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Rehab for the Dying

Updated: Oct 6, 2022

Today, 46 million Americans are over the age of 65 and this number is expected to more than double by 2060. Baby boomers born between 1946 and 1964 are now between the ages of 54 and 70 and are contributing to the aging face of America.

The desire of almost every person you ask is to continue to live at home for as long as possible.

Very few people willingly raise their hand and ask to move to long term care or a nursing home. However, this is not always possible as individuals develop complex health problems and chronic conditions and require an increasingly higher level of care that can’t always be provided in the home. The need for elder care is on the rise also due in part to the surging number of people living with Alzheimer’s.

According to the Centers for Disease Control and Prevention, about 1.4 million Americans live in nursing homes. In 2014, there were 15,600 nursing homes and 69.8% were privately owned for-profit homes.

What happens as residents get closer to death? You may expect that medical directives would include the provision of palliative care to keep the individual comfortable and pain-free. However, you may be shocked to know that rehab services are on the rise and increasingly being administered to people within their final weeks and even last days. This was the focus of a study published in the Journal of the American Medical Directors. It was found that the practice is much more common in for-profit homes than not-for-profit homes.

Exactly what types of services are being provided by therapists? Rehab services covered by Medicare include physical, occupational and speech therapy. When the focus of care shifts to hospice or palliative care, the potential revenue streams of rehab come to an end. Of course, there is a time and place for rehab services and they can provide tremendous benefits. But the question that needs to be asked is: Are the services meeting the needs of residents near end of life or are they simply a way to increase profits?

If you care for a loved one who lives in a nursing home, here are a few tips to consider:

  1. Keep an eye on what is happening with your family member’s care. Be an involved participant on the team. You know your loved one best.

  2. Ask to see the assessment. How was it determined that a therapy would be beneficial and why? What difference is it expected to make?

  3. Don’t be afraid to ask questions and raise concerns. If you feel that your loved one is receiving services that are not in their best interests, speak to the medical team.

  4. Involve your loved one in the decision-making process. What do they want for themselves and their own care? They should have a voice if they are able to communicate and make decisions.

Naturally, you don’t want to withhold a therapy if it can improve your family member’s quality of life, but it’s important to assess the value. Is it truly adding benefit or is it simply filling the coffers of the nursing home?

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