Pennsylvania recorded a steep increase in the deaths of older adults following an abuse or neglect complaint the last few years, as COVID-19 ravaged the nation, complaints grew and agencies struggled to keep caseworkers on staff.
The staggering increase shown in state data — from 120 deaths reported in 2017 to almost 1,400 in 2022, a more than tenfold increase — may have had several contributing factors, and the state and county-level agencies that field and investigate complaints gave varying answers explaining why.
Mostly, Pennsylvania's Department of Aging and county-level agency officials speculated that it had to do with a growing population of people 65 and older, an increase in complaints and the devastating impact of the COVID-19 pandemic on older adults.
One county said errors in its data entry procedure — now corrected — led to undercounting in the initial years. Another pointed to cases staying open longer.
Some county agencies wouldn't answer questions about it at all.
The increase came as agencies in Pennsylvania and nationwide struggled to keep caseworkers on staff through the pandemic and manage caseloads.
The Department of Aging said it has no data to suggest that a lack of caseworkers contributed to the increase in deaths, and suggested that the data could be misleading since the deaths may have had nothing to do with the original abuse or neglect complaint.
"The data does not make any correlation between the provision of protective services and how the older adult died," the agency said.
The department doesn't track causes of death, and individual county-level agencies aren't required to provide that information to the state. When caseworkers enter data on a case, they are given a choice of reasons for why a case was closed, including death.
If anything changed in recent years, state efforts to train caseworkers likely improved how data on cases was recorded and entered, former department employees and county officials said.
It's not clear to what extent better data collection helps explain Pennsylvania's increase, but evidence suggests that other similar jurisdictions did not see a similarly steep increase.
Officials from the National Adult Protective Services Association said they had not heard discussion of such a steep increase in deaths among the state programs that investigate abuse and neglect complaints of adults.
Although states have different practices for investigating complaints and collecting data, two states with similar-sized populations — Illinois and Michigan — also reported significant increases in deaths.
But those increases — roughly triple during the pandemic — were nowhere near the proportion of Pennsylvania's.
The broader death rate of older adults did not increase nearly as steeply during the pandemic, going from about 4% of those 65 and older in 2018 to 4.5% in 2021, according to federal statistics.
All told, Pennsylvania's data shows caseworkers reported closing 120 neglect or abuse cases due to death in 2017.
That number rose steadily every year. It reached 784 in 2020, 1,284 in 2021 and then 1,389 in 2022 — rising by more than 10 times in five years, or more than 1000%.
The number of complaints called into caseworkers rose over that period, too. But it rose by a much smaller proportion — by about half, or 55%, according to state data.
This year, the pace of cases closed due to death slowed a bit, but still remained well above 2020's pace. Through the first six months of 2023, the number of deaths was 528, on pace for 1,056 over the full year.
The department also doesn't disclose the details of case investigations or what shortcomings it finds when it inspects the performance of the 52 county-level "area agencies for aging" across Pennsylvania.
Some agencies are county-run while others are nonprofits, and field calls about elder abuse or neglect under state contracts. They employ caseworkers to investigate complaints and coordinate with doctors, service providers and if necessary, law enforcement.
Most calls involve someone who lives alone or with a family member or caregiver. Poverty is often a factor.
The department released the deaths data in response to a request filed by The Associated Press under Pennsylvania's open records law.
The AP submitted the request after reviewing internal emails — also released through an open records request — showing that state protective services staff had become alarmed at how Philadelphia's agency had handled the cases of three people in 2021.
The department refused to disclose the fate of the three people — including when a state lawmaker asked about it following AP's story on it.
In Pennsylvania, state data shows caseworkers took longer to close some cases as the pandemic wore on and often handled more cases than state regulations allow.
The shortage of caseworkers during the COVID-19 pandemic became so extreme that, in 2021, then-Gov. Tom Wolf's administration took the extraordinary step of marshaling state employees to handle investigations for Philadelphia's agency.
The agency, the nonprofit Philadelphia Corporation for Aging, reported four cases closed due to death in 2017. By 2020, that number rose to 220. In 2021, it hit 472 before dropping to 295 in 2022.
Bob Burns, the director of Dauphin County's Area Agency on Aging, said he wasn't surprised by the increase in deaths, considering the ravages of the COVID-19 pandemic.
The shortage of caseworkers leads to higher caseloads because it might take longer to close out a case, Burns said. But, he said, counties began using experienced caseworkers up front to quickly investigate complaints to determine right away if a person was in a dire situation.
Gov. Josh Shapiro's secretary for the Department of Aging, Jason Kavulich, told lawmakers in a March hearing that many county-level agencies "are struggling for a variety of reasons, from not having adequate staff to a high number of staff turnover to some serious training issues, that we need to get them up to an acceptable level of understanding."
Even before the pandemic, the performance of area agencies on aging had drawn criticism.
In 2018, the state's internal investigation agency, the Office of Inspector General, issued a report that criticized how the state and counties handle abuse and neglect reports. That report pointed to failures to properly investigate complaints under timelines required by state law and inadequate staffing of the Department of Aging office that monitors those agencies.