‘You’ve got to do something’: Pa. rehabs buckle, begin to close under COVID-19 strain

This story originally appeared on Spotlight PA.

Faced with the financial burdens of COVID-19 and a lack of state support, drug and alcohol treatment facilities in Pennsylvania could begin closing at an alarming rate, even as overdose deaths rise and the need for treatment is expected to grow.

In a hearing before lawmakers Tuesday, treatment providers, advocates, and state officials warned that the industry has not received dedicated coronavirus relief funding, nor has it been prioritized for state-provided protective gear or testing supplies.

Facility operators said they have had to increase pay to employees facing risky conditions, while cutting down on the number of patients they can accept to maintain social distancing.

The result is a historically underfunded system buckling under the weight of dual pandemics: addiction and the coronavirus. Since March, 10 facilities have closed, though it’s unclear if the coronavirus was to blame, according to the state Department of Drug and Alcohol Programs.

Without more funding, that trend will continue, those at the hearing said.

“In my 30-plus years of doing this work, I have never seen programs closing at the rate that they are right now,” said Bill Stauffer, executive director of the Pennsylvania Recovery Organizations Alliance, a nonprofit advocacy group. “And we’re going to be in dire straits without the kind of care that we need.”

Stauffer called on lawmakers to increase funding, not just during the COVID-19 crisis but over the long-term. With the increased isolation of the pandemic, he said, a growing number of people are suffering from substance use and mental illness. Public health experts are predicting rises in overdose deaths and suicide over the coming months.

The addiction treatment system needs to be ready to help, Stauffer said.

As of August, no state or federal coronavirus funds have been allocated specifically for drug and alcohol facilities. Instead, they’re often competing with other industries for limited funds. That includes the $1.6 billion in federal funds that went to county governments to spend as they wish. The money was often split between many pressing needs, including small business grants and emergency response services for the pandemic.

Drug and alcohol facilities also competed with grocery stores and security companies, among others, for $50 million in state grants to give frontline workers hazard pay. And they are able to request protective equipment from the state stockpile, but the Department of Health has said nursing homes generally receive top priority.

The lack of support, previous Spotlight PA reporting found, has left well-meaning facilities that want to protect clients from COVID-19 without the resources to do so.

The Department of Drug and Alcohol Programs said it can’t help monetarily, as it doesn’t fund facilities directly. Instead, the department has provided a list of COVID-19 resources on its website and tries to connect facilities with suppliers to acquire protective equipment.

Some companies that manage benefits for Medicaid patients have temporarily increased the amounts they pay rehabs, or agreed to continue paying for the number of patients who were enrolled before COVID-19. But facilities say these stopgap measures are not nearly enough.

Jonathan Wolf, CEO of Pyramid Healthcare — which owns dozens of facilities across Pennsylvania — said that since March, his company has spent nearly $1.5 million on protective equipment and hazard pay for employees, cleaning of facilities, and setting up telehealth services so fewer patients had to visit in person.

They’ve also created isolation pods within facilities for patients who get sick or those who are awaiting COVID-19 test results, sometimes for weeks. Since other patients can’t be housed with those individuals, the company has had fewer clients. Many people are also reluctant to seek treatment right now, fearing they’ll contract COVID-19.

Pyramid has lost about $13 million in revenue this year, Wolf said.

“It’s been a double whammy of hugely increased costs and hugely decreased revenue,” he said.

The company has closed seven treatment facilities over the past year, including one of the few remaining adolescent rehabs in the state.

Providers who treat patients on Medicaid have been hit particularly hard, Wolf and other speakers at the hearing said. COVID-19 has exacerbated long-standing issues with the low rates that Medicaid pays for patients in rehab.

Mark Schor, division president for Acadia Healthcare — which owns 25 facilities in Pennsylvania — said the average daily amount Medicaid pays for rehab has only increased about $50 over 30 years. That hardly keeps up with inflation, let alone increased costs during the pandemic, he said.

Over the past six months, Acadia has closed eight programs. As someone in recovery from heroin use himself, Schor said that scares him.

“[If this continues], one by one, we’re going to be closing these places and people like me aren’t going to have the opportunity to get care,” he said.

“You’ve got to do something,” he implored legislators.

Schor and others who testified asked lawmakers to allocate some COVID-19 funds specifically to addiction treatment, to increase Medicaid reimbursement rates, and to maintain relaxed regulations to allow widespread use of telehealth.

Drug and Alcohol Secretary Jennifer Smith echoed those calls, explaining that rehab facilities are facing many of the same challenges as hospitals and nursing homes: acquiring masks, gloves, and cleaning supplies; accessing testing with quick results amid a national backlog; and having enough staff even when people call out sick or take care of family members.

It’s crucial to address these challenges, Smith said, so treatment facilities will be around to handle the ongoing addiction epidemic once COVID-19 has passed.

“We are seeing increased overdoses. We are seeing recurrence of use for individuals who are in recovery,” she said. “We will need these programs.”