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Nursing Homes Profiting from High Intensity, Possibly Unnecessary Therapy, Research Shows

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, & Blanco, our Philadelphia nursing home injury attorneys represent victims and families who have suffered as a result of nursing home abuse and neglectin 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, & Blanco, contact us. Our firm provides free and confidential consultations and serves clients throughout Pennsylvania.

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