We should give long-term care residents the quality care they need and deserve

Nursing homes face constant criticism. Most recently, nursing homes have been consistently questioned and scrutinized for the amount of therapy provided to the people for whom we provide care.

Some say it is too much therapy, others too little. Now critics are using a recent study in the, “Journal of the American Medical Directors Association (JAMDA)” to go one step further by accusing nursing homes of inappropriately providing increasingly intense levels of rehabilitation to long-stay residents nearing the end of life.

{mosads}The entire issue of how much care to provide at the end of life is a challenging question surrounded by medical, theological and ethical issues. Nursing homes — because of the nature of the work and the characteristics of the long-term residents for whom we care — face this reality every single day. 

Health-care consumers have access to more information today than ever before. There are numerous publicly available studies that tout the benefits that rehabilitation therapies can have on quality of life — even in late life. These studies and clinical guidelines from the Journal of the American Medical Association, the Journal of Gerontology and even JAMDA itself have demonstrated that for certain nursing home patients, higher-intensity rehabilitation results in better outcomes than lower-intensity traditional therapies. Educated consumers are asking for more therapy because they believe it works.

Ultimately, care decisions should be made based on each individual person’s needs. Deciding what is best for each patient requires close collaboration between residents, families, physicians, direct care nursing staff, rehabilitation therapists and other health-care professionals to make educated decisions on how much and what kind of care to provide.

Medicare regulations require that nursing homes evaluate and modify a long-stay resident’s care plan when there is a health change, including a decline in function. Should a long-stay resident be hospitalized then return to a nursing home, the care team is required to perform assessments to determine the right plan of care. That plan may include rehabilitation and therapy to help address functional losses associated with the recent hospitalization.

Using the JAMDA study to make broad generalizations about therapy for nursing home residents is a mistake. Only about two percent of the patients included in the study within one state received what the authors characterize as potentially excessive “dose” of therapy. The authors acknowledge they did nothing to evaluate care goals or potential benefits from the therapy that was provided. I have seen firsthand residents in nursing homes that have benefited from therapy at all stages of life.

Nursing homes don’t have a crystal ball. A recent study highlighted in Forbes magazine pointed out that the health care community is not good at predicting death, and that using spending in late life “… as a proxy for futile care is deeply flawed.” 

Instead of speculating, we should rely on the real doctors who know the resident and have ordered therapy. Caregivers and physicians are not thinking about studies that show nursing homes should deliver more or less therapy. They are thinking about what’s best for their residents.

There are many complex issues that go into determining exactly how much therapy is the right amount. We may never be able to answer that question and in the meantime, we should not deny residents, families, and physicians the care they need, desire and deserve.  

Mark Parkinson is the president and CEO of American Health Care Association and National Center for Assisted Living.