Schemes to Manipulate Revenue

One common misconception within Skilled Nursing Facilities is that the facility is constructed to improve the condition of our loved ones. In reality, this almost never occurs, as nursing facilities more often act as inadequate and inattentive daycares, providing the bare minimum to our most vulnerable population until they transition to hospice and pass away.

This does not have to be the case, however. In an article published in the Journal of the American Geriatrics Society, authors consider the benefits of adopting strategies available through the PDPM (Patient Driven Payment Model) to prevent patients from experiencing the horror described above (or being “rehabbed to death,” as they say.)

Essentially, the authors suggest that the Centers for Medicare & Medicaid Services should encourage facility owners to adopt this PDPM method to improve the care and legitimacy of their facilities.

This proposal would mean skilled nursing facilities change their process so that the first 20 days of rehabilitation care act as a trial. Within this trial period, the patients should be having regular conversations about their health, prognosis, and personal goals.

After these 20 days, the resident and their family can decide if the care has been effective and if they want to continue. If they decide to continue with the facility’s care, they would then start to incur copay (per the Medicare status quo). If they have not seen their condition improve and decide that a continuation of skilled nursing care is not beneficial, they have the option to transition to another caregiving support system, such as hospice or at-home support.

Further, the articles’ authors suggest that residents and their family members should be more aware of the reality of palliative care and hospice care. Many understand such care to signify end-of-life care, but this is a stigma, and in many cases, these options offer more beneficial and pleasant care than skilled nursing can. By examining all these possible options and picking which is best, high costs, confusion and subpar care can be avoided. This method may also allow patients to avoid unnecessary hospital trips and all the stress and confusion that comes with each transition.

While you may already imagine that conversations regarding the status and care of residents already occur in long-term care facilities, this tends to not be the case. In fact, the authors suggest that facility care providers start receiving education on how to talk about end-of-life care with families, as they are not currently adept with this skillset. Further, staff are often overworked and too busy to have these critical, long, and honest discussions.

Although beneficial, the suggestions by these authors are simply the bare minimum and should immediately be implemented in any facility that has legitimate concern for the well-being of its residents. With the suggestions these authors offer and by considering more than just often-understaffed nursing home facilities, our family members can find more comfortable, affordable, and individualized care.

Seniors are encouraged to start looking at these plans and preparing as soon as possible, so they and their loved ones can avoid the stressful pressure of making a decision when they run out of time.

(Lead author Sarguni Singh, MD, Assistant Professor of Medicine University of Colorado School of Medicine and an American Political Science Association Health & Aging Policy Fellow)