Improving Opioid Use Disorder Care in Skilled Nursing Facilities

Accessing skilled nursing facilities (SNFs) for individuals diagnosed with opioid use disorder (OUD) can be challenging, and opportunities to initiate or continue medications for opioid use disorder (MOUD) are often inconsistent or nonexistent across facilities, according to a study published in JAMA Network Open.

“We conducted qualitative interviews with administrative and clinical leaders of SNFs (hereafter referred to as administrators) in Rhode Island to explore facilitators and barriers to accepting and caring for residents with OUD,” wrote Patience Moyo, PhD, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, and coauthors. “By examining the perceptions of this group of stakeholders within SNFs, we intend to contribute insights that can guide efforts to optimize care and support for individuals with OUD in postacute and long-term care settings,” they added.

The qualitative study explored the challenges faced by 29 participants working in various capacities (including nursing home administrators, directors of nursing, and directors of admissions) across 27 SNFs in Rhode Island. These individuals, with a majority having over a year of experience in their roles, provided insights into the operational and ethical complexities of managing OUD referrals within their facilities. The study determined four primary themes encapsulating the systemic and interpersonal hurdles in integrating OUD care into SNFs.

1. Limited Mental Health and Addiction Services: Facilities faced challenges in providing MOUD due to certification issues and logistical problems with methadone delivery. Telehealth, although beneficial, added to the staff burden.
2. Staffing and Industry Crises: COVID-19 exacerbated existing staffing shortages, impacting the facilities' ability to admit and care for residents with OUD. High staff turnover and reliance on temporary nurses complicated care continuity and specialized OUD training.
3. Resident Population and Facility Culture Concerns: Mixing residents with OUD with the traditional resident population raised concerns about behavioral management and social integration, with some participants expressing stigmatizing views towards residents with OUD.
4. Cost of Care, Funding, and Regulatory Concerns: Financial and regulatory hurdles were highlighted, with concerns over poor insurance reimbursement for OUD care and the risk of regulatory fines.

The theme of stigma emerged distinctly, showing how biases against residents with OUD affect admissions and care practices, often using "stability" as an informal criterion and conflating MOUD with active addiction. This study underscores the need for systemic changes to address staffing, service availability, and stigma to improve OUD care in SNFs.

“This qualitative study among SNF administrators found that being diagnosed with OUD introduced challenges to accessing SNFs and that opportunities to initiate or continue MOUD were inconsistent and often nonexistent across facilities,” concluded the study authors.

Reference

Moyo P, Nishar S, Merrick C, et al. Perspectives on admissions and care for residents with opioid use disorder in skilled nursing facilities. JAMA Netw Open. 2024;7(2):e2354746. doi:10.1001/jamanetworkopen.2023.54746