Study Shows Profit-Driven Nursing Homes May be Pushing Residents into Costly, Unnecessary Rehab

A recently published study from the University of Rochester is revealing an alarming pattern among nursing homes: some facilities may be pushing elderly residents into rehabilitation treatment and unjustified high-intensity therapy in order to profit financially.

The newly published study, which analyzed hundreds of nursing home facilities in New York and data from the U.S. Centers for Medicare and Medicaid Services, focused on “ultrahigh intensity” rehabilitation services – such as speech, occupational, and physical therapy – within the last 30 days of a resident’s life. These types of services generate the largest insurance payouts.

Key findings from the study include:

• From 2012 to 2016, the number of residents at nursing homes reviewed by researchers who received “ultrahigh intensity” rehab services increased by 65%. According to CMS, rehab services are defined as “ultrahigh” when they are performed over 12 hours per week.
• Some residents reviewed in the study received the highest concentration of rehab services during the last week of their lives.
• For-profit nursing facilities in the study were over two times more likely to deliver ultrahigh intensity services than non-profit facilities.

These findings have prompted researchers and others to question whether some nursing homes may be financially incentivized to push residents into ultrahigh intensity rehab, even if they may be toward the end of their lives, and/or therapy may be unnecessary. Experts state decisions about therapy interventions and how often they are performed should be based on a resident’s individual health status and needs, rather than any financial motivation or desire to deliver more and more expensive services.

Those sentiments and concerns are also being expressed by advocates and non-profit nursing facilities, who point out that Medicare pays substantial reimbursements to skilled nursing facilities (SNF) with residents in need of high therapy. They also say this is a problem in nursing homes nationwide, and that while therapy is proven to benefit patients when properly prescribed and performed, the highest intensity treatments for residents approaching death may not only prevent staff from providing proper end-of-life care but may also potentially accelerate the decline of their health.

PROTECTING NURSING HOME RESIDENTS & VICTIMS’ RIGHTS

If there is any silver lining to what is being widely viewed as alarming research, it is that new policy and payment changes by Medicare, set to take effect in October of 2019, may help realign the focus on patients’ individual health and needs, rather than incentivizing and reimbursing skilled nursing facilities based on the amount or intensity of services provided. However, as our legal team at Hare, Wynn, Newell & Newton, LLP sees all too often, those changes may not be enough to stem the questionable and often negligent decisions made by corporations that care about profits more than they do people.

At Hare, Wynn, Newell & Newton, LLP, our award-winning injury firm in Birmingham proudly serves victims and families throughout Kentucky and Alabama in matters involving nursing home abuse and neglect. If you have questions about a potential case, including any matter where your loved one may have been given unnecessary treatment, our team is available to help. During a free consultation, we can personally review the facts of your case, discuss your rights and options, and explain how we may be able to guide you through the legal journey ahead. Contact us to request a free and confidential consultation.