Rehabilitation therapy enhances or restores an individual’s ability to return to their prior level of function and health. The emphasis is placed on prior level of function and typically has a higher intensity and shorter duration.
Maintenance therapy helps to maintain, prevent or slow unnecessary decline in a patient’s health and function. This type of intervention emphasizes current level of function and typically has a decrease in intensity and increase in duration. The goal is to minimize the impact of a medical condition.
The court case of Jimmo, et al. versus Sebelius:
- The Jimmo agreement settles once and for all that Medicare coverage is available for skilled services to maintain an individual’s condition.
- Under the maintenance coverage standard articulated in the Jimmo Settlement, the determining issue regarding Medicare coverage is whether the skilled services of a health care professional are needed, not whether the Medicare beneficiary will “improve.”
- Pursuant to Jimmo, medically necessary nursing and therapy services, provided by or under the supervision of skilled personnel, are coverable by Medicare if the services are needed to maintain the individual’s condition, or prevent or slow their decline.
Guidelines for Maintenance Therapy
- The skills of a qualified therapist are needed to restore an individual’s function
- The individual’s condition requires a qualified therapist to design or establish a maintenance program
- The skilled of a qualified therapist (or assistant in a SNF) are needed to perform maintenance therapy.
Individuals with these conditions may be at higher risk for decline and may be suitable for maintenance therapy. Remember, the individual’s medical condition and needs, not their diagnosis determines the appropriateness of maintenance therapy. This can include the following diagnoses:
Cerebral vascular accident
Amyotrophic lateral sclerosis
Chronic pulmonary disease
Traumatic brain injury
Patient advocacy is a key component to our role in long term care. All residents in LTC have the right to achieved and maintain their highest functional level (based on OBRA regulations). While we recognize that not all residents will be able to completely restore function, it is our responsibility to identify each resident’s skills, needs and opportunities to allow therapy and nursing care plans to maximize the resident’s strengths and abilities while preventing decline. The Advocacy Model of Care provides three levels of skilled therapy intervention: restorative, compensatory and adaptation.