A recent URMC study shows an increasing number of nursing homes across New York State are pushing patients in their final months of life to do excessive amounts of rehabilitation.
The study examined more than 600 facilities involving over 55,000 long-term residents throughout New York.
According to this study, the rehab has increased 65-percent between 2012 and 2016.
“Hours of additional rehabilitation services, as they’re approaching really the last month of their life,” said Dr. Thomas Caprio. “And some of these patients were actually receiving these services the last week or even the day they died.”
Rehab plays a vital role in nursing homes, but Dr. Thomas Caprio says for-profit homes might be taking advantage of the system, profiting off patients doing excessive amounts of unnecessary rehab in their final days.
“Having that amount of rehabilitation services could actually contribute to some of their discomfort, impact their quality of life and contribute to their suffering,” said Dr. Caprio.
Dr. Helena Temkin-Greener, who aided the study, found many for-profit nursing home staff were more concerned about reimbursement for their services than they were with supporting end-of-life care.
“Even though staff may see what’s happening, their nursing home is pressuring them to provide a different type of therapy because it pays more,” says Dr. Temkin-Greener.
Matthew Rossman is the rehab director at Saint John’s, a non-profit facility. He says each assessment should be case-by-case.
“We base it on need, what their goals are, what they can tolerate and what their preferences are,” said Rossman. “It’s usually fairly obvious when it’s time to change what we’re doing or maybe step back from treatment at all.”
According to the Department of Health, patients should have 100 percent say in the amount of rehab they receive; if they choose not to participate, they don’t participate.
The URMC researchers found that facilities with a higher percentage of registered nurses had lower rates of excessive therapy, as they can notice patients approaching the end of their life much sooner.
It’s important to note this study was conducted using administrative data after the patient had passed away — no personal experiences were included.