North Carolina Nursing Facilities Set New Standard for Addiction Admissions

Two skilled nursing facilities in North Carolina have reached a significant settlement that prohibits them from discriminating against individuals with a history of substance use. This agreement, finalized in March 2023, could influence how long-term care facilities across the United States address issues related to addiction.

Under the terms of the settlement, the facilities, Sunnybrook Rehabilitation Center and Treyburn Rehabilitation Center, are required to implement new admission policies that focus on individual judgment rather than blanket exclusions based on past substance use. This applies to individuals taking medications such as methadone and buprenorphine, as well as those who currently use illegal drugs. Importantly, these facilities are not obligated to ignore their own rules regarding patient substance use.

The case marks a pivotal moment, as it is believed to be the first instance in the U.S. where long-term care facilities have been compelled to confront systemic discrimination against individuals with substance use disorders.

Rebekah Joab, an attorney with the New York-based Legal Action Center, emphasized the implications of the settlement, stating, “The Americans with Disabilities Act prohibits the denial of health services to people on the basis of current drug use.” This law mandates that individuals with a substance use disorder must be treated equitably alongside all other applicants.

The lawsuit was initiated by the Legal Action Center and Disability Rights North Carolina, representing an anonymous client known as “John Doe,” who had previously been denied admission to the two facilities in Raleigh and Durham. In a statement, Sara Harrington, an attorney at Disability Rights North Carolina, clarified that the settlement does not require facilities to admit potentially disruptive patients. Instead, it mandates equal treatment for all applicants, regardless of their substance use history.

“We’re not saying that they need to condone drug use or let people break their rules,” Harrington explained. “We’re just saying that people need a chance.” She noted that had their client been subjected to non-discriminatory policies during the admission process, he would likely have been accepted. Currently, he is thriving in a different facility.

The two rehabilitation facilities did not respond immediately to requests for comment regarding the settlement.

This agreement is part of a broader trend of legal actions that have expanded the reach of the Americans with Disabilities Act (ADA) in recent years. Specifically, it has increasingly applied to individuals undergoing recovery, those on medications for opioid use disorders, and even current users of illicit drugs. While the ADA recognizes addiction as a disability, it does not shield individuals from consequences stemming from their drug use, such as job termination.

During the administration of former President Joe Biden, the Department of Justice (DOJ) issued guidelines indicating that denying addiction medications like methadone or buprenorphine to individuals with opioid use disorders could violate the ADA. Recent judicial developments include a certified class-action lawsuit against a branch of the Salvation Army for refusing to admit individuals on addiction medications due to its religious beliefs.

The DOJ has also reached settlements with various organizations, including a trial court in Massachusetts, the Indiana Board of Nursing, a Colorado-based social services program, and the court system in Pennsylvania, all of which discriminated against individuals with opioid use disorders.

While the North Carolina settlement does not create new legal precedents for skilled nursing facilities nationwide, it establishes a foundation for future litigation. The ongoing commitment of the DOJ to combat discrimination against individuals with addiction remains uncertain under the current administration.

Holly Stiles, the assistant legal director for litigation at Disability Rights North Carolina, remarked on the broader implications of the settlement. “The implication should be understood by nursing homes in every state and territory that they have to have antidiscrimination policies and they cannot exclude individuals who have substance use disorder or who are in active use,” she stated. Stiles emphasized that federal law requires uniform interpretation across the country, urging other facilities to recognize their obligations.

This settlement not only signifies a change for the involved facilities but also sets a potential benchmark for how addiction is viewed within the context of healthcare and rehabilitation services across the nation.