Nursing homes may be targeted for turning away patients being treated for opioid addiction

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AHCA's David Gifford says CMS regulations allow facilities to deny patients they can't help.
AHCA's David Gifford says CMS regulations allow facilities to deny patients they can't help.

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.

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.”