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What you need to know about Pa.’s slow elder abuse investigations

Illustration of an older person looking outside a window as days go by.
Daniel Fishel
/
For Spotlight PA
Illustration of an older person looking outside a window as days go by.

This investigation will be highlighted in How We Care, a weekly newsletter by Spotlight PA featuring original reporting and perspectives on how we care for one another at all stages of life. Sign up for free here.

In Pennsylvania, county-level agencies investigate allegations of abuse and neglect involving older adults and come up with service plans to keep them safe.

There are 52 such agencies across the state, formally called Area Agencies on Aging, that collectively work to protect residents aged 60 or over in all 67 counties.

But a Spotlight PA investigation found that many of those agencies are woefully slow in completing those investigations despite state regulations requiring them to take action within 20 days of learning that an older adult may be in harm’s way.

Failing to meet that deadline, protective services workers, legislators, and others say, can leave older adults at risk and have devastating consequences. Those failures have coincided with a staggering increase in deaths of older adults during open investigations.

Here are key takeaways from Spotlight PA’s months-long investigation into the problem.

Falling short

In Pennsylvania, state regulations require county aging agencies to make “all reasonable efforts” to complete investigations of suspected abuse or neglect as soon as possible, but “at least within 20 days.” An investigation is complete only when the allegation has or has not been substantiated; and if substantiated, after necessary steps have been taken to reduce imminent risk to the older adult.

In its investigation, Spotlight PA requested and analyzed data dating back to the 2016-17 fiscal year from the Department of Aging, which oversees the county agencies.

During that time frame, anywhere from a third to nearly half the total cases investigated annually by the 52 agencies either missed that critical deadline or contained incomplete or faulty paperwork, making it impossible even to figure out whether they fell outside the 20-day window — let alone by how many days.

Some of those that fell outside the 20-day window were in cases classified as emergencies, meaning the older adult was at imminent risk of death or serious physical harm.

In the 2016-17 fiscal year, 49.5% of abuse and neglect investigations missed the deadline or lacked proper paperwork to know. The year after that, it was 46%. That number decreased to 35.4% in 2022-23, the most recent complete year of data.

Though that is an improvement, serious deficiencies persist, especially in Pennsylvania’s largest counties that serve more people and have the highest number of reports of suspected neglect and abuse.

An alarming rise in deaths

During the same time frame, there has been a staggering increase in the number of older Pennsylvanians who died during an open investigation of an abuse or neglect complaint, according to data obtained by Spotlight PA.

In 2018, 888 people died under these circumstances. In 2022 (the last complete year of data), that number was nearly 1,700 — a 91% increase.

State aging officials have attributed the spike in large part to the state’s growing population of older adults, a sharp rise in abuse and neglect complaints, and the pandemic that wreaked disproportionate havoc on vulnerable populations.

But because the department does not track the cause of death for people who die during open investigations and county agencies aren’t required to report it, accountability is near impossible.

Jason Kavulich, who heads the Department of Aging, has said he’s launching a “fatality review” process for cases where the circumstances surrounding an older adult’s death are suspicious.

Several lawmakers have urged the department to begin tracking the cause of death in every instance an older adult dies during an open investigation.

Little public information

The Department of Aging monitors compliance of county agencies by randomly selecting investigations completed in a given year to see how they were handled, and then assigning a performance score.

Few of its findings are readily available to the public.

If the bureau finds deficiencies, it can cite the county agency for noncompliance and require it to submit a plan to correct the problems. That plan is not a public record, according to a department spokesperson. As a result, the public cannot know what deficiencies exist, what is being done to fix them, or the ramifications they might have had for the people affected.

At Spotlight PA’s request, the Department of Aging provided a list of county agencies that are currently in noncompliance status, meaning their unsatisfactory performance left older adults at risk.

The department sent letters to those agencies between last summer and the start of this year informing them of their status. None of the letters described the actual problems. Nor did they say what the repercussions were, including whether older adults were harmed, or in what way.

A department spokesperson has told Spotlight PA that the agency intends to make compliance information available on its official website. In June, the department began posting someinformation, which it will update monthly, on how quickly a caseworker conducts a face-to-face interview with an older adult suspected of being abused or neglected (state regulations require that occurs within 24 hours in cases where the person is deemed at risk of imminent harm).

The spokesperson said the department intends to put more compliance-related data on the website in the coming months, although what information and in what format is not yet known.

‘We … have to do better’

State Rep. Lou Schmitt (R., Blair) recently introduced legislation that would require the Department of Aging to publish the compliance status of each of the 52 county agencies.

And Kavulich told Spotlight PA that “we as a department have to do better.”

Kavulich said he has mandated monthly meetings with the county agencies with the worst compliance rates. The hope, he said, is to hear what may be causing the problems and provide technical assistance.

At least one longtime protective services director told Spotlight PA that he would support changing the regulations to give county agencies longer than 20 days to complete investigations of suspected abuse and neglect.

Kavulich said he too believes the regulations should be modernized, but stopped short of calling for lengthening the 20-day deadline.

Read Spotlight PA’s full investigation here.