Elder abuse agencies reject cases experts say they should investigate as Pa. scales back oversight

Shortly after 10 a.m. on March 31, the state’s elder abuse hotline got a call about a 65-year-old woman who was potentially at imminent risk of danger.

The Allegheny County woman, the caller reported, lived alone, had just lost her job, did not drive, and was socially isolated. A portion of the roof on the front side of her home was starting to cave in. On the back side of the house, the roof was missing entirely, leaving a mattress, desk, chair, and what looks to be a space heater exposed to the elements, a photo from the scene shows.

A roofer who had inspected the house was worried about its structural integrity and warned that electrical problems could cause a fire.

According to confidential documents obtained by Spotlight PA, the caller described the woman’s situation as “life-threatening.” The intake worker agreed, said the woman was self-neglecting, and recommended her case “immediately” be assigned to a caseworker for further investigation.

Yet within hours, the Allegheny County agency in charge of protecting older adults from abuse and neglect reversed that assessment.

Without interviewing the woman, visiting her home, or collecting additional information about her situation, a protective services worker for the county said they believed the case did not rise to the level of needing protection from potential abuse, neglect, or self-neglect.

She was, in the parlance of the older adult protective services world, a “no need.”

It was the wrong call, according to four former protective services specialists who reviewed the woman’s case file at Spotlight PA’s request.

The case demonstrates how Pennsylvania’s county-based protective services system for older adults can fail to recognize risk and reject reports it should be investigating, they said. Meanwhile, the state Department of Aging, which monitors and funds the counties, has retreated from providing daily oversight over such cases, as it once did.

Department spokesperson Karen Gray defended the agency’s actions, calling statements that “insinuate” it intentionally leaves older adults in harm’s way “grossly inaccurate.”

Gray called the previous review process “arbitrary,” explaining that the department continues to monitor a sample of no-need cases as part of its comprehensive oversight of county agencies. She also said the department provides more targeted feedback and training than in previous years to help those agencies swiftly and accurately assess and respond to reports of suspected abuse and neglect.

Yet, no-need cases have been a concern for state officials going back nearly a decade, records show.

In the 2016-17 fiscal year, 20% of all calls received by county aging agencies were classified as no-need cases. At the time, the state inspector general raised the alarm about that number, and in response, Department of Aging specialists began reviewing these cases daily, overturning findings of no need that they disagreed with and directing the counties to investigate.

That ongoing oversight showed results: It correlated with a drop in disagreements — from 14% in 2019 to a low of almost 5.4% a few years later, records obtained through a public records request show.

But shortly after the Shapiro administration came to office in 2023, the department sharply scaled back the review process.

Gray said the department made the decision because the previous system unfairly usurped the counties’ role and didn’t equip them to do the job themselves. But critics say the lack of daily oversight means older adults are being wrongly turned away from the very system intended to keep them safe.

“These numbers represent human beings,” said Peter Hans, who regularly assessed abuse and neglect investigations by county aging agencies before retiring from the Department of Aging in 2024. “Some of these people … do not have a family member or someone else in the community to take care of them. And that is what protective services are supposed to do.”

Pennsylvania’s system for protecting its most vulnerable older adults is complex and multilayered. Spotlight PA has spent the past two years investigating internal failures and devastating consequences, including older adults dying under painful and potentially preventable circumstances.

The news organization has uncovered how some county aging agencies are chronically late in completing investigations of older adults’ circumstances despite state-mandated timelines for them to do so — delays that leave people at potentially increased risk of harm. It has also revealed that some county agencies have failed, year after year, to comply with strict state standards for conducting quality abuse and neglect investigations.

In all, 52 Area Agencies on Aging serve all 67 counties in the state. Those agencies offer a range of services to adults 60 and over, from educational and recreational programs to meals and transportation.

But one of the hardest and most important things they do is provide protective services. This work starts when reports of potential abuse and neglect are called in. The reports are screened at intake and given one of five designations, including no need. A protective services worker at the county aging agency reviews that initial designation and either confirms or rejects it.

Each designation is defined in Pennsylvania’s regulations and has rules regarding how caseworkers must handle the matter. A report can be classified as no need only if one or more of the following apply: The adult is under 60; has the capacity to get help and services necessary to stay physically and mentally healthy; has a caretaker; or is “not at imminent risk of danger to his person or property.”

Unlike emergency, priority, or even non-priority cases, a no-need designation means that a protective services caseworker does not have to investigate an older adult’s situation any further.

Such investigations include visiting the older adult and obtaining their medical records to determine whether they are at risk of abuse, neglect, or self-neglect. If they are, the county provides them with services that run the gamut from help with cleaning and meals to overnight shelter or supervision to guardianship.

An older adult found not to need protective services could be referred to another care management program within the county aging agency, although referrals are not guaranteed.

A long-time concern

In 2018, the Office of State Inspector General released a special investigative report highlighting multiple problems within Pennsylvania’s protective services program for older adults. Among the concerns highlighted in it were no-need designations.

The report noted that about 20% of all calls received in the 2016-17 fiscal year were classified as no-need cases. Aging department staff told the inspector general that county-level staff may be swayed by supervisors or outside factors to classify a case that way.

Those outside factors ranged from not having enough staff to “It’s late on a Friday afternoon,” according to the report, meaning employees did not want to work late or managers didn’t want to pay staffers who were on call for after-hours shifts.

The Department of Aging also wasn’t monitoring or reviewing the accuracy of those designations in real time, the report found — and that could result in older adults being left at risk of harm.

Following the report, state aging officials began reviewing every no-need designation beginning in early 2019, said Denise Getgen, the department’s director of protective services until 2023.

At the start, department officials often disagreed with those no-need decisions and directed county aging agencies to go back and investigate those cases for suspected abuse or neglect, she said.

Spotlight PA requested data dating back to 2019 from the Department of Aging on the number of no-need designations that it overturned. The department denied the request and only provided it — months later — after the Office of Open Records forced it to.

The data show that in 2019 the department disagreed with about 14% of no-need designations. Over the next four years, the disagreement rate dropped to a low of about 6.5% in 2022.

However, in mid-September of 2023, Department of Aging leaders told county agencies that it was halting daily no-need monitoring. At the time, the disagreement rate was just 5.37% for the year, records show.

“The Department thanks you for your continued efforts to provide quality protective services to older Pennsylvanians and commends the network for achieving nearly 94% accuracy in ‘No Need’ categorization,” department officials said in an email obtained by Spotlight PA.

At the time, Rich Llewellyn was the department’s aging services supervisor, overseeing the collection and analysis of protective services data.

In an interview, Llewellyn said that unbeknownst to the counties, state aging officials continued monitoring some no-need cases, albeit fewer than before: one week’s worth of such cases every month. He said state aging officials did not notify counties when they disagreed unless it involved an emergency.

The results were startling, according to the data provided to Spotlight PA.

During the first four months of secret monitoring, department officials disagreed with nearly 10% of no-need designations. For all of 2024, that number increased to over 18%. Additionally, by the 2024-25 fiscal year, the percentage of no-need designations statewide had risen to 21% — higher than the levels that initially raised concerns by the inspector general’s office.

“I was alarmed,” said Llewellyn. “It clearly demonstrated that without oversight, the (county aging agencies) weren’t doing what they were supposed to.”

Llewellyn said that the secret review ended last year, after the department launched its new system for monitoring and scoring county aging agencies on the quality of their protective services investigations.

In a statement, Gray said the agency reviews a sampling of no-need cases when it monitors county aging agencies every 18 months. During that monitoring process, state officials also check whether counties are properly categorizing reports of alleged abuse and neglect overall.

Gray also said the department has updated and clarified guidance to counties on identifying and handling potential no-need cases, and noted that older adults in such cases may still end up receiving services other than protective services.

“The Department remains unwavering in its commitment to keep older adults safe and help them thrive in their golden years,” she wrote. “Twisting data without context to serve a narrative that only seeks to detract from that work does not keep older adults safe.”

Spotlight PA provided the department with a description of its findings, based on data it received from the agency through its public records request. The department did not dispute the data in its response, nor explain how it was being twisted.

Gray also did not respond when asked whether the department was concerned that its own staff had disagreed with a growing number of no-need designations by county aging agencies.

Last year, Llewellyn sued the department in federal court, alleging that aging department brass retaliated against him for being a whistleblower and cooperating on investigations with outside agencies, such as the inspector general and auditor general. He was fired from his position shortly after.

Department officials have not commented publicly on the lawsuit, saying they do not discuss pending litigation or personnel issues. They seek to have the lawsuit tossed.

‘Is this person in a life-threatening situation?’

It’s unclear what, if any, services Allegheny County provided to the woman with the collapsing roof after it determined she did not need protective services. (Spotlight PA is not publishing the woman’s name because she declined to be interviewed.)

The intake worker who took the call this March classified the case as a “priority,” which calls for immediately contacting a protective services caseworker with the information. If the caseworker agrees with the priority classification, they initiate an investigation within 24 hours.

But the caseworker for Allegheny County who reviewed the designation disagreed. That same day, they noted in the woman’s file that “this is an environmental issue with no need for PS (protective services) involvement.”

They wrote that the woman was enrolled in another Department of Aging program, which provides transportation, meals, and other in-home services for older adults living independently.

In a statement, a spokesperson for Allegheny County’s Department of Human Services said it does not comment on specific cases. “It would be common practice in a case like the one described to ensure that the senior involved is assigned a caseworker who would arrange for services such as home-delivered meals and other supports, and could also help explore alternative housing options,” the spokesperson said.

The spokesperson also wrote that it conducts more than 5,000 investigations every year, and that the county’s rate of no-need determinations is “in line with the statewide average of roughly 20%.”

Sheri McQuown, like Hans, was a specialist at the Department of Aging who monitored the handling of protective services cases by the counties.

In an interview, she said the department’s protective services program, unlike other agency programs, offers services to older adults on a priority basis.

“The right place (for her) was protective services,” McQuown said, adding that the very least that should have happened was an investigation into her situation to determine whether to substantiate the allegation that she was self-neglecting.

“But when you no need a case, you don’t have to investigate it at all,” she said.

Hans said the department should have prioritized investigating the Allegheny County woman’s situation, and if the allegation of self-neglect was substantiated, provided her with the services she needed to avoid harm.

“Prior to this administration, we would have looked at that no-need (designation), and it would have been overturned,” he said. “There literally is a question on the (intake form) that asks, ‘Is this person in a life-threatening situation?’ If the answer is yes, it is not a no-need.”

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This story was originally published by Spotlight PA and distributed through a partnership with The Associated Press.