re the Feds getting ready to put the squeeze on skilled nursing facilities who refuse to accept patients with opioid addictions? That’s what experts are saying according to a new report by McKnights Senior Living. At odds are a Federal law protecting the disabled and Federal regulations imposed by CMS. (emphasis added)
Federal investigators could begin cracking down on nursing facilities that refuse admission to patients being treated for opioid addiction, experts are warning.
Legal professionals argue the Americans with Disabilities Act prohibits such denials.
But an investigation by STAT found that many nursing facilities still refuse to accept such patients, “often because of stigma, gaps in staff training, and the widespread misconception that abstinence is superior to medications for treating addiction.”
A nurse case manager at Boston Medical Center told the medical website it can be “next to impossible” to find a place willing to accept such patients.
“It’s so bad — you’re just begging and pleading with these places,” said Maureen Ferrari, who noted only two nursing facilities in her area accept people on addiction medicines.
But the American Health Care Association argues that the Centers for Medicare & Medicaid Services specifically prohibits nursing homes from accepting patients for whom they cannot provide appropriate care.
“The concern with many of our members is that it (medically-assisted addiction treatment) requires specialized training and staff, especially if it’s someone with an active problem,” said SVP David Gifford, M.D.
He compared selective admissions to accepting patients who use ventilators and need respiratory therapists and other supports. Facilities can deny those patients if they don’t have services in place.
But New York’s Legal Action Center, already encouraging lawsuits from people denied access to medication-assisted treatment in the criminal justice or child welfare systems, says its concerns about ADA extend to skilled care settings too.
“Opioid addiction is a chronic disease like any other, and nursing homes should be ashamed of themselves for excluding people who are receiving the most effective form of treatment for this chronic disease,” legal director Sally Friedman told STAT.
I disagree that opioid addiction is chronic disease. It is a chronic health condition. Being in an opioid addicted state is not a natural occurrence in the human body. It does not manifest on its own. The mental and physical health problems are a result of elective, artificially introduced “harm”, whether by a well meaning health practitioner or a self-harming addict. Opioid addiction is a societal plague with many contributing factors.
In Ohio, a trade group representing more than 900 facilities said none of its members accepts patients taking methadone or buprenorphine for addiction. Other state advocacy groups STAT polled said they did not know whether local facilities had addiction treatment policies.
Gifford said nursing homes may see methadone storage, physician capabilities and patient safety as barriers to serving that population.
Experts interviewed by STAT agreed that staff clinicians might not be licensed to prescribe buprenorphine, but they argued that patients’ primary care doctors can continue prescribing after admission.
Meanwhile, the U.S. Department of Justice has begun investigating detention centers that don’t make medication-assisted treatment available to inmates with addictions. And health and law professor Leo Beletsky said a campaign to improve ADA enforcement in nursing homes may follow.
Gifford acknowledged that the nation’s opioid crisis is putting pressure on the healthcare industry to find ways to offer addiction services and medical care simultaneously. He said CMS and the Department of Health and Human Services should be hammering out new policies and regulations, and that treatment centers might be part of the solution for post-acute patients.
“We’re beginning to have that dialogue, but I don’t think the answer is to have every nursing home do it,” Gifford said. “Lawsuits are not a good way to make policy in this country.”
Though nursing facilities have traditionally been designed to treat the elderly, younger residents are using facilities more often — bringing with them fewer physical demands and more behavioral health diagnoses.
Seniors who seek rehab at higher-rated short term nursing facilities are less likely to transition into long-term care facilities afterward, finds a study from the Journal of the American Geriatrics Society.
This is a tough situation. You basically have two sets of Federal law competing for different interests. I can understand both sides of the argument. On the one hand, we want to treat all people in need and who have a right to care under the law. Senior care professionals are in the business after all because most of them are very compassionate people. On the other hand, we have to be sure that only trained and skilled individuals perform this kind of specialty service. What happens when people die due to ill-equipped and untrained nursing staff administering and managing opioid addiction treatment? Of course innumerable lawsuits will ensue.
With regard to the stigma factor and the misconception that abstinence is superior to medications for treating addiction., skilled nursing facility administrators are going to have to get over that. In many cases seniors have become addicted due to illness or injury treatment and through little or no fault of their own.
As medical and social needs change, health care facilities need to adapt. A younger senior patient set is now being treated at skilled nursing facilities, traditionally a place for the elderly to receive care and age in place. Though many nursing facilities in the U.S. are dealing with some kind of serious financial pressure, investments should be made to sensitize and train staff to deal with opioid addicted patients.
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