Characterization of Skilled Nursing Facility Residents Admitted With Substance Use Disorders

Abstract

For reasons including the opioid epidemic and more widespread substance use across all ages, the prevalence of individuals meeting preadmission criteria for skilled nursing facility (SNF)-level care and who have substance use disorders (SUDs) is growing. However, little is known about this population. We characterized a sample of residents with SUDs in two SNFs that target admission of difficult-to-place individuals in Hartford, Connecticut. Residents admitted between June 1, 2018 and May 31, 2019 and had an SUD per Pre-Admission Screening and Resident Review (PASRR) were included. Using retrospective chart review, we collected data including demographics, physical and mental health conditions, psychiatric medications, and participation in SNF-provided SUD counseling. Of 163 residents admitted with an SUD, all were admitted following an acute hospitalization. Residents’ average age was 49.9(SD=11.7) years (range 21-79). They were 61% male and racially diverse; 56% Caucasian, 27% Hispanic, 16% Black. SUDs on admission included opioid use disorder (48%), alcohol use disorder (33%), unspecified psychoactive SUD (26%), cocaine use disorder (25%), and Other (20%). Of these, 18% and 16% were taking methadone or suboxone, respectively and 25% were taking an antipsychotic medication. Comorbidities such as bipolar disorder (15%) and viral hepatitis (26%) were prevalent. A total of 40 (25%) residents participated in SUD counseling; none of the aforementioned factors was associated with participation. This is the first study to characterize a sample of residents from SNFs that target individuals with SUDs. Improved understanding of this unique and growing subset of the SNF population may help optimize their treatment.