The 1997 Medicare Prospective Payment System (PPS) includes reimbursement for nursing home rehabilitation services in the daily reimbursement for skilled nursing facility services. This policy may discourage some nursing homes from providing costly rehabilitation services. Yet, when stroke patients and others who need rehabilitation receive nursing home rehabilitation services, they are more likely to be able to return to the community, and they survive longer than residents who don't receive such services, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00059).
Researchers from Case Western Reserve University examined survival and community discharge outcomes related to rehabilitation services among 11,150 patients admitted to one of 945 Ohio nursing homes from 1994 to 1996 for stroke, hip fracture, congestive heart failure, chronic lung disease, or other conditions. Rehabilitation was provided to 58 percent of the residents.
Residents who received rehabilitation were 48 percent more likely than those who did not to be discharged into the community, and the risk of death was 19 percent lower among rehabilitation recipients. Overall, relative risk for discharge back into the community improved by 3.6 percent with each additional hour of weekly therapy, with similar results across all conditions studied. There was only a weak association between additional hours of therapy and decreased risk of death.
See "Outcomes of rehabilitation services for nursing home residents," by Patrick K. Murray, M.D., M.S., Mendel Singer, Ph.D., Neal V. Dawson, M.D., and others, in the August 2003 Archives of Physical Medicine and Rehabilitation 84, pp. 1129-1136.