Breaking rules intended to keep Pa.’s older adults safe is rarely met with state sanctions

Angela Couloumbis of Spotlight PA

Photo Courtesy of Commonwealth Media Services

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HARRISBURG — In the fall of last year, a Pennsylvania Department of Aging specialist fired off an email to management with an urgent plea.

The staffer had just finished reviewing cases involving older adults who had died after someone had reported them as being at risk of neglect and abuse. Those people, the email said, died while the agencies in their counties responsible for keeping them safe were supposed to be investigating their circumstances.

The specialist had spoken up many times about the “massive inability” of some of those county organizations, called area agencies on aging, to follow the state’s rules for protecting older adults.

“We are not doing enough as a department to address this crisis,” the employee wrote, according to a copy of the message obtained by Spotlight PA. “This is not okay. This is not moral.”

Since 2017, the Department of Aging has found anywhere from 10% to more than a third of Pennsylvania’s 52 area agencies on aging were failing annually to comply with state regulations, according to data analyzed by Spotlight PA. The regulations are intended to keep older adults safe, imposing standards on everything from training staff to correctly investigate allegations of elder abuse to setting deadlines for conducting those probes.

In all, six county agencies fell short of the regulations in most years examined by the news organization. In some years, the Department of Aging didn’t monitor them at all, despite those chronic failures. Some of those agencies, including the ones in Philadelphia and Westmoreland County, serve some of the largest and densest populations of older adults in the state.

Yet, the Department of Aging, which annually monitors the county agencies for compliance with the regulations and funds their operations, has never taken punitive action against those that don’t meet state standards. The department has not yanked their funding, forced them to spend more on protective services, or even regularly alerted the county’s local government officials to the problems.

In fact, it keeps the information about their performance largely secret.

The department does not publicly identify deficient counties, and is fighting efforts by Spotlight PA to reveal the problems it has pinpointed in the aging agencies, as well as what counties are doing to improve the quality of their protective services. It also did not disclose critical data about the quality of protective services provided by some of those county agencies — and in doing so, created a false picture of their ability to comply with the rules.

As a result, the public is left almost entirely in the dark about the performance of agencies that are often the first line of defense in keeping older adults safe from harm.

More crucially, it is near impossible to determine how often or to what extent older adults are left at risk or die because of deficiencies at a county aging agency. Investigative case files are confidential, and the department does not track the cause of death when an older adult dies during an active protective services investigation.

“We see noncompliance year after year, and it’s just like, ‘Hey, you shouldn’t do this,’” said Peter Hans, a veteran aging services specialist at the Department of Aging who retired this past summer. “But if the department doesn’t hold them to account for their behavior, there is no incentive to change … and the public doesn’t know what’s happening.”

Hans said the department’s watchdog role has been further eroded since Democratic Gov. Josh Shapiro appointed a new head of the agency in January of last year. Under new leadership, Hans said, the department is currently changing its monitoring rules in ways that will make it easier for county aging agencies to be deemed compliant with the law.

Department spokesperson Karen Gray said in an email that the department has worked cooperatively, rather than punitively, with the county agencies to help them improve the quality of their protective services.

Taking actions such as withholding funding could create a crisis.

“Without , there is no other government entity or organization readily available that has the expertise to provide these critical services for older adults,” said Gray.

Gray also said the department has created “specific and measurable goals” to help noncompliant county agencies improve their performance, including enhanced training and emphasizing accountability among supervisors who work there and oversee the day-to-day work. (Read her full response here.)

The Department of Aging monitors compliance of county agencies by randomly selecting investigations completed in a given year to see how they were handled. It then uses a scoring system to assign the agencies a rating: compliant or noncompliant.

Through Pennsylvania’s public records law, Spotlight PA requested the compliance status for every county aging agency from 2017 through 2023. (The data for 2024 are not complete.)

The news organization also asked for the dates the agencies were monitored, if they were found out of compliance, the number of deficiencies discovered, what those deficiencies were, and any plans the counties submitted to the department for how they intended to correct the problems.

The aging department refused to provide most of the requested information, aside from the compliance status of counties. Spotlight PA has appealed the denial to the independent Office of Open Records. But through other sources, the news outlet has obtained some of the denied information, including the list of deficiencies found at county agencies.

The data show that the overall number of county agencies found to be out of compliance increased in most years. In 2017, 10 agencies, or nearly 20%, did not comply with state regulations. In 2018, that number jumped to 15, or 28%; in 2019, it was 19, or 36.5%; and when COVID-19 hit in 2020, it was 17, or almost 33%.

The number of noncompliant agencies dropped in 2021 and 2022, but that decrease coincided with a sharp spike in the number of counties the Department of Aging left unaudited in those years: 14 counties in 2021 and 23 in 2022.

In the three years before that, every county had been assessed.

The Dauphin County Area Agency on Aging was among those that the department did not review in 2022 — this despite having been found noncompliant with state regulations in the three years prior.

According to records obtained by Spotlight PA, Dauphin County had been cited in those previous years for problems ranging from shoddy paperwork to failing to conduct a comprehensive investigation.

The Dauphin County Area Agency on Aging did not respond to emails seeking comment.

Philadelphia’s aging agency, called the Philadelphia Corporation for Aging (PCA), was also not assessed last year, despite being found noncompliant in the five years prior.

Its deficiencies over the years have included a failure to consult with medical professionals during an abuse and neglect investigation, preparing investigation case files that weren’t “understandable,” and not completing service plans for an older adult in need of protection.

In a statement, PCA President and CEO Najja R. Orr said the agency is working to improve protective services for older adults, but noted that the efforts are occurring during a time of increased demand, staffing challenges, budget cuts, and a growing older adult population.

“We remain relentless in our pursuit of PCA’s mission to improve the quality of life for older Philadelphians and to assist them in achieving their maximum level of health, independence, and productivity,” Orr wrote.

Philadelphia’s aging agency is among the six that were noncompliant during the majority of the seven years examined by Spotlight PA. The other agencies serve Carbon, Northampton, Schuylkill, and Westmoreland Counties, and the Fayette/Greene/Washington County area (the latter is represented by one agency called the Southwestern Pennsylvania Area Agency on Aging).

The deficiencies found in those counties ran the gamut from incomplete investigations to failure to put in place comprehensive service plans to keep older adults safe.

In statements to Spotlight PA, several directors of those county agencies pointed to staffing shortages, and the challenge of attracting and retaining protective services staff. The work is difficult, and the jobs often are not highly paid, leading to high turnover.

“Over the past few years we have noticed a decline in the number of candidates applying for these crucial roles in Aging,” said DeAnna Orlowsky, who heads Schuylkill County’s agency. “For my office, I am continually recruiting whether it would be to attend job fairs, the local Career Link, universities for interns, etc. It is not just in Aging, but all of the Human Service fields who are feeling this pain.”

Carrie Nelson, the administrator of Westmoreland County’s aging agency, said her agency has also faced “enormous staffing challenges,” and noted that between 2017 and last year, the number of reports of alleged abuse and neglect has dramatically increased.

But, said Nelson, her agency has taken steps to address problems, adding several positions to its protective services team, retraining its members, and offering signing and retention bonuses for new employees.

Chronic failures, no action

In Pennsylvania, the Department of Aging contracts with 52 county agencies to provide services to older adults. Some of those agencies are county-run, while others are private, nonprofit organizations. The services they offer range from educational programs to delivering meals and other support at home.

But among the most critical functions they provide are protective services for vulnerable older adults suspected of being abused or neglected.

Under the agreements with the counties, the Department of Aging can “consider all options,” including withholding funding and even terminating the contract with a county agency that fails to comply with state regulations.

The department, which was created in 1978, has never terminated a contract with a county, agency officials confirmed. Instead, the county agencies are asked to submit so-called “corrective action plans,” or documents that outline what they intend to do to rectify any deficiencies the state found.

“ has no teeth, no strength,” said Sheri McQuown, a former protective services specialist who monitored the county agencies for seven years.

“So it’s difficult to blame the Triple A because the Triple A is permitted by PDA to do what they are doing,” she said, referring to the area agencies on aging.

Indeed, data obtained by Spotlight PA show the department often discovers the same deficiencies in counties year after year.

Carbon County has had four noncompliance ratings since 2017. In three of those years, the Department of Aging found that it was not completing investigations in a timely manner, according to records obtained by Spotlight PA.

In a statement, Susan Zeigler, administrator of Carbon County’s aging agency, said hers is a small agency that did not have a dedicated protective services unit in 2019 and 2020 due to staffing shortages. That has since changed, she said.

“We now have one dedicated Protective Service worker and are in the process of hiring a Protective services supervisor,” Zeigler said.

Both Hans and McQuown said they left their Department of Aging positions because they think the agency’s oversight of counties has gotten progressively weaker under its current secretary, Jason Kavulich. Kavulich was appointed by Shapiro at the start of his administration in 2023.

Kavulich has a long history in the field of human services — but his recent background makes him more sympathetic to the county area agencies on aging, Hans and McQuown believe.

Kavulich ran the county aging agency in Lackawanna County, and also helmed the statewide association that advocates for the interests of all 52 area agencies on aging in Pennsylvania.

Hans said Kavulich unnecessarily split the department’s protective services bureau, edged out its longtime and well-respected director, and is overseeing an effort to relax the metrics used to determine whether county agencies are complying with state regulations.

He argued the department should instead be strengthening accountability measures to make sure county agencies are doing their job.

Every monitoring result, he said, should be placed online. And if a county fails to live up to the expectations in state regulations, its commissioners should be alerted and informed of the failing grade. The department could also mandate retraining in protective services in counties with chronic problems, he added.

Hans argues that greater transparency alone would go a long way toward creating change, including publishing information on the department’s website about a county’s compliance.

“The Department of Aging should be advocating for the older adult, not the Triple A,” he said.

In a statement, Gray denied that the department’s oversight over the county agencies has been weakened, and said Kavulich has ushered in “a multitude of program and policy innovations” that will improve services for older adults.

His background, she said, is an asset.

“Secretary Kavulich understands what this work looks like when it is done correctly, and the obstacles local agencies face when they falter in meeting performance standards,” she said.

There is little disagreement, however, that the consequences of not following state regulations for providing protective services can be devastating.

The email by the Department of Aging specialist, who Spotlight PA is not identifying because the message was obtained through other sources, listed six instances in Allegheny County in 2022 and 2023 when an older adult died during an open investigation into allegations of abuse or neglect — and where there were large gaps in the timeline of the probe conducted by the county.

Melissa Brock, a spokesperson for Allegheny County’s human services department, said in an email, “Pennsylvania confidentiality laws preclude … discussing specific details about any family or individual who may be receiving services from the Area Agency on Aging.”

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 one case cited in the email, an emergency was reported to Allegheny County’s aging agency five days before Christmas in 2022. The case involved allegations that a caregiver was withholding insulin when they were angry with the person who took the medication.

The person who reported the allegations said the older adult had seeping sores and wounds, experienced frequent falls, and could not access the bathroom on the house’s second floor. An investigator attempted a face-to-face visit within 24 hours, as state regulations require, and again within 48 hours. But then there was a large gap in investigative activity.

During the first visit, the older adult did not want to speak to the investigator. During the second visit, the caregiver and the older adult denied allegations of neglect.

After that, there did not appear to be any record of investigative activity for more than eight months.

On the second to last day of August 2023, an Allegheny County caseworker checked in on the older adult.

They learned the person had died months earlier, in February 2023, in a hospital. The older adult had been taken there after a wound became infected.

“We need to be open about this issue and fix it,” the Department of Aging specialist wrote, adding: “Please, I implore you, to give me some kind of response, some kind of direction so we can work towards a solution versus just continuing to observe the problem.”

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