Later this month, new residents will arrive at a nursing home in the Bronx. Like others coming to Jewish Home Lifecare, they will be recuperating from hospitalization for cardiac surgery, strokes, fractured hips — the whole panoply of senior ills. But these residents also will be addicted to alcohol or prescription drugs, and so they will be enrolled in an unusual rehab program at the nursing home.
“Traditionally, people with these issues have been ‘undesirable admissions,’” said administrator Gregory Poole-Dayan. “They may have behaviors the staff isn’t prepared to cope with. There may be family dynamics.”
“This is a population nursing homes have shied away from,” he said.
Older adults suffer plenty of substance abuse, though it often goes unrecognized. They may struggle with lifelong addictions or misuse prescription drugs they began taking only recently to cope with pain, either physical or psychological.
Sometimes, the drinking that caused no problems a couple of decades ago becomes dangerous, because aging bodies metabolize alcohol differently or because booze interacts with the many medications older people typically take. A generational stigma may have prevented them from ever addressing the mental illnesses that often accompany substance abuse.
When such seniors have a health crisis, emerge from a hospital and aren’t well enough to return home, where can they go? Mr. Poole-Dayan, after consulting with local hospitals, decided Jewish Home Lifecare should be the first nursing home in the country — he believes — to help them recover from both their medical conditions and their addictions.
Persuading the organization’s planning group proved challenging, and Jewish Home Lifecare decided it would not yet admit seniors addicted to illegal street drugs. But it proceeded, hiring a director with a grant from the Fan Fox and Leslie R. Samuels Foundation and planning to set aside a 40-bed unit for these patients. Eventually, Mr. Poole-Dayan said, he hopes to treat 480 addicted seniors a year.
They’ll get a thorough screening, group and individual therapy, 12-step programs on the campus and counseling on preventing relapses. When they’re ready to leave, the home will connect them with community programs and professionals, because “the important part is continuing recovery,” Mr. Poole- Dayan said. He figures that Medicare and Medicaid will cover the costs.
But there’s a lot still to learn here. Is an average stay of just 25 days long enough to make progress? Will families, sometimes convinced that a parent is too old to make fundamental changes, be supportive or obstructive or indifferent? How can you help people recover from injury and surgery, which often requires pain management, while simultaneously trying to wean them from inappropriate pain medications? What sort of additional training will the staff need?
Steven Wollman, the newly hired director of the Geriatric Substance Abuse Recovery Program (and, he volunteers, a recovering prescription drug abuser who has maintained sobriety for 18 years), has few illusions about the task.
He’s braced for older patients’ denial. “If they’re newly addicted, they think they don’t have a problem,” he said. “Their doctor prescribed this, so it must be perfectly O.K.”
He expects to see a fair amount of evasion, too, because “a lot of people addicted to pain meds have multiple doctors and several pharmacies” and “the doctor prescribing pain meds doesn’t know that someone else is prescribing tranquilizers.” More than drug abuse, he expects to see alcoholism, which requires no such subterfuge.
But regardless of age, Mr. Wollman said, “I think anybody can recover if they want to do it and have the guidance.”
He told me about a 78-year-old he had worked with in Florida to overcome addiction to crack cocaine. “He stayed clean until he died three years later, and he said they were the best three years of his life,” Mr. Wollman said. “He reconnected with the family that had wanted nothing to do with him.”
Jewish Home Lifecare is applying for research grants to see what will work and how well; Mr. Poole-Dayan hopes to create a program that other facilities can adopt.
After all, he notes, “We’ve always had people with substance abuse problems in nursing homes. We either haven’t known it, or we haven’t done anything about it.”
August 15 2014
Dear Drugs-Forum readers: We are a small non-profit that runs one of the most read drug information & addiction help websites in the world. We serve over 4 million readers per month, and have costs like all popular websites: servers, hosting, licenses and software. To protect our independence we do not run ads. We take no government funds. We run on donations which average $25. If everyone reading this would donate $5 then this fund raiser would be done in an hour. If Drugs-Forum is useful to you, take one minute to keep it online another year by donating whatever you can today. Donations are currently not sufficient to pay our bills and keep the site up. Your help is most welcome. Thank you.