The Opioid Crisis hits LTC

[Not_A_Hat_Person, RN]

The Boston Globe ran a story about the problems hat can arise when people with a history of substance abuse enter LTC.

Kenneth Bubba” Levesque was taking medicine to quell his cravings for heroin when he entered Braemoor Health Center last summer. Massive infections had forced the amputation of his lower left leg, and he needed help learning how to walk again with a prosthetic limb.

Levesque, a teddy bear of a man, seesawed between addiction and recovery many times over the years, and told his family that this was his wake-up call, that he was finally going to get clean” while in the Brockton nursing home.

But state records show that three days after Levesque was discharged from Braemoor in March, the 43-year-old was dead from an opioid overdose, a grim coda to his seven months at the nursing home.

During those months, according to state reports and Levesque's family, he received escalating doses of opioid medications and no substance abuse counseling — at the very time he had vowed to banish narcotics from his life.

Even as regulators and health leaders have launched myriad initiatives to combat the opioid crisis in Massachusetts, nursing homes — where potent pain medications are routinely administered — remain distant outposts.

Few nursing homes are prepared to identify and treat residents with a history of substance abuse, and even when they do, services to care for such patients have typically not been a priority, say addiction and long-term care specialists.

The issue became news this summer when Braemoor became one of at least two Massachusetts nursing homes where state inspectors declared patients in immediate jeopardy” because of serious violations, including lack of substance abuse treatment and staff training.

[TheCommuter, BSN, RN]

First and foremost, these overdose deaths are truly tragic...

Thus, the story has an unnecessarily sensational spin to it. Nursing homes are not, and never were, intended for substance abuse treatment. Chronic understaffing and lack of employee training does not allow for addiction treatment in those places.

Nonetheless, I foresee a greedy admissions manager at the nursing home who may have knowingly accepted new patients/residents with recent addiction histories without implementing any plan of care to properly meet their various needs.

In other words, someone may have been trying to get 'heads in the bed' to keep the profits coming in by any means necessary. Unfortunately, people are now dead.

[nuangel1, BSN, RN]

I agree with the commuter.That said his death is sad.

[dream'n, BSN, RN]

LTC facilities do not have the knowledge or staff to detox and provide substance abuse counseling to patients. They will need a behavioral counseling program for that.

[TheCommuter, BSN, RN]

LTC facilities do not have the knowledge or staff to detox and provide substance abuse counseling to patients. They will need a behavioral counseling program for that.

Unfortunately, many of the addicts and substance abusers who end up in LTC facilities usually come from a specific demographical subset.

They tend to be younger than the little old ladies and gentlemen we envision when we think of nursing homes. My youngest LTC resident was an uninsured 29-year-old female who was being treated for infective endocarditis secondary to injecting heroin. She told me she had been using since she was 17. All the LTC facility could do was provide her with IV Nafcillin every four hours in addition to oxycodone. The resources for substance abuse treatment are not present in this setting.

Also, the addicted residents tend to be uninsured, which is one of the reasons they end up in the nursing home instead of an inpatient chemical dependency program. Many LTC facilities of poor repute will accept uninsured Medicaid-pending residents without any regard for the staff's ability to address whatever addictions they may have. I have had residents leave the facility to score their dope, only to return a few hours later high as a kite. One 40-something-year-old resident had a MI soon after smoking crack across the street from the nursing home.

I agree that the LTC setting is inappropriate for substance abuse treatment. However, the poorer addicts in society will continue to get the short end of the stick.

[sevensonnets]

There was an old rehab/LTC facility here that accepted addicted patients who had other physical problems without any plan to detox them. Several of them were younger men who were LTC residents (paralyzed, double amputees, etc.) The doctor wrote orders to allow these patients to go out back of the facility at night to smoke. Their drug suppliers met them there and there wasn't a thing the nurses could do about it beause they were allowed to have visitors. One resident was found dead in his wheelchair of an overdose by the back door of the facility. Thank God the property was bought by a nearby hospital and a cancer center sits on top of it now.

[Geslina, BSN, RN]

Sounds like where I work, we will take ANYONE. Even rapists and murderers. No one cares, as long as the beds are full. I've seen patients whose medical hx clearly states problems with addiction, but the MD, no questions asked, will write scripts for whatever they want, and then I'm stuck having to give it to them when they are in "severe pain" q 4 hours. Yeah, sitting in your WC, licking potato chip salt off your fingers while watching TV and talking on the phone, and you need 2 Percocet for severe pain. What can I do about it? I know the patient isn't in severe pain, but we are taught that pain is what the patient says it is....

[MrNurse(x2), ADN]

This article was written by a reporter who had nothing else. Though a horrible piece of journalism, nursing and medicine should be aware that the hippies of the 60's are now in their seventh and eighth decade of life. Their pain med needs are so much more exaggerated by even marijuana use and there may not be an addiction problem, but there is a tolerance problem. I have also encountered the 80 year old addict. We are entering a new world where people are given dilaudid for every pain and their pain receptors are now screwed up for life, needing higher doses for heightened pain response from these super narcotics.