COLLATERAL DAMAGE: Elder Abuse and the Opioid Epidemic in Rural Virginia

Many articles, studies, and commissions were completed, and various workshops, seminars, and conferences were held on opioid challenges in cities, states, and the federal government. For example, in its' fourth year, the Southwest Virginia Legal Aid, in collaboration with the Southwest Virginia Elder Justice Task Force, sponsored a virtual conference on Zoom, entitled, "COLLATERAL DAMAGE: Elder Abuse and the Opioid Epidemic in Rural Virginia."

How is this topic so significant to the elderly? Understanding what opioids are, how it impacts elders' lives, and how you can recognize, prevent, and identify resources to assist you, a family member, a friend, or even a stranger.

Joseph Carico, Esquire, Executive Director of Southwest Virginia Legal Aid, gave the welcome remarks, where he thanked the sponsors for their support and welcomed over 500 participants.

The first keynote speaker, Kimberly Snow, Cutter Institute, Elder Abuse, and Medicare Policy, provided an enlightening presentation entitled, "The Role of the Opioid Crisis in Elder Abuse: Lessons from Main APS Investigations," a study completed by herself, Jennifer Pratt, and Stuart Bratesman in Maine. Some takeaways from the presentation:

• Compared with the national statistic, 25% of adults 65 and older have the highest opioid prescription medication usage versus 15% nationally have at least one opioid prescription.
• Common systematic issues in rural areas are decrease availability of healthcare and long-term services and support, increase levels of poverty, and social isolation. When you add the opioid crisis to these challenges, it magnifies these issues.
• Older adults have opioid addiction because of chronic pain, thus developing dependency and addiction. In addition, opioids stay in the body longer compared to younger adults.
• Between 2006-2018, the number of opioid inpatient admission per 1,000 people 65 and older increased. From 2018, it has decreased. However, little data has been collected or released during the pandemic.
• Significant financial ramifications include vulnerability to poor financial decision making. Other implications include: dying at home in an opioid crisis, Hospices grapple with stolen medications, caregiver neglect, and physical abuse.
• Over 9,000 elderly abuse cases from 2015-2018, 2,400 investigations with opioid-related inappropriate opioid use. Clients with drug-related investigations were more lively to live with a relative and less likely to live in a facility.

Snow presented both quantitative and qualitative findings, barriers of clients assessing prescription opioid medications, client mismanagement of opioid medications, clients’ denial of misuse, and clients’ silence about abuse from relatives or friends.

Suggestions given:

• Improve data collection
• Need to stop abuse, restorative justice option.
• Improve medication management
• Improve risk assessment for an opioid prescription for older adults
• Compassionate tapering off of opioid medication
• Expand treatment strategies in a rural landscape
  

The study can be found at  https://digitalcommons.usm.maine.edu/aging/126/

The breakout sessions built on the keynote research and espoused specific topics in more detail. These topics ranged from Financial Abuse, Opioid Abuse, Medicaid Fraud, Restorative Justice, and Virginia's Family First Initiatives. Two of the sessions are highlighted below.

Financial Abuse, "Protecting Our Seniors from Financial Abuse," by DeMarion Johnston, Esq., General Counsel, Virginia Bankers Association

The workshop centered on why seniors are so vulnerable, why we should care, and the types of elder financial exploitation. According to Johnson's presentation, "Elder financial exploitation" or "Elder/Adult financial abuse" is the fraudulent or illegal use of the resources of an older adult for monetary or personal benefit.

Johnson cited the following information and trends regarding financial abuse:

• It’s the fastest growing crime in the United States.
• The Consumer Financial Protection Bureau found actual losses and attempts at elder financial exploitation reported by financial institutions nationwide were $1.7 billion in 2017.
• Studies published from 2016 to 2020 from New York, Pennsylvania, and Virginia estimated that financial exploitation costs could be more than $1 billion in each state alone.
• It is estimated that one in five seniors is a victim of financial exploitation each year.
•  Victims suffer financial losses averaging $120,000.
• The financial abuse perpetrators are usually family or trusted persons, sometimes strangers, and legal guardians, agents, or proxies. The closer the relationship between the victim and perpetrator, the greater the financial loss. The presenter recommended a limited Power of Attorney (POA).

Johnston highlighted the federal and state laws, elderly financial exploitation code of Virginia, how to report suspected abuse, the role of a mandatory reporter, Virginia code 63.2-1609, www.law.lis.virginia.gov, emergency order for Adult Protective Service (APS), Senior Safe Act, Financial abuse warning signs, and the challenges with elder financial abuse.

For additional information on the Consumer report article entitled: How to prevent Senior financial abuse, please go to: https://www.consumerreports.org/elder-fraud/ways-to-prevent-elder-financial-abuse/

Elder Justice Efforts in a Restorative Justice Framework

Sarah M. Morton, Esq., Elderly Services Attorney, Blue Ridge Legal Services, Harrisonburg, VA

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What is Restorative Justice? The focus is less on laws and more on what the victims want and needs to make them "whole." This process is much like a mediation or conflict resolution and most likely includes the survivor, offender, and a neutral trained facilitator.

According to Morton, the major themes of all restorative justice efforts are:

• A foundational belief is that acknowledging the offense and the harm is both helpful to the victim's healing and a necessary condition for a future right relationship.

• Focus shifts from broken laws and punishment to broken relationships and healing the damage.

• Victim plays an active role in the goal setting, the process, and how the offender will make amends.

• Offenders are held accountable yet still cared for, and in the end, are restored as members of the family and community.

• Aims to reduce recidivism by promoting positive behavior.

• Acknowledges that the offense impacts the survivors, their family, their community, and the offenders themselves.

The major benefits are:

• Re-compensation and restoration
• Reconcile relationships
• Having life get back to normal
• Achieving the goals in a way that helps the client finds meaningful
• Restorative justice may have fewer of the pitfalls we sometimes face

Morton explained the history of restorative justice, who benefits, when might a senior uses restorative justice, elder-focused restorative justice efforts, and the pitfalls. Some of the pitfalls include:

• Power Imbalances  
• Lack of an enforcement mechanism. A fallback to the adversarial system may be needed.
• Less fact-finding, de-emphasis of guilt determination
• Group or family punishment
• Possible unequal treatment from one offender to the next
• Spiritual components can be seen as a positive or a negative

Other workshops focused on law enforcement, caregivers, advocacy, and physical, mental, and financial abuse of the elderly. please visit the following site for course material and information about the presenters, https://www.swvalegalaid.org/ea21-materials

The closing plenary was a powerful session on "Methamphetamine: The "Alpha Drug" by

First Sergeant Charles L. Parsons, Drug Enforcement Section, Virginia State Police, Wytheville, VA.

Parson showed a video on the history of methamphetamine (meth). He explained that meth use has double in recent years, where there has been a decrease in heroin; the increase in meth has been 814% from 2012-2019. Meth is a powerful drug that affects the nervous system, produces dopamine in the brain, gives an intense rush that lasts up to 12 hours, is highly addictive, and there is only a 7% success rate of getting off meth. Once a person is addicted, meth is a mental addiction that, once addicted, a person never stops thinking about it. The presentation highlighted what meth does to a person's short-term and long-term usage.

Meth has taken its toll on many communities. Cartels bring meth to Southwest Virginia, sell it cheap, and the demands are high. He explains that the cartels migrated to West Coast and now the East Coast. Communities in Virginia should be aware that meth may be on its way to their communities, if not already, Parson said.

Daveena Sexton, Director of Advancement, Southwest Virginia Legal Aid, gave the closing remarks. Sexton thanked the attendees, presenters, and sponsors. The sponsors were: Virginia Law Foundation, the Virginia Coalition for the Prevention of Elder Abuse (VCPEA), and Anthem Healthkeepers Plus.

Other topics covered during the conference are below and can be seen at the link provided above:

• Medicaid Fraud by Janine Myatt, Esq., Assistant Attorney General, Medicaid Fraud Control Unit, Office of the Attorney General of Virginia

• Elder Abuse Guide for Law Enforcement (EAGLE) – Part One, Part Two, and Part Three National Center on Elder Abuse (NCEA), Alhambra, CA, by Julie Schoen, Deputy Director, NCEA, and Alexis Calleros, Administrative Assistant, NCEA

• Grandparents and Other Non-Parent Kinship Families: Legal Rights by Gerard Wallace, Esq., Program Director Retired, New York State Kinship Navigator
  
• ​Virginia's Family First Initiative: Prioritizing Prevention Services and Family-Based Placements by  Lauren Weidner, Family First Change Management Specialist, VA Department of Social Services, and Nancy Boyd, Kinship Navigator, Dickenson County Department of Social Services Amanda Romans, Kinship Navigator, Smyth County Department of Social Services

• Seniors, Pain Relief, and Opioid Abuse: A History Lesson Taught Through Time by Deborah H. Bell, Community Outreach Coordinator, Office of the Attorney General of Virginia
  
• Battered, Broken, and Burned: Recognizing Injuries in Suspected Older Adult Abuse by Melissa Ratcliff Harper, MSN, APRN, SANE-A, SANE-P