Missouri’s APS Response to the Opioid Crisis

By Jessica Bax, Division Director, Department of Health & Senior Services, Division of Senior & Disability Services, Jefferson City, Missouri

We have all seen the headlines about the opioid epidemic sweeping the nation. The issue is a national priority. With focus on the topic and how to combat the problem, sometimes it is easy to forget that the problem has a face and a real impact to our communities. Missouri’s Division of Senior and Disability Services prioritized the issue in 2018 by initiating efforts to identify the scope of the problem, how it is affecting the lives of those we serve, and strategies to assist individuals and communities with healing.

Earlier this year, the National Adult Protective Services Association (NAPSA) requested statistics from states on the frequency of adult abuse/neglect/exploitation hotlines relative to opioid use. As a result, Missouri initiated the use of a Significant Event Indicator “Opioid Hotline” to track hotline reports related to opioid use. Since February 13, 2018, 156 reports of abuse, neglect and exploitation have involved the use and/or abuse of opioids. But as stated above, the problem is not just about the numbers.

To understand the true impact of the crisis, we have to talk to people. DSDS frontline staff witness the impact to those we serve on a daily basis. So, we asked them. This is what they had to say:

  • Investigations of maltreatment of vulnerable adults tend to be more complex and place more burdens on services, requiring more time.
  • There is a lack of community resources for referral.
  • Some vulnerable adults will sell prescribed opioids, causing them continued pain and emotional issues.
  • Some vulnerable adults over medicate to the point they cannot meet their daily needs, resulting in poor hygiene, unsanitary living conditions, missing medical appointments, and difficulty with meal preparation.
  • Overmedicated individuals are severe fall risks. Unable to get up after falling, broken bones and head injuries often result.
  • Some vulnerable adults smoke cigarettes while over medicated, causing house fires, physical burns or even death.
  • Adult protective service response is often required quickly to ensure the safety of the vulnerable adult, who may be at risk of harming themselves or others. This takes up additional time and resources.
  • The abuse of opioids by those we serve presents a liability for adult protective services struggling with resources to assist those in crisis.

Frontline workers also had stories to tell, highlighting the face of the issue:

  • A live-in caregiver was stealing a vulnerable adult’s Hydrocodone, neglecting the disabled woman she is supposed to take care of.
  • A son steals his elderly mother’s pain medications. She caught him doing it, but believes he will not do it again. She refuses to press charges and refuses protective services’ interventions.
  • An elderly mother is evicted from her home due to domestic disturbances by her adult son and daughter, both known to have opioid addictions. The daughter is reported to be verbally abusive and the son allegedly broke his mother’s jaw in the past.

These stories suggest that this epidemic could touch the lives of any of us, affecting our mother, father, grandparent, sibling or other loved one. These are community problems, requiring a community effort to combat. Hearing the voices of those affected is a step in the right direction.

The National Center on Elder Abuse Director, Dr. Laura Mosqueda recognized Missouri during her Elder justice Coordinating Council meeting: Watch full video of the meeting. (her testimony begins at 17:47 min). National Adult Protective Services Association, National Policy Advisor Bill Benson’s testimony utilizing Missouri’s examples can also be viewed: (his testimony begins at 41:53-45:48 min).

This was such an incredible illustration of field voices being heard on Capitol Hill!

Want to learn more about us? Browse through our stop adult abuse site and read our Annual Report.


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Special Thanks to Judith D. Tamkin

We are sincerely appreciative to Judith D. Tamkin for her gift to help establish the USC Center on Elder Mistreatment’s website. Her deep and personal commitment to eradicating elder abuse is helping to reshape our understanding of elder abuse and ultimately save innumerable older adults from abuse and neglect.