Massachusetts’ skilled nursing homes are not taking patients who have a history of drug use, according to a new study conducted by Boston Medical Center’s Grayken Center for Addiction and published in the Journal of Addiction Medicine.  In 2018, up to 29 percent of facilities refused individuals with a history of use who needed hospital aftercare.  Researchers said they were “surprised to see ‘do not take people who use drugs’ or ‘do not accept methadone patients’ in referral rejection comments,” and that the rejections continued despite discrimination settlements within the state.“Typically, with discrimination, people are not quite so open,” said lead author Dr. Simeon Kimmel, infectious disease and addiction medicine specialist. “So, it really was surprising to us that we found so much open discrimination.”The report concluded 83 skilled nursing facilities barred patients with a history of drug use from being accepted for care. Kimmel said he suspects “the findings only capture a sample of the problem because case managers didn’t call nursing homes already known to decline patients prescribed addiction treatment medications.”

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“It took 7.5 referrals, on average, before a patient with a history of drug use could be transferred from Boston Medical Center to a site where the patient could get wound care, physical therapy after a stroke or IV antibiotics for a serious infection,” he added. “About a third of the patients were not able to find a facility that would take them.”The study proves the denial comments continued even after federal prosecutors reached a settlement in May with Charlwell House, a Norwood center that refused to care for a patient taking Suboxone.  The settlement found the rejection violated the Americans with Disabilities Act.  In 2019, the U.S. Attorney’s Office reached a similar agreement with Athena Health Care Systems, which has facilities in Massachusetts, Connecticut, and Rhode Island.The Massachusetts Department of Public Health (DPH) specifically disseminated information to nursing facilities in 2016 outlining the necessity of allowing the admission of patients a history of use who require addiction treatment medications, and the Massachusetts Senior Care Association, a nursing home trade group, said its members are committed to caring for patients with opioid use disorder (OUD).“Admitting patients with OUD requires services and supports that not all skilled nursing facilities are currently able to provide, but progress is being made,” said Tara Gregorio, the group’s president. “In fact, many of our members do care for patients with OUD and have established the necessary programs and services to provide safe and appropriate care to this population.”However, Gregorio also said facilities “may not have the funding to transport patients daily to and from a methadone clinic, and don’t always have access to physicians who prescribe medication to treat addiction and to addiction counselors.”  She added, members are “not licensed as recovery centers and therefore do not provide the level of care that many patients with OUD require.”The study demonstrates that the state’s nursing facilities and rehab centers need funding to modernize care, making it feasible for all to admit addiction patients and ensure they continue to receive their treatment protocols.Kimmel said, “Hospitals have had to make adjustments to care for patients with drug addictions, bringing on addiction management specialists” and “nursing homes may need to make changes to care for these patients as well.”

Sources:

29% Of Mass. Nursing Homes Refused Patients Who’ve Used Opioids, Study FindsRejection of Patients With Opioid Use Disorder Referred for Post-acute Medical Care Before and After an Anti-discrimination Settlement in Massachusetts