One of the major issues with America’s health care system is how we treat people with addictions. Anyone who has been affected by the ongoing opioid crisis can attest to the lack of resources for those addicted to the deadly scourge. Many are stuck in nursing homes. This is not an ideal situation for numerous reasons. Rehabilitation hospitals work with patients to achieve therapy goals. But for long-term care, if a patient isn’t able to live independently in the community, the patient typically goes to a nursing home.
Athena Health Care Systems, a privately owned long-term care company based in Connecticut, has become one of the health care providers to offer programs to care for patients who have a history of addiction on top of the physical care diagnosis for which they are referred. However, nursing homes are licensed by the state Department of Public Health and are surveyed by DPH to certify that they comply with federal Medicare and Medicaid regulations. They are not regulated as detoxification or addiction recovery centers. Athena-owned facilities are the only ones that have developed partnerships with drug treatment centers and in-house programs to train staff and support patients who also have substance use disorders.
“It’s an excruciating problem,” Peter Zawrotniak, program manager in addiction counseling services at UMass Memorial Medical Center, said about placing patients with substance use disorders in appropriate aftercare, particularly if they need methadone treatment.
Zawrotniak said none of the long-term care facilities in the area is equipped to address the full range of services needed for treatment and recovery. Suboxone, as long as it is prescribed by a physician with a waiver to do so, can be dispensed by nursing home staff and is easier to manage, Zawrotniak said.
Methadone, another form of medication-assisted treatment for opioid addiction, can only be administered to patients at a licensed methadone clinic. Patients must be registered with the clinic, a bureaucratic process that can be time consuming to coordinate. One patient waited in a hospital bed for two weeks. The nursing home must then transport the patient to the methadone clinic every day for their dose.
The state DPH’s Bureau of Health Care Safety and Quality issued a letter in 2016 about admission of residents on medication-assisted treatment for opioid use disorder. According to the letter, patients who have completed detoxification and are receiving medication-assisted treatment, and are otherwise eligible for admission to the long-term care facility, are expected to be admitted and have their treatment continued as prescribed by the patient’s physician or opioid treatment program.
There is no federal guidance on what reasonable accommodations need to be made for patients with substance use disorders. And extra services such as addiction counselors and enhanced security measures are not reimbursed by Medicare or Medicaid.