The current staffing, she said, means the welfare department depends on the homes to report serious incidents honestly.

"She's not going to get 38," Richman said. "But she will get more staff."

Richman said personal-care homes were one area competing for scarce dollars in a welfare budget that had been reduced in recent years.

Reforming a deeply troubled government program takes time, she said.

"We went through, in essence, three different directors in that program in two years," she said. "That tells you that I am aware of what's going on and I am not satisfied with what I am getting."

Years of appeals

When the welfare department does take enforcement action, it often finds itself stymied by a glacial appeals process.

The case of the Cedarwood personal-care homes outside Pittsburgh is a telling example.

In August 2004, sometime before 7 a.m., Anna Mae Edwards, 90, suffered a stroke in her room. She had fallen on the floor and hit her head. No staff member was on hand to help her.

The owner, Judith Reynolds, had gone to Harrisburg early that morning, leaving eight frail and elderly residents alone. An employee was due in at 7 a.m., Reynolds said in an interview, but showed up an hour late.

Resident Anna Latronico, 100, walked outside to get help, fell and hurt herself.

Edwards died in a hospital three days later. Allegheny County prosecutors charged Reynolds with two counts of neglect of a care-dependent person, a misdemeanor.

Prosecutors later dropped the one count related to the death, saying they could not prove Reynolds' absence caused it. On the charge of neglecting Latronico, Reynolds entered a program that allowed her to avoid a criminal conviction if she completed 24 months of probation.

After Edwards died, the state moved to revoke Reynolds' licenses for all five of her personal-care homes on the grounds of "gross incompetence, negligence and/or misconduct."

She appealed. Later, inspectors found she was supervising residents alone, defying an order to have another caregiver present at all times.

Reynolds, a registered nurse who lives in one of the homes, said she kept her residents safe. She acknowledged ignoring the order, but said she couldn't afford to have a staffer on duty overnight.

She called Edwards' death a "tragedy" that could not have been prevented. "God chose to end her life," she said.

In December, after nearly two years of state efforts, a judge ordered Cedarwood's five homes closed.

Much of the delay was attributable to the welfare department's Bureau of Hearings Appeals, Kroh said. Homes have a right to a hearing on closure actions, which can take months or years to complete.