Unprotected

The first call was logged at 11:37 a.m. on July 12, 2022, case number 1346228045.

Subject: Luen Ng

Age and gender: 75-year-old woman

Location: Living alone in Northeast Philadelphia, with no close relatives nearby.

Situation: Self-neglect. She holds a job, but her memory is failing, likely dementia. Her house is teeming with trash and infested with pests. Rotting food litters the counters and fridge. Putrid smells.

Could someone please help?

The report was filed by Ng’s daughter, who lived out of state and was unable to provide care around the clock. It was passed to the local county agency tasked with protecting older Pennsylvanians from harm. But confidential records obtained by Spotlight PA show officials were slow to recognize the danger Ng was in, and even slower to develop a plan to keep her safe.

It took months of persistence and a dire warning from a doctor for the agency to spring into action and try to secure services, including meals, a home health aide, and emergency guardianship. The eleventh-hour scramble would come too late.

In late 2022, Ng was struck by a van in a hit-and-run crash just blocks from her house, dragged for an unknown distance as her bones shattered and layers of skin tore from her legs. She died weeks later from an infection after multiple hospital stays.

She was one of 1,511 older adults in Pennsylvania — mothers, fathers, sisters, brothers, grandparents — to die in 2023 while their cases of suspected abuse or neglect were still under investigation or pending with their local county protective services agency.

But you won’t see a collage of their faces on billboards, websites, or television ads. Their stories unfold in the shadows. Their investigative files are kept confidential, and what happened in the days leading up to their deaths is rarely made public.

Yet the details involving the harrowing final days in cases like Ng’s illustrate the fragility and inadequacy of Pennsylvania's system for protecting older adults — who are often poor, marginalized, and have no alternative safety net.

While the state Department of Aging tracks the number of older adults who die during an open abuse or neglect investigation by a county agency, it does not track the reason for their death — even though officials concede it is possible to trace the cause. As a result, they don’t know how many of the deaths could have been prevented had the county aging agencies they oversee done a better job.

Data show many of those agencies are failing.

A Spotlight PA analysis of data obtained through public records requests shows many county protective services agencies exceed the maximum 20 days allowed under state rules to investigate and take action on allegations of abuse and neglect — with some taking five or more times that limit.

The year Ng died, the local aging agency that covers Philadelphia missed the 20-day deadline in 53% of the cases it investigated. The local agency was noncompliant with state rules in all five years before Ng died.

Yet when those county agencies fall short, the state Department of Aging, which oversees them, takes no punitive action — even though the number of older adults who died during open investigations has nearly doubled since 2018.

Despite these data and the potential for devastating outcomes when the system fails, the Shapiro administration and lawmakers have taken few steps to fix the problem. There have been no public hearings, nor have state aging officials openly acknowledged the failures.

“They’re burying their heads in the sand,” Peter Hans, a former protective services specialist at the Department of Aging, said of elected and government officials.

Hans and other former and current aging staffers interviewed by Spotlight PA have alerted more than two dozen people in state and federal offices about the status of protective services in Pennsylvania. They’ve been largely met with silence or indifference, he said.

“I don’t understand it,” he said, “but it’s inexcusable.”

‘Force of nature’

Karen Leung, Ng’s daughter, lived and worked more than three hours from Philadelphia. Leung knew her mother was experiencing a decline, but also could not convince the older woman to move closer and leave the job and life she had toiled for years to build. Getting Ng into an assisted living facility was an even harder sell.

A friend recommended reaching out to protective services in Pennsylvania to see if they could help. So on that July day, Leung reported that her mother lived alone, was forgetful and confused due to what appeared to be dementia, and had left her front door unlocked on several occasions. The house, Leung said, was cluttered with trash. There were mice, roaches, and flies.

This was, Leung said in an interview with Spotlight PA, not normal for her mother, a woman she called “a force of nature” — always in motion, always working.

“She was always moving,” Leung said. “She was 90 pounds soaking wet … but she was 90 pounds of sheer will.”

Ng’s grit, said Leung, sustained her when she immigrated to the United States from Hong Kong more than two decades ago as an adult. Her mom, Leung said, had little more than an elementary school education, but worked multiple jobs to support herself: seamstress, domestic helper, home health aide.

She eventually saved enough money to buy a small row house in Northeast Philadelphia, which was sparse and tidy. In what little free time she had, Ng, a collector of recipes, would bake. As a treat, she loved to shop at Macy’s.

“I could see her coming up the street. She was a tiny old lady and always carried a bag that was bigger than her,” Leung recalled.

Everything changed when the pandemic hit. Through the blur of lockdowns and restrictions, Leung couldn’t visit regularly. But the signs were there.

Her mom would sometimes call and say she was standing outside her house, but couldn’t figure out how to get in — she had lost her keys.

“It was beyond scary,” said Leung, who felt powerless and frantic in those moments.

In 2022, the situation spiraled. During one visit, she noticed a stack of unpaid bills on her mother’s table and realized they dated back to the start of the pandemic. The house brimmed with clutter and filth and screamed of neglect.

Though Ng insisted she was fine, and refused to leave her home and her job, Leung knew she wasn’t.

Her complaint was assigned to the county aging agency that covers Philadelphia: the Philadelphia Corporation for Aging (PCA).

The delay

The call was deemed a priority, which under state regulations requires the protective services worker assigned to the case to conduct a face-to-face interview within 24 hours.

That didn’t happen.

A PCA caseworker made several attempts to visit Ng at home, but couldn’t catch her there. Leung had warned PCA that her mother left the house around 9:30 each morning for work and didn’t return until late in the evening, sometimes after 10 p.m. Yet case workers visited between those times anyway, and no one went to Ng’s workplace, according to her case file.

Leung said she had to intervene to arrange that face-to-face interview, which records show occurred on July 22 — 10 days after she first reported her concerns.

A spokesperson for PCA declined requests to respond to this story. In a statement, Department of Aging spokesperson Karen Gray said investigations in large cities like Philadelphia present “unique challenges.” The department has in recent years provided the city with technical assistance, Gray said, to decrease caseloads and improve how PCA handles “complex cases.” She did not provide details.

During the July 22 interview, records say that Ng was “fully dressed, groomed appropriately, and odorless.” But she couldn’t remember the last time she had been to a doctor or recall the name of her pharmacy. Nor could she remember the name of her place of employment, an area home health care agency where she worked as an aide helping other older adults.

When the caseworker gave Ng a cognitive test — which includes questions like “How old are you?” and “Who is the current president?” — she scored three out of 10.

“And I said, ‘What does it mean, that she failed all these questions?’” Leung told Spotlight PA. “And they said she qualifies for services, and they would figure out what to get her.”

The caseworker also reported observing “trash on the floor, in the kitchen, living room and the dining room, dishes piled in the sink, trash and rotten food on the tables, a roach infestation, smell of cat urine and rotten food, dead mice and live mice.” Flies were everywhere.

The worker wrote she witnessed Ng “cleaning up maggots on the living room floor.”

But after the caseworker left, the case file went largely dormant for months until Leung called back to file a second report of suspected self-neglect involving her mother. It was now late September 2022.

Strict standards

In Pennsylvania, there are strict standards for both initiating and conducting investigations of suspected abuse and neglect involving adults 60 or older.

When someone reports a concern, it is known as a report of need. Depending on the nature of the allegations, that report is then classified into one of five categories — including emergency, priority, non-priority, or no need — and assigned to one of the 52 county Area Agencies on Aging that serve the state’s 67 counties.

Some of those agencies are government-run, while others are organized as nonprofits. All of them receive operational funding from Pennsylvania’s Department of Aging, which uses a mix of state and federal dollars to underwrite the services they provide to older adults. Those services range from meals and transportation to educational programming to legal advice.

But one of the most critical things they provide is protective services. Often, the people they serve have limited resources and little or no family nearby to lean on.

State regulations require county aging agencies to make face-to-face contact with an older adult within 24 hours in both emergency and priority cases, and 72 hours in non-priority cases.

After that, caseworkers determine whether to substantiate the allegations. That determination has to be made “as soon as possible,” but at least within 20 days. The regulations make clear that an investigation is complete only when the allegation has or has not been substantiated; and if substantiated, after steps have been taken to reduce imminent risk to the older adult.

In Pennsylvania, those investigations are often woefully slow. A Spotlight PA analysis of seven years of data found that, in the best year, nearly a third of cases investigated annually by the 52 county agencies either missed the 20-day deadline or contained faulty paperwork that made it impossible to determine how they performed.

Both state and county protective services officials have defended their work, which is grueling and often low-paid; turnover is high. Caseloads across the state have been on the rise for several years, according to data from the Department of Aging, overwhelming what staff is available.

Meeting the state-imposed deadlines, officials said, can be complicated by circumstances outside their control, such as getting timely access to doctors or medical records.

In an interview last year with Spotlight PA, Department of Aging Secretary Jason Kavulich said he believed state regulations need to be “modernized,” though he stopped short of saying county agencies should have more time to investigate reports of abuse and neglect.

He and others also noted that the cases themselves are not straightforward.

“When you are dealing with people’s lives in protective services, it’s not black and white,” said JR Reed, board president of the Pennsylvania Association of Area Agencies on Aging, an advocacy organization. “Everything is gray, unfortunately. And every case is very case-specific. There are generalities of things that you can do, but every case has very different and unique circumstances.”

Reed said caseworkers don’t have unlimited powers when dealing with at-risk older adults. For someone to be swiftly removed from their home, he said, there has to be “imminent risk of serious bodily injury or death. That’s straight out of the regs.” Even in those instances, they would have to consult with a supervisor and their agency’s lawyers, and seek intervention through the courts.

A caseworker could also pursue emergency guardianship when they determine that an older adult doesn't have cognitive capacity. That too has to go through the courts.

“But it should be a last resort,” said Rebecca May-Cole, who heads the state association. “Because guardianship takes away the rights of the individual completely.”

She added: “The piece that I think is really critical is respecting the rights of the older adult. If they have the ability to make the decision for themselves, they have the right to make those decisions.”

‘Accident waiting to happen’

The second call from Leung was logged at 2:10 p.m. on Sept. 21, 2022.

The allegations were nearly identical, yet more urgent: Her mom has dementia. She lives alone. She frequently loses keys and her phone. She is not eating properly and is losing weight. She likely forgets to take her medications. Her house is infested with flies and roaches. She gets upset when she tries to help. She feels threatened by people.

At the intake center, the new report on Ng was again classified as a priority.

This time, Ng was interviewed in person the very next day.

The confidential case records obtained by Spotlight PA show the caseworker’s notes of that interview are a near carbon copy of the wording describing the first face-to-face meeting from a month earlier.

The PCA caseworker made only one observation about Ng that appeared to be new: “There was more trash accumulation in the living and dining room this time … utilities still appeared to be working.”

Ng again could answer only three out of 10 questions on the cognitive test they gave her.

Again, there was little activity in Ng’s case for over a month.

Finally, in late October, a PCA worker substantiated the allegations of self-neglect, more than a month after Leung’s second call — and nearly four months after the first. Soon after, a caseworker caught up with Ng at her place of employment, yet noted in the case file that Ng “presented without signs of cognitive impairment (confusion, repetition, etc).”

Ng’s employer, the caseworker also wrote, said that Ng was sometimes “forgetful and confused,” but is “very friendly and polite to the consumers she works with and her coworkers.”

During that meetup, the caseworker asked Ng if she would be interested in deep cleaning services. She declined, replying she knew how to clean. She also refused the offer of a home health aide, noting she was one herself.

For Leung, that was a turning point.

“I was livid. I was exasperated,” Leung said. “I just felt like after all of this effort and time … and you're telling me she's OK? How can you say she is OK? You are a trained professional.”

Leung said she reached out to another supervisor at PCA, who she believes advocated for her within the agency.

In early November, Leung told PCA protective services workers that she wanted to be deemed her mother’s guardian. PCA ordered a psychological evaluation for Ng.

In the days leading up to that evaluation, a new caseworker was assigned to Ng’s case and tried to meet with her, with no success.

On Nov. 9, a PCA caseworker logged that the results of Ng’s psychological evaluation had been received. The doctor who conducted it reported that Ng did not know her address, couldn’t discuss her finances, and was living in filth.

Leung, who was there during the evaluation, said the memory of it haunts her. She said the doctor looked at her and said, “Something catastrophic is going to happen. It is just a matter of when.”

“I just remember my heart dropping,” Leung said.

Officials at PCA were also warned, records show. Ng’s caseworker wrote that the doctor said Ng was “an accident waiting to happen.” She needed a guardian “asap.”

No consequences for repeated failures

The Pennsylvania Department of Aging annually monitors the county aging agencies to determine whether they are complying with state regulations on conducting protective services investigations.

The department does so by pulling a random sample of protective services cases to see how the local agency handled them. The agencies are assessed in a number of areas and given a score that determines whether or not they are compliant.

Since 2017, the Department of Aging has found anywhere from 10% to more than a third of the Area Agencies on Aging failed to comply in a given year, according to a Spotlight PA review of the records. Some, like PCA, failed multiple years in a row, with chronic deficiencies.

According to data obtained through a public records request, state aging monitors have found PCA out of compliance in five out of the seven years examined by the news organization. In the remaining two years, PCA was not monitored at all.

In 2022, the year Ng’s case was being investigated by PCA, the agency was noncompliant. The department does not make public the reasons, but records provided to Spotlight PA by sources familiar with the agency’s operations found the deficiencies included failing to start investigations in a timely fashion, failing to contact medical professionals, and failing to mitigate risk for an older adult suspected of abuse or neglect.

Ng’s case, the records show, was reviewed by the Department of Aging in the weeks before her death, according to internal records obtained by the news organization.

It is not clear how or why state officials became aware of Ng. Gray, the department’s spokesperson, did not respond to questions about the agency’s involvement in Ng’s matter, saying it does not comment on specific cases for confidentiality reasons.

But that year, the Department of Aging, alarmed at the backlog of open protective services cases at PCA, took steps to help the agency clear its caseload, according to three sources familiar with the matter. The sources requested anonymity because they were not allowed to publicly discuss internal deliberations about PCA’s problems.

The department could punish noncompliant county agencies by withholding funding, among other measures, but it has never done so. And because the results of state reviews aren’t made public, there is no opportunity for outside accountability.

“What are the consequences?” said Sheri McQuown, a former Department of Aging specialist who monitored county aging agencies for seven years. “Older adults are left at risk.”

Since leaving the department in 2023, McQuown has fired off emails to state and federal officials — among them, a U.S. senator and high-ranking members in Gov. Josh Shapiro’s administration — laying out the problems she witnessed with Pennsylvania’s system for keeping older adults safe.

Her emails have largely been met with silence. She and at least a half dozen other employees from the Department of Aging said they were interviewed about the state of protective services by investigators with the Pennsylvania Office of Inspector General.

The office — which investigates waste, fraud, and misconduct in state agencies — normally produces a report following its investigations. Historically, it has not made those reports public, instead providing them only to the governor and top staff of the agency being investigated.

After a 2017 change in state law, the office prioritized making many of its findings public.

Shapiro administration officials did not respond to questions about whether the inspector general produced a report, and if so, why it wasn’t made public. An inspector general spokesperson also declined comment.

In the meantime, the number of older adults who die every year during active abuse and neglect investigations has skyrocketed.

Between 2018 and 2022 — the latest year for which the aging department has provided complete data — deaths jumped from 888 to 1,696, an increase of nearly 91%.

Since 2021, the state aging department has conducted “fatality reviews,” or assessments of cases where an older adult dies under suspicious circumstances.

But under the Shapiro administration, those reviews are no longer carried out by state officials. Instead, Kavulich, a onetime county aging agency director himself, transferred that power to the local agencies — effectively allowing them to monitor themselves.

A frantic search, a tragic end

Within days of receiving the results of the psychological evaluation — and nearly four months after Leung first reported the self-neglect allegations — Ng’s PCA caseworker began assembling a plan for her safety.

The first step: a deep cleaning of Ng’s house.

Ng’s caseworker documented the emotional toll the service had taken on the elderly woman, and on Leung, who was at the house when it happened. Mice were scurrying out of the boxes being used to haul away trash and other items. Ng, according to records, tried to shoo away the cleaners, and several times, climbed into the truck where the boxes were being stacked.

“I had to physically remove her,” said Leung, who said the items from the living room and the kitchen alone filled up two trucks. “She was trying to take the trash back out. It was really bad.”

The next step: setting up frozen meals delivery, and arranging for personal care services and a house extermination. There was also a flurry of calls between Leung and PCA about a timeline for moving Ng in with Leung, who was researching programs designed for older Chinese adults that her mother could attend during the day.

It would never happen.

In the early hours of the morning on Nov. 18, Ng was struck by a van with no license plate, according to the records obtained by Spotlight PA, and was “dragged an unknown distance.” It appeared she was on her way to work.

The PCA worker wrote that Ng had fractures in her left tibia and fibula.

She also “suffered bilateral lower extremity degloving injuries,” leaving tendons exposed, the caseworker noted.

What isn’t in the report: Leung’s frantic attempts to find her mother in the hours after the crash, before she even knew her mother had been struck.

Leung said she received a call from her mother’s employer that morning, informing her that Ng hadn’t reported to work. She drove to Philadelphia, went to the police station, and tried to file a missing persons report, but her mother hadn’t been missing long enough.

A police officer helped her call area hospitals, eventually tracking Ng down at Jefferson Hospital.

“She was lying in the ICU unconscious, intubated,” said Leung. “I don't know how she was alive.”

The abrasions on her mother’s legs were so severe, said Leung, that Ng required multiple skin graft procedures. She said she still has nightmares about it.

The next few weeks involved a whirlwind of surgeries, skin grafts, and rehabilitation services. There was an emergency court hearing, where Leung was granted guardianship of her mother.

For a while, it seemed that Ng would pull through.

It didn’t last. On Jan. 8, 2023, Ng died.

The next day, a PCA worker noted that the agency was closing her case. Ng, the caseworker wrote, was “no longer in need of protective services.”