The United States’ population of older adults is increasing rapidly. With this growth, the number of older adults requiring physical therapy is also increasing. There are different concerns when performing physical therapy with older adults as opposed to younger patients.
Older adults have weaker bones and are more vulnerable to injury, including dangerous falls. Therefore, it is important that there are enough physical therapists who specialize in or are educated in geriatric therapy in order to reduce the risk of injury.
Many physical therapist (PT) and physical therapist assistant (PTA) programs have made efforts to incorporate geriatrics into existing curricula. However, barriers to the expansion of geriatric clinical internships exist because of lack of funding, lack of qualified faculty, and lack of student interest. It seems obvious that schools need to make additional efforts to improve their geriatric programs because of the growing demand.
All Medicare-certified nursing home facilities are required to assess each resident’s status and needs, including the medical necessity for physical and occupational therapy. In order to qualify for Medicare coverage, the therapy must be: reasonable, necessary, specific, and effective treatment for the resident’s condition. The Department of Health and Human Services, Office of Inspector General released a report in 1999 on the Cost of Improper Billings to Medicare.
This report revealed that Medicare reimbursed skilled nursing facilities for almost $1 billion of improperly billed physical and occupational therapy in 1998. The primary reason was because the therapy was not medically necessary or was performed by staff that did not have the appropriate skill for the resident’s medical condition. Medicare also reimbursed skilled nursing facilities almost $331 million for undocumented physical and occupational therapy in 1998.
These discrepancies in Medicare covered physical therapy are alarming because residents might not be receiving physical therapy that was ordered by their physicians. Some residents’ medical records did not match the time billed to Medicare for therapy. So, either they did not receive the prescribed amount of therapy or their charts had errors, either of which is worrisome.
When a physician prescribes physical therapy for a nursing home resident, that resident should receive the therapy from a staff member with the appropriate skill level; otherwise, who is to say that the resident is receiving the full benefit of the therapy or that the therapy will be safely performed.
It is important that nursing home staff members ensure that each and every resident’s medical records match physician’s orders and Medicare bills so that residents receive proper treatment and that treatment is recorded. Without such precautions, vulnerable nursing home residents can suffer serious injuries.
A news report revealed that some nursing home facilities are competing with hospitals and rehabilitation facilities for short-term patients who require postoperative rehabilitation. These nursing homes often offer treatment at lower costs, allowing people to save money. This is because Medicare estimates that a nursing home can rehabilitate a knee or hip replacement patient for far less than a hospital (from 33-50% less cost than a hospital, see chart on right). This is because nursing homes have a lower overhead than hospitals.
However, some people criticize nursing homes’ lack of expertise when compared to hospitals. Some data shows a decline in the quality of their rehabilitative care (In March 2007, the Medicare Payment Advisory Commission cited data that it said showed a falling quality of rehab care at nursing homes). Some nursing home rehab facilities don’t have the same access to therapy equipment or doctors as hospital rehab facilities. This calls into question how well nursing homes can offer rehabilitative services to these people, many of whom are younger than the typical nursing home resident. As the number of residents requiring rehabilitative services grows, you have to ask whether the quality of care offered by nursing homes can keep up or will your health suffer?
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