speech, physical and occupational therapy, has been raising worrying questions in the medical community and beyond. The latest data from a new study helps to provide some answers to the troubling questions of whether intensive therapy is actually necessary and beneficial for people in their final days of life, or if it is just another way for nursing homes to up their profits?
A new study investigating the recent trend was published in the Journal of the American Medical Directors Association. The researchers looked at data from 647 New York nursing home institutions. What emerged was that there was a 65% increase between 2012 and 2015 and that oddly most of the rehab therapy provided to residents occurred in the final week of their lives. An author of the study stated that “some of these services are being provided in the last week and sometimes on the day of their death.”
The study indicated that the increasing prevalence of pushing near end of life patients into intense therapy may be motivated by greed rather than by the best interest of the patient, in that facilities are looking to maximize reimbursement rates from Medicare. Nursing homes can bill Medicare for the intensive rehab therapies at the highest reimbursement rate. Additionally, it was revealed that the practice occurred twice as often in nursing homes that are for profit, compared to those that are non-profit facilities. The study raises important questions because even among patients not considered to be at the end of their life, the value and benefit of intensive therapy is questionable, as it is not believed to always lead to a better outcome than regular less intensive therapy.
“This study raises several concerns and questions regarding the scope and intensity of therapy provided to nursing home residents prior to death,” writes the lead author of the study, Helena Temkin-Greener, Ph.D., M.S., “If it is being driven by a failure to recognize that a resident is approaching end-of-life, then it calls for improving the skills of nursing home teams. If it is being driven by financial considerations then regulatory and policy interventions may be necessary.”
Despite the grim report positive legislative change seems to be on the horizon, according to Strom & Associates beginning in October, 2019 the “Centers for Medicare and Medicaid Services will implement a new ‘Patient Driven Payment Model” where reimbursement for treatment will not be linked to the amount of care but rather will be focused on the patient’s condition.