Rehabilitation Therapy for Nursing Home Residents at the End-of-Life.
Rehabilitation therapy
end-of-life
nursing home
Journal
Journal of the American Medical Directors Association
ISSN: 1538-9375
Titre abrégé: J Am Med Dir Assoc
Pays: United States
ID NLM: 100893243
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
15
05
2018
revised:
31
07
2018
accepted:
31
07
2018
pubmed:
6
10
2018
medline:
17
9
2020
entrez:
6
10
2018
Statut:
ppublish
Résumé
Ultrahigh therapy use has increased in SNFs without concomitant increases in residents' characteristics. It has been suggested that this trend may also have influenced the provision of high-intensity rehabilitation therapies to residents who are at the end of life (EOL). Motivated by lack of evidence, we examined therapy use and intensity among long-stay EOL residents. An observational study covering a time period 2012-2016. New York State nursing homes (N = 647) and their long-stay decedent residents (N = 55,691). Data sources included Minimum Data Set assessments, vital statistics, Nursing Home Compare website, LTCfocus, and Area Health Resource File. Therapy intensity in the last month of life was the outcome measure. Individual-level covariates were used to adjust for health conditions. Facility-level covariates were the key independent variables of interest. Multinomial logistic regression models with facility random effects were estimated. Overall, 13.6% (n = 7600) of long-stay decedent residents had some therapy in the last month of life, 0% to 45% across facilities. Of those, almost 16% had very high/ultrahigh therapy intensity (>500 minutes) prior to death. Adjusting for individual-level covariates, decedents in the for-profit facilities had 18% higher risk of low/medium therapy [relative risk ratio (RRR) = 1.182, P < .001], and more than double the risk of high/ultrahigh therapy (RRR = 2.126, P < .001), compared to those with no therapy use in the last month of life. In facilities with higher physical therapy staffing, decedents had higher risk (RRR = 16.180, P = .002) of high/ultrahigh therapy, but not of low/medium therapy intensity. The use of high/ultrahigh therapy in this population has increased over time. This is a first study to empirically demonstrate that facility characteristics are associated with the provision of therapy intensity to EOL residents. Findings suggest that facilities with a for-profit mission, and with higher staffing of therapists, may be more incentivized to maximize therapy use, even among the sickest of the residents.
Identifiants
pubmed: 30287262
pii: S1525-8610(18)30418-3
doi: 10.1016/j.jamda.2018.07.024
pmc: PMC8491277
mid: NIHMS1743110
pii:
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
476-480.e1Subventions
Organisme : NIA NIH HHS
ID : R01 AG052451
Pays : United States
Informations de copyright
Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Références
Med Care Res Rev. 2011 Oct;68(5):559-78
pubmed: 21478193
J Am Geriatr Soc. 2010 Apr;58(4):627-35
pubmed: 20398146
J Am Med Dir Assoc. 2013 Oct;14(10):741-8
pubmed: 23664483
J Am Geriatr Soc. 2012 Nov;60(11):2035-41
pubmed: 23110337
Med Care. 2017 Sep;55(9):e68-e72
pubmed: 25763665
Gerontologist. 2002 Jun;42(3):342-9
pubmed: 12040136
Arch Phys Med Rehabil. 2018 Jan;99(1):107-115
pubmed: 28860096
Gerontologist. 1995 Apr;35(2):172-8
pubmed: 7750773
Arch Intern Med. 2012 Nov 12;172(20):1573-9
pubmed: 23026981
Health Aff (Millwood). 2015 Dec;34(12):2121-8
pubmed: 26643633
J Am Med Dir Assoc. 2012 Sep;13(7):595-601
pubmed: 22784698
J Am Geriatr Soc. 2013 Nov;61(11):1900-8
pubmed: 24219191
N Engl J Med. 2011 Sep 29;365(13):1212-21
pubmed: 21991894
BMC Health Serv Res. 2003 Nov 04;3(1):20
pubmed: 14596684
Geriatr Nurs. 2013 May-Jun;34(3):233-4
pubmed: 23639913
J Palliat Med. 2012 Jan;15(1):43-50
pubmed: 22175816
Gerontologist. 2018 Jul 13;58(4):e218-e225
pubmed: 29309584
Health Serv Res. 2010 Dec;45(6 Pt 2):1963-80
pubmed: 20403059