Are el­derly get­ting pro­tec­tion from abuse and ne­glect?

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So­ci­ety has a duty to pro­tect its most vul­ner­a­ble mem­bers. So it’s con­cern­ing to hear ques­tions be­ing raised about whether abuse and ne­glect of the el­derly is be­ing in­ves­ti­gated promptly and thor­oughly in Penn­syl­va­nia.

The state in­spec­tor gen­eral’s of­fice said in a re­port

Tues­day that not all vic­tims were be­ing in­ter­viewed quickly enough. Also, dead­lines for sub­stan­ti­at­ing ac­cu­sa­tions were missed by county-level area agen­cies on ag- ing, which in­ves­ti­gate com­plaints.

In fis­cal year

2016-17, the area agen­cies re­ceived 18,275 com­plaints. They did not in­ter­view 3,724 of the al­leged vic­tims (20 per­cent) within three days. And they did not de­ter­mine whether the abuse al­le­ga­tions were true in 7,859 of the cases (43 per­cent) within 20 days, ac­cord­ing to the re­port. (It did not break down the data by county.)

The in­spec­tor gen­eral ques­tioned whether the pri­or­ity sta­tus of com­plaints was be­ing cat­e­go­rized con­sis­tently and whether in­ves­ti­ga­tions were thor­ough. The in­spec­tor gen­eral’s of­fice said it was told dur­ing the probe that some area agen­cies on ag­ing “have lit­tle or no med­i­cal sup­port on their cases; do not con­sult nurses on ba­sic fun­da­men­tals; and do not re­view med­i­cal records dur­ing their in­ves­ti­ga­tions.”

The in­spec­tor gen­eral called on the Penn­syl­va­nia Depart­ment of Ag­ing to more closely mon­i­tor the county agen­cies to en­sure timely in­ves­ti­ga­tions. It also rec­om­mended the depart­ment hire more em­ploy­ees and im­prove train­ing.

The Depart­ment of Ag­ing said many of the in­spec­tor gen­eral’s rec­om­men­da­tions have been im­ple­mented, or will be.

They in­clude hir­ing a di­rec­tor of ed­u­ca­tion and out­reach to co­or­di­nate train­ing; up­dat­ing the con­tent and im­prov­ing the qual­ity of train­ing; and in­creas­ing the fre­quency of train­ing. Poli­cies and di­rec­tives will be changed to en­sure com­pli­ance with state law and a more con­sis­tent re­view and mon­i­tor­ing of area agen­cies on ag­ing.

“The Depart­ment of Ag­ing has worked with area agen­cies on ag­ing where there have been in­stances of non­com­pli­ance,” the depart­ment said in a state­ment, “and the agen­cies have been co­op­er­a­tive and dili­gent in their ef­forts to im­prove time­li­ness of their in­ves­ti­ga­tions to meet le­gally re­quired time­frames.”

While the depart­ment and the Penn­syl­va­nia As­so­ci­a­tion of Area Agen­cies on Ag­ing agreed that there is room for im­prove­ment, they sought to clar­ify some of the data cited by the in­spec­tor gen­eral.

In a writ­ten re­sponse to the in­spec­tor gen­eral, the Depart­ment of Ag­ing said in­ves­ti­ga­tions of fi­nan­cial ex­ploita­tion are not re­quired to be com­pleted within 20 days, as it takes time to gather doc­u­men­ta­tion. It said that gen­er­ally, in abuse and ne­glect cases, 20 days is long enough to de­ter­mine and doc­u­ment whether there is a need for pro­tec­tive ser­vices. It said more time may be nec­es­sary in some cases, though, and it’s im­por­tant to take that time.

“While ex­tend­ing the in­ves­ti­ga­tion be­yond 20 days can need­lessly pro­long po­ten­tial risk to the older adult re­ported to be in need of pro­tec­tive ser­vices, it is rec­og­nized that cir­cum­stances may arise that ne­ces­si­tates that more time is needed to con­duct a thor­ough in­ves­ti­ga­tion,” the depart­ment said.

There is no re­quire­ment for al­leged abuse vic­tims to be in­ter­viewed in per­son within 72 hours, said Re­becca May-Cole, ex­ec­u­tive di­rec­tor of the Penn­syl­va­nia As­so­ci­a­tion of Area Agen­cies on Ag­ing.

She said state law says a case­worker “shall make ev­ery at­tempt” to visit a vic­tim within 24 hours for com­plaints clas­si­fied as emer­gency and pri­or­ity lev­els. For non­pri­or­ity cases, the law says in­ves­ti­ga­tions are to be­gin within 72 hours, with a visit to oc­cur “at an ap­pro­pri­ate point in the course of the in­ves­ti­ga­tion,” she said.

The as­so­ci­a­tion and the depart­ment said more money must be spent to pro­tect older adults, as the work­load is in­creas­ing.

May-Cole said com­plaints of abuse have been ris­ing while fund­ing and staffing at area agen­cies on ag­ing has re­mained static. She said com­plaints rose 57 per­cent be­tween fis­cal years 2013-14 and 2017-18, and sub­stan­ti­ated re­ports rose 47 per­cent.

The state bud­geted an ad­di­tional $2 mil­lion last year for pro­tec­tive ser­vices for older adults. But an­other $6 mil­lion is needed, May-Cole said.

The Depart­ment of Ag­ing said it would work to ob­tain ad­di­tional fund­ing and sup­port from the state Leg­is­la­ture, and would al­lo­cate ad­di­tional em­ploy­ees to fur­ther sup­port pro­tec­tive ser­vices staff.

The in­spec­tor gen­eral ques­tioned whether the pri­or­ity sta­tus of some com­plaints was ap­pro­pri­ately clas­si­fied. In re­sponse, the Depart­ment of Ag­ing said that as of this month, it started hav­ing state pro­tec­tive ser­vice spe­cial­ists re­view all com­plaints that were clas­si­fied as “no need” for in­ves­ti­ga­tion by area agen­cies on ag­ing, to de­ter­mine if they should be re­clas­si­fied and looked into.

The changes sound like a good start. It will be im­por­tant for the in­spec­tor gen­eral to con­tinue mon­i­tor­ing how older adults are pro­tected.

State law­mak­ers and the gover­nor should con­sider the needs of the sys­tem as they de­velop their bud­get this year. Money must be spent wisely, but this is one area where in­ad­e­quate fund­ing can truly hurt vul­ner­a­ble peo­ple.

STEPHANE DE SAKUTIN/AFP-GETTY IMAGES

The state in­spec­tor gen­eral’s of­fice ques­tions the time­li­ness and thor­ough­ness of in­ves­ti­ga­tions into al­le­ga­tions of abuse and ne­glect of the el­derly.

Paul Muschick

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