PROJECT SUMMARY Opioid use disorder (OUD) is increasing in older adults (≥65 years) and among younger people with disabilities who are enrolled in Medicare. Increased opioid-related hospitalizations and emergency department visits have also been reported in this population. Comprehensive post-acute care (PAC) for people with OUD (PWOUD) should address the care needs for both OUD treatment and other medical issues. As existing initiatives to prevent and treat OUD primarily target community-based residents, much is still unknown about when and how PWOUD interact with institutional settings for post-acute and long-term care such as skilled nursing facilities (SNFs). There are also knowledge gaps about whether OUD represents a barrier to admission to higher quality SNFs, the outcomes of PWOUD who enter SNFs, and about the capacity to deliver OUD treatment in these settings. Yet, SNFs which are a dominant setting for institutional post-acute care SNFs are receiving more referrals for PWOUD. The long-term goal of this research is eventual partnership with SNFs to improve the willingness and capacity to provide medications for OUD (MOUD) for PWOUD in post-acute and long-term care settings. The objective of this application, the first step toward this long-term goal, is to examine the quality of SNFs that admit PWOUD, survival and health care trajectories after OUD-related hospitalization, and elicit provider perspectives on strategies to improve access to MOUD in SNFs. The two-pronged study rationale is to address knowledge gaps on SNF use and outcomes for PWOUD, and encourage better integration of addiction treatment with gerontologic and post-acute care services. We will analyze 2015-2019 inpatient hospital claims for 100% fee- for-service Medicare beneficiaries linked to or combined with other data (e.g., enrollment, Nursing Home Compare, Minimum Data Set, Part D, Omnicare PAC pharmacy data and SNF electronic medical records). Our Specific Aims are to: 1) Assess receipt of post-acute care by Medicare beneficiaries with OUD, including the attributes of SNFs they enter, health care use and survival trajectories, and availability of providers for OUD treatment in neighborhoods where SNFs are located. 2) Identify and describe barriers and facilitators for the placement of PWOUD in nursing homes, and best practices for providing access to OUD treatment by eliciting the views of nursing home personnel. In Aim 2, we will conduct semi-structured telephone interviews with nursing home administrators, admissions coordinators, and direct care staff to obtain rich contextual information about the mechanisms that shape post-acute SNF use and outcomes for PWOUD. The interviews will also provide preliminary data to inform the design and potential feasibility of interventions to improve OUD treatment in SNFs. Both aims will also examine whether SNF use and outcomes differ between younger and older adults with OUD. Developing this evidence will enhance efforts to des...