Granny in the weight room? Some research says it might do her some good. And a growing number of long-term-care facilities think it makes bottom-line sense.
Under Medicare's new skilled-nursing prospective payment system, to go into effect in January for most of the country's nursing homes, facilities will be paid a per day, per patient sum. Keeping costs per day lower means more profits, and strength training can speed recovery times and help nursing homes cut costs. So says Gary Reinl, a former athletic trainer now in charge of marketing Novacare's Nautilus-based rehab system.
Novacare, the country's top provider of contract rehabilitation services, developed the system-which goes by the trade name Vigor-three years ago. But only in the past year, with PPS looming, have a substantial number of nursing homes expressed interest in the program.
Nursing homes either buy the equipment outright or rent it from Novacare for about $200 per month. Rehabilitation therapists from the King of Prussia, Pa.-based company then use the machines to work with nursing home residents on their doctor-ordered rehabilitation programs.
The machines provide postural support and resistance, allowing therapists to supervise several patients at once, Reinl says. Weights can be adjusted in half-pound increments, making progress attainable for even the very weak.
"I think it's a solution to PPS," says Brian Cloch, president and chief executive officer of Quality Care Management. The Skokie, Ill.-based chain has committed about a quarter of a million dollars to install the modified Nautilus fitness equipment in each of its five Illinois skilled-nursing facilities.
"It's a large sum of money to invest upfront," Cloch says, "but it will help maximize efficiency to get (patients) to a higher level of therapy." That way, the facility can take advantage of higher per day rates.
Reinl says Novacare now has Vigor equipment in 111 sites around the country. That represents a paltry portion of the approximately 2,000 nursing homes served by Novacare contracts. But Reinl says the pace is picking up.
"Last year we opened a new facility every 51/4 days. This year we will exceed two a week," Reinl says.
Strength training is not new to the rehabilitation business. In fact, says Carol Mobley, a rehabilitation consultant with Fort Smith, Ark.-based Beverly Enterprises, dumbbells and ankle weights have always been the backbone of the company's rehabilitation programs.
New at Beverly, she says, are four pilot programs designed to keep nursing home residents, discharged patients and other members of the over-55 set from needing doctor-ordered rehabilitation programs. Maintaining strength so that people don't have to go into rehabilitation in the first place saves money, she says. The pilot programs, which use large fitness-center-type equipment much like the machines used in the Novacare system, were not designed as a response to PPS, she says. Instead they stemmed from growing scientific evidence that the frail elderly can benefit from strength training.
For assisted-living facilities, strength training is a way to retain residents for more than the two-year average length of stay. Patricia Brill, director of gerontological fitness at NGH Marriott in Houston, an assisted-living subsidiary of Marriott Senior Living, says her strength-training program is designed to do just that.
Brill says that large training equipment was simply too large and expensive to be feasible. So 600 residents in 16 communities now spend a few hours a week wielding dumbbells and ankle weights in group training programs in converted sun rooms. Brill is testing a pilot program in two Marriott facilities that house nursing home residents and people living independently.
Muriel Brunger, director of Activities for Presbyterian Homes, a continuing-care retirement community in Evanston, Ill., says she was disappointed that only a few nursing home residents make regular treks to the community's 25,000-square-foot fitness center, located on the other side of the campus from the nursing home. Brunger now takes the fitness center to the residents, rolling pint-sized weights and other small pieces of exercise equipment to them on a cart.
John Schnelle, director of the Borun Center of Gerontological Research in Reseda, Calif., is cautious about the cure-all potential of weights and pulleys for the nursing home set. Published research so far focuses on ambulatory and mentally unimpaired elderly, not on the frailer, sicker residents typical in most nursing homes.
Schnelle also warns against unrealistic expectations of the benefits of weight training. While studies have shown that weight training does increase muscle mass in the elderly, Schnelle points out that they have not measured the effects of such training on injury prevention or quality of life.
An ongoing study of more typical nursing home residents of five nursing homes should give some more answers later this year, he says, but preliminary results show no change in eating or nutritional status among those who lifted weights. They also indicated that about a quarter of weight-training residents saw their quality of life decrease, possibly because of pain or depression, Schnelle says. "Training, and strength training in particular, has such a positive aura about it that people are much more enthusiastic than the data should lead them to be," he says.
Some nursing home administrators are reluctant to commit to the regimen. Sandy Lawson, senior vice president of total quality management at Atlanta-based Mariner Post-Acute Network, says the company has not heavily emphasized strength training because of the frailty of patients in the subacute population.
But that's not stopping some nursing home administrators.
Mike Sweeney, vice president and administrator of Hilltop Retirement Community in Johnson City, N.Y., has been using Novacare's program for about a year.
Schnelle notwithstanding, he says, "It improves their quality of life; it empowers people."
No less important, though, is the appealing image of the ill and frail making good use of machines usually reserved for the young and fit. "I think it is a great marketing tool," he says.