Optimizing care transitions to post-acute care following hospitalization for people with opioid use disorder.

Background and objectives: Increased referrals to skilled nursing facilities (SNFs) from hospitalized people with opioid use disorder (OUD) carry risk for financial, safety, and legal consequences for poor transitions in care. We aimed to better understand the hospital to SNF referral process and identify opportunities to improve transitions and care for people with OUD, an increasing share of whom are older adults.

Research design and methods: Participants included administrative, executive leadership, and clinical staff involved in SNF admission decisions across the United States. To identify key themes, descriptive thematic analysis was used to analyze semi-structured interview data collected between March and October 2023.

Results: There were 29 participants from 27 SNFs in 19 states. We identified five themes. (1) Large variation in facility experience, stigma, and readiness to care for people with OUD: resources and willingness to care for people with OUD in SNFs varied with stigma, further impeding SNF access. (2) Conflation of OUD with pain management: participants struggled to distinguish between opioids for pain, OUD, and physiologic dependence, highlighting knowledge deficits about OUD. (3) Navigating information transfer: SNF staff screen referrals for challenges that could negatively impact patient care and perceive hospitals to sometimes omit important details to secure SNF placement. (4) Siloed regulations and care landscapes: regulatory structures complicated admissions and limited access to medications for OUD. (5) Building trust and managing expectations during transition: the hospital-to-SNF transition represents a crucial period for developing trust between people with OUD and SNF staff.

Discussion and implications: Education about OUD and stigma, enhanced information transfer and care coordination, and regulatory reforms to expand access to medications for OUD in SNFs are needed to improve transitions and care for people with OUD in SNFs. Since SNF transitions increase with aging, these findings can inform efforts to address OUD in older adults.