Regulations tape off empty drug rehab beds

(The Center Square) – Pennsylvania’s drug rehabilitation centers have open beds and the capacity to accept more patients, but a glut of paperwork and unique staffing requirements means that those struggling with drug addiction get turned away.

The result is that the commonwealth has potentially hundreds of open beds to treat drug addiction, but legal roadblocks to getting people the help they need.

Reaching a point where someone with addiction seeks out treatment can be a long road. When rehab centers have to turn them away, or require them to repeat the process somewhere else, many give up.

“Everywhere you turn, we’re talking about and hearing about a workforce crisis. And, of course, we have an overdose death crisis,” said Jason Snyder, director of substance use disorder treatment services for the Rehabilitation and Community Providers Association. “Anything that becomes a barrier to people accessing treatment needs to really rise to the top of our priority list.”

Across Pennsylvania in 2021, more than 5,100 people died from a drug overdose.

Though the regulations are meant to preserve high-quality care, the unintended result is that the rules require providers to deny addicts treatment. Even with open beds and the professional judgment of doctors that they could treat the patient, providers legally cannot admit them.

Current regulations require different client/staff and client/counselor ratios depending on inpatient and outpatient services, detoxification in hospitals or non-hospitals, inpatient treatment and rehabilitation, and outpatient services. These rules can require an on-call physician at all times, one primary care staff for every five or seven clients, or one counselor for every five to 35 clients.

The Department of Drug and Alcohol Programs can grant a waiver for these ratios, but it requires a written petition to justify a waiver.

Neighboring states have less-onerous requirements. Maryland has no staffing ratio rules at all, Snyder noted, and New Jersey’s ratios are almost twice as high as Pennsylvania’s.

“From our perspective, we believe that we can allow our staff to take care of more patients – reasonably so – which will in turn enable more people to get into treatment,” Snyder said. “We’re far better served bringing someone who’s asking for help into a safe environment than keeping them out.”

The situation is similar to Pennsylvania’s problem with nursing homes, where staffing shortages have meant 2,000 people statewide are on a waiting list to get admitted, as The Center Square previously reported. The facilities are there, but a lack of workers limits nursing homes in a way that legal requirements for staffing ratios limits rehab centers.

Changing the DDAP regulation takes time, but Snyder argued that officials could offer a blanket exception to facilities with the capacity to take in more patients. Making it easier to get an exception would cut down on paperwork and allow providers to focus on more important tasks.

For one of the largest providers in the commonwealth, a blanket exception would allow them to use the resources they already have.

“Gaudenzia has somewhere in the ballpark of 60 residential facilities,” Snyder said. “Ten percent of the beds across that board are not being used, they’re not online. That is potentially hundreds of beds. This is what Gaudenzia would say: If that ratio was relaxed, they could immediately care for 100 additional patients on a monthly basis. That’s just one organization.”

Sometimes, there’s only one shot to get help for someone who’s fighting a drug addiction.

“Delays matter,” Snyder said. “While we may not directly be sending them back to the street, the more hoops we require somebody to go through, the greater likelihood that we are, in fact, indirectly gonna send them back to the street.”

A lack of good data as well as treatment options has made it difficult to reduce drug overdose deaths in Pennsylvania, as The Center Square previously reported. Sometimes, it’s the unintended consequences of existing law that has tied the hands of health care providers in improving the status quo.