A new study is revealing an alarming trend among nursing homes –
facilities are increasingly providing elderly residents with intensive,
costly, and possibly unnecessary therapy, even in the last weeks of their
lives. The study, conducted by the University of Rochester and published
recently in the
Journal of the American Medical Directors Association, is raising concerns about the necessity and potential dangers of intensive
therapy, as well as whether profits may be prompting their use.
Here are a few key details about the study:
- For the study, researchers gathered and reviewed data from over 600 nursing
facilities in the state of New York and the records of nearly 56,000 deceased
individuals who were long-stay residents.
- The study had a special focus on residents who received “ultrahigh
intensity” rehabilitation services in the 30 days prior to their
death. These services, including various forms of physical, speech, and
occupational therapy, are classified at “ultrahigh” by Medicare
if they are provided for more than 12 hours in a week, which is equivalent
to 2 hours of rehab a day.
According to researchers, nursing homes are increasingly utilizing ultrahigh
intensity therapy. From October 2012 to April 2016, the study notes, there was a
65 percent increase in the proportion of residents who received these services.
- Most of the ultrahigh rehabilitation services residents received was provided
during their final days of life.
The study, while limited to the state of New York, is raising red flags
for experts, advocates, and government regulations, many of whom say the
findings are indicative of a nationwide problem. The most concerning issues
and questions the research prompts include:
Financial motives – The findings raise significant questions about whether the boom
in use of ultrahigh intensity therapies is being driven by profits. According
to researchers, for-profit facilities were
over 2x more likely to provide these services than non-profit nursing homes. This begs the
question: if ultrahigh therapies are beneficial for residents, especially
those near the end of their life, then why are for-profits using them
far more than non-profits? The answer, according to many experts, may
have a lot to do with facilities wanting to maximize reimbursement rates,
especially as nursing homes across the country has seen a decline in patients
over recent years.
Policies and regulations – Medicare reimburses nursing homes based on how complex, intense,
and frequent care is provided to residents. Patients who receive ultrahigh
therapies are placed into the highest category, which also provide the
highest level of reimbursement to facilities. Government regulators have
noticed the trend and how facilities may be exploiting current policies
to optimize their revenues. Medicare has already announced it will be
amending policies to focus on “payment-driven” reimbursement
models that base payments on the individual health and needs of residents,
rather than on frequency or intensity of treatment provided. Those changes
are slated to take effect in October of next year.
Necessity – Researchers in the study acknowledged some rehabilitative therapies
are important to improving the health and quality of life of elderly residents.
Even in cases of residents approaching end-of-life, some therapies like
speech therapy can help with difficulties they may have in swallowing
or eating. Still, medical professionals state it is often the case low
to moderate intensity levels of therapy can provide benefits, and that
for end-of-life residents, ultrahigh intensity therapy is generally unnecessary.
Potential harm – In addition to providing a level of intensive care residents may
not need, ultrahigh intensive therapy may actually pose risks to those
in the final weeks or days of life. Rather than focusing on making patients
comfortable, some nursing facilities may be failing to evaluate, or may
be willfully ignoring, when patients are nearing their final days, or
failing to identify when intensive levels of rehab outweigh benefits for
those in fragile states of health. This can increase levels of pain and
exhaustion that increase residents’ suffering, delay the timely
introduction of palliative or hospice care, or ultimately accelerate their decline.
Accountability: Nursing Homes & Civil Lawsuits
It is often the case with situations involving excessive and unnecessary
medical billing that federal regulators intervene to investigate and penalize
nursing homes and assisted living facilities. While regulatory and enforcement
actions are critical to ensuring nursing facilities abide by the law and
that care in nursing homes meet acceptable standards, they do not provide
victims who have been harmed by negligent, unlawful, and / or abusive
conduct with any viable source of compensation. To pursue financial recoveries
for damages, residents and their families will need to take action on
their own in the civil justice system.
At Shrager & Sachs, our Philadelphia nursing home injury attorneys
represent victims and families who have suffered as a result of
nursing home abuse and neglect in whatever
form it takes – whether it may be financially motivated or the result of inexcusable
negligent or wrongful acts. By providing residents and families with caring
and compassionate support, we help them navigate difficult times and unfamiliar
legal proceedings. Through the application of our extensive experience,
determination, and resources, we provide the representation they need
to fight back against nursing homes and their powerful insurers, and pursue
the justice and compensation our clients deserve.
To discuss a potential nursing home case with a lawyer from Shrager & Sachs,
contact us. Our firm provides free and confidential consultations and serves clients