Hospitals are discharging more older adults with substance-use disorders to skilled nursing facilities, but many of those facilities remain underprepared to treat such patients, according to a study published Thursday in BMC’s Harm Reduction Journal.
Analyzing data from six years, the researchers from New York’s Department of Health and Mental Hygiene and researchers from the University of California, San Diego, School of Medicine found significant increases in cocaine-, cannabis- and opioid-related hospitalizations that resulted in discharge to a SNF among adults aged 55 to 64 years. For adults 65 and older, sharp increases were seen across all substances with larger increases in opioids compared with adults aged 55 to 64.
For both age groups, alcohol-related hospitalizations were the leading cause of discharge to a SNF. By virtue of their age, older people with substance-abuse disorders are more likely to need post-hospital care in a SNF after a hospitalization, because of increased rates of chronic diseases and functional limitations.
But the researchers warned that long-term care facilities often were under-equipped and under-trained in how to handle opioid addictions in particular.
“As more adults age 55 and older take medications for opioid use disorder, SNFs will need the capacity to continue … care whether a patient’s disease is stable or not,” they wrote. “We also recognize the multiple challenges that exist in providing quality care in SNF settings for complex medical patients before even considering (substance-use disorders) and, therefore, models of care need to be developed to help assist providers in SNFs with the management of patients with SUD [substance use disorder].”
They urged post-acute and long-term care providers to prepare to care for an increase in older patients with substance use disorders by integrating a range of harm reduction interventions into care settings.
The team said “a broad effort” should be made to either increase the number of medical providers in SNFs who train to receive a buprenorphine Drug Addiction Treatment Act X waiver or discontinue the buprenorphine X waiver policy to reduce the barriers to prescribing the drug, which is used treat pain as well as addiction to narcotic pain relievers.
The study used data from New York State’s Statewide Planning and Research Cooperative System and extrapolated it based on New York City population estimates.
