Home welcomes methadone clinic

By N. Clark Judd

A Westchester hospital and a Kingsbridge Heights nursing home hope to create the first-ever methadone clinic to operate in a New York nursing home.

Every week, 45 people — including people in wheelchairs, people who are unable to stand on their own, even people in their 30s who need skilled nursing care — wait at their nursing home in Kingsbridge Terrace for a ride to Westchester.

They live in the Terrace Health Care Center, a facility in the southeastern end of Community Board 8’s coverage area. They take methadone for addiction treatment, and go to St. Joseph’s Medical Center to get their weekly doses.

Lowell Feldman, the administrator of Terrace Health Care Center, says these trips are an insult to his residents’ dignity. Medicaid spends $50,000 a year annually to shuttle the patients between Westchester and Kingsbridge Heights, Mary O’Mara, a vice president at St. Joseph’s, said.

They have proposed an unprecedented solution: open a satellite of St. Joseph’s methadone treatment program at the nursing home. The facility would be a satellite clinic with a registered nurse on site seven days a week, counselors five days a week, and a part-time clerical staff member, Ms. O’Mara told Board 8’s health and hospitals committee Monday night.

Currently, nursing homes can dispense methadone for pain, but not for addiction. Ms. O’Mara said the clinic would seek to begin with a license to serve 50 patients, with about 45 of those coming from Terrace Health.

St. Joseph’s will eventually seek to serve 100 people out of the facility, which will go into space at Terrace Health now being renovated for the purpose, Ms. O’Mara said. The clinic would be a satellite of St. Joseph’s existing program, which serves 300 people with chronic narcotic addiction, and would remain targeted specifically to people who live at Terrace Health.

However, federal guidelines require methadone clinics to make treatment available to people in the communities surrounding them. Those guidelines are apparently vague as to how many spaces in a treatment program must be kept open to the community or even a definition of what “community” means in this context.

A spokeswoman for the state Office of Alcoholism and Substance Abuse Services, Jennifer Farrell, said anyone for whom methadone was medically necessary would be eligible for treatment regardless of where they live.

“It’s manpower-intensive,” said Lowell Feldman, the administrator of Terrace Health Care Center, of taking his residents to Westchester as part of their treatment. “Some of them are seriously ill … and it’s become overwhelming to get them there in a dignified and confidential manner.”

“They get enrolled in a program,” Ms. O’Mara explained. “This is not like a pharmacy. They get counseling services, they get medical services … So you don’t just walk in and say, ‘Here, give me my methadone.’ You have to be a member, you have to be enrolled in the clinic.”

The chairman of Board 8’s health and hospitals committee, Dr. Martin Katzenstein, said the goal of the program was “very laudatory.”

But the idea of people coming to the clinic from elsewhere — as he put it, “from all over the Bronx” — concerned him.

And members of his committee peppered Ms. O’Mara with questions about how St. Joseph’s and the nursing home would be reimbursed by the state for the care of these patients.

Ms. O’Mara said the clinic would need 75 clients in order to be viable.

Ms. Farrell, the state spokeswoman, said the hospital has not yet filed its application with the state.

Members of the Board 8 committee anticipated opposition by default from people who live in the Riverdale/Kingsbridge area.

“People are just going to automatically get upset” at the idea of a methadone clinic, said Board 8 member Phil Friedman.

When the matter goes to the full community board for approval, Mr. Katzenstein predicted, “It’s going to be one of those meetings.”

Among people devoted to caring and advocating for people with drug addictions, the idea may have a warmer reception.

“What is absolutely shameful … is that indeed I do believe it is a first,” said Dr. Robert Newman, a pioneer in the field of methadone maintenance as a treatment for chronic addition. “And it is inexplicable.”

Dr. Newman said methadone radically lowers the mortality rate among opiate-dependent people, which may mean that nursing homes will receive more people who could use an in-house methadone treatment program in the future.

Terrace Health Care does not just take care of older folks, though. It’s open to anyone who needs skilled nursing care who is 21 or older.

Ms. O’Mara, of St. Joseph’s, said the hospital hopes to open the clinic in the fall.