To the Editor.
—The recent column by Dr Vladeck,1 administrator of the Health Care Financing Administration (HCFA), warning physicians not to order therapy assessments or treatments for nursing facility residents is alarming. Vladeck suggests that therapy is not appropriate and should not be ordered if the resident will not "improve."Vladeck's interpretation threatens residents' ability to get therapy, as mandated by the federal nursing home reform law. That legislation, which Congress enacted in 1987, requires facilities to provide residents with therapy services that they need in order to "attain and maintain" their "highest practicable physical, mental, and psychosocial well-being." So-called medical improvement is not the federal standard for receiving therapy under the Medicare or Medicaid programs. Therapy is also mandated under both programs to maintain nursing facility residents' functioning and to prevent residents' avoidable decline.The first case brought under the reform law, in which one of the undersigned