Patients in Recovery Facing Discrimination from Post-acute Care Medical Facilities

Twenty-nine percent of private post-acute care medical facilities in MA rejected certain hospitalized patients’ referrals for admission according to the results of a new study. The rejected patients in this instance had OUD (opioid use disorder) and were explicitly discriminated against in this instance.

Scientists at Boston Medical Center (BMC) were responsible for conducting the research. They also discovered that in 15% of rejections for SUD (substance abuse disorder), the reason for rejection was for one of the following reasons:
1. The patient already had a SUD diagnosis.
2. The patient was taking either methadone or buprenorphine. These medications are used to treat OUD (opioid use disorder).

The medical facilities had been involved in “documented and explicit” forms of discrimination against patients. The results were published in the Journal of Addiction Medicine.

What are Post-acute Care Medical Facilities?

Post-acute care medical facilities provide several services, depending on a patient’s needs. They are meant for patients who continue to need care following discharge from the hospital where the family is unable to provide it.

Skilled nursing facilities provide short and long-term care for patients recovering from a stroke, knee replacement, hip replacement, heart/respiratory issues, neurological diseases, and more. Assisted living facilities offer short-term care (14-30 days) focusing on safety while transitioning between hospital and home. They offer assistance for patients who need wound care, nursing observation, physical or speech therapy, nursing observation, fall management, etc.

Electronic Health Records Form Basis for Study

Researchers examined data taken from electronic health records (EHR) from adult BMC patients. Specifically, they wanted to track referrals to private facilities made in 2018. The scientists made categories for reason given for rejections and made special note of those mentioning substance use or addiction treatment medications. The records in these categories were considered discriminatory.

Their findings were as follows:

    • Two hundred nineteen hospitalizations at BMC led to 1,648 referrals to 285 private, post-acute care facilities in MA. Of these, 1,348 (81.8%) were rejected.
    • Fifteen percent of the rejections were deemed discriminatory.
    • One hundred and five patients were rejected because they being treated with methadone or buprenorphine. Ninety-eight patients were rejected because they had been diagnosed with substance abuse.
    • Eighty-three of the facilities (29.1%) had a minimum of one discriminatory rejection based on the review of patient records.

Private Facilities Previously Sanctioned for Discrimination

In 2016, the Department of Public Health cautioned private facilities that they should not be rejecting patients based on a history of substance abuse. In 2018 and again the following year, the US Attorney’s office for the District of Massachusetts settled with two private facilities for their discriminatory practices, which meant the facilities were violating the Americans with Disabilities Act.

The study authors called for more research to ultimately reduce these discriminatory practices. The Massachusetts Department Board of Health paid for a project starting in 2019. It provided technical support and training for better access to addiction treatment medications in skilled nursing facilities and long-term care homes.