A growing number of nursing homes are forcing their dying residents into intense therapies so they can get financial kick-backs a new study suggests.
Medicaid provides rebates to nursing homes that have to care for patients in need of high-intensity rehabilitation services that take up as much as two hours a day.
While some of the 1.3 million Americans that live in nursing homes certainly do need physical, occupational and speech therapies, the lure of the extra funds for these services is ripe for abuse.
And people with only a little life left are being pushed to spend hours a day in therapies to improve a future they don’t have.
The University of Rochester found that a shocking number of New York nursing home residents – and likely people throughout the US – have been enrolled in intense rehabs that may well have done more harm than good in the last week of their lives.
Elderly people are among the most vulnerable populations.
In fact, one in 10 elderly people is the victim of some form of abuse.
Nursing homes are especially fraught with abuse of various kinds.
Residents spend their final days in the care of a staff that they are helpless to question or push back against.
The American population is aging, so the number of relatives left to care for the elderly is shrinking, leaving more and more people in the hands of nursing home staff.
And taking on more residents means these facilities’ resources are stretched thin and they may be left strapped for cash.
The majority of nursing home residents are insured by Medicaid, which covers long-term care.
But each home gets a certain amount of money from Medicaid based on the services they are providing the residents.
One of the biggest cash cows for these facilities is a period right after a patient gets hospitalized and then returns to the nursing home.
During this period, the rebate rate offered by Medicaid is far higher than what nursing homes would normally get for rehab therapies.
In their previous research, Dr Helena Temkin-Greener and Dr Thomas Caprio had interviewed nursing home employees.
‘Staff kept telling us that they were pushed to do rehab when they wanted to do palliative care’ for patients who they thought were reaching the ends of their lives, says Dr Temkin-Greener.
In their new study, they looked at data on 647 nursing homes in the state of New York between 2012 and 2015.
During that time period, the number of residents who received very high intensity or ‘ultrahigh’ intensity rehabilitation therapies during their last month of life increased by 65 percent.
These sessions were particularly concentrated in the last week of the residents’ lives.
This raises two questions for Dr Temkin-Greener: ‘Can staff recognize the signs that someone is terminal, and are they really consciously weighing how much therapy will be beneficial?
‘Or, are they thinking that therapy is good for the institution?’
Dr Tempkin-Greener says she can’t answer that question yet, but one of their other findings may provide a hint about what’s happening in these homes.
Far more residents were undergoing these high-rebate therapies at the ends of their lives at for-profit homes than at non-profits.
‘That suggests that either for-profit staff are less skilled at identifying the signs of end of life, or that there is an incentive to maximize profits,’ says Dr Temkin-Greener.
‘The fact that it’s much more prevalent in for-profit [nursing homes]raises an eyebrow.’
She says that, depending on why so many more dying elderly people are being funneled into doing as much as two hours of therapy a day just before their deaths, one of two fixes will be needed: either better education or tighter regulation.
‘On one hand it’s hard to predict when someone is going to die, and it’snot that therapy is never good but it’s a matter of how much and when,’ says Dr Temkin-Greener.
If the same phenomenon she and her research team saw in New York is happening across the country – and they are pretty sure it is – then scores of elderly Americans are spending their final days in intense therapies instead of in comfort.