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Long-term Care

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Traditional community-based nursing homes are offering more rehabilitation services to residents

If Ohio is any indication, growing numbers of traditional nursing homes are providing rehabilitation services to their residents. Half of newly admitted nursing home patients in Ohio received substantial amounts of physical, occupational, and/or speech rehabilitation therapy during 1994 and 1995, according to a study supported in part by the Agency for Health Care Policy and Research (National Research Service Award training grant T32 HS00059). In fact, 50.5 percent of residents received at least 90 minutes of therapy per week. Of the total average amount of therapy per week, 53 percent was physical therapy, 37 percent was occupational therapy, and 10 percent was speech therapy.

The proportion of newly admitted patients receiving therapy increased by 2.2 percent each quarter. The amount of therapy provided to each patient increased by 6.4 minutes each quarter. The largest increase in type of therapy was occupational therapy (4.3 minutes per quarter) followed by physical therapy (1.6 minutes) and speech therapy (.65 minutes).

Larger, urban, and for-profit nursing homes provided more therapy to their patients than did the smaller, rural, and public or not-for-profit nursing homes. Overall, occupational therapy services were responsible for 17 of the 27 minutes of increase in rehabilitation services per year. This probably indicates an increased awareness of the functional deficits beyond mobility that affect the frail, elderly population.

Rehabilitation care at the traditional skilled nursing facility can be accomplished at a fraction of the cost of care in an acute-level-hospital rehabilitation unit and at substantially less cost than in subacute hospital units. Insurers, including Medicare, may focus only on the issue of cost and increasingly use nursing homes as a major site for rehabilitation care, note the Ohio researchers. They retrospectively examined rehabilitation services received by 52,705 newly admitted residents of Medicaid-certified nursing homes in Ohio in 1994 and 1995.

More details are in "Rapid growth of rehabilitation services in traditional community-based nursing homes," by Patrick K. Murray, M.D., Mendel E. Singer, Ph.D., Richard Fortinsky, Ph.D., and others, in the April 1999 Archives of Physical Medicine and Rehabilitation 80, pp. 372-378.

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