OSIG Investigation of PA’s Older Adult Protective Services Program
*The following report has been edited for length.
House Aging and Older Adult Services Committee & Senate Aging and Youth Committee
4/29/19, 11:00 a.m. Room 156 Main Capitol Building
- Bruce Beemer, Inspector General
- Robert Torres, acting secretary, Department of Aging
- Denise Getgen, director of the Protective Services Office, Department of Aging
- Chris Dubble, director, Institute on Protective Services, Temple University Harrisburg
- JR Reed, executive director, Lehigh County Office of Aging and Adult Services
- Krista Geer, president, Pennsylvania Association of Area Agencies on Aging (P4A)
- OSIG Investigative Report on Older Adult Protective Services
The committees held a joint public hearing on the OSIG Investigative Report on Older Adult Protective Services.
Bruce Beemer, Inspector General, told lawmakers, “I want to emphasize that the Department of Aging has, at all times, been a cooperative and engaged partner throughout the process of our investigation and report.” He noted Sec. Torres and his staff “have already made significant changes” to the department’s protective services operations. Beemer said, “The recommendations our office has made and those suggested by the department and the area agencies on aging (AAAs) as well as those I anticipate from our partners in the General Assembly, will improve the services for our older citizens, and their families and loved ones, deserve from their government.”
According to Beemer, the report identified four main areas of concern:
- The importance of conducting timely in-person interviews with seniors to follow-up on reports of alleged abuse.
- The need for front line AAA staff to quickly and accurately categorize “reports of need” to determine appropriate next steps.
- The necessity of adequate training for those front-line intake staff and for their supervisors and other participants in the protective services system.
- The absolute necessity to monitor and review the triage of incoming reports of need for uniformity and accuracy.
Beemer stated the report made recommendations to address the areas of concern. He suggested the department and the AAAs “continue to work together to improve uniformity in the categorization of reports, however made, to AAA staff.” Beemer also recommended the department and the General Assembly work together to create strong mandatory training requirements for report intake staff. He added the training “should be based on a curriculum which provides the sophisticated skills necessary to handle reports of elder abuse appropriately.” Beemer stressed the importance of the department adopting a standardized framework for evaluating and categorizing reports of need and promulgating it to the AAAs. He argued, “Every effort should be made to provide the resources necessary to attract and retain employees to perform the critical work of managing cases of elder abuse.”
Beemer also told committee members, “PDA and the AAAs would benefit from a shared system which allows real-time evaluation of categorization and investigation of reports of need.” He continued, “This system should allow the use of data analytics to identify potential problems.” Beemer suggested, “A centralized call center might assist in that effort.”
Chairman Murt wanted to know what credentials and background are looked for when hiring field representatives. Beemer said there is not a requirement for someone to have an investigatory background. He added that with these sorts of hires, it makes the training even more important. Chairman Murt asked if there is a need for more people or more training or both. Beamer noted that in the last ten years alone there has been almost a quadrupling of the number of calls that have come in that require a report of need. He stated there has been enormous strain placed on the AAAs in terms of being able to handle that kind of volume. Beamer said resources and staffing is a significant issue.
Minority Chairman Collett said the report also includes a statement that the department would not become aware of these issues because of the quarterly review. She asked if a quarterly review is adequate. Beemer responded, “No.” He explained, “Our investigation found that in many instances with regard to looking at individual cases not having real time information coming back from the AAAs to what is happening led to a situation where in many instances it was nine months to a year before the department would become aware of specific instances.” Beemer noted the department has taken several steps to address the issue.
Chairman DiSanto asked if the complaints were coming from AAA employees, former employees or vulnerable seniors. Beemer said a number came from within the department.
Robert Torres, acting secretary, Department of Aging, testified, “The investigation and subsequent report by the OSIG highlighted findings which the department has and will continue to address.” He commented, “Although many improvement measures were already in place prior to the release of the report, the department working with the AAAs, continues to pursue opportunities for further refinement related to the finding identified in the report.” Sec. Torres reported, “The department has experienced a continued increase in the number and complexity of elder abuse reports.” He noted that the department has experienced a 60 percent increase in the number of reports received and a 61 percent increase in the number of reports substantiated from fiscal years 2014-15 to 2017-18.
Sec. Torres reported, “When the OSIG’s investigation began in May of 2017, the department was already working to improve its monitoring of the delivery of protective services and better position the department to improve quality while facing the growing need.” According to Sec. Torres, the work resulted in the creation of an updated monitoring tool and process used by the department for oversight. He said, “This tool has helped standardize the process and measures by which the AAAs are monitored.” Sec. Torres explained, “Prior to the implementation of this new monitoring protocol, each AAA was only monitored once annually, regardless of the findings. He added, “Now, not only are annual visits occurring, follow-up monitoring can occur every six months or quarterly, depending on the level of deficiencies identified prior to the monitoring visit.” Sec. Torres noted, “The AAAs have been cooperative and diligent in their efforts to improve and meet the demand.”
Sec. Torres outlined some of the other steps taken by the department including making changes to the Investigation, Summary, and Assessment (ISA) forms to allow for more accurate data collection; developing new Intake Working training curriculum; streamlining the process for issuing Aging Program Directives and Aging Technical Assistance Bulletins; and adding staff to its protective services office. He thanked the members of the General Assembly for including $2.1 million for protective services in last year’s budget and expressed his hope the legislature will support the additional $2.8 million in Gov. Wolf’s proposed budget.
Chairman DiSanto reported that of January of this year the department says it is reviewing all cases categorized as “no need” on a daily basis with the authority to re-categorize and request an investigation if necessary. He wanted to know how many times the department has reclassified and called on a local AAA to investigate. Denise Getgen, director of the Protective Services Office, Department of Aging, explained her office is daily looking at every single case where the AAAs have classified as “no need” so they are looking at them in “real time” so it varies day to day and it varies from AAA to AAA. She said some AAAs have had no cases re-categorized and some have been re-categorized.
Chairman Murt asked what type of technical assistance is provided to an AAA with a staffing issue by the department. Sec. Torres explained it would depend on the request. He further explained if the AAA is having trouble with compliance the department will help with data requests. He said if they have backlogs they will try to see if there are things the department can do such as cross-checking death records. Chairman Murt asked if the assistance is provided in a timely fashion. Sec. Torres responded, “It has since I have been there.”
Sen. Brooks wanted to know with increasing requirements for additional training and oversight, how the department is going to help the AAAs offset that staffing so there is still staffing that remains in those counties. Sec. Torres indicated the department is meeting with the P4A leadership on a bi-weekly basis. He reported the department has streamlined the process for making any policy changes. Sen. Brooks asked if the local AAA employees would have online training or bringing them to Harrisburg. Sec. Torres indicated the department and Temple University are looking at ways to provide more online training.
Rep. Thomas asked if enrichment trainings are required. Getgen said the enrichment trainings are required by regulations and it part of the quality assurance monitoring done by the department.
Rep. Keefer asked if the $2.8 million proposed by Gov. Wolf will be going to the AAAs. Sec. Torres responded that it is committed to go out to the AAAs.
Rep. DeLissio asked if some of the issues raised in the OIG report a result of chronic underfunding and if it was considered a variable in this situation. Sec. Torres said he did not know. Rep. DeLissio then asked how much funding is needed to do the job correctly. Sec. Torres responded, “We would always welcome additional resources.”
Chris Dubble, director, Institute on Protective Services, Temple University Harrisburg, explained, “The institute is the sole provider of basic training and primary provider of enrichment training for staff working in protective services from the 52 Area Agencies on Aging.” He further explained, “The basic training is the course required by regulation prior to someone being able to work in protective services. Enrichment trainings meet the need for annual continuing education required by regulation.” He pointed out the institute also offer a protective services supervisor course and a five year refresher course targeting the educational needs of supervisors and experienced protective services caseworkers.
Dubble also explained, “In addition to training for protective services caseworkers, the institute provides education for other Area Agency on Aging staff, like solicitors, and other allied professionals about the identification, referral and resolution of cases of victimization of older adults.” He reported the Institute also helps AAAs and law enforcement determine whether there are civil and/or criminal remedies to seek justice for the victimized older adult.
JR Reed, executive director, Lehigh County Office of Aging and Adult Services, testified, “Since the implementation of the Older Adult Protective Service Act (OAPSA) in 1988, AAA’s have had the responsibility to receive reports and investigate potential acts of abuse, neglect, financial exploitation and abandonment of individuals age 60 and over.” Regarding the OSIG report, Reed commented, “The overall report shows that there are issues surrounding the delivery of OAPSA and these issues need to be addressed because of the vulnerability of this population.” He added, “The issues are very complex and need to be looked at in a comprehensive way. It will take a multi-pronged approach to bring a solution.” Reed observed, “In an effort to address the various aspects in this report. I feel it would have been beneficial, as part of the investigation to interview current Protective Service staff (investigators, supervisors and management staff) from AAA’s.” He said, “Their input would have been valuable to add to the other information that was gathered during this investigation in order to provide a full, global picture of how OAPSA is operationally completed at the local level.” Reed also highlighted the dramatic increases in the number of reports of elder abuse and investigations over the past several years. He outlined some of the steps that have been taken over the past several months, some initiated prior to the report and some after.
Krista Geer, president, Pennsylvania Association of Area Agencies on Aging (P4A), expressed appreciation for the opportunity the report has provided P4A “to work with the Department of Aging closely to try to address some long standing issues.” Geer stated, “These recommendations are substantial, but include the need to revamp our current report of need form, update the software program our staff use while in the field to improve efficiencies and eliminate redundancies, as well as technical support to our case workers on the most complicated investigations related to financial exploitation.” Noting the $5 million for protective services in the proposed budget, Geer said, “This is a great start and we appreciate both the Governor and the Legislature’s efforts. She commented, “But when you consider that $5 million being spread across 52 Area Agencies on Aging, you have to acknowledge that it will be spread very thin.” Geer noted P4A’s full request is for $8 million.