Driven by a need to fill beds, some skilled nursing facilities are opening their doors to more individuals needing post-acute care for opioid use.
But doing so poses significant policy and operational changes, and providers interested in expanding their role will need to make critical changes to staff training and development, report the authors of a new paper published in Health Affairs Thursday.
“The challenges for admitting and treating individuals with [opioid use disorder] in SNFs are many, but so are the needs,” the researchers wrote. “With appropriate planning, reimbursement, and training, SNFs can play a key role in combating the opioid crisis while also strengthening their own financial solvency.”`2
The researchers looked at two converging trends: the need for more treatment options for opioid users after hospitalization and lagging occupancy rates in skilled nursing. Some facilities have stepped in to provide post-acute care for patients recovering from opioid use and substance abuse as a tool to fill beds.
While there has been a federal push to have more skilled nursing providers take on more substance and opioid disorder patients, not all facilities are prepared for the challenges, McKnight’s Long-Term Care News reported in September. Being under equipped or having unprepared staff could open operators to a range of related Centers for Medicare & Medicaid Services citations.
The number of overdose deaths rose from 70,630 to 106,699 in 2021, according to the National Institute on Drug Addiction. That increase is primarily attributed to a rise in opioid overdoses, which the article says has “only become dangerous since 2021.”
The Health Affairs article noted that a March public safety alert from the US Drug Enforcement Agency warned about a veterinary sedative being added to opioids to prolong the high, but the drug commonly results in users experiencing severe skin wounds.
“Providing well-managed and supervised post-acute care for these patients within SNFs could improve their adherence and outcomes with medical and [opioid use disorder] treatments,” the authors wrote.
But the skilled nursing workforce – both administrative and nursing – is trained to handle conditions and diseases associated with aging, and without proper and additional training, they could mistake substance use or withdrawal symptoms as behavioral problems instead of medical issues, the article said.
The authors, all of them affiliated with the Health Management Associates consulting firm, detailed three models under which nursing homes could integrate opioid and substance use patients into their residential and care models. In the first, facilities would work with substance use disorder providers to offer treatment on site..
Under the second, facilities would provide on-site counseling while a nearby substance use disorder provider handles medication-assisted treatments either at a nearby facility or even in a mobile unit in the nursing home’s parking lot. The third model calls for the SNF medical team to be trained to provide the medication-assisted treatments under the direction of a substance-use disorder provider.
Facilities would also need a reimbursement model that would cover the cost of this specialized care, the article noted.