The number of people age 50 and older in the U.S. who have substance use disorders is projected to more than double from 2.8 million in 2002 to 5.7 million in 2020, yet few senior living facilities have the resources to cope with the growing substance abuse epidemic.
And as short-term stay rehabilitation and skilled nursing facilities are continuing to heed pressure from health care providers to lower hospitals’ readmission rates, experts say those who also need substance abuse treatment fall through the cracks — and often end up back in the hospital.
“This is an issue not being addressed, and will only become more acute as Baby Boomers age,” says Gregory Poole-Dayan, administrator of Jewish Home Lifecare’s Bronx campus. “People are living longer and with more chronic pain, their children are moving away and they have less social support — these are all variables that are going to influence people to turn to drugs and alcohol to cope with those issues.”
A new pilot program focused on addiction
New York City’s nonprofit Jewish Home Lifecare recently launched the country’s first nursing home-based recovery program for older adults dealing with alcohol and/or prescription drug addiction, Jewish Home Lifecare officials say.
The Jewish Home Lifecare Geriatric Substance Abuse Recovery Program, which will be located on Jewish Home’s Bronx campus, started in August with a pilot expected to serve 720 patients over two years. The pilot has served 11 to date.
Jewish Home’s Bronx campus offers short-stay rehabilitation, skilled nursing, adult day programs and special therapies. Jewish Home also has post-acute and long-term residences on campuses in Manhattan and Westchester.
One in three U.S. adults 65 and older experience a fall in a given year, according to data collected by the CDC. And about 95% of hip fractures occur within the context of a fall.
And while seniors are already more vulnerable to falls and the severe consequences they can impose — broken bones, head trauma and other life-changing injuries — substance abuse can exacerbate the everlasting hazards falls pose, Poole-Dayan says.
“For example, someone falls at home from drinking too much and fractures a hip,” he says. “The industry does a good job of healing the hip, but after he is healed we send him home to the same environment. He is likely to drink and fall or hurt himself again. This program allows us to address not just the physical, but the sociological issues at play.”
A growing problem
Substance abuse among older adults is a complex and growing problem which often goes undiagnosed or is misdiagnosed, says Poole-Dayan, noting that even when correctly identified, it is insufficiently treated.
In New York City, 17% of adults over 65, or 170,000 people, suffer from alcohol abuse, according to the New York State Office of Alcoholism and Substance Abuse Services (OASAS). In New York State, the fastest growth rate of substance abuse, 24% a year, is among older adults.
Poole-Dayan, who has more than two decades of experience working in hospitals, nursing homes and skilled nursing facilities, says he regularly sees facilities struggle with how to treat older patients with substance abuse issues.
“They are deemed to be undesirable, or problematic,” he says. “We thought, ‘Who’s looking over these people that have substance abuse issues?’”
At the end of the Jewish Home’s substance abuse pilot, which is being underwritten by a $213,000 grant from The Fan Fox & Leslie R. Samuels Foundation, Inc., officials say the program will become a full-fledged, self-sustaining operation expected to care for 480 patients annually.
Partnerships with local hospitals like Montefiore Medical Center and NewYork-Presbyterian, which often refer patients to Jewish Home for post-acute care, will be essential to the success of the new program, officials say. In addition, Jewish Home has initiated outreach to other area hospitals as well, including Beth Israel Medical Center, Mount Sinai Roosevelt and the VA Medical Center in the Bronx, and to Odyssey House, a program for older adults with substance abuse disorders.
“Hospitals are interested in this program because by addressing the substance abuse issue we’re getting at the heart of trying to prevent rehospitalizations,” he says. “[Without substance abuse treatment] it’s a revolving door — the person gets treated at the hospital, goes to post acute care, goes home and then returns to the emergency room.”
A long-term plan
Each patient entering the Jewish Home Lifecare Geriatric Substance Abuse Recovery Program will receive an initial assessment to determine his or her medical rehabilitation needs and addiction-recovery needs. The resulting team-focused treatment plan will involve the family and will coordinate care among the physical and occupational therapy staff, mental health and addiction professionals, social services personnel and organizations like Alcoholics Anonymous.
The grant also allowed for the hiring of a program director, who provided specialized training to post acute staff nurses, nurses aides, rehabilitation therapists, recreation therapists and others working with program participants.
When patients are ready to be discharged, the staff will work with each person and his or her family to make sure a support team is in place that draws on community recovery programs, thus giving the patient the greatest chance possible of long-term recovery, Poole-Dayan says.
But, ultimately, the first step in substance abuse treatment is acknowledging the addiction exists.
“There’s a stigma,” he says. “But, if we don’t ask they’re not going to tell. We need to get better at asking — asking with sensitivity and being able to do something about it when we ask. Substance abuse is the elephant in the room, and we need to start talking about it.”
Written by Cassandra Dowell