People with intellectual disabilities died and were injured at Pa. group homes. Regulators are taking action.

At a group home for people with disabilities, a resident languished on a bedroom floor for 12 hours, too weak to move. By the time they got to the hospital last spring, they had no feeling in their fingers and couldn’t speak. The person eventually needed a partial arm amputation and to be fed through a tube.

Another resident died in December at a Berks County home operated by the same nonprofit, Supportive Concepts for Families, after months of inadequate medical care and losing dangerous amounts of weight. The person couldn’t stand on the only scale at the house, so staffers recorded inaccurate weights.

At least four deaths at Supportive Concepts homes were investigated by state regulators in the span of a year.

That was just the start. Investigators also confirmed four serious injuries, 11 cases of abuse, 77 cases of neglect, four cases of exploitation, two suicide attempts, and two rights violations at its homes in the year ended Feb. 28, according to data from the Pennsylvania Department of Human Services.

The Inquirer requested the tally, as the state does not routinely release information on its investigations into group homes.

The pattern of neglect led to state sanctions for Supportive Concepts last month and is raising questions about its fast-growing owner, Inperium Inc., a corporate parent for a constellation of human services nonprofits. Inperium has more than doubled the number of group homes it operates after acquiring Philadelphia’s financially ailing Resources for Human Development last year.

Inperium CEO Ryan D. Smith started his career in human services three decades ago at Supportive Concepts. Its model of profiting from government-funded care provided the springboard for the creation of Inperium in 2016. Since then, Inperium has acquired 40 nonprofits. It now operates in behavioral health, children’s services, and substance-use disorders treatment, in addition to intellectual disabilities services.

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“This is heartbreakingly distressing to me to see this type of abuse all from the same provider and to also see it all occurring within a short time frame,” said Leonard G. Villari, a Philadelphia lawyer who has represented many people with intellectual disabilities and their families in abuse and neglect cases.

Inperium and Supportive Concepts, both based in Reading, did not respond to requests for comment.

It is unusual to see so many deaths and serious harm events in the same organization, advocates for people with disabilities say. Few details are known about the incidents, because the state heavily redacts its reports to protect residents’ privacy.

Last month, Pennsylvania regulators barred Supportive Concepts from accepting new residents in its 103 group homes for intellectually disabled people in Northeastern Pennsylvania and prohibited it from opening new homes in that 15-county region.

Regulators also revoked the license of the Berks County house where the person died Dec. 19 after Supportive Concepts staff repeatedly failed to follow medical instructions — including after a 16-day hospital stay, according to a state report. Eight staff members were not properly trained in the person’s care.

“DHS takes reports and complaints about the safety of individuals in licensed facilities seriously, and we work to ensure that any allegations and potential violations that put people at risk are investigated and handled urgently,” the agency said in a statement.

Last year, Inperium made its biggest deal yet, when it took over RHD, which runs 173 licensed community homes, even more than the 161 operated by Supportive Concepts.

Now Inperium could take a significant financial hit from the state’s sanctions at a time when it faces heightened scrutiny from investors following a $176 million bond sale in December.

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Inperium told bondholders that it had appealed the April 16 licensing action and noted that the state will keep paying Supportive Concepts during the appeals process.

Each licensed home can have more than one location, making it difficult to know the full scope of Inperium’s operations. Group homes can have up to four residents. Annual budgets for the care of individuals can be as much as $500,000 per person.

Inperium downplayed the financial impact of not being able to open new locations in Northeast Pennsylvania, Supportive Concepts’ biggest market.

That area accounts for just 8% of the revenue for Inperium businesses that are responsible for bond payments, the bondholder notice said.

However, Supportive Concepts overall accounted for about two-thirds of Inperium’s cash profits in fiscal 2024. That includes the losses at RHD, which added more than $300 million in annual revenue to Inperium’s books but was on the verge of bankruptcy before Inperium agreed to acquire it.

That’s how Inperium operates: In an Inquirer interview last year, Smith, the CEO, described how he finds acquisition targets by using a computer program to comb through tax returns looking for financial weakness at human services nonprofits.

Inperium’s model calls for consolidating back-office operations and information technology support in one of its subsidiaries as a way to boost profitability. That’s what happened at RHD.

The organization’s CEO, Brian Rhodes, said at a conference in Philadelphia last week RHD that is expecting to swing to a $4 million to $5 million operating profit this year, compared to a $10 million loss in fiscal 2024.

After The Inquirer requested information on Supportive Concepts’ quality inspections and operations, state regulators provided seven reports from their so-called unannounced monitoring visits.

That type of inspection happens when a complaint or an incident reported by a provider triggers an inspection to consider whether the status of an operating license should be revoked or be changed to provisional.

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At the house where the Berks County resident died in December after months of neglect, the state went straight to revocation. Regulators also barred further expansion by Supportive Concepts in a key region.

DHS “considers the totality of regulatory noncompliance, including repeated and serious violations, when determining sanctions,” it said in a statement, declining to provide specific comments about the incidents at Supportive Concepts facilities because of privacy regulations.

Six of the seven unannounced monitoring reports provided to The Inquirer revealed regulatory violations.

Inspectors found abuse, failure to provide required one-on-one care, rights violations, dozens of missed medication doses, and the use of an illegal restraint during a behavioral episode.

Dee Coccia, an advocate for people with intellectual and developmental disabilities, finds it baffling that regulators don’t close Supportive Concepts. “How many people need to be harmed before you end it for an agency?”

The failings at Supportive Concepts homes go beyond physical harm.

The reports show that the organization is not meeting a key aim of group homes to enable residents to experience life in the community, instead of being isolated.

For example, an individual who “enjoys going to church, going out to eat and for coffee, and getting a monthly haircut” was taken on only one outing from August through October last year, the report says.

After reviewing the Supportive Concepts reports, Villari, the plaintiff attorney with experience in the intellectual disabilities field, said the government should do more to stop such systemic failure.

“I cringe to even ponder the scope of what is going on at an organization of this size throughout the number of group homes they run,” he said.