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The Metamorphosis of “Plateau”

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The mere mention of the word “plateau” in a group of therapists can be viewed as the equivalent of uttering a swear word in a church. For many years, this term has been connected to the need to end therapy services and fostered the idea of a “three strikes and you are out” philosophy. Debates regarding the number of visits in a row that do not show improvement that can be completed before discharge is mandatory have cycled through this industry for years.

Starting in 2011, Medicare turned a spotlight on maintenance therapy by implementing specific billing codes and the Jimmo v Sebelius court case turned up the brightness even higher. This level of attention has caused therapists and home health agencies to take a look at this focus of care and the light has revealed several interesting issues:

  • Therapy is so intertwined with “improvement” that it permeates everything they do and document.

  •  The idea of referring a patient for therapy who is not expected to improve has become a foreign concept limiting patient access.

  • “Rehabilitation potential” has become synonymous with “ability to improve” which is NOT the actual meaning.

  • Many therapists struggle with the idea of care planning and documentation in a maintenance situation.


Understanding maintenance therapy requires a CLEAR vision of what constitutes skilled care. Improvement alone has never defined the skills of a therapist.  Use of therapy specific interventions and clinical decision making to stabilize function – to slow or stop decline – is in fact an important tool in the toolbox.

What this means is that PLATEAU can actually be the goal of therapy services and not the automatic call to discharge. Making that kind of monumental shift in thinking takes solid education and time to implement effectively and should not be taken lightly.



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