Federal report faults state’s oversight of homes for those with disabilities

Pennsylvania’s human services agency should improve its monitoring of group homes where people with developmental disabilities live, particularly monitoring and reporting when there are serious health incidents, according to a report by a federal watchdog.

The state Department of Human Services needs to do a better job of making sure serious incidents are reported quickly, ensuring deaths are examined, and that suspicious deaths are referred to law enforcement, according to a report released Wednesday by the U.S. Department of Health and Human Services Office of Inspector General.

The audit was one of several performed in response to congressional requests, federal officials said.

Pennsylvania human service officials said they have since improved the oversight at issue in the report and cautioned against drawing broad conclusions from the inspector general’s audit, which examined one type of service.

Group home operators are required to report certain

incidents within 24 hours of their occurrence, such as certain emergency room visits or deaths. The state didn’t have adequate controls in place to detect such incidents when they weren’t reported, and thus did not ensure all deaths were investigated or suspicious deaths reported to law enforcement, according to the report. It examined data from 2015 and 2016.

The audit used Medicaid billing data from patients who had hospital stays and emergency room visits to see if ER visits and hospital stays were appropriately reported.

The report estimated thousands of such hospital visits went unreported to the state.

If such visits are unreported, they cannot be investigated and patterns cannot be identified, Charles Hubbs, an assistant regional inspector general with the Department of Health and Human Services Office of Inspector General, said in an interview last week.

A person with developmental disabilities who lived alone but who had inhome care was admitted to an emergency room twice, in one example the report cited.

The first emergency room visit, for a suicide attempt, was not reported within 24 hours of the incident as required, but instead wasn’t reported for 63 days. The second visit, for another suicide attempt, was not reported at all.

“Because of the delay in reporting the first emergency room visit, the state agency could not review it in a timely manner and ensure prompt corrective actions were taken. Because the second emergency room visit was not reported, the state agency could not review it and ensure prompt corrective actions were taken or identify patterns of beneficiary care,” the report noted.

Additionally, group homes must report suspicious deaths to the state, as well as report them to local law enforcement. Of the 13 cases federal officials examined that met the criteria for referral, two cases had not been referred.

Pennsylvania human service officials say they’ve made many improvements since the period examined in the report.

The agency “is committed to continuous improvement in our oversight responsibility to ensure that people served by these programs are receiving the care they need and deserve,” officials said in a statement Tuesday.

“The audit was of 20152016 data, and DHS has made many advances in incident-management oversight in the four to five years that have elapsed between the [Office of Inspector General’s] evaluation period and the present day.”

Among the changes: a more sophisticated management system, mortality reviews for all deaths, clarification of the types of incidents that require reporting, and more collaboration with law enforcement, state officials said.

In a response to what federal inspectors found, the state also said some incidents might appear to be unreported but actually were because the date of the incident and the claim didn’t exactly match, for instance, in a case of a person arriving at a hospital late at night.

DHS agreed with the recommendation that it work with community-based providers to identify and report all such incidents, such as making sure providers know the requirements for the reporting time frame.

The report comes at a sensitive time for the state Department of Human Services, which announced a plan last year to close two state institutions, with plans to slowly transition residents to the system of community-based group homes.

Such institutions have been slowly closing for years, part of a state and national trend that favors people with disabilities remaining in their homes or closer to home in a smaller and less institutional setting.

Most disability advocacy organizations favor group homes and have advocated for more funding for community-based services, as group home staff frequently have low wages and high turnover.

Following the closure announcement last year, the state has faced pushback from families, workers at the state centers and legislators. A bill that would put a moratorium on the closures passed the state House overwhelmingly last week; Gov. Tom Wolf has said he would veto it.

A group of family members said Tuesday they will file a federal lawsuit fighting the planned closures.