Twenty-nine percent of nursing facilities in Massachusetts refused to take patients in 2018 who had a history of drug use and needed post-hospital care. The findings are in a study out of Boston Medical Center’s Grayken Center for Addiction. Researchers said they were surprised to see “do not take people who use drugs” or “do not accept methadone patients” in comments explaining why skilled nursing and rehab centers rejected a referral.
“Typically with discrimination, people are not quite so open,” said Dr. Simeon Kimmel, lead author of the report published in the Journal of Addiction Medicine. “So it really was surprising to us that we found so much open discrimination.”
In raw numbers, 83 nursing facilities indicated that a history of drug use was the reason the patient was not accepted. Kimmel, an infectious disease and addiction medicine specialist, 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.
Kimmel said 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. About a third of the patients were not able to find a facility that would take them.
The study shows that comments citing addiction as a reason to deny admission continued through 2018, even though federal prosecutors reached a settlement in May with Charlwell House, a Norwood rehabilitation center that would not admit a patient taking Suboxone, a medication used to treat an opioid use disorder (OUD). The settlement said the patient’s right to admission and care was protected under 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. Kimmel said federal prosecutors are aware of the study findings. The U.S. Attorney’s Office declined a request for comment on the study and did not answer questions about whether it is investigating any of the 83 facilities.
The Massachusetts Department of Public Health issued guidelines to nursing facilities in 2016 that include the expectation that patients prescribed addiction treatment meds will be admitted. DPH currently offers trainings about OUD and some technical support for nursing facilities unsure about the care of these patients.
The Massachusetts Senior Care Association, a nursing home trade group, said in a statement that members are committed to caring for patients with an 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, president of the Mass. Senior Care Association. “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.”
But Gregorio said providing this care is difficult. She 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. Gregorio said state and federal regulators need to “modernize” rules for long term care facilities designed for frail elders.
Gregorio added that her members are “not licensed as recovery centers and therefore do not provide the level of care that many patients with OUD require.”
Kimmel said hospitals have had to make adjustments to care for patients with drug addictions, bringing on addiction management specialists, and that nursing homes may need to make changes to care for these patients as well.
The study does not differentiate between patients who are actively using drugs and those who are in recovery. Kimmel said about 46% of the hospitalizations were related to infections, many, but not all, tied to injection drug use. Relapse is common, so patients may move between active use and treatment. Nurses in some of these facilities say caring for patients who have drugs smuggled in or who use on the grounds is very difficult.
The settlement with Charlwell House in Norwood said a patient who is “currently engaging in the illegal use of drugs when the covered entity acts on the basis of such use” is not considered disabled and not covered under the ADA. But a federal regulation says health care facilities must still provide services to a patient, regardless of their drug use.
This article was originally published on July 16, 2020.