A Chance in a Lifetime: Using Opioid Settlement Funds Creatively to Help Older Adults
July 11, 2023
This guest post was written by: Cassie Cramer, Project Manager for Older Adult Behavioral Health, Massachusetts Association for Mental Health; Deborah Steinberg, Senior Health Policy Attorney at the Legal Action Center; and Lina Stolyar, Senior Policy and Program Research Associate, Massachusetts Association for Mental Health.
While substance use disorders and opioid overdose fatalities are rising at high rates for older adults, few if any states and local jurisdictions have proposed using opioid settlement funds to support this population’s access to treatment and recovery. The following recommendations can assist states and localities to leverage funding to help meet the needs of older adults with substance use disorders and save lives.
In 2021, over 13 million adults ages 50 and older had a substance use disorder, including 4.3 million individuals ages 65 and older. However, fewer than 10% of older adults with substance use disorders received treatment in 2021. From 2000 to 2020, drug overdose deaths among adults ages 65+ increased almost 400% (from 2.4 deaths per 100,000 to 8.8 deaths per 100,000). It is likely that these numbers are an underestimate due to co-occurring health conditions that can mask the cause of death. Furthermore, health disparities are evident when examining these rates, with the overdose death rate of Black men ages 65+ being almost seven times as high as the rate of white men of the same age.
Opioid Settlement Funds and Older Adults
Opioid settlement funds could be used to fill in the treatment continuum and help ensure that older adults have access to the full range of evidence-based substance use disorder care and recovery supports. As states determine how to use these funds, they should consider the following recommendations on how settlement funds could be used to benefit older adults:
- Addressing Medicare Substance Use Coverage Gaps
More than one million individuals with Medicare – the federal insurance program for adults ages 65 and older and people with chronic disabilities – had an opioid use disorder in 2021, with more than 50,000 Medicare Part D beneficiaries experiencing an overdose that year.
Prescription opioid use is common among Medicare beneficiaries ages 65 and older — approximately one in three Medicare beneficiaries is prescribed opioids and misuse in this population is increasing. With 94% of older adults covered by Medicare, Medicare can be a useful means to pay for the delivery of substance use disorder treatment. However, there are significant gaps in what Medicare covers with respect to substance use disorder services, such that financial barriers remain one of the main reasons that older adults are unable to access the treatment they need. Funds from the settlements could be used to fill in gaps in the continuum of care to ensure older adults can access the most appropriate treatment in the least restrictive setting. This includes older adult focused residential treatment, certified substance use disorder counselors, intensive outpatient treatment in community-based substance use treatment settings, harm reduction, and recovery housing. Given the high rates of opioid prescribing and use among older adults, states and municipalities could explore whether to use funds for harm reduction, such as naloxone distribution and syringe services programs in senior centers, skilled nursing and assisted living facilities, nursing homes, and other settings with high populations of older adults. By better equipping facilities to serve older adults with injection drug use history, these investments could also address nursing home and short-term rehabilitation admission refusals of this population.
- Addressing age-related barriers to behavioral health and peer recovery supports
In addition to insurance related issues, older adults face additional treatment barriers such as difficulty getting to appointments due to mobility impairments or lack of transportation; difficulty managing appointments due to co-occurring cognitive conditions such as dementia, and higher rates of stigma around treatment. An increasingly diverse aging population also faces cultural and linguistic treatment barriers. There is also a lack of understanding of medical needs of older adults with substance use conditions, including age- related metabolic changes and medication interactions among adult-centered substance use programs.
Settlement funds could be used to address these barriers by creating culturally responsive home-based options for substance use disorder treatment and peer recovery supports that are overseen and/or informed by geriatric psychiatrists. Funding could also be used to train personal care attendants, home health aides and staff at Area Agencies on Aging and Councils on Aging to better serve older adults with substance use disorders and increase numbers of staff to meet the more intensive needs of this population. Funding also can be used to enable peer specialists and recovery coaches to be trained as Certified Older Adult Peer Specialists and to offer home-based peer recovery supports. Developing treatment and recovery programs specifically for older adults can help people who may feel uncomfortable with more youth-centered programs. These support services can then be embedded into the aging network to better reach older adults that need them.
- Support for programs assisting older adults affected by the opioid overdose crisis
Other consequences of opioid misuse may include elder abuse or neglect and grandparents raising grandchildren whose parents misuse opioids or died due to overdose. A 2021 report investigating the impact of opioid use on Adult Protective Services (APS) found that APS teams were ill-equipped to serve older adults with opioid use disorders. None of the interviewed APS programs had a policy specific to older adults and opioids. Workers cited a lack of substance use disorder and homelessness prevention services for older adults, with the longer-term impacts including pain not being managed properly, poverty, and risk of homelessness.
Settlement funds could be used to help at risk Protective Services clients through providing comprehensive wrap-around services older adults, including housing and homelessness prevention services. An increased investment in Protective Services would enable communities to deliver quality services to some of the most vulnerable older adults who are at high risk of adverse outcomes.
Funds could also be used to reach older adults who are raising grandchildren through Family Caregiver Support or Grandparents Raising Grandchildren Resources. Support groups like Families Anonymous also help older adults who are coping with an adult child’s opioid addiction. Increasing funds for support groups and integrating support groups in the aging network, through offerings at senior centers, help decrease stigma and isolation associated with being the parent of a person using opioids.
- Chronic Pain Management
Settlement funds could also be used to advance better practices for pain management, which is a critical strategy for addressing the opioid epidemic. Emerging evidence supports a role for both psychotherapy and complementary practices such as massage, acupuncture, and mindfulness. Yet, non-medication-based interventions are often poorly reimbursed, if at all, by third-party payers. Funds could be used to expand Chronic Pain Self-Management Program and increase access to psychotherapy and complementary services through managed care programs and senior centers. Funds could also go towards recommendations for reducing supply and demand including drug take back programs and public education.
Settlement funds provide a once in a lifetime opportunity to address treatment barriers related to inequitable Medicare coverage and a lack of older adult specific treatment options that recognize our unique physical medical and social needs as we age. Older adults deserve the same access to effective substance use treatment. Investing in older adult substance use and recovery supports will help begin to remediate the impact of the opioid epidemic on a population that has largely been overlooked.
To learn more, visit:
Medicare Policy Recommendations: https://www.lac.org/assets/files/Roadmap-for-Reform-Medicare-SUD-2021.10.15-akformatted.pdf.
Disability and Aging Programs and Resources: https://acl.gov/programs/addressing-opioid-crisis
Abatement Report Fact Sheet: OpioidAbatementFactSheet-Chapter2-v1.pdf (lac.org)
ACL Opioid Public Health Epidemic and Older Adults issue brief
ACL Grandparents Raising Grandchildren Report https://acl.gov/SGRG/report
ACL National Strategy to Support Family Caregivers https://acl.gov/CaregiverStrategy
US Department of Health and Human Services Overdose Prevention Strategy: https://www.hhs.gov/overdose-prevention/
Deborah Steinberg and Cassie Cramer are both members of the National Coalition on Mental Health and Aging