Massachusetts Nursing Homes Face Challenges in Providing Care for Residents Needing Medication-Assisted Treatment for Opioid Addiction
Few Massachusetts nursing homes offer programs to care for patients with issues of addiction, even when they have other conditions qualifying them for nursing home care. Nursing homes across the nation continue to refuse admission to patients needing medication-assisted treatment (MAT) for opioid addiction. Legal experts contend this violates the Americans with Disabilities Act and other regulations.
Financial and regulatory issues and a lack of guidelines are cited as the basis for refusing admission to residents needing MAT for opioid addiction. For example, residents receiving methadone in their treatment programs must be transported daily to and from the licensed methadone clinic where they are registered in order to receive their daily doses. Another concern expressed is the freedom that many residents in nursing homes have to “come and go” that make it easy for a person dealing with addiction to leave and obtain drugs. There are also problems with potentially illicit visitors, i.e., drug dealers, coming into the facility and posing a possible risk to other residents.
A program manager for the addiction counseling services at a large medical center described trying to place patients with substance use disorders in appropriate aftercare facilities as an “excruciating problem.” This is due to the lack of long-term care facilities in the area equipped to provide the services these patients need for treatment and recovery. According to the program manager, some facilities are admitting patients using Suboxone, as long as it is prescribed by a physician with a waiver to do so. It can then be dispensed by nursing home staff, and the person’s needs are easier to manage.
The Massachusetts Department of Public Health’s (DPH), Bureau of Health Care Safety and Quality, issued a letter in 2016 requiring nursing homes to admit patients who have “completed detoxification and are receiving medication-assisted treatment” provided they are eligible for admission into a long-term care facility. Facilities are expected to continue treatment for those residents as prescribed by their physician or opioid treatment program.
Compliance Perspective
Failure by a nursing home to admit residents receiving Medication-Assisted Treatment (MAT) for addiction to opioids, who also have other conditions qualifying them for care in a long-term care facility, may be considered discrimination under the Americans With Disabilities Act and deemed a violation of state and federal regulations that would make a facility ineligible to receive reimbursement from Medicare and Medicare.
Discussion Points:
- Review policies and procedures regarding the non-discrimination provision under the Americans with Disabilities Act requiring admission of residents receiving MAT for addiction to opioids who also need the healthcare services a long-term care facility provides.
- Train staff regarding the policies and procedures covering the admission of residents receiving MAT for addiction to opioids who are otherwise eligible for long-term care services.
- Periodically audit denials of admission to the facility to determine if the facility is denying admission to persons receiving MAT for opioid addiction who have other conditions qualifying them for long-term care services in violation of state and federal regulations.
