HARRISBURG — The Shapiro administration has changed the way it grades the performance of agencies that protect Pennsylvania’s most vulnerable older adults from abuse and neglect, a move critics say will create a false impression of how effective they are at providing quality protective services.
For years, many of the 52 county Area Agencies on Aging have struggled to comply with strict standards for keeping older adults safe, in some cases even leaving them at risk of harm.
The Department of Aging, which oversees the agencies, eliminated its weighted system of scoring their performance this year, meaning counties will no longer be graded more harshly for serious investigative failures, according to interviews and documents obtained by Spotlight PA through public records requests.
Instead, the department will equally score relatively minor problems — such as poorly kept paperwork — and more serious deficiencies, such as failing to swiftly complete abuse and neglect investigations. The latter is considered a critical part of reducing an older adult’s risk of harm.
Department critics believe the change will further mask persistent failures in the state’s system for protecting older adults — many of them poor, marginalized, and with no alternative safety net — even as this population continues to die in alarming numbers while under the care of the system.
From 2023 through the end of last year, nearly 3,000 older adults died during open abuse and neglect investigations. The majority had no final determination or service plan to keep them safe within 20 days, as required under state law.
“I will be shocked if almost all [counties] don’t show up compliant” with state standards, said Peter Hans, a former Department of Aging employee who monitored county aging agencies before retiring last year.
“But when you water down monitoring, who are you really helping? It’s not the older adult.”
In an interview with Spotlight PA earlier this spring, Secretary of Aging Jason Kavulich did not answer when asked whether the new monitoring platform would make it easier for county agencies to be found compliant with state regulations.
Department spokesperson Karen Gray later rejected the notion in a statement, asserting it had “no basis in fact,” and is “predicated on the notion that an ‘overall pass-fail grade’ should be the centerpiece of understanding, evaluating and improving a [county’s] performance.”
She also said the old monitoring system risked ignoring problems in areas considered less important under the weighted scoring rubric, potentially leading to ignoring “the small stuff” that can have just as much of an impact on an older adult’s safety.
In the interview, Kavulich said the department wanted to move away from the old practice of doling out pass or fail scores that simply label counties as compliant or noncompliant. The new system would provide a sharper picture of what county aging agencies are doing well, he said, as well as where their weaknesses lie, so that the department can work with them to fix problems.
“We’re moving away from that pass-fail system,” Kavulich said. “If you think about it, it really is a minimal standard — it was just enough to get you over the finish line that made you compliant. This is about really looking comprehensively at their work.”
He added: “One of the failures of the legacy system was that the agencies weren’t fixing the problems. Just because an agency got to compliance didn’t mean that they were correcting the issues that were prevalent.”
In a statement, the association that represents the aging agencies praised the department’s new monitoring system, calling it “more extensive” and objective. The focus on quality improvement, the association said, will ultimately lead to better services and outcomes for older adults.
In Pennsylvania, the Department of Aging funds the 52 county aging agencies — some government-run, others nonprofit — that provide protective and other services (including meals and transportation) to the state’s nearly 3.5 million adults aged 60 or older.
The department is also responsible for monitoring the aging programs administered by the counties, chief among them, protective services for older adults. Under state guidelines, counties investigate allegations of abuse and neglect, and if the claims are substantiated, they assemble service plans (which can include meals, caregiving, and guardianship) to ensure the older adult's safety.
It is difficult work, aging officials say, and the department for years employed a lengthy checklist of criteria for assessing the counties. Those criteria included how quickly counties launched an investigation; whether they properly documented the steps they took to determine whether the older adult was at risk of harm; and whether they provided services that minimized that risk.
It then used a weighted system to calculate an overall score that determined whether the agency was compliant or noncompliant with state regulations.
For instance, failing to conduct a timely abuse and neglect investigation — a harder standard to achieve than others — was weighted more heavily under the old system, according to records obtained by Spotlight PA.
The heaviest weight was placed on whether abuse and neglect investigations were comprehensive, and whether risks to an older adult’s safety were “eliminated, mitigated, or reduced.”
Under the new monitoring system — called the Comprehensive Agency Performance Evaluation, or CAPE — every category is weighted the same, and county aging agencies are no longer labeled as compliant or noncompliant.
The aging department also did away with a handful of assessment categories, including one that looked at whether a county’s abuse and neglect investigations were comprehensive.
Sheri McQuown, a former department specialist who monitored counties for seven years, said the latter is particularly troubling.
“If the investigation was not comprehensive … it is not possible to accurately assess if risk is present, and if so, to offer risk-mitigating services,” she said. “This decision is detrimental to the health and safety of older adults.”
The threshold for being found compliant with state regulations was also lowered from a score of 85% to 75% (although Kavulich said it will eventually go back to 85%). And counties will be assessed every 18 months, rather than annually.
Still, Kavulich said his department is adding a new layer of accountability and transparency for county aging agencies with chronic problems. For the first time in his agency’s history, he said monitoring results will be posted on the department’s website.
He also said if a county agency does not make significant progress in problem areas after three monitoring cycles — that is, over a four-and-a-half-year period — the department will move to decertify it.
All 52 county aging agencies have five-year contracts with the state to provide senior services. Those agreements are being renewed this month, and Kavulich said the department will add in clear language to that effect.
“One of the failures of the legacy system was that the agency didn’t necessarily fix the problem and still could become compliant,” he said. “So this helps us say, ‘You didn’t fix the problem … and we are going to have to take some serious action.’”
During a legislative hearing in April, Kavulich told lawmakers he inherited a monitoring system in disarray. He called it “subjective,” governed by the whims and opinions of whichever aging department employee was doing the assessment.
He asserted that there was no consistency in how many sample cases the department reviewed when conducting a monitoring, and even suggested that the weights assigned to areas it monitored would randomly change from one county to another — an assertion Hans and McQuown said was false.
“The weights and the categories were subject to the person sitting there doing them,” Kavulich said.
Kavulich also said the legacy monitoring system was erratic. The department is supposed to assess all 52 county aging agencies annually. But in 2022, the year before he took over the agency, only 29 counties were monitored, he said.
In contrast, he said in his first year overseeing the department, the agency monitored 48 counties (public records obtained by Spotlight PA show 40 counties were assessed that year). The department refused to say how many were monitored last year, when CAPE was being piloted, but Spotlight PA has learned through two sources that only seven were assessed.
Kavulich said assessments will be done on a consistent schedule, adding that the 18-month timeline builds in time for the department to work with counties to assemble improvement plans, as well as time for counties to execute those improvements.
Denise Getgen, the department’s former director of protective services, rejected Kavulich’s assessment of the old monitoring system.
She said the department’s monitoring mirrored requirements derived straight from state regulations. She also disputed the idea that assessments were based on opinion, saying “all serious findings that involved risk or injury to an older adult were reviewed by multiple experienced staff who agreed on the findings.”
So far this year, the department has monitored six aging agencies using CAPE, according to monitoring information it recently started publishing for the first time on its website. They are Armstrong, Beaver, Centre, Chester, Mifflin-Juniata, and York Counties.
The department publishes overall scores in five main categories. Of the six agencies assessed so far, five scored over 75% in the majority of the five categories.
Because the department does not assign an overall score or a compliant or noncompliant designation, it is difficult for the public to understand exactly where their local agency is falling short.
Asked to explain why, Gray said, “Instead of focusing on an averaged, overall grade, CAPE is holding AAAs to a high standard on individual metrics. This new approach creates a tailored performance plan for a AAA with deficiencies, and is designed to recognize the importance of multiple areas of services – not simply just a passing or failing score.”
Updated records recently obtained by Spotlight PA through public records requests — and not available on the department’s website — show that since Kavulich took over the department, the 52 county agencies fell far short of completing abuse and neglect investigations in a timely manner — a critical requirement.
State regulations say they must complete those investigations and put a service plan in place to help the older adult within 20 days or less. In 2023, nearly 61% of abuse and neglect investigations statewide missed that deadline.
In 2024, just over 57% of investigations missed that mark, according to records; that number could change, since there are cases from last year that might remain open.
Under Kavulich, the department has asserted that the 20-day requirement is “a goal” rather than a requirement. Yet Pennsylvania’s regulations clearly state that in cases of abuse and neglect specifically, investigations must be completed “at least within 20 days” from the time an allegation is reported.
Meanwhile, older adults continue to die in high numbers while protective services workers are investigating their cases — many past the 20-day state deadline.
“Why is that not a huge problem for our legislature, when cases are open many, many times beyond 20 days?” said Hans, who, along with other former Aging employees, has met with lawmakers in recent months to sound the alarm. “We are talking open for hundreds, sometimes I saw them open for multiple years. The same investigation.”
Hans said he came across one case in 2023 that had been open for 549 days when the older adult died.
“And we have to sit here month after month after month discussing this,” he added. “We can’t get the legislature to hold hearings to say, `We’ve got a fricking problem, this is unacceptable, our citizens are dying.’”