Long-Term Care Facilities Must Provide Addiction Care, Advocates Say

When you think about the opioid crisis, the image of adults in their 20s, 30s, even sometimes those who are middle-aged, may come to mind. Rightly so, since most overdose deaths occur in people between ages 25 and 64.

But did you know older adults are increasingly at risk of overdosing from opioids, too?

In fact, from 2021 to 2022, adults over 65 saw the largest increase — 10 percent — in overdose death rates across all age groups.

Yet their addiction care needs are often overlooked, even in places teeming with medical staff, such as long-term care facilities that primarily serve older patients. My colleague Aneri Pattani and I dug into the issue.

One study estimated that older adults were the least likely in 2022 to receive any type of care for opioid use disorder. They were also unlikely to receive medications such as buprenorphine and methadone — considered the treatment gold standard.

When people think of who actively uses drugs, “they don’t want to think about grandma, they don’t think about grandpa, and they certainly don’t want to think about what could be happening at a nursing home,” said A. Toni Young, executive director of Community Education Group, a nonprofit that advocates on substance use policy.

But Young’s organization, along with more than 50 other advocacy groups, is working to bring the issue front and center. In a letter shared exclusively with KFF Health News and the Health Brief, the coalition is urging the Centers for Medicare and Medicaid Services to ensure older patients get the help they need.

“Many Americans living in residential care facilities may not be in a position to effectively advocate for their own medical interests,” the letter says. “They must be able to trust you to hold their facility operators accountable to uphold the law.”

Facilities that receive Medicaid and Medicare payments are required to abide by federal laws, including the Americans With Disabilities Act and the Fair Housing Act. The laws bar discrimination due to current or past addiction and mandate appropriate medical care, including medications for opioid use disorder.

“However, without enforcement, the law is just words,” the letter notes.

To change that, the letter writers urge CMS to “undertake a systematic education, investigation, and enforcement effort, covering all categories of residential care facilities that you oversee.”

In a statement to KFF Health News, CMS said its updated staffing guidelines, released this year, require nursing facilities to ensure they have the staffing and resources to care for patients with serious mental illness or substance use disorder. The agency directs facilities to have care plans in place to “prevent adverse events, such as an overdose.” It has also partnered with other federal agencies to create free programs to boost nursing home care for patients with addiction and mental health concerns.

The agency did not directly address how such guidelines would be enforced.

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