Ensuring care for Vermonters with OUD in skilled nursing facilities

BURLINGTON, Vt. (WCAX) – Skilled nursing facilities in Vermont are key for inpatient rehab and medical treatment for people with a wide range of needs. That includes care for patients following an accident, illness, or surgery. It can also include treatment for opioid use disorder.

But are those struggling with addiction being turned away for care?

U.S. Attorney for Vermont Nikolas Kerest says there have not been any reports of skilled nursing facilities turning away patients for substance use disorder but it is a topic of conversation in neighboring states.

“Facilities need to do an individualized assessment of each potential patient.” Vermont’s U.S. Attorney Nikolas Kerest sent out a reminder to each of Vermont’s 30 skilled nursing facilities as a precaution as the state’s opioid crisis continues to get worse.

“They can’t have blanket policies against admitting people who use medication, medication-assisted treatment or substance use disorder,” said Kerest.

“We do admit those types of applicants.” Woodbridge Rehabilitation and Nursing in Berlin is one of the nursing facilities that have a dedicated unit for patients with substance use disorder.

William Kowaleski of Woodbridge says there are anywhere from three to ten of these specific patients in the facility at any time.

“Our providers, we have one physician and three nurse practitioners are all skilled in prescribing suboxone relief and support to people with OUD,” said Kowaleski.

Not every skilled nursing facility in the state has a dedicated unit like this but Kowaleski says the limiting factor for patients of any kind to be admitted is that the facility is almost always full. They get 50 or 60 referrals a month statewide with the ability to admit five or six a week. He says 2/3 of the population are long-term care patients.

“We look at the code and also the skill set of our staff. We want to make sure that we have staff that have the skills to handle the applicants that we admit,” said Kowaleski.

“We know and are working hard on the problem that many folks are turned away for admission simply because the services to match the treatment plan are not available.” Helen Labaum of the Vermont Health Care Association says she too hasn’t heard of any skilled nursing facilities turning patients away because of substance use disorder but says it indirectly highlights the staffing and capacity challenge many facilities face.

Vermont is currently ranked last in the country for stability of the workforce and services in skilled nursing facilities, according to federal data. In a broader healthcare context, Vermont’s nursing turnover is 61% the second highest in the country.

“We’ve got a shortage of mental health workers, counselors, the folks who can provide those services that often go along with the medications prescribed that are the focus of this particular memo,” said Labaum.

Despite people Channel Three spoke with saying skilled nursing facilities are not turning away patients with Substance Use Disorder Vermont’s U.S. Attorney says if they do, there are violation fines up to around $111,000 that increase as the violations do.

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