The owner of 16 Massachusetts nursing homes has agreed to accept patients being treated for opioid addiction, forgoing a practice that remains common among other nursing homes.
In a settlement reached Tuesday with the office of US Attorney Andrew E. Lelling, Athena Health Care Systems agreed to adopt a nondiscrimination policy, provide training to admissions personnel about the rights of disabled people and opioid addiction, and pay a civil penalty of $10,000.
Advocates and hospital officials in Massachusetts and around the country have long complained that nursing homes turn away patients who take medication for opioid addiction. These are patients who were hospitalized for a condition such as a heart infection and need continuing care to recover from that medical problem.
But many nursing homes feel ill-equipped to handle a population with dramatically different needs than the frail elders they were built to care for.
“The facilities have no real guidance on how to take care of the population,” said Helen Magliozzi, director of regulatory affairs for the Massachusetts Senior Care Association, a trade group of nursing homes and others.
Dr. Sarah E. Wakeman, medical director of Massachusetts General Hospital’s Substance Use Disorders Initiative, said she has seen “slow progress” in finding nursing home placements for addicted patients.
“Unfortunately,” Wakeman said in an e-mail, “we still come across daily barriers where people who are being treated with medications for opioid use disorder are not accepted to facilities because of these medications. . . . I am hopeful that this ruling will continue to change practice on the ground.”
The US attorney’s office had alleged the Athena nursing homes violated the Americans with Disabilities Act by rejecting two patients because they were being treated with buprenorphine, one of three medications used to treat opioid use disorder. The patients sought nursing home care for health issues unrelated to their addiction, but still needed to keep taking buprenorphine.
People receiving treatment for opioid addiction are generally considered disabled under the ADA, which prohibits private health care providers from discriminating on the basis of disability.
In May 2018, the US attorney’s office in Massachusetts reached a similar settlement with Charlwell House, in Norwood, as part of what the office described as an ongoing effort to eliminate discriminatory barriers to treatment for opioid use disorder.
In 2016, the state Department of Public Health notified nursing homes that they must accept patients taking the medications that treat opioid addiction if they qualify for nursing home care.
But Magliozzi said that’s not a simple proposition. The nursing home has to make connections with providers in the community who are licensed to prescribe the medications and who can continue following the patients during their stay.
Sometimes patients go to the nursing home early in their recovery, Magliozzi said. Yet, unlike an inpatient addiction rehab center, a nursing home is not allowed to bar patients from leaving the facility or from accepting visitors, making it easy for people to obtain illicit drugs, she said. Patients with addiction also tend to be younger, have shorter stays, and need different types of activities and counseling than typical nursing home residents.
Despite these challenges, Magliozzi said, a growing number of nursing homes are stepping up to establish systems and relationships that enable them to care for people with opioid use disorder. She could not say how many are accepting such patients, and acknowledged that some still do not.
About 18 months ago, she said, the Massachusetts Senior Care Association established a working group to help nursing homes learn how to care for addicted patients. That group has now become the advisory committee to a federal grant to the Department of Public Health intended to help nursing homes care for this new population.
In July, the department launched the Medication for Opioid Use Disorders in Long-Term Care Program, working with nursing homes to coordinate care for these patients.
Athena Health Care Systems owns dozens of nursing homes in Massachusetts, Connecticut, and Rhode Island. All are currently accepting patients taking medication for addiction, and Athena is a member of the Massachusetts Senior Care Association’s working group on opioid addiction, according to spokesman Tim Brown.
“Athena fully cooperated with the investigation and has ensured that our policies fully comply with the ADA,” said a statement from the company. “Athena and its managed centers share in the struggle with individuals and families facing opioid addiction and other substance use disorders and will continue to provide much needed care and services.”
Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.