Description: A nursing facility with strengths in empathic communication and a multidisciplinary care approach lacked adequate awareness and training around substance use issues. To support the facility, the Center of Excellence for Nursing Facilities (COE-NF) delivered targeted educational resources and strategies to foster a recovery-oriented environment. These included staff training on addiction science, initiating 12-step support meetings, and enhancing communication with residents about substance use. By addressing these challenges, the facility aims to improve the quality of care and resident outcomes.
Case Description: Recognizing an increasing need to provide support to residents with substance use disorders, as well as new referrals for additional recovery support, the corporate director of behavioral health and dementia contacted the COE-NF for assistance.
Unique Challenges: While the facility excels in empathic communication, fosters a supportive environment, and uses a multidisciplinary approach, staff did not have the education and training to support residents with substance use disorders. Located in a small, rural area, the facility also has limited access to substance use support services and public transportation. Additionally, some staff were unfamiliar with non-stigmatizing language around substance use disorders, potentially leading to unintended harm.
Providing recovery support and fostering a recovery-based environment are essential, evidence-based practices, but they are not baseline skills. Supporting recovery involves more than medical treatment, and substance use disorders do not disappear when someone enters a nursing home. Research shows that factors such as increased isolation, chronic pain, and issues with medication management can make residents more susceptible to addiction. These challenges must be addressed compassionately and without judgment. With proper support, residents can experience improved outcomes and a better quality of life.
COE-NF Solution: The COE-NF recommended the following training and resources to the facility and supplied detailed information on each.
- Staff Education Training
- Resources
- Comfort Menu (to provide a guide for opening conversations with residents about substance use recovery support.) This offers an opportunity to discuss 12-step meetings with residents who have a substance use disorder.
- Staying Connected is Important: Virtual Recovery Resources
- 4 Ways Nursing Homes Can Promote Substance Use Recovery
- Establishing 12-step Meetings in Nursing Facilities using community Anonymous (AA)/Narcotics Anonymous (NA) resources.
- Language Matters Substance Use
- Identification and Intervention for Potential Substance Use Disorders in Nursing Facilities
- Substance Use Disorder In-Service Toolkit
- Substance Use and the Brain
In addition, the COE-NF took the following actions to initiate a 12-step support meeting:
- Located nearby NA meetings via the NA World Services website.
- Contacted the local NA hospitals and institutions chairperson, who is responsible for bringing the message of recovery to area facilities.
- Met with the representative to discuss the facility’s needs, expectations, confidentiality policies, meeting frequency, and volunteer numbers.
- Requested NA recovery literature, including a “Just for Today” book. This book serves as a daily meditation tool for NA members, offering daily affirmations and reflections to help individuals in recovery focus on sobriety.
- Promoted the 12-step meetings via bulletin boards, monthly calendars, and facility schedules, during staff meetings, and morning gatherings.
- Appointed a facility contact for the 12-step meetings (Social Services Department).
- Emphasized confidentiality for residents and volunteers.
- Designated a dedicated space for meetings.
Outcome/Benefits: Fifty-nine staff members completed the COE-NF-recommended training sessions. The regional director reports that the training has equipped staff with essential substance use education, enhanced their understanding of the pharmacology of addiction, and encouraged the use of more appropriate language. The corporate director also completed 20 training sessions.
In response to the facility’s growing interest, the COE-NF also delivered Crisis Prevention Intervention (CPI) De-Escalation training to 25 department heads. All received two-year CPI certifications.
COE-NF educational resources were printed and posted in employee areas and on bulletin boards for reference. A compelling example of impact came from a resident who, after using the Comfort Menu, reported feeling truly heard. This validation improved his relationships with other residents and his overall quality of life.
The facility now hosts bi-monthly 12-step meetings. Holding meetings in the facility removed transportation barriers, and cost was not an issue, as NA operates independently of insurance and is self-funded. During these sessions, staff receive materials on empathic communication and understanding addiction.
Implementation of these initiatives has led to improved staff confidence, knowledge, and morale, enhanced organizational culture, and better resident care. Through these efforts, the facility is advancing its commitment to supporting residents’ recovery journeys and building a more compassionate and recovery-informed environment.
