The Relationship Between Quality of Care, Physical Therapy, and Occupational Therapy Staffing Levels in Nursing Homes in 4 Years' Follow-up

Livingstone, Ian; Hefele, Jennifer Gaudet; Nadash, Pamela; Dan, Dan; Leland, Natalie E.

doi:10.1016/j.jamda.2019.02.002

Cited by 22 publications

(44 citation statements)

References 33 publications

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“…Instead, the daily payment rate will be determined by patient characteristics, not service delivery (CMS, 2018b). This new approach has generated concerns about the adequacy of reimbursements, which may affect the quality of care offered to the Medicare population (Livingstone et al, 2019). Such a change in payment has not occurred since the introduction of the PPS in 1998.…”

Section: Discussionmentioning

confidence: 99%

“…More specifically, OT staff provide more holistic and alternative approaches to care. OT staff assist patients (and caregivers) to improve the safety of their environment and support patients by recommending modifications to daily activities and educating them on their condition, which leads to an increase in physical activity, engagement in self-care, reduced pain, and maintaining independence (Livingstone et al, 2019). PT staff, on the other hand, engage patients in strength training to increase strength and endurance, offer high-intensity exercises to improve balance and gait, and provide therapeutic services to improve functioning and mobility (Boyd et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…PT staff, on the other hand, engage patients in strength training to increase strength and endurance, offer high-intensity exercises to improve balance and gait, and provide therapeutic services to improve functioning and mobility (Boyd et al, 2008). Both OT and PT staff serve an important role in nursing homes and have been associated with improved health outcomes for recipients of their care in the form of lower prevalence of falls, higher functioning, reduced impairment, improved quality of life, and shorter length of stay (Boyd et al, 2008; Jette et al, 2005; Leland et al, 2017; Livingstone et al, 2019; Wong & Leland, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Nursing Home Providers With Distinct Patterns of Physical and Occupational Therapy Staffing

2020

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Previous work found a substantial growth in therapy staffing among nursing home providers following the introduction of Medicare’s Prospective Payment System (PPS). Since the PPS, however, several new Medicare policies have been implemented that may impact the provision of rehabilitative care in nursing homes. In view of the rising focus on patient outcomes and provider performance, it is worthwhile to explore more recent therapy staffing patterns following the introduction of these Medicare programs. While our results show stable staffing levels through prior policy changes, upcoming Medicare payment changes will likely have a stronger impact that may result in reduced therapy staffing. In addition, given that our findings show that staffing patterns vary across provider type, we may see greater variation as a result of the upcoming changes. Thus, therapy staffing should continue to be monitored and deeper explorations into the impact of staffing changes on patient outcomes should be undertaken.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics of Nursing Home Providers With Distinct Patterns of Physical and Occupational Therapy Staffing

2020

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“…That is, SNFs operating under a utility-maximization model with both profit and service provision as objectives may actually seek to increase share of therapy assistants to decrease staffing costs while continuing to provide higher intensity therapy services in light of changing reimbursements under PDPM. However, it is important to note that associations do not suggest directionality in the relationship between quality and therapy staffing, and quality may be a function of therapy staffing among other factors (Livingstone et al, 2019). Furthermore, the optimal amount of therapy services for SNF residents is unknown.…”

Section: Discussionmentioning

confidence: 99%

Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors

et al. 2020

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Employment of therapy assistants enables skilled nursing facilities to provide more therapy services at lower costs. Yet little is known about employment of therapy assistants relative to organizational characteristics. Taking advantage of publicly available Medicare administrative data from 2016, we examined the relationships between organizational characteristics of skilled nursing facilities and employment of therapy assistants. Therapy assistants represent approximately half of the therapy workforce in skilled nursing facilities. Regression analyses indicate significantly higher percentages of therapy assistants are employed in facilities that are staffed by contract therapists, provide more therapy, have more total stays, operate in rural areas, and are located in states with certificate of need laws or moratoria. Skilled nursing facility quality was not significantly associated with employment of therapy assistants. As new payment mechanisms change incentivizes for therapy in skilled nursing facilities, employment of therapy assistants may be a cost-effective way to continue to provide services when necessary.

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“…Function‐focused care in NHs involves various types of employees (e.g., nurses, physical therapists, social workers, and occupational therapists) and, based on institutional policies, focuses on a variety of care areas, such as self‐care, mobility, and psychosocial and cognitive functions (Park et al, 2019). In this context, adopting a cooperative approach to FFC has been reported to be effective in NHs, since it can lead to more continuous stimulation of functional activity in all aspects of care (Lee et al, 2019; Livingston, Hefele, Nadash, Barch, & Leland, 2019). Practitioners, such as nurses, physiotherapists, occupational therapists, and social workers, in NHs routinely engage in direct care in the context of FFC.…”

Section: Introductionmentioning

confidence: 99%

Conceptualizations of function‐focused care used by practitioners in Korean nursing homes

Chang

Lee

Park

et al. 2020

Nursing & Health Sciences

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This qualitative study aims to explore practitioners' (nurses, physiotherapists, social workers, and occupational therapists) conceptualizations of function-focused care for nursing home residents. Between September 2017 and February 2018, we collected data from 18 participants in five nursing homes using semi-structured interviews. We then performed phenomenographic data and content analyses. Five categories were identified in the assessment domain: "functional limitation associated with physical condition," "functional limitation associated with cognitive condition," "change from baseline function," "ability to cooperate with caregivers to improve function," and "motivation to improve function." Five categories were identified in the intervention domain: "minimizing damage," "strengthening physical resources," "repetitive musculoskeletal strengthening," "stimulating motivation for self-care," and "planning enhancement of function through emotional stability." Our findings may contribute to improving understanding of actual practice and provide an important starting point for developing knowledge about how function-focused care is performed in nursing homes.

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The Relationship Between Quality of Care, Physical Therapy, and Occupational Therapy Staffing Levels in Nursing Homes in 4 Years' Follow-up

Cited by 22 publications

References 33 publications

Characteristics of Nursing Home Providers With Distinct Patterns of Physical and Occupational Therapy Staffing

Characteristics of Nursing Home Providers With Distinct Patterns of Physical and Occupational Therapy Staffing

Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors

Conceptualizations of function‐focused care used by practitioners in Korean nursing homes

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