CULPEPER STAR-EXPONENT, ALLISON BROPHY CHAMPION
Another side effect of the prolonged pandemic and associated economic distress, substance abuse disorder and overdoses continue to be on the rise at alarming levels.
In that environment, Boxwood Recovery Center has only been able to accept half the usual patients in the past 23 months.
This is due to COVID restrictions on distanced living arrangements at the area’s only state-run residential treatment center for drug and alcohol addiction, a chronic medical disease. The program is 28 days and has been around for decades. It was formerly located in Ruby Beck’s iconic Boxwood Inn & Restaurant on U.S. Route 29.
The trailblazing Black female entrepreneur named the place—popular among all segments of the population—for the decorative hedge, rooted in her love of landscaping. Beck ran the integrated business successfully during segregation and it later became Boxwood Recovery Center.
Rep. Abigail Spanberger got a first-hand look at the decreased capacity last week at the current facility off of Brandy Road in Culpeper during the first stop on her tour of recovery centers. She heard from Rappahannock-Rapidan Community Services administrators about how they have adapted to COVID while keeping the recovery efforts going.
COVID cuts capacity in half
The old Boxwood was quietly closed down and reopened at the new location a decade ago, in 2012. Boxwood today offers 26 residential beds in male-female mirrored dorm areas along with a shared cafeteria, library, workout room and spaces for meetings and other program offerings.
The sun-lit facility with high ceilings has another six medically-monitored detox beds, said RRCS Director Jim LaGraffe on the tour.
“We have to talk pre-COVID, current COVID because being a residential treatment center,” the pandemic has certainly impacted Boxwood.
“Because of COVID, we actually converted the detox (area) temporarily for quarantine,” LaGraffe told Spanberger. “They take a (COVID) test (when patients arrive) and clear them after 72 hours. The program also is designed for shared occupancy rooms, but we have all single occupancy rooms.”
The community services director hoped the program would ramp back soon.
“Hopefully, we’ll get better in the future because we have to learn a little better to live with COVID,” LaGraffe said.
Spanberger asked how the decreased occupancy has impacted the site’s ability to serve clients.
“We’re serving half the people we were serving before,” LaGraffe said.
People previously detoxed at Boxwood are now sent to overcrowded local hospitals while PCR testing is done at the residential rehab facility to limit spread in the congregate setting.
“We just discharged a bunch of people today so today’s population is very low, five people,” said LaGraffe during the Jan. 27 tour. “Would have been higher, but had some tested for COVID…The overdose rates have just been astronomical,” he added.
Shutting down detox, doing their best
RRCS Behavioral Health Division Director Ryan Banks said the agency is dealing with an epidemic during a pandemic. Drug use is ever on the rise and deadlier than ever.
“The nuances of keeping services open and recognizing the services are absolutely necessary and also keeping people safe from COVID and just pivot, pivot, pivot continuously all of our programs,” she said. “We never closed. We just adapted and adjusted.”
There are facilities in areas around Culpeper where detox is available, Banks said. The way the detox area is set up and how Boxwood is designed are not conducive to treating and monitoring patients in a pandemic, she said.
“We have to reimagine how we can use the building to get everything back and running but it’s a matter of physical orientation,” Banks said. She added it was “a moving target” as to when Boxwood would return to full capacity, saying her goal is as soon as possible.
There is nothing like a waiting list for the facility, said Boxwood program manager Kolapo Olarinde. Clients are typically referral-based having undergone a pre-admission assessment through RRCS crisis services.
At full capacity, Boxwood has three counseling clinicians on site, down to one clinician currently and Olarinde stepping in as a second counselor with his counseling background.
With the reduced occupancy right now, Spanberger asked, people who can’t come to Boxwood, what other options exist for them?
That is based on a client’s place of residence, Olarinde said, of potential transfers to other residential facilities and other options. Boxwood is much lower cost that private-run centers; the closest thing like it is located in Charlottesville through Region 10 community services.
“We do our best,” said Olarinde, “Even if somebody were initially to have a situation where they are not a candidate for Boxwood, we try to help them address it, constantly trying to work with people even with COVID-if somebody’s positive we reassess later after they quarantine.”
Worker shortage hinders expansion
Boxwood staff members also have their own recovery stories and recognize the importance of services and getting people connected with the recovery community, Banks said: “They can relate and (clients) see that they understand.”
Boxwood accepts repeat clients, Olarinde said. It’s the nature of the disease.
“If you look at substance abuse as more of a journey, as a process in their life, there is different ways to measure success. Someone might leave, relapse and come back, but that whole journey is part of the process of living a life of sobriety.
“When they come back they’re better than they were before,” the recovery center director said.
Added Banks, “Boxwood is 28 days, but people need more than that. But they don’t necessarily need more Boxwood, they need the full spectrum of services. We work very hard to try and bring all levels of care to the community, and are trying to expand that.”
Boxwood clients return as well to lead NA and AA meetings, come back to share their stories, Olarinde said: “That’s the great thing about recovery because it is a family amongst people trying to support people.”
The residential recovery center sits on 12 acres close to the Route 29 junction and entrance to Northern Virginia. The dorms have patio areas and in the expansive yellowed winter field out back is a volleyball court, horseshoe pits and a faded figure-eight walking path, not currently maintained due to the worker shortage.
LaGrafff said they have no current plans to expand.
“The biggest impediment to everything we do and not do right now is the workforce issue,” he said last week. RRCS has 60 open positions of 415 total budgeted. “About 14 percent and frankly we’re doing really well at that vacancy rate,” said LaGraffe.
Direct support professionals are most in need at the moment with the largest vacancy for those to run residential programs for people with intellectual disabilities, he said.
“Mental health (positions), nursing is a killer,” LaGraffe said of severe shortages. “We live in a weird area here—the draw of Charlottesville, Fredericksburg and northern VA—all of those areas pay significantly more than we can and we’re an expensive place to live.”
Needs, solutions, legislation and an anniversary
Virginia ranks 47th for the availability of licensed behavioral health professionals, horribly below the national average, the RRCS director said. The field is further bracing for a tsunami of retirement of social workers coming in the near future, Banks added.
The five-county Culpeper area lacks a single acute level behavioral health bed for people needing hospital level of care while in a mental health crisis, said LaGraffe pointed out. There is no crisis stabilization center, he added.
“When we approached the dept. of behavioral health a year ago said we would love to create a crisis stabilization unit we were told our population did not support one,” LaGraffe said.
“So they have to leave area, their families and support systems and people aren’t going to do that.”
Spanberger asked for specific policy items she could help address related to local recovery services. Banks was quick to answer, referencing a restriction that prevents licensed professional counselors for billing Medicare for their services.
Only licensed professional social workers can, Banks said, even though both positions require the same college education and credentialing.
“We need to fix it because I never know who I am going to hire in our workforce shortage,” she told the congresswoman. “They are learning the same things, same service, same requirements to become fully licensed and then have counselors who are limited it does at times put a backlog on Medicare.”
According to an aide at the tour, legislation has been introduced on the issue and Spanberger has supported it.
“It’s such an easy fix,” LaGraffe said.
Spanberger was also quick to reply.
“Within the confines of this pandemic, that would be the urgency for me to push it further,” she said. “We’ll follow up on that.”
Boxwood accepts patients from across the state and has 20 such agreements in place with other entities for doing so.
Keeping it running, in good health and bad, RRCS is celebrating its 50th anniversary this year of providing local behavioral health services, since Oct. 30, 1972.