II
Calendar No. 617
109th CONGRESS
2d Session
S. 2010
[Report No. 109–337]
IN THE SENATE OF THE UNITED STATES
November 15, 2005
Mr. Hatch (for himself, Mrs. Lincoln, Mr. Smith, Mr. Kohl, Ms. Landrieu, Mr. Chambliss, Mr. Schumer, Mr. Santorum, Mrs. Clinton, Mr. Bunning, Mr. Pryor, Mr. Lautenberg, Mr. Lieberman, Mr. Enzi, Ms. Collins, Ms. Snowe, Ms. Stabenow, Mr. Bingaman, Mrs. Boxer, Mr. Bayh, Mr. Rockefeller, Ms. Murkowski, Mr. Salazar, Mr. Nelson of Florida, Mr. Johnson, Mr. Menendez, Mr. Reed, and Mr. Specter) introduced the following bill; which was read twice and referred to the Committee on Finance
September 19, 2006
Reported by Mr. Grassley, with an amendment
Strike out all after the enacting clause and insert the part printed in italic
A BILL
To amend the Social Security Act to enhance the Social Security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation, and for other purposes.
Short title; table of contents
Short title
This Act may be cited as the Elder Justice Act
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Purposes.
TITLE I—Department of Health and Human Services
Sec. 101. Amendment to the
Social Security Act.Sec. 102. Supporting the long-term care ombudsman program.
Sec. 103. Adult protective services functions and grant programs.
Sec. 104. Assuring safety of residents when nursing facilities close.
Sec. 105. National nurse aide registry.
Sec. 106. Background checks on direct access employees of long-term care facilities or providers.
TITLE II—Department of Justice
Sec. 201. Model State laws and practices.
Sec. 202. Office of Elder Justice of the Department of Justice.
Sec. 203. Victim advocacy grants.
Sec. 204. Supporting local prosecutors in elder justice matters.
Sec. 205. Supporting state prosecutors in elder justice matters.
Sec. 206. Increased support for federal cases involving elder justice.
Sec. 207. Supporting law enforcement in elder justice matters.
Sec. 208. Evaluations.
TITLE III—Tax provisions
Sec. 301. Long-term care facility worker employment tax credit.
Findings
Congress finds the following:
The proportion of the United States population age 60 years or older will drastically increase in the next 30 years as 77,000,000 baby boomers approach retirement and old age.
Each year, anywhere between 500,000 and 5,000,000 elders in the United States are abused, neglected, or exploited.
Elder abuse, neglect, and exploitation have no boundaries, and cross all racial, social class, gender, and geographic lines.
Victims of elder abuse, neglect, and exploitation are not only subject to injury from mistreatment and neglect, they are also 3.1 times more likely to die at an earlier age than expected than elders who were not victims of elder abuse, neglect, and exploitation.
There is a general dearth of data as to the nature and scope of elder abuse, neglect, and exploitation.
Despite the dearth of data in the field, experts agree that most cases of elder abuse, neglect, and exploitation are never reported and that abuse and neglect shorten a victim’s life, often triggering a downward spiral of an otherwise productive, self-sufficient elder’s life. Programs addressing other difficult issues such as domestic violence and child abuse and neglect have demonstrated the need for a multi-faceted law combining public health, social service, and law enforcement approaches.
For over 20 years, Congress has been presented with facts and testimony calling for a coordinated Federal effort to combat elder abuse, neglect, and exploitation.
The Federal Government has been slow to respond to the needs of victims of elder abuse, neglect, and exploitation or to undertake prevention efforts.
No Federal law has been enacted that adequately and comprehensively addresses the issues of elder abuse, neglect, and exploitation and there are very limited resources available to those in the field directly dealing with these issues.
Differences in State laws and practices in the areas of elder abuse, neglect, and exploitation lead to significant disparities in prevention, protective and social services, treatment systems, and law enforcement, and lead to other inequities.
The Federal Government has played an important role in promoting research, training, public safety, data collection, the identification, development, and dissemination of promising health care, social, and protective services, and law enforcement practices relating to child abuse and neglect, domestic violence, and violence against women. The Federal Government should promote similar efforts and protections relating to elder abuse, neglect, and exploitation.
The Federal Government should provide leadership and assist States and communities in their efforts to protect elders in the United States by—
promoting coordinated planning among all levels of government;
generating and sharing knowledge relevant to protecting elders;
providing leadership to combat the abuse, neglect, and exploitation of the Nation’s elders; and
providing resources to States and communities to promote elder justice.
The problem of elder abuse, neglect, and exploitation requires a comprehensive approach that—
integrates the work of health, legal, and social service agencies and organizations;
emphasizes the need for prevention, reporting, investigation, assessment, treatment, and prosecution of elder abuse, neglect, and exploitation at all levels of government;
ensures that sufficient numbers of properly trained personnel with specialized knowledge are in place to treat, assess, and provide services relating to elder abuse, neglect, and exploitation, and carry out elder and vulnerable adult protection duties;
is sensitive to ethnic and cultural diversity;
recognizes the role of mental health, disability, dementia, substance abuse, medication mismanagement, and family dysfunction problems in increasing and exacerbating elder abuse, neglect, and exploitation; and
balances adults’ right to self-determination with society’s responsibility to protect elders and vulnerable adults.
The human, social, and economic cost of elder abuse, neglect, and exploitation is high and includes unnecessary expenditures of medicare and medicaid funds.
The failure to coordinate activities relating to, and comprehensively prevent and treat, elder abuse, neglect, and exploitation threatens the future and well-being of millions of elders in the United States.
All elements of society in the United States have a shared responsibility in responding to the national problem of elder abuse, neglect, and exploitation.
Purposes
The purposes of this Act are as follows:
To bring a comprehensive approach to preventing and combating elder abuse, neglect, and exploitation, a long invisible problem that afflicts the most vulnerable among the aging population of the United States.
To raise the issue of elder abuse, neglect, and exploitation to national attention, and to create the infrastructure at the Federal, State, and local levels to ensure that individuals and organizations on the front lines who are fighting elder abuse, neglect, and exploitation with scarce resources and fragmented systems have the resources and information needed to carry out their fight.
To bring a comprehensive multi-disciplinary approach to elder justice.
To set in motion research and data collection to fill gaps in knowledge about elder abuse, neglect, and exploitation.
To supplement the activities of service providers and programs, to enhance training, and to leverage scarce resources efficiently to ensure that elder justice receives the attention it deserves as the Nation’s population ages.
To examine the many different laws and practices relating to elder justice in different States and jurisdictions to ascertain which among those laws and practices are the most effective.
To promote the development of an effective adult fiduciary system, including an adult guardianship system, that protects individuals with diminished capacity, maximizes their autonomy, and develops effective resources and an elder rights system.
To recognize and address the role of mental health, disability, dementia, substance abuse, medication mismanagement, and family dysfunction problems in increasing and exacerbating elder abuse, neglect, and exploitation.
To create a short- and long-term strategic plan for the development and coordination of elder justice research, programs, studies, training, and other efforts nationwide.
To promote collaborative efforts and diminish overlap and gaps in efforts in developing the important field of elder justice.
Department of Health and Human Services
Amendment to the Social Security Act
The Social Security Act (42 U.S.C. 301 et seq.) is amended by adding at the end the following:
Elder justice
Definitions
In this title:
Abuse
The term abuse means the knowing infliction of physical or psychological harm or the knowing deprivation of goods or services that are necessary to meet essential needs or to avoid physical or psychological harm.
Adult protective services
The term adult protective services means such services provided to adults as the Secretary may specify and includes services such as—
disseminating reports of adult abuse, neglect, or exploitation;
investigating the reports described in subparagraph (A);
case planning, monitoring, evaluation, and other case work and services; and
providing, arranging for, or facilitating the provision of medical, social service, economic, legal, housing, law enforcement, or other protective, emergency, or support services.
Caregiver
The term caregiver means an individual who has the responsibility for the care of an elder, either voluntarily, by contract, by receipt of payment for care, or as a result of the operation of law and includes a family member or other individual who provides (on behalf of such individual or of a public or private agency, organization, or institution) compensated or uncompensated care to an elder who needs supportive services in any setting.
Direct care
The term direct care means care by a caregiver who provides assistance or long-term care services to a recipient.
Elder
The term elder means an individual age 60 or older.
Elder justice
The term elder justice means—
from a societal perspective, efforts to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation and to protect elders with diminished capacity while maximizing their autonomy; and
from an individual perspective, the recognition of an elder’s rights, including the right to be free of abuse, neglect, and exploitation.
Eligible entity
The term eligible entity means a State or local government agency, Indian tribe, or any other public or private entity that is engaged in and has expertise in issues relating to elder justice or in a field necessary to promote elder justice efforts.
Exploitation
The term exploitation means the fraudulent or otherwise illegal, unauthorized, or improper act or process of an individual, including a caregiver or fiduciary, that uses the resources of an elder for monetary or personal benefit, profit, or gain, or that results in depriving an elder of rightful access to, or use of, benefits, resources, belongings, or assets.
Fiduciary
The term fiduciary—
means a person or entity with the legal responsibility—
to make decisions on behalf of and for the benefit of another person; and
to act in good faith and with fairness; and
includes a trustee, a guardian, a conservator, an executor, an agent under a financial power of attorney or health care power of attorney, or a representative payee.
Grant
The term grant includes a contract, cooperative agreement, or other mechanism for providing financial assistance.
Granting authority
The term granting authority means the Secretary, the Attorney General, or the Secretary and the Attorney General jointly, as appropriate.
Guardianship
The term guardianship means—
the process by which a State court determines that an adult individual lacks capacity to make decisions about self-care and property, and appoints another individual or entity known as a guardian, as a conservator, or by a similar term, as surrogate decision maker;
the manner in which the court-appointed surrogate carries out duties to the individual and the court; or
the manner in which the court exercises oversight of the surrogate.
Indian
The term Indian means a person who is a member of an Indian tribe.
Indian tribe
The term Indian tribe means any Indian tribe, band, nation, or other organized group or community, including any Alaska Native village or regional corporation as defined in or established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), that is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians.
Knowingly
The term knowingly has the meaning given such term in section 3729(b) of title 31, United States Code.
Law enforcement
The term law enforcement means the full range of potential responders to elder abuse, neglect, and exploitation including—
police, sheriffs, detectives, public safety officers, and corrections personnel;
prosecutors;
medical examiners;
investigators; and
coroners.
Long-Term care
In general
The term long-term care means supportive and health services specified by the Secretary for individuals who need assistance because the individuals have a loss of capacity for self-care due to illness, disability, or vulnerability.
Loss of capacity for self-care
For purposes of subparagraph (A), the term loss of capacity for self-care means an inability to engage in activities of daily living, including eating, dressing, bathing, and management of one’s financial affairs.
Long-Term care facility
The term long-term care facility means a residential care provider that arranges for, or directly provides, long-term care.
Neglect
The term neglect means—
the failure of a caregiver or fiduciary to provide the goods or services that are necessary to maintain the health or safety of an elder; or
self-neglect.
Nursing facility
The term nursing facility has the meaning given such term under section 1919(a).
Self-neglect
The term self-neglect means an adult’s inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks including—
obtaining essential food, clothing, shelter, and medical care;
obtaining goods and services necessary to maintain physical health, mental health, or general safety; or
managing one’s own financial affairs.
Serious bodily injury
In general
The term serious bodily injury means an injury—
involving extreme physical pain;
involving substantial risk of death;
involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty; or
requiring medical intervention such as surgery, hospitalization, or physical rehabilitation.
Criminal sexual abuse
Serious bodily injury shall be considered to have occurred if the conduct causing the injury is conduct constituting aggravated sexual abuse under section 2241, or sexual abuse under section 2242, of title 18, United States Code, or any similar offense under State law.
Social
The term social, when used with respect to a service, includes adult protective services.
State
The term State means any of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the United States, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Mariana Islands.
State Long-Term Care Ombudsman
The term State Long-Term Care Ombudsman means the State Long-Term Care Ombudsman described in section 712(a)(2) of the Older Americans Act of 1965.
Underserved population
The term underserved population means the population of an area designated by the Secretary as an area with a shortage of elder justice programs or a population group designated by the Secretary as having a shortage of such programs. Such areas or groups designated by the Secretary may include—
areas or groups that are geographically isolated (such as isolated in a rural area);
racial and ethnic minority populations; and
populations underserved because of special needs (such as language barriers, disabilities, alien status, or age).
Federal elder justice system
Office of Elder Justice of the Department of Health and Human Services
Establishment
There is established within the Department of Health and Human Services under the Assistant Secretary for Aging an Office of Elder Justice.
Director
Appointment
The President, with the advice and consent of the Senate, shall appoint a Director of the Office of Elder Justice, from among individuals with experience and expertise in elder justice issues, to manage the Office of Elder Justice established under this section.
Duties
The Director of the Office of Elder Justice shall—
develop objectives, priorities, policies, and a long-term plan for elder justice programs and activities relating to prevention, detection, training, treatment, evaluation, intervention, research, and improvement of the elder justice system in the United States;
implement the overall policies and a strategy to carry out the plan described in clause (i); and
hire personnel to assist the director in carrying out the policies, programs, and administrative activities related to the duties under clauses (i) and (ii); and
provide advice to the Secretary on elder justice issues.
Reporting relationship
The Director of the Office of Elder Justice shall report to the Assistant Secretary for Aging.
Compensation
The Director shall be compensated at a rate that shall not exceed the rate established for level I of the Executive Schedule under section 5312 of title 5, United States Code.
Elder Justice Coordinating Council
Establishment
There
is established within the Office of the Secretary an Elder Justice Coordinating
Council (in this section referred to as the Council
).
Membership
In general
The Council shall be composed of the following members:
The Secretary (or the Secretary's designee).
The Attorney General (or the Attorney General's designee).
The head of each Federal department or agency or other governmental entity identified by the Co-Chairs referred to in subsection (d) as having responsibilities or administering programs relating to elder abuse, neglect, and exploitation.
Requirement
Each member of the Council shall be an officer or employee of the Federal Government.
Vacancies
Any vacancy in the Council shall not affect its powers, but shall be filled in the same manner as the original appointment was made.
Co-Chairs
The members described in subparagraphs (A) and (B) of subsection (b)(1) shall be Co-Chairs of the Council.
Meetings
The Council shall meet at least 2 times per year, as determined by the Co-Chairs.
Duties
In general
The Council shall make recommendations to the Secretary and the Attorney General for the coordination of activities of the Department of Health and Human Services, the Department of Justice, and other relevant Federal, State, local, and private agencies and entities, relating to elder abuse, neglect, and exploitation and other crimes against elders.
Report
Not later than the date that is 2 years after the date of enactment of the Elder Justice Act and every 2 years thereafter, the Council shall submit to Congress a report that—
describes the activities of, accomplishments of, and challenges faced by—
the Council; and
the entities represented on the Council; and
makes such recommendations for legislation, model laws, or other action as the Council determines to be appropriate.
Powers of the Council
Information from federal agencies
In general
Subject to subparagraph (B), the Council may secure directly from any Federal department or agency such information as the Council considers necessary to carry out this section. Upon request of the Co-Chairs of the Council, the head of such department or agency shall furnish such information to the Council.
Protection of privacy
The Secretary shall oversee the activities of the Council under this paragraph in order to ensure the protection of individual health privacy consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 and State and local privacy regulations (as applicable).
Postal services
The Council may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.
Travel expenses
The members of the Council shall not receive compensation for the performance of services for the Council. The members shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter 1 of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Council. Notwithstanding section 1342 of title 31, United States Code, the Secretary may accept the voluntary and uncompensated services of the members of the Council.
Detail of government employees
Any Federal Government employee may be detailed to the Council without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.
Advisory Board on elder abuse, neglect, and Exploitation
Establishment
There
is established a board to be known as the Advisory Board on Elder Abuse,
Neglect, and Exploitation
(in this section referred to as the
advisory board
) to create a short- and long-term
multidisciplinary strategic plan for the development of the field of elder
justice, and to make recommendations to the Secretary, the Attorney General,
and the Elder Justice Coordinating Council established under section
2212.
Solicitation of nominations
The Secretary shall publish a notice in the Federal Register soliciting nominations for the appointment of members of the advisory board under subsection (c).
Composition
The advisory board shall be composed of 27 members appointed by the Secretary from the general public who are individuals with experience and expertise in elder abuse, neglect, and exploitation prevention, intervention, treatment, detection, or prosecution.
Vacancies
In general
Any vacancy in the Advisory Board shall not affect its powers, but shall be filled in the same manner as the original appointment was made.
Filling unexpired term
An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced.
Election of officers
The advisory board shall elect a chairperson and vice chairperson from among the members. The advisory board shall elect its initial chairperson and vice chairperson at its initial meeting.
Duties
Not later than 18 months after the establishment of the advisory board under subsection (a), and annually thereafter, the advisory board shall prepare and submit to the Secretary, the Attorney General, and the appropriate committees of Congress a report containing—
information on the status of Federal, State, and local public and private elder justice activities;
recommendations (including recommended priorities) regarding—
elder justice programs, research, training, services, practice, enforcement, and coordination;
coordination between entities pursuing elder justice efforts and those involved in related areas that may inform or overlap with elder justice efforts, such as activities to combat violence against women and child abuse and neglect; and
activities relating to adult fiduciary systems, including guardianship and other fiduciary arrangements, including the development of State interdisciplinary guardianship committees;
recommendations for specific modifications to Federal and State laws (including regulations) or for programs, research, and training to enhance prevention, detection, diagnosis, treatment, intervention in, investigation, and prosecution of elder abuse, neglect, and exploitation;
recommendations for the most effective coordinated national data collection with respect to elder justice, and elder abuse, neglect, and exploitation; and
recommendations for a multidisciplinary strategic plan to guide the effective and efficient development of the elder justice area.
Powers of the Advisory Board
Information from Federal agencies
In general
Subject to subparagraph (B), the advisory board may secure directly from any Federal department or agency such information as the advisory board considers necessary to carry out this section. Upon request of the chair, the head of such department or agency shall furnish such information to the advisory board.
Protection of privacy
The Secretary shall oversee the activities of the advisory board under this paragraph in order to ensure the protection of individual health privacy consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 and State and local privacy regulations (as applicable).
Sharing of data and reports
The advisory board may secure from any entity pursuing elder justice activities under the Elder Justice Act or an amendment made by that Act, any data, reports, or recommendations generated in connection with such activities.
Postal services
The advisory board may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.
Gifts
The advisory board may accept, use, and dispose of gifts or donations of services or property.
Travel expenses
The members of the advisory board shall not receive compensation for the performance of services for the advisory board, but shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the advisory board. Notwithstanding section 1342 of title 31, United States Code, the Secretary and the Attorney General may accept the voluntary and uncompensated services of the members of the advisory board.
Detail of government employees
Any Federal Government employee may be detailed to the advisory board without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.
Status as permanent advisory committee
Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the advisory board.
Authorization of Appropriations
There are authorized to be appropriated to carry out this subsection—
$6,000,000 for fiscal year 2007; and
$7,500,000 for each of fiscal years 2008 through 2013.
Activities to promote elder justice
Data collection and dissemination
Elder Justice Resource Center
Establishment
The
Secretary, after consultation with the Attorney General, shall establish within
the Office of Elder Justice, an Elder Justice Resource Center (in this section
referred to as the Center
) to be the central repository for
information regarding elder abuse, neglect, and exploitation.
Duties
The Center shall—
develop the capacity and procedures to collect, maintain, and disseminate information relevant to consumers, families, providers, clinicians, advocates, regulators, law enforcement, policymakers, researchers, fiduciaries including guardians, judges, and lawyers, relevant to the prevention, detection, assessment, identification, and treatment of, intervention in, and prosecution of, elder abuse, neglect, and exploitation;
provide, in a user-friendly manner, information on—
ways to promote autonomy in the face of aging or diminishing capacity and mobility;
how to avoid becoming a victim of elder abuse, neglect, or exploitation; and
advance planning and how to avoid the need for a fiduciary;
provide links and references to other sources of information;
compile, analyze, and publish a summary of research conducted on elder abuse, neglect, and exploitation and information on how to obtain the original research materials;
solicit public comment and comment from the advisory board established under section 2213 on the activities of the Center;
establish a toll-free number for information and referrals;
coordinate activities with resource centers and clearinghouses on elder justice topics; and
provide funding to public and private agencies and entities to develop or continue the efforts of specialized elder justice-related clearinghouses and information repositories, to be linked to the Center, that address topics such as those enumerated in subparagraphs (A) and (B) and that provide effective services.
Coordination of available resources
In establishing the Center under this subsection the Secretary, after consultation with the Attorney General, shall—
consult with other Federal agencies that operate similar resource centers;
consult with private entities that operate resource centers or clearinghouses on elder justice-related topics;
consult with the head of each agency participating in the Elder Justice Coordinating Council established under section 2212, as well as other agencies with clearinghouses comparable to the Center, such as clearinghouses relating to child abuse and neglect, to determine the most efficient and effective manner for collecting, maintaining, and disseminating information on elder abuse, neglect, and exploitation; and
solicit public comment on the components of such Center.
National Elder Justice Library
Establishment
The
Secretary shall establish within the Center a National Elder Justice Library
(in this paragraph referred to as the Library
) to serve as a
centralized repository for all types of appropriate materials concerning
training, technical assistance, and promising practices relating to elder
justice including—
brochures and pamphlets;
video and computer-based resources;
books; and
training materials.
Index
The Library shall create and maintain an up-to-date index of the materials described in subparagraph (A) by title, author, date, subject, and type of material, and a brief description of such materials. Such index shall be available on the Internet as well as in printed form in order to be easily accessible to the general public.
Availability
The materials held by the Library shall be available for copying by individuals and entities nationwide and shall be disseminated at a nominal or no fee. The materials shall be copied and disseminated in accordance with the applicable provisions of title 17, United States Code.
Duties
Additional materials
The Library shall—
collect data on materials that would be appropriate for such library;
make efforts to identify and obtain appropriate materials; and
identify and obtain materials relating to effective methods of conducting training and providing technical assistance relating to elder justice, including conducting training and providing assistance for underserved populations.
Information packets
After evaluating the materials described in this paragraph, the Library shall compile and develop information packets for use by groups in various settings, including groups who are underserved or have other special needs. Such information packets shall include information and materials on training, technical assistance, and promising practices targeted at specific topics, groups, and settings.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$4,000,000 for fiscal year 2007;
$5,000,000 for fiscal year 2008; and
$6,000,000 for each of fiscal years 2009 through 2013.
Collection of uniform national data on elder abuse, neglect, and exploitation
Purpose
The purpose of this subsection is to improve, streamline, and promote uniform collection, maintenance, and dissemination of national data relating to elder abuse, neglect, and exploitation.
Phase I
In general
Not later than 1 year after the date of enactment of the
Elder Justice Act, the Director of the Centers for Disease Control and
Prevention (in this subsection referred to as the Director
),
after consultation with the Attorney General and working with experts in
relevant disciplines, shall—
develop a method for collecting national data regarding elder abuse, neglect, and exploitation; and
develop uniform national data reporting forms adapted to each relevant entity or discipline (such as health, public safety, social and protective services, and law) reflecting—
the distinct manner in which each discipline receives and maintains information; and
the sequence and history of reports to or involvement of different disciplines, independently, or the sequence and history of reports from one discipline to another over time.
Forms
The national data reporting forms described in subparagraph (A)(ii) shall incorporate the definitions of this title for use in determining what is considered a reportable event.
Phase II
In general
Not later than 1 year after the completion of the activities described in paragraph (2), the Director shall ensure that the national data reporting forms and data collection methods developed in accordance with such paragraph are pilot tested in 6 States determined by the Director.
Adjustments to the form and methods
The Director, after considering the results of the pilot testing described in subparagraph (A), and after consultation with the Attorney General and relevant experts shall adjust the national data reporting forms and data collection methods as necessary.
Phase III
Distribution of national data reporting forms
After completion of the adjustment to the national data reporting forms under paragraph (3)(B), the Director shall submit the national data reporting forms along with instructions to—
the heads of the relevant components of the Department of Health and Human Services, the Department of Justice, and the Department of the Treasury, and such other Federal entities as may be appropriate; and
the Governor’s office of each State for collection from all relevant State entities of data, including health care, social services, and law enforcement data.
Data collection grants
Authorization
The Director is authorized to award grants to States to improve data collection activities relating to elder abuse, neglect, and exploitation.
Application
To be eligible to receive a grant under this subparagraph, a State shall submit to the Director an application at such time, in such manner, and containing such information as the Director may require.
Requirements
Each State receiving a grant under this subparagraph for a fiscal year is required to report data for the calendar year that begins during that fiscal year, using the national data reporting forms described in subparagraph (A).
Funding
First year
For the first fiscal year in which a State receives grant funds under this subsection, the Secretary shall initially distribute 50 percent of such funds. The Secretary shall distribute the remaining funds at the end of the calendar year that begins during that fiscal year, if the Secretary determines that the State has properly reported data required under this subsection for the calendar year.
Subsequent years
Except as provided in subclause (I), the Secretary shall distribute grant funds to a State under this subsection for a fiscal year if the Secretary determines that the State properly reported data required under this subsection for the calendar year that ends during that fiscal year.
Required information
Each report submitted under this paragraph shall—
indicate the State and year in which each event occurred; and
identify—
the total number of events that occurred in each State during the year; and
the type of each event.
Report
Not later than 1 year after the date of enactment of the Elder Justice Act and annually thereafter, the Secretary shall prepare and submit to the appropriate committees of Congress, including to the Special Committee on Aging and the Finance Committee of the Senate, a report regarding activities conducted under this section.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$10,000,000 for fiscal year 2007;
$30,000,000 for fiscal year 2008; and
$100,000,000 for each of fiscal years 2009 through 2013.
Enhancing research and training and strengthening services, systems, and prevention
General grants and centers of excellence
General grants
The Secretary may award grants to eligible entities for the prevention, detection, assessment, and treatment of, intervention in, investigation of, and prosecution of elder abuse, neglect, and exploitation including—
physical, psychological, and emotional abuse and neglect by family and other in-home caregivers;
physical, psychological, and emotional abuse and neglect of residents in institutional and other residential care facilities;
elder sexual abuse;
domestic violence in later life;
financial fraud and exploitation; and
self-neglect.
Centers of Excellence
Grants authorized
The Secretary, through the Director of the National Institute on Aging, and after consultation with the Director of the Centers for Disease Control and Prevention, the Director of the Office of Elder Justice in the Department of Health and Human Services, the Director of the Office of Elder Justice in the Department of Justice, and the members of the advisory board established under section 2213, may award grants to institutions of higher education and other appropriate entities to establish 5 Centers of Excellence nationwide that shall specialize in research, clinical practice, and training relating to elder abuse, neglect, and exploitation.
Authorized activities
The Centers of Excellence established with funds provided under subparagraph (A) shall conduct the following activities:
Examine potential issues relating to the protection of elders who are the subjects of research on elder abuse, neglect, and exploitation and provide guidance to other elder abuse, neglect, or exploitation researchers regarding human subjects, protections, and the institutional or peer review boards at research institutions.
After consultation with the Director of the National Institute on Aging, and the Director of the Office of Human Research Protections, develop and recommend to the Secretary guidelines to assist the institutional or peer review boards in the review of research conducted under this title.
Coordinate activities, to the extent feasible, among the Centers and with other researchers of elder abuse, neglect, and exploitation and related areas, and designate 1 such Center to lead such coordination.
Additional activities
The Centers of Excellence established under subparagraph (A) may conduct activities including the following:
Carrying out a study to determine the national incidence and prevalence of elder abuse, neglect, and exploitation in all settings.
Developing uniform, validated screening tools to assist individuals, families, practitioners, institutions, and communities in detecting ongoing or potential elder abuse, neglect, and exploitation. The tools that may be developed include—
a screening tool to determine whether a particular elder is at risk for becoming, or is, a victim of elder abuse, neglect, or exploitation;
a screening tool to measure whether caregivers are at risk of committing elder abuse, neglect, or exploitation;
a screening tool to measure whether families are at risk for elder abuse, neglect, and exploitation; and
a screening tool to assess communities, evaluating how each individual agency or system relating to elder abuse, neglect, or exploitation operates in such a community and how all of such agencies or systems communicate and operate in relationship to each other within such community.
Carrying out various types of intervention research.
Identifying steps that can be taken (and replicated) to make homes, neighborhoods, communities, and facilities safer for elders, and to enhance elders’ sense of security in all kinds of environments.
Researching successful fiduciary practices and systems to enhance the well-being of persons with diminished capacity.
Collaboration and access to records
In awarding a grant under this paragraph the Secretary shall—
consider the potential for collaboration among researchers and other relevant entities, such as State agencies with statutory responsibility for adult protective services and State Long-Term Care Ombudsmen, that receive reports of elder abuse, neglect, and exploitation, but that may be restricted from participating in research as a result of State law, confidentiality requirements, or other provisions; and
require that each institution of higher education desiring a grant under this subsection ensure that the researchers working at such institution will have access to records necessary to conduct research in accordance with this paragraph.
Authorization of appropriations
There are authorized to be appropriated for the purpose of carrying out paragraphs (1) and (2) of this subsection—
$12,000,000 for fiscal year 2007;
$20,000,000 for fiscal year 2008; and
$25,000,000 for each of fiscal years 2009 through 2013.
Safe haven and legal advocacy grants
Safe haven grants
Grants authorized
The Secretary may award grants to 6 diverse
communities to examine various types of elder shelters (in this paragraph
referred to as safe havens
) and to test various models for
establishing safe havens at home or elsewhere.
Authorized activities
Grant funds awarded pursuant to subparagraph (A) shall be used to establish safe havens that—
provide a comprehensive, culturally sensitive, and multidisciplinary team response to allegations of elder abuse, neglect, or exploitation;
provide a dedicated, elder-friendly setting;
have the capacity to meet the needs of elders for care; and
provide various services including—
nursing and forensic evaluation;
therapeutic intervention;
victim support and advocacy; and
case review and assistance to make the elder safer at home or to find appropriate placement in safer environments, including shelters, and, in some circumstances, long-term care facilities, other residential care facilities, and hospitals.
Legal advocacy grants
Grants authorized
The Secretary, after consultation with the Attorney General, may award grants—
to study the need for community resources in order to provide assistance for legal and related services for victims of elder abuse, neglect, or exploitation; and
to provide assistance for such services by awarding grants for demonstration projects in diverse communities.
Authorized activities
Grant funds awarded pursuant to subparagraph (A) shall be used to provide—
court-appointed advocates;
authorized fiduciaries, including public guardians;
monitoring and oversight of fiduciaries;
legal services; and
such other services as the Secretary, after consultation with the Attorney General, determines appropriate.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$3,000,000 for fiscal year 2007;
$4,000,000 for fiscal year 2008; and
$5,000,000 for each of fiscal years 2009 through 2013.
Grants to enhance volunteer services
Grants
The Secretary, after consultation with the Attorney General, may award grants to nonprofit organizations and faith-based organizations to encourage such organizations to establish or continue volunteer programs that focus on the issues of elder abuse, neglect, and exploitation, or that provide related services.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$1,500,000 for fiscal year 2007;
$2,000,000 for fiscal year 2008; and
$2,500,000 for each of fiscal years 2009 through 2013.
multidisciplinary efforts
Grants
In general
The Secretary may award grants to fund various multidisciplinary elder justice activities, including the following:
Supporting and studying team approaches for bringing a coordinated multidisciplinary or interdisciplinary response to elder abuse, neglect, and exploitation, including a response from individuals in social service, health care, public safety, and legal disciplines.
Establishing State coordinating councils modeled after the national Elder Justice Coordinating Council established under section 2212. Such State coordinating councils shall identify the individual States’ needs and provide the national Elder Justice Coordinating Council with information and recommendations relating to State efforts to combat elder abuse, neglect, and exploitation.
Providing
training, technical assistance, and other methods of support to groups carrying
out multidisciplinary efforts at the State level (referred to in some States as
State Working Groups
).
Broadening and studying various models for elder fatality and serious injury review teams, to make recommendations about their composition, protocols, functions, timing, roles, and responsibilities, with a goal of producing models and information that will allow for replication based on the needs of other States and communities.
Carrying out such other interdisciplinary or multidisciplinary efforts as the Secretary determines to be appropriate.
Authorization of appropriations
There are authorized to be appropriated to carry out this paragraph, $5,000,000 for each of fiscal years 2007 through 2013.
Interdisciplinary study
In general
The Director of the Centers for Disease Control and Prevention, after consultation with the Director of the Office of Elder Justice in the Department of Health and Human Services and the Director of the Office of Elder Justice in the Department of Justice, shall conduct an intensive interdisciplinary study of entities that conduct elder justice activities in several different communities, examining how the entities address elder abuse, neglect, and exploitation issues (such as an assessment of various types of health care and social service providers, public safety agencies, law enforcement agencies, prosecutor offices, and the judiciary).
Goal
The goals of the study described in subparagraph (A) include—
making an assessment of the functioning and effectiveness of each entity in a community that conducts elder justice activities, and the interdisciplinary communications and collaborations among such entities; and
developing a procedure for communities to conduct a self-assessment to assist them in identifying the manner in which the entities described in clause (i) in such communities respond to elder justice issues, the needs of such communities relating to elder justice issues, and ways to improve the response systems of such communities for elder abuse, neglect, and exploitation.
Authorization of appropriations
There are authorized to be appropriated to carry out this paragraph—
$2,500,000 for fiscal year 2007;
$3,000,000 for fiscal year 2008; and
$3,500,000 for each of fiscal years 2009 through 2013.
Training grants
Grants authorized
The Secretary may award grants to groups representing the targeted disciplines described in paragraph (2)(B) to train individuals with respect to issues of elder abuse, neglect, and exploitation.
Authorized activities
In general
Grant funds awarded under paragraph (1) shall be used for training within a discipline as well as cross-training activities that permit individuals in multiple disciplines to train together, fostering communication, coordinating efforts, and ensuring collaboration.
Targeted disciplines
Groups representing disciplines that will be targeted for training through grants awarded under paragraph (1) include—
physicians, including geriatricians, medical residents, interns, and fellows;
nurses and nurse’s aides, including geriatric nurse practitioners, directors of nursing, and Sexual Abuse Nurse Examiners (SANE) nurses;
social workers;
public health and safety professionals, including Emergency Medical Services professionals;
therapists, including creative arts, occupational, speech, and physical therapists;
State surveyors of nursing facilities and other long-term care facilities;
staff of long-term care facilities or hospitals;
coroners and funeral home operators;
Federal, State, and local offices with responsibility for elder justice or long-term care matters;
employees or contractors of State and local agencies with responsibility for training persons who provide adult protective services;
State Long-Term Care Ombudsmen;
victim advocates and advocates for elders and individuals with disabilities;
individuals involved in volunteer organizations (including faith-based organizations) who are involved in issues of elder abuse, neglect, and exploitation;
police officers, sheriffs, detectives, firefighters, Federal and State investigators, public safety officers, and corrections personnel;
Federal, State, and local prosecutors, attorneys in private practice involved in elder justice issues, judges, and court employees;
federally recognized partnerships of elders, sheriff departments, and the American Association of Retired Persons (commonly referred to as TRIADs);
elder service officers;
individuals who work with the public, including bank personnel, postal workers, utility workers, providers of home-delivered meals, and others who may work with elders;
students in professional and paraprofessional schools, internships, fellowships, and other training programs in a relevant profession;
fiduciaries, including guardians, conservators, and agents under powers of attorney; and
staff and volunteers of domestic violence and child abuse and neglect programs.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$10,000,000 for fiscal year 2007;
$15,000,000 for fiscal year 2008; and
$20,000,000 for each of fiscal years 2009 through 2013.
Increasing the number of health care professionals with geriatric training
Increasing the number of health care professionals with geriatric training
In general
The Secretary shall establish programs to increase—
the number of health care professionals (including physicians, nurses, nursing personnel, social workers, and therapists) and students in the health care professions, who receive education and training related to geriatrics; and
the number of such professionals who provide health care related to geriatrics.
Inclusion of geriatric services as part of obligated service under the public health service act
For purposes of applying sections 338B and 338C of the Public
Health Service Act (42 U.S.C. 254l, 254m), the term obligated
service
shall include any period during which an individual who has
entered into a written contract with the Secretary under such section 338B (42
U.S.C. 254l) is enrolled and participating in an accredited (as determined by
the Secretary) educational program that provides geriatric training. Upon the
completion of such training, the individual, after consultation with the
Secretary, shall provide geriatric services as appropriate during the remainder
of the period of obligated service of such individual.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$2,500,000 for fiscal year 2007; and
$3,500,000 for each of fiscal years 2008 through 2013.
Dementia training grants
Grants authorized
The Secretary may award grants to eligible entities to provide training within the health and social science disciplines, as well as cross-training activities that permit individuals in multiple such disciplines to train together, to foster communication, coordinate efforts, and ensure collaboration on best practices in caring for individuals with dementia.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2007 through 2013.
Special needs grants
Grants authorized
The Secretary may award grants to eligible entities to identify, address, and make recommendations on meeting the special needs of underserved populations of elders.
Populations included
The grant funds awarded pursuant to paragraph (1) shall be used to fund programs including the following:
Rural settings
Programs designed to meet the needs of elders living in rural locations, including the needs of their informal caregivers and fiduciaries. The programs shall include—
strategies to decrease isolation;
training for informal caregivers and fiduciaries;
activities involving collaboration between the entities and local secondary schools and institutions of higher education to offer classes for credit, focusing on training individuals to work with elders and caregivers;
training for volunteers to serve in rural communities; and
strategies on the use of advance planning to avoid the need for a guardian or other fiduciary.
Minority populations
Programs designed to meet the needs of elders in minority populations, including culturally and linguistically appropriate programs.
Indian tribes
Programs designed to provide necessary services to elders who are members of Indian tribes, including successful programs in elder abuse, neglect, and exploitation prevention and treatment that target Indian populations. The entities carrying out the programs shall deliver services and distribute educational information on elder abuse, neglect, and exploitation to Indian tribes and other policymakers, health and social service providers, law enforcement, and researchers with a particular interest in elders who are members of Indian tribes.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $7,500,000 for each of fiscal years 2007 through 2013.
Public awareness grants
Grants authorized
The Secretary and the Attorney General, after consultation with the advisory board established under section 2213 and the coordinating council established under section 2212, shall jointly award 1 grant to a national organization, or 1 or more grants to eligible entities, to conduct a national multimedia campaign designed to raise awareness about elder abuse, neglect, and exploitation.
Authorized activities
Grant funds awarded under paragraph (1) shall be used for activities including the following:
Raising public awareness regarding financial schemes that target elders.
Pilot testing the effectiveness of various types of multimedia campaigns in raising awareness about—
the types of elder abuse, neglect, and exploitation;
steps to take if an individual suspects elder abuse, neglect, or exploitation has occurred; and
ways to prevent elder abuse, neglect, or exploitation.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2007 through 2013.
Elder justice innovation fund
In general
The Secretary and the Attorney General are authorized to jointly award grants to individuals or entities working in the elder justice field or related fields for research, a demonstration project, development or implementation of a promising program or practice, or another innovative effort related to the identification or prevention of elder abuse, neglect, or exploitation that might not otherwise be funded or pursued in the absence of a grant under this subsection.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2007 through 2013.
Studies
Roles of entities responding to elder abuse, neglect, and Exploitation
In general
The Secretary and the Attorney General shall jointly sponsor or conduct a study of the roles and responsibilities of Government and Government-funded entities responsible for responding to, investigating, and taking other actions in response to reports of elder abuse, neglect, and exploitation including—
State and local agencies with the responsibility for adult protective services;
the State Long-Term Care Ombudsmen;
law enforcement (including prosecutors);
fiduciaries;
judges and other court personnel; and
such other social and protective service, advocacy, and protection organizations as the Secretary and the Attorney General determine to be appropriate.
Goals
The goals of the study authorized in paragraph (1) (which may be conducted in distinct sections, if there is overall coordination) are—
to identify gaps in the detection of, investigation of, and intervention in elder abuse, neglect, and exploitation;
to improve the response to elder abuse, neglect, and exploitation; and
to reduce elder victimization and its consequences by assessing and improving the systems created to address reports of elder abuse, neglect, and exploitation.
Authorized activities
In conducting the study authorized in paragraph (1), the Director shall—
conduct an evaluation of—
how the social and protective service, advocacy, protection, judicial, and law enforcement entities and systems are operating;
the interplay and allocation of responsibilities among those entities;
how that allocation differs from community to community and State to State; and
how those differences impact the population intended to be protected by the entities and systems;
make recommendations on how to clarify the roles (at the Federal level) of entities such as State agencies with responsibility for adult protective services, the State Long-Term Care Ombudsmen, and other protection and advocacy entities to enhance efficiency, eliminate gaps in service, and identify conflicting mandates and duplication of efforts; and
evaluate how various communities delineate the roles and responsibilities of the types of entities described in subparagraph (A) in order to identify and recommend effective models and methods to duplicate the delineation efforts (such as duplication through memoranda of understanding).
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $2,000,000 for each of fiscal years 2007 through 2013.
Family elder abuse, neglect, and Exploitation study
In general
The Director of the Centers for Disease Control and
Prevention (in this subsection referred to as the Director
),
after consultation with the Director of the Office of Elder Justice in the
Department of Health and Human Services and the Director of the Office of Elder
Justice in the Department of Justice, shall conduct a study to determine the
best method to address elder abuse, neglect, and exploitation from a public
health perspective, including examining methods to reduce elder abuse, neglect,
and exploitation committed by family members.
Collaboration
The Director, in carrying out activities under this subsection, shall collaborate with the Director of the National Institute on Aging, the Director of the Office of Elder Justice in the Department of Health and Human Services, the Director of the Office of Elder Justice in the Department of Justice, the heads of State agencies with responsibility for adult protective services, and the heads of such other entities as the Director determines appropriate.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$1,500,000 for fiscal year 2007; and
$2,000,000 for each of fiscal years 2008 through 2013.
Forensic markers, methodologies, and training
Forensic centers
Grants
The Secretary shall make grants to appropriate entities to establish and operate stationary and mobile forensic centers, to develop forensic expertise regarding, and provide services relating to, elder abuse, neglect, and exploitation.
Coordination among forensic centers and centers of excellence
The entities establishing and operating the forensic centers shall coordinate activities on an ongoing basis with the Centers of Excellence described in section 2222(b)(1). Such coordination shall include ongoing communication among the entities and the Centers of Excellence. The entities shall adhere to procedures and mechanisms developed by the Secretary, including procedures and mechanisms relating to the sharing of data.
Stationary forensic centers
The Secretary shall make 4 of the grants described in paragraph (1) to institutions of higher education with demonstrated expertise in forensics or commitment to preventing or treating elder abuse, neglect, or exploitation, to establish and operate stationary forensic centers. The Secretary shall make at least 2 of the 4 grants to an entity operating a Center of Excellence described in section 2222(b)(1) at an institution of higher education.
Mobile centers
The Secretary shall make 6 of the grants described in paragraph (1) to appropriate entities to establish and operate mobile forensic centers.
Use of funds
Development of forensic markers and methodologies
An entity that receives a grant under this subsection shall use funds made available through the grant to assist in the determination of whether abuse or neglect occurred, or a crime was committed, and to conduct research to describe and disseminate information on—
forensic markers that indicate a case in which elder abuse, neglect, or exploitation may have occurred; and
methodologies for determining, in such a case, when and how health care, emergency service, social and protective service, and legal service providers should intervene and when the providers should report the case to law enforcement authorities.
Applications
An entity that receives a grant under this subsection shall use funds made available through the grant to develop forensic expertise regarding elder abuse, neglect, and exploitation, in order to provide medical and forensic evaluation, therapeutic intervention, victim support and advocacy, case review, and case tracking.
Collection of evidence
An entity operating a Center of Excellence described in section 2222(b)(1) that receives a grant under this subsection shall use funds made available through the grant to develop the capacity to collect forensic evidence, including collecting forensic evidence relating to a potential determination of elder abuse, neglect, or exploitation.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$4,000,000 for fiscal year 2007;
$6,000,000 for fiscal year 2008; and
$8,000,000 for each of fiscal years 2009 through 2013.
Training To develop expertise in geriatric forensics
Fellowship programs
In general
The Secretary shall award fellowships to eligible individuals, to enable the individuals to obtain training through a standard forensic science training program.
Eligible individuals
To be eligible to receive a fellowship under this paragraph, an individual shall be a physician who—
is board certified or board eligible in internal medicine or family practice;
has completed a program in geriatrics that meets such criteria as the Secretary may prescribe; and
has entered into an agreement with the Secretary to provide the team training described in subparagraph (C), after receiving the training described in subparagraph (A).
Team training
An individual who receives a fellowship under this paragraph shall provide training in forensic geriatrics to interdisciplinary teams of health care professionals.
Additional programs
In addition to the fellowships awarded under paragraph (1), the Secretary shall establish programs, and make grants to carry out such programs, that are designed to provide forensic training to experienced geriatricians.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $5,000,000 for each of fiscal years 2007 through 2013.
Increasing security, quality, and consumer information for Long-Term care
Increasing security for Long-Term care
Reporting to law enforcement of crimes occurring in federally funded Long-Term care facilities
Reporting requirement
In general
Each individual who is an owner, operator, employee, manager, agent, or contractor of a long-term care facility that is described in subsection (b)(1) shall report to 1 or more law enforcement entities for the jurisdiction in which the facility is located any reasonable suspicion of a crime (as defined by the law of the applicable political subdivision) against any person who is a resident of or receiving care from the facility.
Timing
If the events that cause the suspicion—
result in serious bodily injury, the individual shall report the suspicion immediately; and
do not result in serious bodily injury, the individual shall report the suspicion not later than 24 hours after forming the suspicion.
Long-term care facility described
Long-term care facility
A long-term care facility is described in this paragraph if such facility will receive at least $10,000 in Federal funds during a year.
Notification
In the case of a long-term facility described in paragraph (1), the owner or operator shall annually notify each individual described in subsection (a)(1) of the obligation to comply with subsection(a).
Penalty
In general
If an individual described in subsection (a)(1) violates subsection (a)—
the individual shall be fined not more than $200,000 or subject to a civil money penalty of not more than $200,000; or
the Secretary shall classify the individual as an excluded individual for a period of not more than 3 years.
Increased harm
If an individual described in subsection (a)(1) violates subsection (a), and the violation exacerbates the harm to the victim of the crime or results in harm to another person—
the individual shall be fined not more than $300,000 or subject to a civil money penalty of not more than $300,000; and
the Secretary shall classify the individual as an excluded individual for a period of not more than 3 years.
Excluded individual
During any period for which an individual is classified as an excluded individual under this paragraph, an entity that employs the individual shall be ineligible to receive Federal funds.
Extenuating circumstances
The Secretary may take into account the financial burden on providers with underserved populations in determining the penalty.
Regulations
The Secretary, after consulting with the Attorney General, shall issue regulations to carry out this section.
Improving the quality of Long-Term care
Grants and incentives to enhance Long-Term care staffing
General authority
The Administrator of the Centers for Medicare &
Medicaid Services (in this section referred to as the
Administrator
) shall carry out activities, including activities
described in subsections (b) and (c), to provide incentives for individuals to
train for, seek, and maintain employment providing direct care in a long-term
care facility.
Specific programs To enhance training, recruitment, and retention of staff
Coordination with other programs to recruit and train Long-Term care staff
The Administrator shall coordinate activities with the Secretary of Labor and the Assistant Secretary for the Administration for Children and Families, in order to provide incentives to participants in programs carried out under section 403(a)(5) and part A of title IV to train for and seek employment providing direct care in a long-term care facility.
Career ladders and wage or benefit increases to increase staffing in Long-Term care facilities
In general
The Administrator shall make grants to eligible entities to carry out programs through which the entities—
offer, to employees who provide direct care in a long-term care facility, continuing training and varying levels of certification, based on observed clinical care practices and the amount of time the employees spend providing direct care; and
provide, or make arrangements with employers to provide, bonuses or other increased compensation or benefits to employees who achieve certification under such a program.
Application
To be eligible to receive a grant under this paragraph, an entity shall submit an application to the Administrator at such time, in such manner, and containing such information as the Administrator may require.
Specific programs To improve management practices
In general
The Administrator shall make grants to eligible organizations to enable the organizations to provide training and technical assistance to eligible persons (including administrators, directors of nursing, staff developers, and charge nurses) who establish or implement management practices for long-term care facilities.
Use of funds
An organization that receives a grant under paragraph (1) shall use funds made available through the grant—
to provide training and technical assistance regarding management practices for employees that provide direct care in a long-term care facility and that are demonstrated to promote retention of those employees, such as—
the establishment of basic human resource policies that reward high performance, including policies that provide for improved wages and benefits on the basis of job reviews;
the establishment of motivational and thoughtful work organization practices;
the creation of a workplace culture that respects and values caregivers and their needs;
the promotion of a workplace culture that respects the rights of residents of a long-term care facility and results in improved care for the residents; and
the establishment of other programs that promote the provision of high quality care, such as a continuing education program that provides additional hours of training, including on-the-job training, for employees who are certified nurse aides; or
to disseminate training materials for the training described in subparagraph (A), and to provide the materials to the National Elder Justice Library established in section 2221(a)(4), so that the materials are available to other providers of such training.
Application
To be eligible to receive a grant under this subsection, an organization shall submit an application to the Administrator at such time, in such manner, and containing such information as the Administrator may require.
Evaluating programs
After the first programs developed under this section have been completed, the Administrator shall evaluate the outcomes of such programs in determining which future applications to fund.
Accountability measures
The Administrator shall develop accountability measures to ensure that funds made available under this section benefit the staff who are the intended beneficiaries of the programs provided under this section, to promote increases in the number of staff and stability in the long-term care workforce.
Compliance with applicable laws
In order to receive funds under this section, an eligible entity shall comply with all applicable laws, regulations, and guidelines.
Authorization of appropriations
There are authorized to be appropriated to carry out this section $10,000,000 for each of fiscal years 2007 through 2013.
Collaborative efforts to enhance communication on promoting quality of and preventing abuse and neglect in Long-Term care
In general
The Director of the Agency for Healthcare Research and
Quality (in this section referred to as the Director
), after
consultation with the Attorney General, may establish pilot projects to improve
long-term care. In carrying out the projects, the Director shall make grants to
eligible partnerships to develop collaborative and innovative approaches to
improve the quality of, including preventing abuse and neglect in, long-term
care.
Eligible partnerships
To be eligible to receive a grant under this section, a partnership shall be a multidisciplinary community partnership, such as a partnership consisting of representatives in a community of nursing facility providers, advocates for residents of long-term care facilities, State Long-Term Care Ombudsmen, surveyors, the State agency with responsibility for adult protective services, the State agency with responsibility for licensing long-term care facilities, law enforcement agencies, courts, family councils, residents, certified nurse aides, registered nurses, physicians, and other appropriate entities and individuals.
Application
To be eligible to receive a grant under this section, a partnership shall submit an application to the Director at such time, in such manner, and containing such information as the Director may require.
Authorization of appropriations
There are authorized to be appropriated to carry out this section $2,500,000 for each of fiscal years 2007 through 2013.
Collaborative efforts to develop consensus around the management of certain quality-related factors
In general
The Director of the Agency for Healthcare Research and
Quality (in this section referred to as the Director
), after
consultation with the Attorney General and the Advisory Board established under
section 2213, shall make grants to eligible entities to establish
multidisciplinary panels to address, and develop consensus on, subjects
relating to improving the quality of long-term care. The Director shall make a
limited number of such grants, including at least 1 grant for the establishment
of such a panel to address, and develop consensus on, methods of managing
resident-to-resident abuse in long-term care.
Use of funds
An entity that receives a grant under this section shall—
establish a multidisciplinary panel to address a specific subject; and
ensure that the panel uses the funds made available through the grant to establish a goal with respect to the subject, examine relevant research and data, identify best practices with respect to the subject, determine the best way to carry out those best practices in a practical and feasible manner, and determine an effective manner of distributing information on the subject.
Application
To be eligible to receive a grant under this section, an entity shall submit an application to the Director at such time, in such manner, and containing such information as the Director may require.
Authorization of appropriations
There are authorized to be appropriated to carry out this section $2,000,000 for each of fiscal years 2007 through 2013.
Increasing consumer information about Long-Term care
Long-Term care consumer clearinghouse
In general
The Director of the Office of Elder Justice in the Department of Health and Human Services, in coordination with the Director of the Agency for Healthcare Research and Quality and the Administrator of the Centers for Medicare & Medicaid Services, shall establish a long-term care consumer clearinghouse in the Department of Health and Human Services.
Information
The clearinghouse shall be established as part of the Elder Justice Resource Center established under section 2221 and shall provide comprehensive detailed information, in a consumer-friendly form, to consumers about choices relating to long-term care providers, such as information (including links to Web sites and other resources that provide information) about—
obtaining the services of, and employing, caregivers who provide long-term care at an individual’s home; and
options for residential long-term care, such as—
the type of care provided by nursing facilities; and
the type of care provided by group homes and other residential long-term care facilities that are not nursing facilities;
the benefits available through the programs carried out under titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.); and
the care available through specific long-term care facilities, including data on the satisfaction level of residents, and families of residents, of the facilities.
Providers
In providing information on long-term care providers under this section, the clearinghouse shall provide information (from States and other sources) on assisted living facilities, board and care facilities, congregate care facilities, home health care providers, and other long-term care providers.
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$2,000,000 for fiscal year 2007;
$3,000,000 for fiscal year 2008; and
$4,000,000 for each of fiscal years 2009 through 2013.
Consumer information about the continuum of residential Long-Term care facilities
Study
In general
The Director of the Agency for Healthcare Research and Quality, after consultation with the Director of the Office of Elder Justice in the Department of Health and Human Services and the Director of the Office of Elder Justice in the Department of Justice, shall, directly or through a grant, conduct a study on consumer concerns relating to residential long-term care facilities other than nursing facilities.
Specific topics
The entity conducting the study shall—
develop definitions for classes of the residential long-term care facilities described in paragraph (1); and
collect information on the prices of, level of services provided by, oversight and enforcement provisions of, and admission and discharge criteria of the facilities.
Report
The Director of the Agency for Healthcare Research and Quality shall prepare a report containing the results of the study and, not later than the date that is 2 years after the date of enactment of the Elder Justice Act, submit the report to the Elder Justice Coordinating Council established under section 2212, the Committee on Ways and Means of the House of Representatives, and the Special Committee on Aging of the Senate.
Authorization of appropriations
There are authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2007 through 2013.
Miscellaneous provisions
Evaluations
Grants
In general
In making a grant under a provision of this title, the granting authority shall—
require the recipient of the grant to—
reserve a portion of the funds made available through the grant; and
use the reserved funds to conduct an evaluation of the other activities carried out through the grant; or
reserve a portion of the funds available for the grant; and
use the reserved funds to provide assistance to an eligible entity to conduct an evaluation of the activities carried out through the grant.
Use of funds
A recipient of a grant described in paragraph (1)(A), or assistance described in paragraph (1)(B)(ii), shall use the funds made available through the grant, or the assistance, respectively, to conduct a validated evaluation of the effectiveness of the activities described in subparagraph (A) or (B), respectively, of paragraph (1).
Applications
Submission
Grants for projects containing evaluations
To be eligible to receive a grant for which the granting authority requires the reservation described in paragraph (1)(A)(i), an entity shall include a proposal for the evaluation in the application submitted for the grant.
Assistance for evaluations
To be eligible to receive assistance under paragraph (1)(B)(ii), an entity shall submit an application to the granting authority at such time, in such manner, and containing such information as the granting authority may require, including a proposal for the evaluation.
Review and assistance
An employee of the National Institute on Aging and a private expert with expertise in evaluation methodology shall review each proposal described in clause (i) or (ii) of subparagraph (A), and determine whether the methodology described in the proposal is adequate to gather meaningful information. If the employee and expert determine that the methodology is inadequate, the employee and expert shall recommend that the granting authority deny the application for the grant described in subparagraph (A)(i), or the assistance described in subparagraph (B)(ii), as appropriate, or make recommendations for how the application should be amended. If the granting authority denies the application on the basis of the proposal, the granting authority shall inform the applicant why the application was denied, and offer assistance to the applicant in modifying the proposal.
Other grants
The granting authority shall make grants to appropriate entities to conduct validated evaluations of activities to reduce elder abuse, neglect, and exploitation that are not funded under this title.
Condition of participation
As a condition of participation in any grant under this title, individuals, facilities, and other entities shall agree to be subject to sections 3729 through 3733 of title 31, United States Code, and other applicable laws.
Human subject research
In general
For purposes of the application of subpart A of part 46 of title 45, Code of Federal Regulations, to research conducted under this title, the term legally authorized representative means, unless otherwise provided by law, the individual, or judicial or other body authorized under the applicable law to consent to medical treatment on behalf of another person.
Guidelines
The Secretary, through the Director of the National Institute on Aging, after consultation with the Director of the Office for Human Research Protections, shall promulgate guidelines to assist researchers working in the area of elder abuse, neglect, and exploitation, with issues relating to human subject protections.
Regulations
The Secretary may issue such regulations as may be necessary to carry out this title.
Rule of construction
Nothing in this title shall be construed to interfere with or abridge an elder’s right to practice his or her religion through reliance on prayer alone for healing when this choice—
is contemporaneously expressed, either orally or in writing, with respect to a specific illness or injury which the elder has at the time of the decision by an elder who is competent at the time of the decision;
is previously set forth in a living will, health care proxy, or other advance directive document that is validly executed and applied under State law; or
may be unambiguously deduced from the elder’s life history.
Authorization of appropriation
There are authorized to be appropriated to carry out this subtitle $7,000,000 for each of fiscal years 2007 through 2013.
.
Supporting the long-Term care ombudsman program
Supporting the long-Term care ombudsman program
In general
Section 712(h) of the Older Americans Act of 1965 (42 U.S.C. 3058g(h)) is amended—
in paragraph (8),
by striking ; and
at the end and inserting a semicolon;
in paragraph (9),
by striking the period at the end and inserting ; and
;
and
by adding at the end the following new paragraph:
make grants, in consultation with the Director of the Office of Elder Justice in the Department of Health and Human Services and the Director of the Office of Elder Justice in the Department of Justice, to eligible entities with relevant expertise and experience to conduct evaluations and pilot studies relating to various programs and methods carried out by the Office of the State Long-Term Care Ombudsman or a local Ombudsman entity under section 307(a)(9) or this chapter, or to provide support (such as an ombudsman resource center).
.
Authorization of appropriations
There are authorized to be appropriated to carry out the amendments made by this subsection—
$5,000,000 in fiscal year 2007;
$7,500,000 in fiscal year 2008; and
$10,000,000 in each of fiscal years 2009 through 2013.
Ombudsman training programs
In general
The Secretary of Health and Human Services (in this Act
referred to as the Secretary
) shall establish programs to
provide and improve ombudsman training with respect to elder abuse, neglect,
and exploitation for national organizations and for State Long-Term Care
Ombudsman programs.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection $10,000,000 for each of fiscal years 2007 through 2013.
Adult protective services functions and grant programs
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by adding at the end the following new section:
Adult protective services functions
Functions
In general
The Secretary shall ensure that the Department of Health and Human Services—
provides funding authorized by this title to State and local adult protective services offices that investigate reports of the abuse, neglect, and exploitation of elders;
collects and disseminates data annually relating to the abuse, exploitation, and neglect of elders in coordination with the Bureau of Justice Statistics of the Office of Justice Programs of the Department of Justice efforts to collect national data under section 2221;
develops and disseminates information on best practices regarding, and provides training on, carrying out adult protective services;
in conjunction with the necessary experts, conducts research related to the provision of adult protective services; and
provides technical assistance to States and other entities that provide or fund the provision of adult protective services, including through grants made under subsections (b) and (c).
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
$2,000,000 for fiscal year 2007; and
$3,000,000 for each of fiscal years 2008 through 2013.
Grant program
Establishment
There is established an adult protective services grant program under which the Secretary shall annually award grants to States in the amounts calculated under paragraph (2) for the purposes of enhancing adult protective services provided by States and local units of government.
Amount of payment
In general
Subject to subparagraphs (B) and (C), with respect to a fiscal year, each State shall be paid an amount equal to the product of—
the amount appropriated for the year under paragraph (5); and
the ratio (expressed as a percentage) of—
the total number of elders who reside in the State, to
the total number of elders who reside in the United States.
Guaranteed minimum payment amount
50 states
Subject to clause (ii), if the amount determined under subparagraph (A) for a State for a year is less than 0.75 percent of the amount appropriated under paragraph (5), the Secretary shall increase such determined amount so that the total amount paid under this subsection to the State for the year is equal to 0.75 percent of the amount so appropriated.
Territories
In
the case of a State other than 1 of the 50 States, clause (i) shall be applied
as if each reference to 0.75
were a reference to
0.1
.
Pro rata reductions
The Secretary shall make such pro rata reductions to the amounts described in subparagraph (A) as are necessary to comply with the requirements of subparagraph (B).
Authorized activities
Adult protective services
Funds made available pursuant to this subsection may only be used by States and local units of government to provide adult protective services and may not be used for any other purpose.
Use by agency
Each State receiving funds pursuant to this subsection shall provide such funds to the agency or unit of State government having legal responsibility for providing adult protective services within the State.
Supplement not supplant
Each State or local unit of government shall use funds made available pursuant to this subsection to supplement and not supplant other Federal, State, and local public funds expended to provide adult protective services in the State.
Reports
State reports
Each State receiving funds under this subsection shall submit to the Secretary, at such time and in such manner as the Secretary may require, a report on the number of elders served by the award of grants under this subsection.
Report by the secretary
Not later than October 1, 2011, the Secretary shall submit to the appropriate committees of Congress a report compiling, summarizing, and analyzing the information contained in the reports submitted under subparagraph (A) together with such recommendations for legislative or administrative action as the Secretary determines to be appropriate.
Authorization of appropriations
There is authorized to be appropriated to carry out this subsection $300,000,000 for each of fiscal years 2007 through 2011.
.
Assuring safety of residents when nursing facilities close
Nursing facility closure under medicaid
Section 1919(c)(2) of the Social Security Act (42 U.S.C. 1396r(c)(2)) is amended by adding at the end the following new subparagraph:
Notice of nursing facility closure and resident transfer plan
In general
The owner or operator of a nursing facility shall—
submit to the Secretary and the State (including the State Long-Term Care Ombudsman) in which the facility is located written notification of an impending closure not later than the date that is 60 days prior to the date of such closure;
include in the notice a plan for the transfer and adequate relocation of the residents prior to closure, including assurances that residents will not be transferred to facilities providing substandard care for which administrative or law enforcement action is pending; and
not later than 10 days after the facility closure, submit to the Secretary and the State information identifying where residents of the closed facility were transferred and on what date.
Sanctions
Any person owning a nursing facility that fails to comply with the requirements of clause (i) shall be subject to—
a civil monetary penalty of up to $1,000,000;
exclusion from participation in the programs under this Act (in accordance with the procedures of section 1128); and
any other applicable civil monetary penalties and assessments.
Procedure
A civil monetary penalty or assessment authorized under clause (ii) shall be imposed against a person in the same manner as a civil monetary penalty, assessment, or exclusion is imposed under section 1128A.
.
Skilled nursing facility closure under medicare
Section 1819(c)(2) of the Social Security Act (42 U.S.C. 1395i–3(c)(2)) is amended by adding at the end the following new subparagraph:
Notice of skilled nursing facility closure and resident transfer plan
In general
The owner or operator of a skilled nursing facility shall—
submit to the Secretary and the State in which the facility is located written notification of an impending closure not later than the date that is 60 days prior to the date of such closure;
include in the notice a plan for the transfer and adequate relocation of the residents prior to closure, including assurances that residents will not be transferred to facilities providing substandard care for which administrative or law enforcement action is pending; and
not later than 10 days after the facility closure, submit to the Secretary and the State information identifying where residents of the closed facility were transferred and on what date.
Sanctions
Any person owning a nursing facility that fails to comply with the requirements of clause (i) shall be subject to—
a civil monetary penalty of up to $1,000,000;
exclusion from participation in the programs under this Act (in accordance with the procedures of section 1128); and
any other applicable civil monetary penalties and assessments.
Procedure
A civil monetary penalty or assessment authorized under clause (ii) shall be imposed against a person in the same manner as a civil monetary penalty, assessment, or exclusion is imposed under section 1128A.
.
National nurse aide registry
Study and report
In general
The Secretary, in consultation with appropriate government agencies and private sector organizations, shall conduct a study on establishing a national nurse aide registry.
Areas evaluated
The study conducted under this subsection shall include an evaluation of—
who should be included in the registry;
how such a registry would comply with Federal and State privacy laws and regulations;
how data would be collected for the registry;
what entities and individuals would have access to the data collected;
how the registry would provide appropriate information regarding violations of Federal and State law by individuals included in the registry; and
how the functions of a national nurse aide registry would be coordinated with the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers established under section 307 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173) and the national criminal background check program established under section 106(c).
Considerations
In conducting the study and preparing the report required under this subsection, the Secretary shall take into consideration the findings and conclusions of relevant reports, including the following:
The Department of Health and Human Services Office of Inspector General Report, Nurse Aide Registries: State Compliance and Practices (February 2005).
The General Accounting Office (now known as the Government Accountability Office) Report, Nursing Homes: More Can Be Done to Protect Residents from Abuse (March 2002).
The Department of Health and Human Services Office of the Inspector General Report, Nurse Aide Registries: Long-Term Care Facility Compliance and Practices (July 2005).
The Department of Health and Human Services Health Resources and Services Administration Report, Nursing Aides, Home Health Aides, and Related Health Care Occupations—National and Local Workforce Shortages and Associated Data Needs (2004)(in particular with respect to chapter 7 & appendix F).
The 2001 Report to CMS from the School of Rural Public Health, Texas A&M University, Preventing Abuse and Neglect in Nursing Homes: The Role of Nurse Aide Registries.
Report
Not later than 24 months after the date of enactment of this Act, the Secretary shall submit a report to the appropriate Committees of Congress containing the findings and recommendations of the study conducted under this subsection.
Funding limitation
Funding for the study conducted under this subsection shall not exceed $500,000.
Establishment of national nurse aide registry
In general
Upon completion of the report described in subsection (a)(4), the Secretary shall take appropriate measures to establish a national nurse aide registry, taking into account the findings and recommendations contained in the report.
Authorization of appropriations
There are authorized to be appropriated such sums as are necessary for the purpose of carrying out this subsection.
Background checks on direct access employees of long-Term care facilities or providers
Screening of skilled nursing facility and nursing facility employee applicants
Medicare program
Section 1819(b) of the Social Security Act (42 U.S.C. 1395i–3(b)) is amended by adding at the end the following:
Screening of skilled nursing facility workers
Background checks on applicants
Before hiring a skilled nursing facility worker, a skilled nursing facility shall conduct a background check on the employee in accordance with such procedures as the Secretary shall establish.
Prohibition on hiring of abusive workers
In general
Subject to clause (ii), a skilled nursing facility may not knowingly employ any skilled nursing facility worker who has any disqualifying information (as defined in subparagraph (F)(ii)).
Provisional employment
A skilled nursing facility may provide for a provisional period of employment for a skilled nursing facility worker pending completion of the background check required under subparagraph (A). Such facility shall maintain direct supervision of the covered individual during the worker’s provisional period of employment.
Procedures
The procedures established by the Secretary under subparagraph (A) shall—
provide a process by which a skilled nursing facility worker may appeal or dispute the accuracy of the information obtained in a background check conducted under this paragraph;
take into account the needs of skilled nursing facilities located in rural areas and skilled nursing facilities that serve a low volume of patients (as determined by the Secretary) with respect to providing supervision for provisional employees who are awaiting the results of a background check conducted under this paragraph; and
provide for the reimbursement of nursing facilities for 100 percent of the costs incurred by such facilities in complying with the requirements of this section.
Immunity from liability
A skilled nursing facility that, in denying employment for an applicant, reasonably relies upon information about such applicant provided by the criminal background check shall not be liable in any action brought by such applicant based on the employment determination resulting from the information.
Civil penalty
In general
A skilled nursing facility that violates the provisions of this paragraph shall be subject to a civil penalty in an amount not to exceed—
for the first such violation, $2,000; and
for the second and each subsequent violation within any 5-year period, $5,000.
Knowing retention of worker
In addition to any civil penalty under clause (i), a skilled nursing facility that knowingly continues to employ a skilled nursing facility worker in violation of subparagraph (A) or (B) shall be subject to a civil penalty in an amount not to exceed $5,000 for the first such violation, and $10,000 for the second and each subsequent violation within any 5-year period.
Definitions
In this paragraph:
Conviction for a relevant crime
The term conviction for a relevant crime means any Federal or State criminal conviction for—
any offense described in section 1128(a); and
such other types of offenses as the Secretary may specify in regulations.
Disqualifying information
The term disqualifying information means information about a conviction for a relevant crime or a finding of patient or resident abuse.
Skilled nursing facility worker
The term skilled nursing facility worker means any individual (other than a volunteer) that has direct access to a patient of a skilled nursing facility under an employment or other contract, or both, with such facility. Such term includes individuals who are licensed or certified by the State to provide long-term care services, and nonlicensed individuals providing such services, as defined by the Secretary, including nurse assistants, nurse aides, home health aides, and personal care workers and attendants.
.
Medicaid program
Section 1919(b) of the Social Security Act (42 U.S.C. 1396r(b)) is amended by adding at the end the following new paragraph:
Screening of nursing facility workers
Background checks on applicants
Before hiring a nursing facility worker, a nursing facility shall conduct a background check on the employee in accordance with such procedures as the Secretary shall establish.
Prohibition on hiring of abusive workers
In general
Subject to clause (ii), a nursing facility may not knowingly employ any nursing facility worker who has any disqualifying information (as defined in subparagraph (F)(ii)).
Provisional employment
A nursing facility may provide for a provisional period of employment for a nursing facility worker pending completion of the background check required under subparagraph (A). Such facility shall maintain direct supervision of the covered individual during the worker’s provisional period of employment.
Procedures
The procedures established by the Secretary under subparagraph (A) shall—
provide a process by which a nursing facility worker may appeal or dispute the accuracy of the information obtained in a background check conducted under this paragraph;
take into account the needs of nursing facilities located in rural areas and nursing facilities that serve a low volume of patients (as determined by the Secretary) with respect to providing supervision for provisional employees who are awaiting the results of a background check conducted under this paragraph; and
provide for the reimbursement of nursing facilities for 100 percent of the costs incurred by such facilities in complying with the requirements of this section.
Immunity from liability
A nursing facility that, in denying employment for an applicant, reasonably relies upon information about such applicant provided by the criminal background check shall not be liable in any action brought by such applicant based on the employment determination resulting from the information.
Civil penalty
In general
A nursing facility that violates the provisions of this paragraph shall be subject to a civil penalty in an amount not to exceed—
for the first such violation, $2,000; and
for the second and each subsequent violation within any 5-year period, $5,000.
Knowing retention of worker
In addition to any civil penalty under clause (i), a nursing facility that knowingly continues to employ a nursing facility worker in violation of subparagraph (A) or (B) shall be subject to a civil penalty in an amount not to exceed $5,000 for the first such violation, and $10,000 for the second and each subsequent violation within any 5-year period.
Definitions
In this paragraph:
Conviction for a relevant crime
The term conviction for a relevant crime means any Federal or State criminal conviction for—
any offense described in section 1128(a); and
such other types of offenses as the Secretary may specify in regulations.
Disqualifying information
The term disqualifying information means information about a conviction for a relevant crime or a finding of patient or resident abuse.
Nursing facility worker
The term nursing facility worker means any individual (other than a volunteer) that has direct access to a patient of a nursing facility under an employment or other contract, or both, with such facility. Such term includes individuals who are licensed or certified by the State to provide long-term care services, and nonlicensed individuals providing such services, as defined by the Secretary, including nurse assistants, nurse aides, home health aides, and personal care workers and attendants.
.
Effective date
The amendments made by this subsection shall take effect on the date that is 1 year after the date on which the evaluation is completed under subsection (c)(1).
Application to other long-Term care facilities or providers
Medicare
Part E of title XVIII of the Social Security Act (42 U.S.C. 1395x et seq.) is amended by adding at the end the following:
Application of skilled nursing facility preventive abuse provisions to long-term care facilities and providers
The provisions of section 1819(b)(9) shall apply to a long-term care facility or provider (as defined in subsection (b)) in the same manner as such provisions apply to a skilled nursing facility.
Long-Term care facility or provider
In this section, the term long-term
care facility or provider
means the following facilities or providers
which receive payment for services under this title or title XIX:
A home health agency.
A provider of hospice care.
A long-term care hospital.
A provider of personal care services.
A residential care provider that arranges for, or directly provides, long-term care services.
An intermediate care facility for the mentally retarded (as defined in section 1905(d)).
.
Medicaid
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a) is amended—
in paragraph (66),
by striking and
at the end;
in paragraph (67),
by striking the period and inserting ; and
; and
by inserting after paragraph (67) the following:
provide that the provisions of section 1919(b)(9) apply to a long-term care facility or provider (as defined in section 1898(b)) in the same manner as such provisions apply to a nursing facility.
.
Effective date
The amendments made by this subsection shall take effect on the date that is 1 year after the date on which the evaluation is completed under subsection (c)(1).
National criminal background check program
Completion of pilot program evaluation
Not later than the date that is 6 months after the completion of the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers established under section 307 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173), the Secretary shall complete the evaluation required under subsection (e) of such section of such Act.
Establishment
In general
Not later than the date that is 1 year after the completion of the evaluation of the program described in paragraph (1), the Secretary, in consultation with the Attorney General, shall establish a national criminal background check program in order to prevent abuse of nursing facility and skilled nursing facility residents and individuals receiving home health care services and other long-term care services under the medicare or medicaid programs, taking into account the findings and recommendations contained in the evaluation.
Use in conducting required background checks
The national criminal background check program shall be made available to a long-term care facility or provider for the purpose of conducting criminal background checks, including the criminal background checks required under sections 1819(b)(9) and 1919(b)(9) of the Social Security Act (42 U.S.C. 1395i–3(b), 1396r(b)) (as added by subsection (a)).
Conduct of background checks by the Federal Bureau of Investigation
The Secretary, in consultation with the Attorney General, shall establish procedures for the background checks to be conducted by the Federal Bureau of Investigation, in cooperation with appropriate State and Federal agencies.
Consultation
In establishing the national criminal background check program, the Secretary shall consult with appropriate interested parties, including—
representatives of long-term care facilities or providers;
representatives of employees of long-term care facilities or providers;
consumers of long-term care services;
consumer advocates; and
appropriate Federal and State officials.
Integration
The Secretary shall take appropriate measures to integrate the national criminal background check program and the national nurse aide registry established under section 105(b) into a single system. The integration of the program and the registry shall be done in such a manner as to efficiently and accurately provide timely responses to long-term care facilities and providers utilizing the integrated system.
Definitions
In this subsection:
Long-Term care facility or provider
The term long-term care facility or
provider
means the following facilities or providers which receive
payment for services under title XVIII or XIX of the Social Security
Act:
A nursing facility (as defined in subparagraph (B)).
A skilled nursing facility (as defined in subparagraph (C)).
A home health agency.
A provider of hospice care (as defined in section 1861(dd)(1) of the Social Security Act) (42 U.S.C. 1395x(dd)(1)).
A long-term care hospital (as described in section 1886(d)(1)(B)(iv) of such Act) (42 U.S.C. 1395ww(d)(1)(B)(iv)).
A provider of personal care services.
A residential care provider that arranges for, or directly provides, long-term care services.
An intermediate care facility for the mentally retarded (as defined in section 1905(d) of such Act) (42 U.S.C. 1396d(d)).
Nursing facility
The term nursing facility
has the meaning
given such term in section 1919(a) of the Social Security Act (42 U.S.C.
1396r(a)).
Skilled nursing facility
The term skilled nursing facility
has the
meaning given such term in 1819(a) of the Social Security Act (42 U.S.C.
1395i–3(a)).
Department of Justice
Model State laws and practices
In general
The Attorney General, after consultation with the Secretary, shall carry out the following duties:
Study
Conduct a study of State laws and practices relating to elder abuse, neglect, and exploitation.
Report to Elder Justice Resource Center
Prepare and submit a report or periodic reports containing the findings of the study conducted under paragraph (1) to the Elder Justice Resource Center established under section 2221 of the Social Security Act, to be made available to the public.
Report to Congress
Not later than 2 years after the date of enactment of this Act, submit to the Chairman and Ranking Member of the Special Committee on Aging of the Senate, and the Speaker and Minority leader of the House of Representatives a report that contains—
a comprehensive description of State laws and practices relating to elder abuse, neglect, and exploitation;
a comprehensive analysis of the effectiveness of such State laws and practices; and
recommendations—
for model State laws and practices relating to elder abuse, neglect, and exploitation; and
with respect to the definitions referred to in subsection (b)(1).
State laws and practices
The Attorney General shall examine State laws and practices under subsection (a) on issues including—
the definition of—
elder
;
abuse
;
neglect
;
exploitation
;
and
such related terms the Attorney General determines to be appropriate;
mandatory reporting laws, with respect to—
who is a mandated reporter;
to whom must they report and within what time frame; and
any consequences for not reporting;
evidentiary, procedural, sentencing, choice of remedies, and data retention issues relating to pursuing cases relating to elder abuse, neglect, and exploitation;
laws requiring immediate reporting of all nursing home deaths to the county coroner or to some other individual or entity;
fiduciary laws, including guardianship and power of attorney laws;
laws that permit or encourage banks and bank employees to prevent and report suspected elder abuse, neglect, and exploitation;
laws that may impede research on elder abuse, neglect, and exploitation;
practices relating to the enforcement of laws relating to elder abuse, neglect, and exploitation; and
practices relating to other aspects of elder justice.
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$1,000,000 in fiscal year 2007; and
$2,000,000 for each of fiscal years 2008 through 2013.
Office of Elder Justice of the Department of Justice
Establishment
There is established within the Department of Justice, under the Assistant Attorney General and the Office of Justice Programs, an Office of Elder Justice.
Director of the office of elder justice
Appointment
The President, with the advice and consent of the Senate, shall appoint a Director of the Office of Elder Justice, from among individuals with experience and expertise in elder justice issues, to manage the Office of Elder Justice established under this section.
Duties
The Director of the Office of Elder Justice shall—
develop objectives, priorities, policies, and a long-term plan for elder justice programs and activities relating to prevention, detection, training, treatment, evaluation, intervention, research, and improvement of the elder justice system in the United States;
implement the overall policies and a strategy to carry out the plan described in clause (i); and
hire personnel to assist the director in carrying out the policies, programs, and administrative activities related to the duties under clauses (i) and (ii);
provide advice to the Attorney General on elder justice issues; and
coordinate activities with the Director of the Office of Elder Justice within the Department of Health and Human Services.
Reporting relationship
The Director of the Office of Elder Justice shall have the same reporting relationship with the Attorney General, the Assistant Attorney General, and the Office of Justice Programs as the directors of the other offices headed by Presidential appointees within the Office of Justice Programs.
Compensation
The Director of the Office of Elder Justice shall be compensated at a rate that shall not exceed the rate established for level I of the Executive Schedule under section 5312 of title 5, United States Code.
Authorization of appropriations
There are authorized to be appropriated to carry out this section $3,000,000 for each of fiscal years 2007 through 2013.
Victim advocacy grants
Grants authorized
The Attorney General, after consultation with the Secretary, may award grants to eligible entities to study the special needs of victims of elder abuse, neglect, and exploitation.
Authorized activities
Funds awarded pursuant to subsection (a) shall be used for pilot programs that—
develop programs, provide training to health care, social, and protective services providers, law enforcement, fiduciaries (including guardians), judges and court personnel, and victim advocates; and
examine special approaches designed to meet the needs of victims of elder abuse, neglect, and exploitation.
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$2,500,000 for fiscal year 2007; and
$3,000,000 for each of fiscal years 2008 through 2013.
Supporting local prosecutors in elder justice matters
Grants authorized
The Attorney General, after consultation with the Director of the Office of Elder Justice in the Department of Health and Human Services, shall award grants to provide training, technical assistance, policy development, multidisciplinary coordination, and other types of support to local prosecutors handling elder justice-related cases, including—
funding specially designated elder justice positions or units; or
funding the creation of a Center for the Prosecution of Elder Abuse, Neglect, and Exploitation by the American Prosecutor Research Institute of the National District Attorneys Association, or any other similarly situated entity, to advise and support local prosecutors nationwide in their pursuit of cases involving elder abuse, neglect, and exploitation.
Duties
The Center created under subsection (a) shall, among other things—
collaborate with experts in elder abuse, neglect, and exploitation;
collaborate with the Advisory Board created by section 2213 of the Social Security Act; and
provide local prosecutors and personnel assisting such prosecutors with training, technical assistance, multidisciplinary teams, and input in the handling, prevention and prosecution of, and special circumstances surrounding, elder abuse, neglect, and exploitation.
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$3,000,000 for fiscal year 2007; and
$4,00,000 for each of fiscal years 2008 through 2013.
Supporting state prosecutors in elder justice matters
In general
The Attorney General shall, after consultation with the Secretary, award grants to provide training, technical assistance, multidisciplinary coordination, policy development, and other types of support to State prosecutors, including employees of State Attorneys General and Medicaid Fraud Control Units handling elder justice-related matters.
Creating specialized positions
Grants under this section may be made for—
the establishment of specially designated elder justice positions or units; or
the creation of a position to coordinate elder justice-related cases, training, technical assistance, and policy development for State prosecutors, by the National Association of Attorneys General (NAAG) or any other similarly situated entity.
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$3,000,000 for fiscal year 2007; and
$4,000,000 for each of fiscal years 2008 through 2013.
Increased support for federal cases involving elder justice
Support and assistance
In general
The Attorney General shall establish procedures to ensure that the Department of Justice dedicates resources to supporting cases relating to elder justice.
Additional staff
The Attorney General shall have additional Federal prosecutors and make funding available to Federal prosecutors to hire nurse-investigators or other experts needed to identify, assist with, or pursue cases relating to elder justice.
Resource Group
The Attorney General may fund through the Executive Office of United States Attorneys a Resource Group to assist prosecutors throughout the Nation in pursuing failure of care and other cases relating to elder justice matters.
Office of inspector general
The Office of Inspector General of the Department of Health and Human Services shall hire nurse investigators and other experts to investigate and pursue failure of care allegations.
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$3,000,000 for fiscal year 2007; and
$4,000,000 for each of fiscal years 2008 through 2013.
Supporting law enforcement in elder justice matters
In general
The Attorney General shall, after consultation with the Secretary, award grants to provide training, technical assistance, multidisciplinary coordination, policy development, and other types of support to police, sheriffs, detectives, public safety officers, corrections personnel, and other frontline law enforcement responders who handle elder justice-related matters, to fund specially designated elder justice positions or units designed to support front line law enforcement in elder justice matters.
Authorization of appropriations
There are authorized to be appropriated to carry out this section—
$6,000,000 for fiscal year 2007; and
$8,000,000 for each of fiscal years 2008 through 2013.
Evaluations
Grants
In general
In making a grant under a provision of this title, the granting authority shall—
require the recipient of the grant to—
reserve a portion of the funds made available through the grant; and
use the reserved funds to conduct an evaluation of the other activities carried out through the grant; or
reserve a portion of the funds available for the grant; and
use the reserved funds to provide assistance to an eligible entity to conduct an evaluation of the activities carried out through the grant.
Use of funds
A recipient of a grant described in paragraph (1)(A), or assistance described in paragraph (1)(B)(ii), shall use the funds made available through the grant, or the assistance, respectively, to conduct a validated evaluation of the effectiveness of the activities described in subparagraph (A) or (B), respectively, of paragraph (1).
Applications
Submission
Grants for projects containing evaluations
To be eligible to receive a grant for which the granting authority requires the reservation described in paragraph (1)(A)(i), an entity shall include a proposal for the evaluation in the application submitted for the grant.
Assistance for evaluations
To be eligible to receive assistance under paragraph (1)(B)(ii), an entity shall submit an application to the granting authority at such time, in such manner, and containing such information as the granting authority may require, including a proposal for the evaluation.
Review and assistance
In general
An employee of the Department of Justice, after consultation with an employee of the Department of Health and Human Services and a nongovernmental member of the advisory board established under section 2213 of the Social Security Act with expertise in evaluation methodology, shall review each proposal described in clause (i) or (ii) of subparagraph (A), and determine whether the methodology described in the proposal is adequate to gather meaningful information.
Denial
If the reviewing employee determines the methodology described in the proposal is inadequate under clause (i), they shall recommend that the granting authority deny the application for the grant described in subparagraph (A)(i), or the assistance described in subparagraph (B)(ii), as appropriate, or make recommendations for how the application should be amended.
Notice to applicant
If the granting authority denies the application on the basis of the proposal under this subparagraph, the granting authority shall inform the applicant why the application was denied and offer assistance to the applicant in modifying the proposal.
Other grants
The granting authority shall make grants to appropriate entities to conduct validated evaluations of activities to reduce elder abuse, neglect, and exploitation that are not funded under this title.
Condition of participation
As a condition of participation in any grant under this title, individuals, facilities, and other entities shall agree to be subject to the provisions of section 571 of title 18, United States Code, as added by this Act.
Authorization of appropriations
There are authorized to be appropriated to carry out this section $7,000,000 for each of fiscal years 2007 through 2013.
Tax provisions
Long-Term care facility worker employment tax credit
Work opportunity tax credit
In general
Section 51(d)(1) of the Internal Revenue Code of 1986
(relating to members of targeted groups) is amended by striking
or
at the end of subparagraph (G), by striking the period at the
end of subparagraph (H) and inserting or
, and by adding at the
end the following:
a qualified long-term care facility worker.
.
Qualified long-Term care facility worker
Section 51(d) of such Code is amended by redesignating paragraphs (10) through (12) as paragraphs (11) through (13), respectively, and by inserting after paragraph (9) the following:
Qualified long-Term care facility worker
The term qualified
long-term care facility worker
means any individual who—
is hired by a long-term care facility (as defined in paragraph (18) of section 2201 of the Social Security Act); and
is certified by the designated local agency as being qualified to provide long-term care (as defined in paragraph (17) of such section 2201).
.
Effective date
The amendments made by subsection (a) shall apply to individuals who begin work for an employer after the date of enactment of this Act.
Short title; table of contents
Short Title
This Act may be cited as the Elder Justice
Act
.
Table of Contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Purposes.
Sec. 4. Definitions.
Sec. 5. Elder Justice.
Subtitle 1—Block grants to states for social services
Subtitle 2—Elder justice
Sec. 2011. Definitions.
Sec. 2012. General provisions.
Part A—National Coordination of Elder Justice Activities and Research
SUBPART 1—Elder Justice Coordinating Council and Advisory Board on Elder Abuse, Neglect, and Exploitation
Sec. 2021. Elder Justice Coordinating Council.
Sec. 2022. Advisory Board on Elder Abuse, Neglect, and Exploitation.
Sec. 2023. Research protections.
Sec. 2024. Authorization of appropriations.
SUBPART 2—Elder abuse, neglect, and exploitation forensic centers
Sec. 2031. Establishment and support of elder abuse, neglect, and exploitation forensic centers.
Part B—Programs to Promote Elder Justice
Sec. 2041. Enhancement of long-term care.
Sec. 2042. Adult protective services functions and grant programs.
Sec. 2043. Long-term care ombudsman program grants and training.
Part C—Collection of Data, Dissemination of Information, and Studies
Sec. 2051. Collection of uniform national data on elder abuse, neglect, and exploitation.
Sec. 2052. Long-term care consumer clearinghouse.
Sec. 2053. Consumer information about the continuum of residential long-term care facilities.
Sec. 2054. Provision of information regarding, and evaluations of, elder justice programs.
Sec. 2055. Report.
Findings
Congress finds the following:
The proportion of the United States population age 60 years or older will drastically increase in the next 30 years as more than 76,000,000 baby boomers approach retirement and old age.
Each year, anywhere between 500,000 and 5,000,000 elders in the United States are abused, neglected, or exploited.
Elder abuse, neglect, and exploitation have no boundaries, and cross all racial, social class, gender, and geographic lines.
Victims of elder abuse, neglect, and exploitation are not only subject to injury from mistreatment and neglect, they are also 3.1 times more likely than elders who were not victims of elder abuse, neglect, and exploitation to die at an earlier age than expected.
There is a general dearth of data as to the nature and scope of elder abuse, neglect, and exploitation.
Despite the dearth of data in the field, experts agree that most cases of elder abuse, neglect, and exploitation are never reported and that abuse, neglect, and exploitation shorten a victim’s life, often triggering a downward spiral of an otherwise productive, self-sufficient elder’s life. Programs addressing other difficult issues such as domestic violence and child abuse and neglect have demonstrated the need for a multifaceted law, combining public health, social service, and law enforcement approaches.
For over 20 years, Congress has been presented with facts and testimony calling for a coordinated Federal effort to combat elder abuse, neglect, and exploitation.
The Federal Government has been slow to respond to the needs of victims of elder abuse, neglect, and exploitation or to undertake prevention efforts.
No Federal law has been enacted that adequately and comprehensively addresses the issues of elder abuse, neglect, and exploitation and there are very limited resources available to those in the field that directly deal with the issues.
Differences in State laws and practices in the areas of elder abuse, neglect, and exploitation lead to significant disparities in prevention, protective and social services, treatment systems, and law enforcement, and lead to other inequities.
The Federal Government has played an important role in promoting research, training, public safety, and data collection, and the identification, development, and dissemination of promising health care, social, and protective services, and law enforcement practices, relating to child abuse and neglect, domestic violence, and violence against women. The Federal Government should promote similar efforts and protections relating to elder abuse, neglect, and exploitation.
The Federal Government should provide leadership and assist States and communities in their efforts to protect elders in the United States by—
promoting coordinated planning among all levels of government;
generating and sharing knowledge relevant to protecting elders;
providing leadership to combat the abuse, neglect, and exploitation of the Nation’s elders; and
providing resources to States and communities to promote elder justice.
The problem of elder abuse, neglect, and exploitation requires a comprehensive approach that—
integrates the work of health, legal, and social service agencies and organizations;
emphasizes the need for prevention, reporting, investigation, assessment, treatment, and prosecution of elder abuse, neglect, and exploitation at all levels of government;
ensures that sufficient numbers of properly trained personnel with specialized knowledge are in place to—
treat, assess, and provide services relating to elder abuse, neglect, and exploitation; and
carry out elder protection duties;
is sensitive to ethnic and cultural diversity;
recognizes the role of mental health, disability, dementia, substance abuse, medication mismanagement, and family dysfunction problems in increasing and exacerbating elder abuse, neglect, and exploitation; and
balances elders’ right to self-determination with society’s responsibility to protect elders.
The human, social, and economic cost of elder abuse, neglect, and exploitation is high and includes unnecessary expenditures of funds from many public programs.
The failure to coordinate activities relating to, and comprehensively prevent and treat, elder abuse, neglect, and exploitation threatens the future and well-being of millions of elders in the United States.
All elements of society in the United States have a shared responsibility in responding to a national problem of elder abuse, neglect, and exploitation.
Purposes
The purposes of this Act are as follows:
To enhance the social security of the Nation by ensuring adequate public-private infrastructure and resolve to prevent, detect, treat, understand, and intervene in, and where appropriate, aid in the prosecution of, elder abuse, neglect, and exploitation.
To bring a comprehensive approach to preventing and combating elder abuse, neglect, and exploitation, a long invisible problem that afflicts the most vulnerable among the aging population of the United States.
To raise the issue of elder abuse, neglect, and exploitation to national attention, and to create the infrastructure at the Federal, State, and local levels, to ensure that individuals and organizations on the front lines, who are fighting elder abuse, neglect, and exploitation with scarce resources and fragmented systems, have the resources and information needed to carry out their fight.
To bring a comprehensive multidisciplinary approach to elder justice.
To set in motion research and data collection to fill gaps in knowledge about elder abuse, neglect, and exploitation.
To supplement the activities of service providers and programs, to enhance training, and to leverage scarce resources efficiently, in order to ensure that elder justice receives the attention it deserves as the Nation’s population ages.
To recognize and address the role of mental health, disability, dementia, substance abuse, medication mismanagement, and family dysfunction problems in increasing and exacerbating elder abuse, neglect, and exploitation.
To create short- and long-term strategic plans for the development and coordination of elder justice research, programs, studies, training, and other efforts nationwide.
To promote collaborative efforts and diminish overlap and gaps in efforts in developing the important field of elder justice.
To honor and respect the right of all individuals with diminished capacity to decisionmaking autonomy, self-determination, and dignity of choice.
To respect the wishes of individuals with diminished capacity and their family members in providing supportive services and care plans intended to protect elders from abuse, neglect (including self-neglect), and exploitation.
Definitions
Except as otherwise specifically provided, any term that is defined in section 2011 of the Social Security Act (as added by section 5(a)) and that is used in this Act has the meaning given such term by such title.
Elder Justice
Elder justice
In General
Title XX of the Social Security Act (42 U.S.C. 1397 et seq.) is amended—
in the heading, by
inserting and elder
justice
after social services
;
by inserting before section 2001 the following:
Block grants to states for social services
; and
by adding at the end the following:
Elder justice
Definitions
In this subtitle:
Abuse
The term abuse means the knowing infliction of physical or psychological harm or the knowing deprivation of goods or services that are necessary to meet essential needs or to avoid physical or psychological harm.
Adult protective services
The term adult protective services means such services provided to adults as the Secretary may specify and includes services such as—
disseminating reports of adult abuse, neglect, or exploitation;
investigating the reports described in subparagraph (A);
case planning, monitoring, evaluation, and other case work and services; and
providing, arranging for, or facilitating the provision of medical, social service, economic, legal, housing, law enforcement, or other protective, emergency, or support services.
Caregiver
The term caregiver means an individual who has the responsibility for the care of an elder, either voluntarily, by contract, by receipt of payment for care, or as a result of the operation of law, and means a family member or other individual who provides (on behalf of such individual or of a public or private agency, organization, or institution) compensated or uncompensated care to an elder who needs supportive services in any setting.
Direct care
The term direct care means care by an employee or contractor who provides assistance or long-term care services to a recipient.
Elder
The term elder means an individual age 60 or older.
Elder justice
The term elder justice means—
from a societal perspective, efforts to—
prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation; and
protect elders with diminished capacity while maximizing their autonomy; and
from an individual perspective, the recognition of an elder’s rights, including the right to be free of abuse, neglect, and exploitation.
Eligible entity
The term eligible entity means a State or local government agency, Indian tribe or tribal organization, or any other public or private entity that is engaged in and has expertise in issues relating to elder justice or in a field necessary to promote elder justice efforts.
Exploitation
The term exploitation means the fraudulent or otherwise illegal, unauthorized, or improper act or process of an individual, including a caregiver or fiduciary, that uses the resources of an elder for monetary or personal benefit, profit, or gain, or that results in depriving an elder of rightful access to, or use of, benefits, resources, belongings, or assets.
Fiduciary
The term fiduciary—
means a person or entity with the legal responsibility—
to make decisions on behalf of and for the benefit of another person; and
to act in good faith and with fairness; and
includes a trustee, a guardian, a conservator, an executor, an agent under a financial power of attorney or health care power of attorney, or a representative payee.
Grant
The term grant includes a contract, cooperative agreement, or other mechanism for providing financial assistance.
Guardianship
The term guardianship means—
the process by which a State court determines that an adult individual lacks capacity to make decisions about self-care and property, and appoints another individual or entity known as a guardian, as a conservator, or by a similar term, as a surrogate decisionmaker;
the manner in which the court-appointed surrogate decisionmaker carries out duties to the individual and the court; or
the manner in which the court exercises oversight of the surrogate decisionmaker.
Indian tribe
In general
The term Indian tribe has the meaning given such term in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450b).
Inclusion of Pueblo and Rancheria
The term Indian tribe includes any Pueblo or Rancheria.
Law enforcement
The term law enforcement means the full range of potential responders to elder abuse, neglect, and exploitation including—
police, sheriffs, detectives, public safety officers, and corrections personnel;
prosecutors;
medical examiners;
investigators; and
coroners.
Long-term care
In general
The term long-term care means supportive and health services specified by the Secretary for individuals who need assistance because the individuals have a loss of capacity for self-care due to illness, disability, or vulnerability.
Loss of capacity for self-care
For purposes of subparagraph (A), the term loss of capacity for self-care means an inability to engage in 1 or more activities of daily living, including eating, dressing, bathing, and management of one’s financial affairs.
Long-term care facility
The term long-term care facility means a residential care provider that arranges for, or directly provides, long-term care.
Neglect
The term neglect means—
the failure of a caregiver or fiduciary to provide the goods or services that are necessary to maintain the health or safety of an elder; or
self-neglect.
Nursing facility
In general
The term nursing facility has the meaning given such term under section 1919(a).
Inclusion of skilled nursing facility
The term nursing facility includes a skilled nursing facility (as defined in section 1819(a))
Self-neglect
The term self-neglect means an adult’s inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks including—
obtaining essential food, clothing, shelter, and medical care;
obtaining goods and services necessary to maintain physical health, mental health, or general safety; or
managing one’s own financial affairs.
Serious bodily injury
In general
The term serious bodily injury means an injury—
involving extreme physical pain;
involving substantial risk of death;
involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty; or
requiring medical intervention such as surgery, hospitalization, or physical rehabilitation.
Criminal sexual abuse
Serious bodily injury shall be considered to have occurred if the conduct causing the injury is conduct described in section 2241 (relating to aggravated sexual abuse) or 2242 (relating to sexual abuse) of title 18, United States Code, or any similar offense under State law.
Social
The term social, when used with respect to a service, includes adult protective services.
State legal assistance developer
The term State legal assistance developer means an individual described in section 731 of the Older Americans Act of 1965.
State long-term care ombudsman
The term State Long-Term Care Ombudsman means the State Long-Term Care Ombudsman described in section 712(a)(2) of the Older Americans Act of 1965.
General provisions
Protection of Privacy
In pursuing activities under this subtitle, the Secretary shall ensure the protection of individual health privacy consistent with the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 and applicable State and local privacy regulations.
Rule of construction
Nothing in this subtitle shall be construed to interfere with or abridge an elder’s right to practice his or her religion through reliance on prayer alone for healing when this choice—
is contemporaneously expressed, either orally or in writing, with respect to a specific illness or injury which the elder has at the time of the decision by an elder who is competent at the time of the decision;
is previously set forth in a living will, health care proxy, or other advance directive document that is validly executed and applied under State law; or
may be unambiguously deduced from the elder’s life history.
National Coordination of Elder Justice Activities and Research
Elder Justice Coordinating Council and Advisory Board on Elder Abuse, Neglect, and Exploitation
Elder Justice Coordinating Council
Establishment
There
is established within the Office of the Secretary an Elder Justice Coordinating
Council (in this section referred to as the Council
).
Membership
In general
The Council shall be composed of the following members:
The Secretary (or the Secretary’s designee).
The Attorney General (or the Attorney General’s designee).
The head of each Federal department or agency or other governmental entity identified by the Chair referred to in subsection (d) as having responsibilities, or administering programs, relating to elder abuse, neglect, and exploitation.
Requirement
Each member of the Council shall be an officer or employee of the Federal Government.
Vacancies
Any vacancy in the Council shall not affect its powers, but shall be filled in the same manner as the original appointment was made.
Chair
The member described in subsection (b)(1)(A) shall be Chair of the Council.
Meetings
The Council shall meet at least 2 times per year, as determined by the Chair.
Duties
In general
The Council shall make recommendations to the Secretary for the coordination of activities of the Department of Health and Human Services, the Department of Justice, and other relevant Federal, State, local, and private agencies and entities, relating to elder abuse, neglect, and exploitation and other crimes against elders.
Report
Not later than the date that is 2 years after the date of enactment of the Elder Justice Act and every 2 years thereafter, the Council shall submit to the Committee on Finance of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report that—
describes the activities and accomplishments of, and challenges faced by—
the Council; and
the entities represented on the Council; and
makes such recommendations for legislation, model laws, or other action as the Council determines to be appropriate.
Powers of the Council
Information from federal agencies
Subject to the requirements of section 2012(a), the Council may secure directly from any Federal department or agency such information as the Council considers necessary to carry out this section. Upon request of the Chair of the Council, the head of such department or agency shall furnish such information to the Council.
Postal services
The Council may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.
Travel Expenses
The members of the Council shall not receive compensation for the performance of services for the Council. The members shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Council. Notwithstanding section 1342 of title 31, United States Code, the Secretary may accept the voluntary and uncompensated services of the members of the Council.
Detail of Government Employees
Any Federal Government employee may be detailed to the Council without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.
Status as Permanent Council
Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the Council.
Advisory Board on Elder Abuse, Neglect, and Exploitation
Establishment
There
is established a board to be known as the Advisory Board on Elder Abuse,
Neglect, and Exploitation
(in this section referred to as the
Advisory Board
) to create short- and long-term multidisciplinary
strategic plans for the development of the field of elder justice and to make
recommendations to the Elder Justice Coordinating Council established under
section 2021.
Composition
The Advisory Board shall be composed of 27 members appointed by the Secretary from among members of the general public who are individuals with experience and expertise in elder abuse, neglect, and exploitation prevention, detection, treatment, intervention, or prosecution.
Solicitation of Nominations
The Secretary shall publish a notice in the Federal Register soliciting nominations for the appointment of members of the Advisory Board under subsection (b).
Terms
In general
Each member of the Advisory Board shall be appointed for a term of 3 years, except that, of the members first appointed—
9 shall be appointed for a term of 3 years;
9 shall be appointed for a term of 2 years; and
9 shall be appointed for a term of 1 year.
Vacancies
In general
Any vacancy on the Advisory Board shall not affect its powers, but shall be filled in the same manner as the original appointment was made.
Filling unexpired term
An individual chosen to fill a vacancy shall be appointed for the unexpired term of the member replaced.
Expiration of terms
The term of any member shall not expire before the date on which the member’s successor takes office.
Election of Officers
The Advisory Board shall elect a Chair and Vice Chair from among its members. The Advisory Board shall elect its initial Chair and Vice Chair at its initial meeting.
Duties
Enhance communication on promoting quality of, and preventing abuse and neglect in, Long-Term care
The Advisory Board shall develop collaborative and innovative approaches to improve the quality of, including preventing abuse and neglect in, long-term care.
Collaborative efforts to develop consensus around the management of certain quality-related factors
In general
The Advisory Board shall establish multidisciplinary panels to address, and develop consensus on, subjects relating to improving the quality of long-term care. At least 1 such panel shall address, and develop consensus on, methods for managing resident-to-resident abuse in long-term care.
Activities conducted
The multidisciplinary panels established under subparagraph (A) shall examine relevant research and data, identify best practices with respect to the subject of the panel, determine the best way to carry out those best practices in a practical and feasible manner, and determine an effective manner of distributing information on such subject.
Report
Not later than the date that is 18 months after the date of enactment of the Elder Justice Act, and annually thereafter, the Advisory Board shall prepare and submit to the Elder Justice Coordinating Council, the Committee on Finance of the Senate, and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report containing—
information on the status of Federal, State, and local public and private elder justice activities;
recommendations (including recommended priorities) regarding—
elder justice programs, research, training, services, practice, enforcement, and coordination;
coordination between entities pursuing elder justice efforts and those involved in related areas that may inform or overlap with elder justice efforts, such as activities to combat violence against women and child abuse and neglect; and
activities relating to adult fiduciary systems, including guardianship and other fiduciary arrangements;
recommendations for specific modifications needed in Federal and State laws (including regulations) or for programs, research, and training to enhance prevention, detection, and treatment (including diagnosis) of, intervention in (including investigation of), and prosecution of elder abuse, neglect, and exploitation;
recommendations on methods for the most effective coordinated national data collection with respect to elder justice, and elder abuse, neglect, and exploitation; and
recommendations for a multidisciplinary strategic plan to guide the effective and efficient development of the field of elder justice.
Powers of the Advisory Board
Information from federal agencies
Subject to the requirements of section 2012(a), the Advisory Board may secure directly from any Federal department or agency such information as the Advisory Board considers necessary to carry out this section. Upon request of the Chair of the Advisory Board, the head of such department or agency shall furnish such information to the Advisory Board.
Sharing of data and reports
The Advisory Board may request from any entity pursuing elder justice activities under the Elder Justice Act or an amendment made by that Act, any data, reports, or recommendations generated in connection with such activities.
Postal services
The Advisory Board may use the United States mails in the same manner and under the same conditions as other departments and agencies of the Federal Government.
Travel Expenses
The members of the Advisory Board shall not receive compensation for the performance of services for the Advisory Board. The members shall be allowed travel expenses for up to 4 meetings per year, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Advisory Board. Notwithstanding section 1342 of title 31, United States Code, the Secretary may accept the voluntary and uncompensated services of the members of the Advisory Board.
Detail of Government Employees
Any Federal Government employee may be detailed to the Advisory Board without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.
Status as Permanent Advisory Committee
Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the advisory board.
Research protections
Guidelines
The Secretary shall promulgate guidelines to assist researchers working in the area of elder abuse, neglect, and exploitation, with issues relating to human subject protections.
Definition of legally authorized representative for application of regulations
For purposes of the application of subpart A of part 46 of title 45, Code of Federal Regulations, to research conducted under this subpart, the term legally authorized representative means, unless otherwise provided by law, the individual or judicial or other body authorized under the applicable law to consent to medical treatment on behalf of another person.
Authorization of appropriations
There are authorized to be appropriated to carry out this subpart—
for fiscal year 2007, $6,500,000; and
for each of fiscal years 2008 through 2010, $7,000,000.
Elder abuse, neglect, and exploitation forensic centers
Establishment and support of elder abuse, neglect, and Exploitation forensic Centers
In general
The Secretary, in consultation with the Attorney General, shall make grants to eligible entities to establish and operate stationary and mobile forensic centers, to develop forensic expertise regarding, and provide services relating to, elder abuse, neglect, and exploitation.
Stationary forensic centers
The Secretary shall make 4 of the grants described in subsection (a) to institutions of higher education with demonstrated expertise in forensics or commitment to preventing or treating elder abuse, neglect, or exploitation, to establish and operate stationary forensic centers.
Mobile centers
The Secretary shall make 6 of the grants described in subsection (a) to appropriate entities to establish and operate mobile forensic centers.
Authorized Activities
Development of forensic markers and methodologies
An eligible entity that receives a grant under this section shall use funds made available through the grant to assist in determining whether abuse, neglect, or exploitation occurred and whether a crime was committed and to conduct research to describe and disseminate information on—
forensic markers that indicate a case in which elder abuse, neglect, or exploitation may have occurred; and
methodologies for determining, in such a case, when and how health care, emergency service, social and protective services, and legal service providers should intervene and when the providers should report the case to law enforcement authorities.
Development of forensic expertise
An eligible entity that receives a grant under this section shall use funds made available through the grant to develop forensic expertise regarding elder abuse, neglect, and exploitation in order to provide medical and forensic evaluation, therapeutic intervention, victim support and advocacy, case review, and case tracking.
Collection of evidence
The Secretary, in coordination with the Attorney General, shall use data made available by grant recipients under this section to develop the capacity of geriatric health care professionals and law enforcement to collect forensic evidence, including collecting forensic evidence relating to a potential determination of elder abuse, neglect, or exploitation.
Application
To be eligible to receive a grant under this section, an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section—
for fiscal year 2007, $4,000,000;
for fiscal year 2008, $6,000,000; and
for each of fiscal years 2009 and 2010, $8,000,000.
Programs to Promote Elder Justice
Enhancement of long-term care
Grants and Incentives for Long-Term Care Staffing
In general
The Secretary shall carry out activities, including activities described in paragraphs (2) and (3), to provide incentives for individuals to train for, seek, and maintain employment providing direct care in a long-term care facility.
Specific programs to enhance training, recruitment, and retention of staff
Coordination with other programs to recruit and train long-term care staff
The Secretary shall coordinate activities under this subsection with the Secretary of Labor and the Assistant Secretary for the Administration for Children and Families in order to provide incentives to participants in programs carried out under part A of title IV to train for and seek employment providing direct care in a long-term care facility.
Career ladders and wage or benefit increases to increase staffing in long-term care facilities
In general
The Secretary shall make grants to long-term care facilities to carry out programs through which the facilities—
offer, to employees who provide direct care to residents of a long-term care facility, continuing training and varying levels of certification, based on observed clinical care practices and the amount of time the employees spend providing direct care; and
provide, or make arrangements to provide, bonuses or other increased compensation or benefits to employees who achieve certification under such a program.
Application
To be eligible to receive a grant under this subparagraph, a long-term care facility shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require (which may include evidence of consultation with the State in which the long-term care facility is located with respect to carrying out activities funded under the grant).
Authority to limit number of applicants
Nothing in this subparagraph shall be construed as prohibiting the Secretary from limiting the number of applicants for a grant under this subparagraph.
Specific programs to improve management practices
In general
The Secretary shall make grants to long-term care facilities to enable the facilities to provide training and technical assistance to eligible employees.
Authorized activities
A long-term care facility that receives a grant under subparagraph (A) shall use funds made available through the grant to provide training and technical assistance to eligible employees regarding management practices using methods that are demonstrated to promote retention of individuals who provide direct care to residents of the long-term care facility, such as—
the establishment of standard human resource policies that reward high performance, including policies that provide for improved wages and benefits on the basis of job reviews;
the establishment of motivational and thoughtful work organization practices;
the creation of a workplace culture that respects and values caregivers and their needs;
the promotion of a workplace culture that respects the rights of residents of a long-term care facility and results in improved care for the residents; and
the establishment of other programs that promote the provision of high quality care, such as a continuing education program that provides additional hours of training, including on-the-job training, for employees who are certified nurse aides.
Application
To be eligible to receive a grant under this paragraph, a long-term care facility shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require (which may include evidence of consultation with the State in which the long-term care facility is located with respect to carrying out activities funded under the grant).
Authority to limit number of applicants
Nothing in this paragraph shall be construed as prohibiting the Secretary from limiting the number of applicants for a grant under this paragraph.
Eligible employee defined
In this paragraph, the term eligible employee means an individual who establishes or implements management practices applicable with respect to individuals who provide direct care to residents of a long-term care facility and includes administrators, directors of nursing, staff developers, and charge nurses.
Accountability measures
The Secretary shall develop accountability measures to ensure that the activities conducted using funds made available under this subsection benefit eligible employees and increase the stability of the long-term care workforce.
Informatics Systems Grant Program
Grants authorized
The Secretary is authorized to make grants to long-term care facilities for the purpose of assisting such entities in offsetting the costs related to purchasing, leasing, developing, and implementing standardized clinical health care informatics systems designed to improve patient safety and reduce adverse events and health care complications resulting from medication errors.
Use of grant funds
Funds provided under grants under this subsection may be used for any of the following:
Purchasing, leasing, and installing computer software and hardware, including handheld computer technologies.
Making improvements to existing computer software and hardware.
Making upgrades and other improvements to existing computer software and hardware to enable e-prescribing.
Providing education and training to eligible long-term care facility staff on the use of technology to implement the electronic transmission of prescription and patient information.
Application
To be eligible to receive a grant under this subsection, a long-term care facility shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require (which may include evidence of consultation with the State in which the long-term care facility is located with respect to carrying out activities funded under the grant).
Authority to limit number of applicants
Nothing in this subsection shall be construed as prohibiting the Secretary from limiting the number of applicants for a grant under this subsection.
Accountability measures
The Secretary shall develop accountability measures to ensure that the activities conducted using funds made available under this subsection help improve patient safety and reduce adverse events and health care complications resulting from medication errors.
Inclusion of adjudicated crimes on nursing home compare website
Not later than
1 year after the date of enactment of the Elder Justice Act, the Secretary
shall ensure that the Department of Health and Human Services includes, as part
of the information provided for comparison of nursing facilities on the
official Internet website of the Federal Government for Medicare beneficiaries
(commonly referred to as the Nursing Home Compare
Medicare
website), the number of adjudicated instances of criminal violations by a
nursing facility or crimes committed by an employee of a nursing
facility—
that were committed inside of the facility; and
with respect to such instances of violations or crimes committed outside of the facility, that were the violations or crimes of elder abuse, neglect, and exploitation, criminal sexual abuse of an elder, or other violations or crimes that resulted in the serious bodily injury of an elder.
Development of consumer rights information page on nursing home compare website
Not later than 1 year after the date of enactment of the Elder Justice Act, the Secretary shall ensure that the Department of Health and Human Services, as part of the information provided for comparison of nursing facilities on the Nursing Home Compare Medicare website develops and includes a consumer rights information page that contains links to descriptions of, and information with respect to, the following:
The documentation on nursing facilities that is available to the public.
General information and tips on choosing a nursing facility that meets the needs of the individual.
General information on consumer rights with respect to nursing facilities.
The nursing facility survey process (on a national and State-specific basis).
On a State-specific basis, the services available through the State long-term care ombudsman for such State.
Development and Adoption of Standards for Transactions Involving Clinical Data by Long-Term Care Facilities
Standards
The Secretary shall develop and adopt uniform open electronic standards for transactions involving clinical data by long-term care facilities. Such standards shall include messaging and nomenclature standards.
Compatibility with other standards
The standards developed and adopted under paragraph (1) shall be compatible with standards established under part C of title XI, standards established under subsections (b)(2)(B)(i) and (e)(4) of section 1860D–4, and with general health information technology standards.
Electronic submission of data to the secretary
In general
Not later than 10 years after the date of enactment of the Elder Justice Act, the Secretary shall have procedures in place to accept the optional electronic submission of clinical data by long-term care facilities pursuant to the standards developed and adopted under paragraph (1).
Rule of construction
Nothing in this subsection shall be construed to require a long-term care facility to submit clinical data electronically to the Secretary.
Regulations
The Secretary shall promulgate regulations to carry out subsections (c), (d), and (e) of this section. Such regulations shall require a State, as a condition of the receipt of funds under this part, to conduct such data collection and reporting as the Secretary determines are necessary to satisfy the requirements of such subsections.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section—
for fiscal year 2007, $20,000,000;
for fiscal year 2008, $17,500,000; and
for each of fiscal years 2009 and 2010, $15,000,000.
Adult protective services functions and grant programs
Secretarial responsibilities
In general
The Secretary shall ensure that the Department of Health and Human Services—
provides funding authorized by this part to State and local adult protective services offices that investigate reports of the abuse, neglect, and exploitation of elders;
collects and disseminates data annually relating to the abuse, exploitation, and neglect of elders in coordination with the Department of Justice;
develops and disseminates information on best practices regarding, and provides training on, carrying out adult protective services;
conducts research related to the provision of adult protective services; and
provides technical assistance to States and other entities that provide or fund the provision of adult protective services, including through grants made under subsections (b) and (c).
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection, $3,000,000 for fiscal year 2007 and $4,000,000 for each of fiscal years 2008 through 2010.
Grants to enhance the provision of adult protective services
Establishment
There is established an adult protective services grant program under which the Secretary shall annually award grants to States in the amounts calculated under paragraph (2) for the purposes of enhancing adult protective services provided by States and local units of government.
Amount of payment
In general
Subject to the availability of appropriations and subparagraphs (B) and (C), the amount paid to a State for a fiscal year under the program under this subsection shall equal the amount appropriated for that year to carry out this subsection multiplied by the percentage of the total number of elders who reside in the United States who reside in that State.
Guaranteed minimum payment amount
50 states
Subject to clause (ii), if the amount determined under subparagraph (A) for a State for a fiscal year is less than 0.75 percent of the amount appropriated for such year, the Secretary shall increase such determined amount so that the total amount paid under this subsection to the State for the year is equal to 0.75 percent of the amount so appropriated.
Territories
In
the case of a State other than 1 of the 50 States, clause (i) shall be applied
as if each reference to 0.75
were a reference to
0.1
.
Pro rata reductions
The Secretary shall make such pro rata reductions to the amounts described in subparagraph (A) as are necessary to comply with the requirements of subparagraph (B).
Authorized activities
Adult protective services
Funds made available pursuant to this subsection may only be used by States and local units of government to provide adult protective services and may not be used for any other purpose.
Use by agency
Each State receiving funds pursuant to this subsection shall provide such funds to the agency or unit of State government having legal responsibility for providing adult protective services within the State.
Supplement not supplant
Each State or local unit of government shall use funds made available pursuant to this subsection to supplement and not supplant other Federal, State, and local public funds expended to provide adult protective services in the State.
State reports
Each State receiving funds under this subsection shall submit to the Secretary, at such time and in such manner as the Secretary may require, a report on the number of elders served by the grants awarded under this subsection.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection, $100,000,000 for each of fiscal years 2007 through 2010.
State Demonstration Programs
Establishment
The Secretary shall award grants to States for the purposes of conducting demonstration programs in accordance with paragraph (2).
Demonstration programs
Funds made available pursuant to this subsection may be used by States and local units of government to conduct demonstration programs that test—
training modules developed for the purpose of detecting or preventing elder abuse;
methods to detect or prevent financial exploitation of elders;
methods to detect elder abuse;
whether training on elder abuse forensics enhances the detection of elder abuse by employees of the State or local unit of government; or
other matters relating to the detection or prevention of elder abuse.
Application
To be eligible to receive a grant under this subsection, a State shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
State reports
Each State that receives funds under this subsection shall submit a report to the Secretary at such time, in such manner, and containing such information as the Secretary may require on the results of the demonstration program conducted by the State using funds made available under this subsection.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection, $25,000,000 for each of fiscal years 2007 through 2010.
Long-term care ombudsman program grants and training
Grants to support the long-term care ombudsman program
In general
The Secretary shall make grants to eligible entities with relevant expertise and experience in abuse and neglect in long-term care facilities or long-term care ombudsman programs and responsibilities, for the purpose of—
improving the capacity of State long-term care ombudsman programs to respond to and resolve complaints about abuse and neglect;
conducting pilot programs with State long-term care ombudsman offices or local ombudsman entities; and
providing support for such State long-term care ombudsman programs and such pilot programs (such as through the establishment of a national long-term care ombudsman resource center).
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection—
for fiscal year 2007, $5,000,000;
for fiscal year 2008, $7,500,000; and
for each of fiscal years 2009 and 2010, $10,000,000.
Ombudsman training programs
In general
The Secretary shall establish programs to provide and improve ombudsman training with respect to elder abuse, neglect, and exploitation for national organizations and State long-term care ombudsman programs.
Authorization of appropriations
There are authorized to be appropriated to carry out this subsection, for each of fiscal years 2007 through 2010, $10,000,000.
Collection of Data, Dissemination of Information, and Studies
Collection of uniform national data on elder abuse, neglect, and exploitation
Purpose
The purpose of this section is to improve, streamline, and promote uniform collection, maintenance, and dissemination of national data relating to the various types of elder abuse, neglect, and exploitation.
Phase I—Development
In general
Not later than the date that is 1 year after the date of enactment of the Elder Justice Act, the Secretary, after consultation with the Attorney General, shall develop—
a method for collecting national data regarding elder abuse, neglect, and exploitation; and
uniform national data reporting forms adapted to each relevant entity or discipline (such as health, public safety, social and protective services, and law enforcement) reflecting—
the distinct manner in which each entity or discipline receives and maintains information; and
the sequence and history of reports to, or involvement of, different entities or disciplines, independently, or the sequence and history of reports from 1 entity or discipline to another over time.
Forms
Subject to the requirements of section 2012(a), the national data reporting forms described in paragraph (1)(B) shall incorporate the definitions of this subtitle for use in determining whether an event is reportable.
Phase II—Pilot tests
In general
Not later than the date that is 1 year after the date on which the activities described in subsection (b)(1) are completed, the Secretary shall ensure that the national data reporting forms and data collection methods developed in accordance with such subsection are pilot tested in 6 States selected by the Secretary.
Adjustments to the form and methods
The Secretary, after considering the results of the pilot testing described in paragraph (1) and consultation with the Attorney General, shall adjust the national data reporting forms and data collection methods as necessary.
Phase III—National distribution
Distribution of national data reporting forms
After completion of the adjustment to the national data reporting forms under subsection (c)(2), the Secretary shall submit the national data reporting forms along with instructions to—
the heads of the relevant Federal entities as may be appropriate; and
the appropriate office of each State for collection from all relevant State entities of data, including health care, social services, and law enforcement data.
Data collection grants
Authorization
The Secretary is authorized to award grants to States to improve data collection activities relating to elder abuse, neglect, and exploitation.
Application
To be eligible to receive a grant under this paragraph, a State shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.
Requirements
Each State receiving a grant under this paragraph for a fiscal year shall report data for the calendar year that begins during that fiscal year, using the national data reporting forms described in paragraph (1).
Funding
First year
For the first fiscal year for which a State receives grant funds under this paragraph, the Secretary shall initially distribute 50 percent of such funds to the State. The Secretary shall distribute the remaining funds to the State at the end of the calendar year that begins during that fiscal year, if the Secretary determines that the State has properly reported data required under this paragraph for the calendar year.
Subsequent years
Except as provided in clause (i), the Secretary shall distribute grant funds to a State under this paragraph for a fiscal year if the Secretary determines that the State properly reported data required under this paragraph for the calendar year that ends during that fiscal year.
Required information
Each report submitted under this paragraph shall—
indicate the State and year in which each event occurred; and
identify the total number of events that occurred in each State during the year and the type of each event.
Report
Not later than 1 year after the date of enactment of the Elder Justice Act and annually thereafter, the Secretary shall prepare and submit to the Committee on Finance of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report regarding activities conducted under this section.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section—
for fiscal year 2007, $10,000,000;
for fiscal year 2008, $30,000,000; and
for each of fiscal years 2009 and 2010, $100,000,000.
Long-term care consumer clearinghouse
Establishment
The Secretary shall establish a long-term care consumer clearinghouse.
Information
The clearinghouse shall provide comprehensive detailed information, in a consumer-friendly form, to consumers about choices relating to long-term care providers, such as information about—
obtaining the services of, and employing, caregivers who provide long-term care at an individual’s home; and
options for residential long-term care, such as—
the type of care provided by nursing facilities; and
the type of care provided by group homes and other residential long-term care facilities that are not nursing facilities;
the benefits related to long-term care that are available through the programs carried out under titles XVIII and XIX; and
links to Federal and State Internet websites that describe the care available through specific long-term care facilities, including data on the satisfaction level of residents of, and families of residents of, the facilities.
Providers
In providing information on long-term care providers under this section, the clearinghouse shall provide information (from States and other sources) on assisted living facilities, board and care facilities, congregate care facilities, home health care providers, and other long-term care providers.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section—
for fiscal year 2007, $2,000,000;
for fiscal year 2008, $3,000,000; and
for each of fiscal years 2009 and 2010, $4,000,000.
Consumer information about the continuum of residential long-term care facilities
Study
In general
The Secretary, after consultation with the Attorney General, shall, directly or through a grant, conduct a study on consumer concerns relating to residential long-term care facilities, other than nursing facilities.
Specific topics
The entity conducting the study shall—
develop definitions for classes of the residential long-term care facilities described in paragraph (1); and
collect information on the prices of, level of services provided by, oversight and enforcement provisions of, and admission and discharge criteria of, the facilities.
Authorization of Appropriations
There are authorized to be appropriated to carry out this section, for each of fiscal years 2007 through 2010, $3,000,000.
Provision of information regarding, and evaluations of, elder justice programs
Provision of Information
To be eligible to receive a grant under this part, an applicant shall agree—
except as provided in paragraph (2), to provide the eligible entity conducting an evaluation under subsection (b) of the activities funded through the grant with such information as the eligible entity may require in order to conduct such evaluation; or
in the case of an applicant for a grant under section 2041(b), to provide the Secretary with such information as the Secretary may require to conduct an evaluation or audit under subsection (c).
Use of Eligible Entities To Conduct Evaluations
Evaluations required
Except as provided in paragraph (2), the Secretary shall—
reserve a portion (not less than 2 percent) of the funds appropriated with respect to each program carried out under this part; and
use the funds reserved under subparagraph (A) to provide assistance to eligible entities to conduct evaluations of the activities funded under each program carried out under this part.
Informatics systems grant program not included
The provisions of this subsection shall not apply to the informatics systems grant program under section 2041(b).
Authorized activities
A recipient of assistance described in paragraph (1)(B) shall use the funds made available through the assistance to conduct a validated evaluation of the effectiveness of the activities funded under a program carried out under this part.
Applications
To be eligible to receive assistance under paragraph (1)(B), an entity shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require, including a proposal for the evaluation.
Reports
Not later than a date specified by the Secretary, an eligible entity receiving assistance under paragraph (1)(B) shall submit to the Secretary, the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives, and the Committee on Finance of the Senate a report containing the results of the evaluation conducted using such assistance together with such recommendations as the entity determines to be appropriate.
Evaluations and Audits of Informatics Systems Grant Program by the Secretary
Evaluations
The Secretary shall conduct an evaluation of the activities funded under the informatics systems grant program under section 2041(b). Such evaluation shall include an evaluation of whether the funding provided under the grant is expended only for the purposes for which it is made.
Audits
The Secretary shall conduct appropriate audits of grants made under section 2041(b).
Report
Not later than October 1, 2011, the Secretary shall submit to the Elder Justice Coordinating Council, the Committee on Finance of the Senate, and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives a report—
compiling, summarizing, and analyzing the information contained in the State reports submitted under subsections (b)(4) and (c)(4) of section 2042; and
containing—
the results of the study conducted under section 2053; and
such recommendations for legislative or administrative action as the Secretary determines to be appropriate.
.
Requirement for State plan under program for temporary assistance for needy families
In general
Section 402(a)(1)(A) of the Social Security Act (42 U.S.C. 602(a)(1)(A)) is amended by adding at the end the following new clause:
Coordinate the program with activities carried out by the Secretary under section 2041(a) in order to facilitate such activities and provide incentives for individuals to train for, seek, and maintain employment providing direct care in a long-term care facility (as such terms are defined in section 2011).
.
Effective date
The amendment made by subparagraph (A) shall take effect on October 1, 2007.
Long-Term Care Facilities
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by adding at the end the following new sections:
Reporting to law enforcement of crimes occurring in federally funded Long-Term care facilities
Determination and Notification
Determination
The owner or operator of each long-term care facility that receives Federal funds under this Act shall annually determine whether the facility received at least $10,000 in such Federal funds during the preceding year.
Notification
If the owner or operator determines under paragraph (1) that the facility received at least $10,000 in such Federal funds during the preceding year, such owner or operator shall annually notify each covered individual (as defined in paragraph (3)) of that individual’s obligation to comply with the reporting requirements described in subsection (b).
Covered individual defined
In this section, the term covered individual means each individual who is an owner, operator, employee, manager, agent, or contractor of a long-term care facility that is the subject of a determination described in paragraph (1).
Reporting Requirements
In general
Each covered individual shall report to the Secretary and 1 or more law enforcement entities for the political subdivision in which the facility is located any reasonable suspicion of a crime (as defined by the law of the applicable political subdivision) against any individual who is a resident of, or is receiving care from, the facility.
Timing
If the events that cause the suspicion—
result in serious bodily injury, the individual shall report the suspicion immediately, but not later than 2 hours after forming the suspicion; and
do not result in serious bodily injury, the individual shall report the suspicion not later than 24 hours after forming the suspicion.
Penalties
In general
If a covered individual violates subsection (b)—
the covered individual shall be subject to a civil money penalty of not more than $200,000; or
the Secretary shall classify the covered individual as an excluded individual, for a period of not more than 3 years.
Increased harm
If a covered individual violates subsection (b) and the violation exacerbates the harm to the victim of the crime or results in harm to another individual—
the covered individual shall be subject to a civil money penalty of not more than $300,000; and
the Secretary shall classify the covered individual as an excluded individual, for a period of not more than 3 years.
Excluded individual
During any period for which a covered individual is classified as an excluded individual under paragraph (1)(B) or (2)(B), a long-term care facility that employs such individual shall be ineligible to receive Federal funds under this Act.
Extenuating circumstances
In general
The Secretary may take into account the financial burden on providers with underserved populations in determining any penalty to be imposed under this subsection.
Underserved population defined
In this paragraph, the term underserved population means the population of an area designated by the Secretary as an area with a shortage of elder justice programs or a population group designated by the Secretary as having a shortage of such programs. Such areas or groups designated by the Secretary may include—
areas or groups that are geographically isolated (such as isolated in a rural area);
racial and ethnic minority populations; and
populations underserved because of special needs (such as language barriers, disabilities, alien status, or age).
Additional Penalties for Retaliation
In general
A long-term care facility may not—
discharge, demote, suspend, threaten, harass, or deny a promotion or other employment-related benefit to an employee, or in any other manner discriminate against an employee in the terms and conditions of employment because of lawful acts done by the employee; or
file a complaint or a report against a nurse or other employee with the appropriate State professional disciplinary agency because of lawful acts done by the nurse or employee,
Penalties for retaliation
If a long-term care facility violates subparagraph (A) or (B) of paragraph (1) the facility shall be subject to a civil money penalty of not more than $200,000 or the Secretary may classify the entity as an excluded entity for a period of 2 years pursuant to section 1128(b), or both.
Requirement to post notice
Each long-term care facility shall post conspicuously in an appropriate location a sign (in a form specified by the Secretary) specifying the rights of employees under this section. Such sign shall include a statement that an employee may file a complaint with the Secretary against a long-term care facility that violates the provisions of this subsection and information with respect to the manner of filing such a complaint.
Procedure
The provisions of section 1128A (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil money penalty under this section in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).
Definitions
In this section, the terms elder justice, long-term care facility, and law enforcement have the meanings given those terms in section 2011.
Ensuring safety of residents when federally funded Long-Term care facilities close
Notification of Facility Closure
If the owner or operator determines under section 1150A(a)(1) that a long-term care facility received at least $10,000 in Federal funds under this Act during the preceding year, the owner or operator of the facility shall—
submit to the Secretary and the appropriate State regulatory agency written notification of an impending closure not later than the date that is 60 days prior to the date of such closure;
include in the notice a plan for the transfer and adequate relocation of the residents of the facility prior to closure, including assurances that the residents will be transferred to the most appropriate facility in terms of quality, services, and location; and
not later than 10 days after the facility closure, submit to the Secretary and the appropriate State agency information identifying where residents of the closed facility were transferred and on what date.
Sanctions
Any person owning or operating a long-term care facility that fails to comply with the requirements of subsection (a) shall be subject to—
a civil monetary penalty of up to $1,000,000;
exclusion from participation in the programs under this Act (in accordance with the procedures of section 1128); and
any other applicable civil monetary penalties and assessments.
Procedure
The provisions of section 1128A (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to a civil money penalty or assessment under this section in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).
Definition
In this section, the term long-term care facility has the meaning given that term in section 2011.
.
National nurse aide registry
Definition of nurse aide
In this section, the term nurse aide
has the
meaning given that term in sections 1819(b)(5)(F) and 1919(b)(5)(F) of the
Social Security Act (42 U.S.C. 1395i–3(b)(5)(F); 1396r(b)(5)(F)).
Study and report
In general
The Secretary, in consultation with appropriate government agencies and private sector organizations, shall conduct a study on establishing a national nurse aide registry.
Areas evaluated
The study conducted under this subsection shall include an evaluation of—
who should be included in the registry;
how such a registry would comply with Federal and State privacy laws and regulations;
how data would be collected for the registry;
what entities and individuals would have access to the data collected;
how the registry would provide appropriate information regarding violations of Federal and State law by individuals included in the registry;
how the functions of a national nurse aide registry would be coordinated with the pilot program for national and State background checks on direct patient access employees of long-term care facilities or providers established under section 307 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173); and
how the information included in State nurse aide registries developed and maintained under sections 1819(e)(2) and 1919(e)(2) of the Social Security Act (42 U.S.C. 1395i–3(e)(2); 1396r(e)(2)(2)) would be provided as part of a national nurse aide registry.
Considerations
In conducting the study and preparing the report required under this subsection, the Secretary shall take into consideration the findings and conclusions of relevant reports and other relevant resources, including the following:
The Department of Health and Human Services Office of Inspector General Report, Nurse Aide Registries: State Compliance and Practices (February 2005).
The General Accounting Office (now known as the Government Accountability Office) Report, Nursing Homes: More Can Be Done to Protect Residents from Abuse (March 2002).
The Department of Health and Human Services Office of the Inspector General Report, Nurse Aide Registries: Long-Term Care Facility Compliance and Practices (July 2005).
The Department of Health and Human Services Health Resources and Services Administration Report, Nursing Aides, Home Health Aides, and Related Health Care Occupations—National and Local Workforce Shortages and Associated Data Needs (2004)(in particular with respect to chapter 7 and appendix F).
The 2001 Report to CMS from the School of Rural Public Health, Texas A&M University, Preventing Abuse and Neglect in Nursing Homes: The Role of Nurse Aide Registries.
Information included in State nurse aide registries developed and maintained under sections 1819(e)(2) and 1919(e)(2) of the Social Security Act (42 U.S.C. 1395i–3(e)(2); 1396r(e)(2)(2)).
Report
Not later than 18 months after the date of enactment of this Act, the Secretary shall submit a report to the Elder Justice Coordinating Council, the Committee on Finance of the Senate, and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives containing the findings and recommendations of the study conducted under this paragraph.
Funding limitation
Funding for the study conducted under this subsection shall not exceed $500,000.
Congressional action
After receiving the report submitted by the Secretary under paragraph (1)(D), the Committee on Finance of the Senate and the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives shall, as they deem appropriate, take action based on the recommendations contained in the report.
Authorization of appropriations
There are authorized to be appropriated such sums as are necessary for the purpose of carrying out this subsection.
Conforming amendments
Title XX
Title XX of the Social Security Act (42 U.S.C. 1397 et seq.), as amended by section 5(a), is amended—
in the heading of section
2001, by striking title
and inserting
subtitle
; and
in subtitle 1, by
striking this title
each place it appears and inserting
this subtitle
.
Title IV
Title IV of such Act (42 U.S.C. 601 et seq.) is amended—
in section 404(d)—
in paragraphs (1)(A),
(2)(A), and (3)(B), by inserting subtitle 1 of
before
title XX
each place it appears;
in the heading of
paragraph (2), by inserting subtitle 1
of
before title XX
; and
in the heading of
paragraph (3)(B), by inserting subtitle 1
of
before title XX
; and
in sections 422(b),
471(a)(4), 472(h)(1), and 473(b)(2), by inserting subtitle 1 of
before title XX
each place it appears.
Title XI
Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended—
in section 1128(h)(3)—
by inserting
subtitle 1 of
before title XX
; and
by striking such
title
and inserting such subtitle
; and
in section 1128A(i)(1),
by inserting subtitle 1 of
before title
XX
.
September 19, 2006
Reported with an amendment