Addiction Medicine in PALTC: Speaker to Share Guidance on Care, Respect, Dignity, Recovery

November 26, 2018

Post-acute and long-term care (PALTC) facilities increasingly are seeing patients with opioid addiction and other substance use disorders. Some are older adults—more like the traditional PALTC patients--and some are younger patients with various clinical needs and comorbidities. Yet, all share a need for focused care and efforts to get them on the road to recovery.

At the Society’s Meet the Experts breakfast, scheduled for March 9, 2019, during the annual conference in Atlanta, Michael Fingerhood, MD, will help his audience understand and address substance use disorders in the PALTC setting. “I hope participants will see how care that includes these patients’ substance use disorders isn’t a futile endeavor. Patients can enter into recovery, and Society members—working in their facilities—can help make this happen.”

Dr. Fingerhood, associate professor of medicine and public health and chief of the Division of Chemical Dependence at Johns Hopkins Bayview Medical Center, will review a paradigm for treating individuals with substance use disorders in PALTC. He will provide a historical background on substance use disorders and will discuss medical morbidities that contribute to individuals with addictions needing PALTC. Additionally, he will offer some strategies to address issues, such as shame, self-esteem, and coping, which are key to helping patients with substance use issues.

Many younger patients with substance use disorders in this setting have been admitted for problems like heart or brain infections, strokes, long-course intravenous antibiotics, brain injuries, and more. As a result, says Dr. Fingerhood, clinicians should be prepared to deal with issues such as friends bringing in illicit drugs. At the same time, these younger patients may be bored in a traditional LTC setting, so practitioners should be prepared to engage them and respond to their unique needs and interests.

As lengths of stay continue to shrink, Dr. Fingerhood notes, practitioners and staff have less time to get to know patients and design individualized care plans. Some of these patients may not be ready for or committed to recovery yet, and they are still craving drugs and looking for opportunities to obtain and use substances. Others may welcome the structure and peace of the facility, he says, and see their stay as a chance for reflection, contemplation, and healing. To help assess where the patient is and what support and care might be most appropriate, Dr. Fingerhood suggests consultations by recovery coaches or addiction counselors. Some of this care, especially in rural or other areas where in-person visits aren’t viable, can be provided via telemedicine.

Dr. Fingerhood stresses that practitioners shouldn’t hesitate to reach out for help. For instance, he says, he is part of the Maryland Addiction Consultation Service, which provides support to primary care and specialty prescribers across the state to help identify and treat substance use disorders and chronic pain management. “Whether it’s the use of telemedicine or networks to access experts, there are resources out there,” Dr. Fingerhood says.

At the same time, he suggests that PALTC practitioners consider additional training in substance use treatment. For instance, physician practices or facilities may want to consider identifying one or two team members who will pursue further study and gain specific knowledge in this area. He also suggests that  certified nursing assistants (CNAs) caring for patients with substance use issues receive targeted training and the opportunity to meet patients in recovery.

“You can make patients’ lives better when you address their substance use issues. I am coming to this program with a message of hope,” says Dr. Fingerhood. However, he observes that effectively addressing substance use problems has a broader impact. “I’ve done cost studies showing that if you provide effective opioid care, you lower care costs and readmission rates,”  he notes. “These patients can get better. Recovery means that they can wake up in the morning and not be sick.”

There is an additional fee to participate in this session and preregistration is required. Breakfast will be served from 6 to 6:30 AM and the presentation will start promptly at 6:30 AM. Click here for more information on the session and here to register for the conference. Discounted early bird rates are available till December 12.