A decade ago, investigators substantiated 159 elder abuse cases reported to the Pennsylvania Department of Health. Last year, the number was 1,018, more than a six-fold increase.
The number of abuse reports is up, too. More than 4,200 suspected cases were reported in 2017, a nearly 45 percent rise since 2008.
But agency regulations that shield caregivers from providing even basic information to the public mean little is known about the kind of elder abuse that is prevalent, who is reporting it and what type is more likely to be substantiated.
State officials were at a loss to explain the surge in reports.
“The Wolf administration and the department are committed to ensuring safety for seniors, which includes residents of nursing homes,” Nate Wardle, a Health Department spokesman, said in an email. “There is no way of knowing what has caused the increase in reported abuse cases over the last 10 years.”
Advocates, however, saw a silver lining.
Diane Menio, executive director of the Center for Advocacy for the Rights and Interests of the Elderly, or CARIE, credited greater awareness for the nearly 60 percent increase in reporting from 2,689 in 2016 to 4,236 last year.
“It’s in the news; people are watching and seeing they can make complaints,” Menio said.
That wasn’t always the case. The Health Department had halted anonymous complaints – even though federal law required the department accept them – for nearly three years. Since reinstituting anonymous complaints in 2015, reporting has steadily climbed.
Still, elder abuse is widely believed to be underreported.
An oft-referenced study out of Boston by the National Research Council touted by advocates as evidence of underreporting estimated only 1 in 14 incidents of elder abuse is reported, and even fewer for financial exploitation, 1 in every 25.
Even though Menio and others – including an industry association and lawmakers – interpreted the increased reporting as a good sign, she also expressed concern that the percentage of substantiated abuse cases – while increasing – remains stubbornly low, only 1 in 4.
“As ombudsmen we struggle with this, that things aren’t getting substantiated,” Menio said. “It’s my sense that they don’t get reported unless it’s pretty serious.”
And what frustrates Menio is that Health Department investigators, she said, do not trust CARIE’s ombudsman.
When conducting a performance review released two years ago, state Auditor General Eugene A. DePasquale found staffing cuts and revised policies had negatively impacted the agency’s ability to prioritize and respond to complaints.
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Recommendations made
In all, the audit made nearly two dozen recommendations, including a suggestion the department prioritize striving to shorten the turnaround on complaint investigations and work with lawmakers to create more stringent civil penalties against poor-performing facilities.
The Health Department, Wardle said, is working on those new regulations and expects to have a draft before the end of the year.
“It has been established that Pennsylvania’s nursing home regulations need to be updated,” Wardle said. “We have been working to rewrite these regulations, but changing regulations takes time.”
Given that elder abuse and the quality of care will become increasingly important as Pennsylvania braces for a gray tsunami of baby boomers turning 65, the issue has a renewed sense of urgency for state agencies.
Elder abuse takes many forms: physical, emotional, sexual or financial. But health officials only disclose tallies of the total statewide abuse reports and substantiated cases.
In a series published in November, a Reading Eagle investigation found that taxpayers are permitted to know very little about how facilities handle suspected abuse against Pennsylvania’s most frail and vulnerable citizens.
Following three Right-to-Know requests the newspaper made to two agencies, the Pennsylvania Office of Open Records determined, in reviewing agency regulations, that only statewide tallies from confidential abuse reports submitted to the Health Department were subject to release.
A dichotomy
So while state and federal tax dollars primarily pay for the care nursing home residents receive, the public cannot know the frequency with which facilities, as required by law, report abuse cases to oversight agencies and local law enforcement.
The newspaper’s investigation also found the Health Department had substantiated more than 1,800 cases of abuse from 2009 through 2015, but had referred just three to the attorney general’s office for prosecution. And an examination of state surveys found these cases frequently go unreported to law enforcement.
“The data doesn’t tell us much until we know what it’s saying,” said Sam Brooks, an attorney with Philadelphia Community Legal Services and a leading advocate for the elderly.
Detailed information on elder abuse and the subsequent investigation, Brooks and Menio said, could help identify trends, target resources and better inform policy makers.
Proposed legislation
A bill with bipartisan support introduced in March by state Rep. Mark M. Gillen would require agencies to disclose, among other things, information on substantiated abuse cases and provide the General Assembly a biennial report that highlights trends and recommendations.
“It’s reprehensible that seniors are subjected to abuse without strong prosecutorial intervention,” said Gillen, a Robeson Township Republican. “Our goal is to not only be just, but to prevent future cases of abuse. Something like this should have been done yesterday, but I’m working on getting it done tomorrow.”
Gillen added, “Nothing is as sanitizing as the light.”
The Pennsylvania Health Care Association, an advocacy group for nursing home owners, hasn’t taken a position on Gillen’s legislation, House Bill 2072.
But the association’s executive director, W. Russ McDaid, has said that he was concerned disclosing this information would have a chilling effect on abuse reporting.
It’s an argument Gillen disputed, noting many nursing home operators are already subject to the disclosure elsewhere.
Concerns aside, McDaid said the association and its 500 members do support laws and regulations that prevent elder abuse.
“Facilities are, and have been, committed to preventing these incidents of abuse and neglect,” McDaid said in an email. “Actions that jeopardize the privacy, dignity and safety of the elderly should be condemned and prosecuted to the fullest degree possible.”
