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Nursing homes tackle opioid addiction in care plans

Cape Cod Times - 2/11/2020

Feb. 11--CENTERVILLE -- Like many other residents at the Cape Regency Rehabilitation and Health Care Center, Joanna Berto receives physical therapy, occupational therapy and assistance with daily living.

But Berto, 35, who is in recovery from opioid use, also gets one-on-one meetings with a licensed drug and alcohol counselor and management of her suboxone medication as part of her nursing home care.

The nursing home owned by Athena Health Care Systems also sends residents to recovery meetings on site and at a nearby church and helps residents with opioid use disorder find appropriate housing after they are discharged, including sober housing if appropriate.

"You can never have too many people on your side. That's what this place has given me," said Berto, a former dental assistant who also has multiple sclerosis and neuromyelitis optica, a disorder of the central nervous system.

John Seaman, a licensed drug and alcohol counselor, said he runs staff training sessions on caring for residents with opioid use disorder, or OUD, and wishes more nursing homes would admit patients with the disorder.

For years, nursing homes have resisted caring for patients on medication-assisted treatment for OUD.

"OUD patients require an additional set of services related to counseling, transportation, activities, security and other needs," said Tara Gregorio, president of Massachusetts Senior Care, a professional organization for nursing homes, senior residences and assisted living centers.

Berto said she travels to Outer Cape Health Services in Harwich once a month to see the physician who prescribes her suboxone.

"The federal skilled nursing facility oversight regulations do not address the special needs of OUD nursing facility residents, which place nursing home facilities at great risk for enforcement actions" and deficiencies, Gregorio said in an email.

Despite the challenges, "nursing homes are increasingly working with their hospital and community partners to meet the care needs of skilled nursing facility patients who have both a skilled nursing need and are on medication assisted treatment for their opioid use disorder," Gregorio said.

"Athena has led this effort," Gregorio said.

Advocates for patients with opioid use disorder say denying them access to nursing home care is discriminatory.

The U.S. attorney's office in Boston said Athena violated the Americans with Disabilities Act by refusing to admit patients being treated with buprenorphine for their opioid use disorder.

In September, Athena reached a settlement with the office of U.S. Attorney Andrew E. Lelling, agreeing to adopt a nondiscrimination policy and pay a civil penalty of $10,000.

Members of the recovery staff at Cape Regency -- including Seaman and Jacqueline Smith, director of social services -- have gone out of their way to help patients like herself, Berto said.

"I see John one on one every Wednesday. He's been a wonderful support for me here. He doesn't ever let you down. I can set my clock by him," Berto said.

Berto said through cognitive behavioral therapy she learns how not to dwell on past tragedies, including the death of her father and the death of a friend who died by suicide.

She said the nursing home encourages her efforts in macrame, wall art and jewelry making -- finding leisure activities is important for people with substance use disorders -- and Smith is helping her with a housing search.

Being at Cape Recency "has been a great experience, but I don't want it to be for the rest of my life," Berto said. She said she is looking for a two-bedroom apartment to share with her mother, who will be her caregiver.

Berto said she became addicted to opioids after a doctor gave her a prescription for pain pills after she tore a ligament in her 20s.

She told her doctor not to write any more scripts after a couple of months, but said by then she was dependent and sought the pills on her own.

"I knew I had to change. I knew I wasn't the person I wanted to be," Berto said.

The road to recovery has not been easy.

Her father died in 2012 and the next year she was diagnosed with MS, Berto said. The neuromyelitis optica diagnosis was fairly recent, she said.

Berto said she ended up going by ambulance to Cape Cod Hospital in March of last year after sliding off her bed and hitting her head in a room she rented in Dennis.

Now in a wheelchair, Berto said Cape Regency has helped her get some strength back, but her conditions are progressing.

"For a time I felt I was being punished for something. Then I chose to think differently," Berto said.

Seaman and Smith said Berto's strength and positive attitude are inspiring, and all the more reason to help patients who have opioid use disorder in addition to the condition that led them to a nursing home.

"She's connected not only with fellow residents but also staff. This isn't the end for her. It's just the beginning," Smith said.

"And all this while maintaining her sobriety. She's using her strategies," Seaman said.

Seaman, who divides his time between Cape Regency and Cape Heritage Rehabilitation & Health Care Center in Sandwich, estimates that one-third of the nursing home's residents in the long-term care and short-term care units have substance use disorders.

"There needs to be a fundamental redesign of the MassHealth reimbursement system so that facilities can meet the care and staffing needs of all of our residents, including those with OUD," Gregorio said.

"There's definitely a need for someone like John in all nursing homes. The world is changing, and needs are, too," Berto said.

Follow Cynthia McCormick on Twitter: @Cmccormickcct.


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