Nursing Homes Increasingly Pushing Patients into Rehab at End-of-life
From EurekAlert and the Journal of Post-Acute and Long-Term Care Medicine:
A new study reveals a growing trend of potentially unnecessary – and harmful – high intensity rehabilitation services for residents of nursing homes. The study finds that this trend, which may be driven by a desire to maximize reimbursement rates, is on the rise for patients in the last 30 days of life, indicating that these services may be interfering with appropriate end-of-life care. “This study raises several concerns and questions regarding the scope and intensity of therapy provided to nursing home residents prior to death,” said Helena Temkin-Greener, Ph.D., M.S., with the University of Rochester Medical Center (URMC) Department of Public Health Sciences and lead author of the study, which appears in the Journal of the American Medical Directors Association. “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.” Nursing home Medicare reimbursement rates are based on categories that place patients into resource utilization groups (RUGs) based on the complexity, intensity, and amount of staff time dedicated to their care. Patients who receive high levels of rehabilitation services fall into a category that makes these facilities eligible to collect the highest level of reimbursement for their care.