[Senate Report 108-391]
[From the U.S. Government Publishing Office]



                                                       Calendar No. 780
108th Congress                                                   Report
                                 SENATE
 2d Session                                                     108-391

======================================================================



 
                         ACT FOR ELDER JUSTICE

                                _______
                                

                October 7, 2004.--Ordered to be printed

                                _______
                                

    Mr. Gregg, from the Committee on Health, Education, Labor, and 
                   Pensions, submitted the following

                              R E P O R T

                         [To accompany S. 2940]

    The Committee on Health, Education, Labor, and Pensions, 
reported an original bill (S. 2940) to amend the Older 
Americans Act of 1965 to assist States in preventing, 
detecting, treating, intervening in, and responding to elder 
abuse, neglect, and exploitation, and for other purposes, 
having considered the same, reports favorably thereon without 
amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary of the Bill..................................1
 II. Background and Need for Legislation..............................2
III. Legislative History and Committee Action.........................3
 IV. Explanation of Legislation and Committee Views...................5
  V. Statement of Administration Policy...............................6
 VI. Cost Estimate....................................................7
VII. Application of Law to the Legislative Branch.....................9
VIII.Regulatory Impact Statement......................................9

 IX. Section-by-Section Analysis......................................9
  X. Changes in Existing Law.........................................11

                   I. Purpose and Summary of the Bill

    The Act for Elder Justice amends the Older Americans Act of 
1965 (OAA) by authorizing the creation of an Office on Elder 
Abuse Prevention and Services and by creating a new Subtitle 
B--Elder Justice Programs under which a new grant is 
established to assist States in preventing, detecting, 
treating, intervening in, and responding to elder abuse, 
neglect, and exploitation.
    In order to accomplish this, the bill focuses on five 
areas: (1) assistance to States and communities in their 
efforts to protect elders in developing a comprehensive, multi-
disciplinary approach to elder justice; (2) promoting research 
and data collection that fill knowledge gaps about elder abuse, 
neglect and exploitation; (3) supporting innovative and 
effective activities of service providers designed to address 
elder abuse issues; (4) assistance to States, Indian Tribes and 
local service providers in the development of short- and long-
term strategic plans for the development and coordination of 
elder justice research, programs, studies, and training; and 
(5) promoting collaborative efforts to diminish overlap and 
gaps in developing the field of elder justice.

                II. Background and Need for Legislation

    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. This 
variance reflects the unfortunate fact that there is a general 
lack of comprehensive data on such abuse, with 500,000 
reflecting the number being reported and a significantly higher 
number of cases that goes unreported.
    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 such maltreatment.
    The primary Federal statute addressing the issue of elder 
advocacy and elder justice is the Older Americans Act. First 
enacted in 1965, the Older Americans Act remains the main 
vehicle for the organization and delivery of social and 
nutrition services to senior citizens. The Act established the 
Administration on Aging (AoA) and also a state grant program 
for community planning and services programs, as well as 
authority for research, demonstration, and training programs in 
the field of aging.
    The act sets out a range of social policy objectives that 
aim to improve the lives of all older Americans, including 
sufficient income in retirement, the best possible physical and 
mental health, employment opportunity, and ample long-term care 
services, to name a few.
    Today the Administration on Aging remains the chief Federal 
agency advocate for elder Americans as it operates the National 
Center on Elder Abuse, the National Eldercare Locator Service, 
the National Long-Term Care Ombudsman Resource Center, the 
National Aging Information Center, and the Pension Counseling 
and Information Program.
    Grants to State and area agencies on aging enable local 
advocates to act on behalf of and to coordinate programs for 
older Americans. Such grants account for 69% of total Older 
Americans Act funds in FY2004 ($1.243 billion out of $1.798 
billion). This grantprogram supports 56 State agencies on 
aging, 655 area agencies on aging, and more than 29,000 service 
providers.
    The act has been amended 14 times in 35 years. The 1992 
amendments restructured some of the act's programs and created 
a new Title VII to combine and develop the programs that 
address elder rights protection which were previously 
authorized under Title III, including the long-term care 
ombudsman program and programs to prevent elder abuse, neglect 
and exploitation. The Act for Elder Justice aims to fill gaps 
in existing authorities and strengthen the Administration on 
Aging so that elder abuse, neglect and exploitation may be 
better prevented, addressed, and treated.
    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 the victims or to undertake 
prevention efforts. No Federal law has been enacted that 
comprehensively addresses the issues of elder abuse, neglect, 
and exploitation and there are limited resources available to 
those in the field directly dealing with these issues.
    The Act for Elder Justice builds on the important role 
played by the Federal Government 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. It is our view that the Federal 
Government should promote similar efforts and protections 
relating to elder abuse, neglect, and exploitation.
    To this end, the Act for Elder Justice seeks to (1) promote 
coordinated planning among all levels of government; (2) 
promote the generating and sharing of knowledge relevant to 
protecting elders; (3) provide leadership to combat the abuse, 
neglect, and exploitation of the Nation's elders; and (4) 
provide resources to States and communities to promote elder 
justice.

             III. Legislative History and Committee Action

    On September 22, 2004 the Senate Committee on Health, 
Education, Labor, and Pensions considered and passed the Act 
for Elder Justice by voice vote.

              HEARINGS AND TESTIMONY--SUMMARY OF WITNESSES

    The Subcommittee on Aging of the Committee on Health, 
Education, Labor, and Pensions held three hearings on elder 
abuse, neglect and exploitation in the 108th Congress.
    The following witnesses testified at a Tuesday, August 19, 
2003, Aging Subcommittee field hearing in Kansas City, Missouri 
entitled ``Elder Justice and Protection: Stopping the Abuse.''
    Tom Klammer from Kansas City, Missouri, is the son of 
Walter Leonard Klammer who was a victim of poor care and abuse 
in nursing homes in Missouri.
    Tony DeWitt is an attorney with Bartimus, Frickleton, 
Robertson & Obetz, PC in Jefferson City, Missouri. He discussed 
the problem of elder abuse and the lack of adequate remedies 
for seniors. He identified insufficient staffing levels and low 
wages as a part of the root of abuse in nursing homes.
    Todd Graves, United States Attorney for the Western 
District of Missouri, discussed successful cases handled by the 
Western District of Missouri that involved egregious instances 
of painful injuries and unhealthy conditions suffered by 
elderly residents as a result of gross neglect on the part of 
nursing home operators. His office took an innovative approach 
by filing civil actions against the nursing home operators 
under the Federal False Claims Act. His office used the Federal 
False Claims Act to prosecute a civil fraud against the 
government, rather than an actual elder abuse because there is 
no actual elder abuse law at the Federal level. One lawsuit 
alleged that these instances of patient harm and abuse were 
attributed, in large part, to the nursing home's failure to 
provide adequate staff to meeting the needs of nursing home 
residents. This particular nursing home was so severely 
understaffed that it could not possibly have provided the level 
of patient care it was obligated to provide for reimbursement 
under the Medicare and Medicaid programs. Aware of these staff 
shortages and still billing Medicare and Medicaid for services 
it clearly had not adequately provided, this nursing home was 
knowingly submitting false and fraudulent claims to the 
Medicare and Medicaid programs and thus violating the Federal 
False Claim Act.
    Paul Vescovo, Sheriff, Clay County Sheriffs Department, 
discussed that the majority of elder abuse and neglect occurs 
in the home at the hands of family members or paid care givers. 
He described the unique challenges investigating elder abuse 
poses for law enforcement and the need for social services 
agencies to assist law enforcement in adequately responding in 
cases of elder abuse and assisting victims. He also discussed 
the need for more education of the public on elder abuse and 
neglect. He cited that public education and media coverage 
concerning domestic violence and child abuse had made the 
public more knowledgeable and proactive in the reporting of 
such abuse and had garnered support for funding for programs to 
combat such abuse.
    Norma Collins, Associate State Director for Advocacy, AARP, 
discussed the need for more public awareness and prevention 
activities to combat elder abuse and neglect. She also raised 
the need to improve the quality of investigation, enforcement 
and prosecution in cases of abuse and neglect as well as the 
need to improve the early detection of warning signs through 
encouragement of wider reporting of abuse.
    The following witnesses testified at a Wednesday, August 
20, 2003, Aging Subcommittee Field Hearing in St. Louis, 
Missouri, entitled ``Elder Justice and Protection: Stopping the 
Abuse.''
    Martha Ballanot from St. Louis, Missouri, is the daughter 
of Burton Reese who was a victim of abuse in a nursing home in 
Missouri.
    Francis (Steve) Stevich from St. Louis, Missouri, is the 
husband of Patricia Stevich who was the victim of neglect in a 
nursing home in Missouri that led to death.
    Ray Gruender, United States Attorney for the Eastern 
District of Missouri, outlined the difficulties and 
complexities of prosecuting abuse and neglect cases from the 
U.S. Attorney's office.
    Jim Gregory, First Assistant Prosecuting Attorney in St. 
Charles County, discussed the prosecution of elder abuse that 
occurred at Claywest House Healthcare in St. Charles, Missouri. 
During his investigations of nursing home practices he 
discovered that facilities utilize various corporate entities 
to limit their individual liability and that nursing home 
operators take advantage of every possible loophole to avoid 
reporting suspected abuse. He discussed that those charged with 
licensing and inspection of facilities are not trained in 
criminal investigations and therefore, many suspected abuses 
are simply not reported. He called for a requirement that 
suspected abuse be reported to law enforcement authorities, in 
addition to the state licensing authority.
    JoAnne Polowy, Missouri Representative of the Association 
for the Protection of the Elderly, raised concerns about the 
effectiveness of Missouri's abuse reporting system and the lack 
of response and proper investigation of reported cases of 
abuse.
    The following witnesses testified at a Thursday, October 
30, 2003, Aging Subcommittee Hearing entitled ``Elder Justice 
and Protection: Stopping the Financial Abuse.''
    Richmond Chambers from Chevy Chase, Maryland was a victim 
of financial exploitation and he shared his personal experience 
with the committee.
    J. Joseph Curran, Jr., Attorney General from the State of 
Maryland Attorney, discussed the role of law enforcement and 
the difficulties that exist in identifying and prosecuting 
financial abuse and exploitation.
    Carol Scott, Missouri Long Term Care Ombudsman and 
President of the National Association of Long Term Care 
Ombudsman, shared Missouri specific cases of financial abuse 
and exploitation that have occurred in a long term care setting 
or residential setting as well the Ombudsman's role as an 
advocate within the state on behalf of victims of financial 
abuse.
    Robert Blancato, President of the National Committee for 
the Prevention of Elder Abuse, defined the magnitude of the 
problem of financial abuse. In addition, because he serves as 
coordinator of the Elder Justice Coalition, a coalition of over 
190 organizational members that advocate on behalf of the Elder 
Justice Act, he provided background on the Coalition and 
expressed their support of legislative action on Elder Justice 
legislation.
    W. Lee Hammond, Board Member of the AARP, discussed the 
consumer protection as well as outreach and education 
activities that AARP offers to their membership.

              IV. Explanation of Bill and Committee Views


                         1. PURPOSE OF THE BILL

    The committee is aware that the Senate Finance Committee 
has passed a comprehensive bill, S. 333, addressing elder 
justice issues. The HELP Committee bill was designed to address 
two issues within our committee's jurisdiction, the creation of 
an Office on Elder Abuse Prevention and Services and the 
creation of a competitive State grant. Both of these issues had 
been included in S. 333 but were removed and referred to the 
HELP Committee on jurisdictional grounds. The HELP Committee 
bill was designed to complement rather than be a substitute to 
S. 333. The committee looks forward to working with the Finance 
Committee to secure passage of both bills.

            2. OFFICE OF ELDER ABUSE PREVENTION AND SERVICES

    The Administration on Aging remains the chief Federal 
agency advocate for elder Americans, operating the National 
Center on Elder Abuse, the National Eldercare Locator Service, 
the National Long-Term Care Ombudsman Resource Center, the 
National Aging Information Center, and the Pension Counseling 
and Information Program. The committee supports the 
establishment of an office on Elder Abuse, Prevention and 
Services to facilitate better coordination of these services to 
more effectively address issues around elder justice. 
Therefore, the committee has given the Secretary of HHS the 
statutory authority to establish an office on Elder Abuse 
Prevention and Services.

                          3. ELIGIBLE GRANTEES

    The committee intends that entities eligible to compete for 
funding for the new competitive grant program contained in the 
Act for Elder Justice include public and private organizations 
(including community-based and faith-based organizations) that 
are engaged in and have expertise in issues relating to elder 
justice.

                 V. Statement of Administration Policy

                The Secretary of Health and Human Services,
                                Washington, DC, September 21, 2004.
Hon. Judd Gregg,
Chairman, Committee on Health, Education, Labor, and Pensions,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: This letter conveys the views of the 
Department of Health and Human Services on the committee's 
draft bill, the ``Act for Elder Justice''. The bill authorizes 
grants to States and Indian tribes for a comprehensive range of 
services, including elder shelters, multidisciplinary teams, 
and training. We support the objectives of this legislation. It 
enhances the existing authority of this Department's 
Administration on Aging (AoA) to raise awareness about elder 
abuse, promote coordination, and support intervention efforts.
    Current authority under the Older Americans Act of 1965 
(OAA) permits States to develop and carry out programs for the 
prevention and treatment of elder abuse, including providing 
public education and outreach, conducting training, and 
ensuring the coordination of elder rights programs. The AoA 
also provides funding under the OAA for the National Center on 
Elder Abuse, which provides information to the public and 
offers training and technical assistance to State units on 
aging and protective services programs for the elderly.
    The bill calls for AoA to develop priorities and a long-
term plan for supporting State and local protective services 
programs, including providing them with training, technical 
assistance, and information on best practices. This provision 
reinforces the role AoA plays in providing these and other 
elder rights programs with support and guidance.
    The bill authorizes grants to States and Indian tribes for 
specific abuse prevention efforts, such as support for cross-
training activities and volunteer programs that focus on the 
issue of elder abuse. We do not object to clarifying and 
expanding the types of activities that States and Indian tribes 
may undertake.
    While we support the committee's desire to amend the OAA to 
further strengthen this Department's efforts to prevent and 
address elder abuse through this draft legislation, we believe 
it would be more appropriate to make these and other 
enhancements to the Act in the broader context of the 
reauthorization next year. However, we do not object to 
enactment of this legislation.
    The Office of Management and Budget advises that there is 
no objection to the transmittal of this report.
            Sincerely,
                                         Tommy G. Thompson,
                                                         Secretary.

                           VI. Cost Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                   Washington, DC, October 7, 2004.
Hon. Judd Gregg,
Chairman, Committee on Health, Education, Labor, and Pensions,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for the Act for Elder 
Justice.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Christina 
Hawley Sadoti.
            Sincerely,
                                      Elizabeth M. Robinson
                               (For Douglas Holtz-Eakin, Director).
    Enclosure.

Act for Elder Justice

    Summary: This legislation would authorize an Office on 
Elder Abuse Prevention and Services within the Administration 
on Aging in the Department of Health and Human Services (HHS). 
In addition, the bill would authorize grants to states for the 
purpose of strengthening long-term care and providing 
assistance for elder justice programs. CBO estimates that the 
bill would authorize appropriations of $210 million for fiscal 
year 2005 and $877 million over the 2005-2009 period, including 
adjustments for inflation. Assuming appropriation of the 
estimated amounts, CBO estimates that implementing the bill 
would cost $27 million in fiscal year 2005 and $768 million 
over the 2005-2009 period. Enacting the bill would not affect 
direct spending or receipts.
    The bill contains no intergovernmental or private-sector 
mandates as defined by the Unfunded Mandates Reform Act (UMRA). 
State, local, and tribal governments would be eligible for 
grants authorized by the bill, and the costs of any 
requirements tied to those grants would be incurred 
voluntarily.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of the Act for Elder Justice is summarized in 
the following table. The costs of this legislation fall within 
budget function 500 (education, training, employment, and 
social services).

------------------------------------------------------------------------
                                         By fiscal year, in millions of
                                                   dollars--
                                      ----------------------------------
                                        2005   2006   2007   2008   2009
------------------------------------------------------------------------
              CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Office of Elder Abuse Prevention and
 Services:
    Estimated Authorization Level....     10     10     11     11     11
    Estimated Outlays................      7     10     11     11     11
State Grants:
    Estimated Authorization Level....    200    204    208    212      0
    Estimated Outlays................     20    120    182    206    189
Total Changes:
    Estimated Authorization Level....    210    214    219    223     11
    Estimated Outlays................     27    130    193    217    200
------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes that the 
bill will be enacted near the start of fiscal year 2005 and 
that the necessary amounts will be appropriated for each year. 
The estimated outlays are based on the spending patterns of 
activities similar in nature to those authorized under this 
bill.

Office of Elder Abuse Prevention and Services

    The bill would establish a federal Office of Elder Abuse 
Prevention and Services within HHS' Administration on Aging. 
The office would carry out elder justice programs and 
activities; collect data relating to the abuse, exploitation, 
and neglect of elderly people; and conduct research, develop 
best practices, and provide technical assistance to states and 
other entities. This office would be added to the existing 
Administration on Aging, for which there is a permanent 
authorization of appropriations of such sums as may be 
necessary. Based on recent appropriations for similar 
activities dealing with the administration of child abuse and 
neglect programs. CBO estimates that authorizations for these 
activities would total $10 million for fiscal year 2005 and $54 
million for the 2005-2009 period.

State Grants

    The bill would authorize the appropriation of such sums as 
may be necessary for fiscal years 2005 through 2008 for grants 
to states and Indian tribes for strengthening long-term care 
and assisting with elder justice programs--including the 
prevention, detection, assessment, treatment of, intervention 
in, and investigation of elder abuse, neglect, and 
exploitation. Based on recent appropriations for similar 
activities dealing with child abuse and neglect and the number 
of elderly persons relative to the number of children, CBO 
estimates that authorizations for these activities would total 
$200 million for fiscal year 2005 and $823 million for the 
2005-2008 period.
    Intergovernmental and private-sector impact: The bill 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. The bill would authorize grants to state, 
local, and tribal governments for prevention and intervention 
programs, elder shelters, volunteer programs, training, and 
multidisciplinary and collaborative programs tied to elder 
abuse, neglect, and exploitation. The costs of any requirements 
tied to these grants would be incurred voluntarily.
    Previous CBO estimate: On September 27, 2004, CBO provided 
an estimate for S. 333, the Elder Justice Act of 2004, as 
ordered reported by the Senate Committee on Finance on 
September 20, 2004. S. 333 differs in scope from this bill, and 
contains specific (rather than ``such sums'') authorizations 
for fiscal years 2006 through 2009. CBO estimated that S. 333 
would cost $763 million over the 2006-2009 period.
    Estimate prepared by: Federal Costs: Christina Hawley 
Sadoti. Impact on State, Local, and Tribal Governments: Leo 
Lex. Impact on the Private Sector: Meena Fernandes.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

           VII. Application of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1, the Congressional 
Accountability Act (CAA) requires a description of the 
application of this bill to the legislative branch. This bill 
does not amend any act that applies to the legislative branch.

                   VIII. Regulatory Impact Statement

    The Committee has determined that there will be de minimus 
changes in the regulatory burden imposed by this bill.

                    IX. Section-by-Section Analysis


                         SECTION 1. SHORT TITLE

    This Act may be cited as the ``Act for Elder Justice.''

                    SECTION 2. STATEMENT OF PURPOSE

    The purposes of this Act are as follows: (1) To assist 
States, Indian Tribes and communities in their efforts to 
protect elders by developing a comprehensive, multi-
disciplinary approach to elder justice; (2) To promote research 
and data collection to fill gaps in knowledge about elder 
abuse, neglect and exploitation; (3) To support innovative and 
effective activities of service providers designed to address 
elder abuse issues; (4) To assist States, Indian Tribes and 
local service providers in the development of short- and long-
term strategic plans for the development and coordination of 
elder justice research, programs, studies, and training; and 
(5) To promote collaborative efforts and diminish overlap and 
gaps in developing the field of elder justice.

  SECTION 3. AUTHORIZES THE ESTABLISHMENT OF AN OFFICE OF ELDER ABUSE 
                        PREVENTION AND SERVICES

    Amends Sec. 201 of OAA to authorize the establishment of an 
Office of Elder Abuse Prevention and Services within the 
Administration on Aging. Directs the Assistant Secretary to, 
through the Director of the office, develop objectives, 
priorities, policy and a long-term plan for: (1) Carrying out 
elder justice programs related to abuse prevention, detection, 
treatment, evaluation, intervention and response; training; and 
overall improvement of the elder justice system; (2) Collecting 
and disseminating data annually on abuse, exploitation and 
neglect of elders (and, at the discretion of the Secretary 
other vulnerable adults) in coordination with DOJ's Bureau of 
Justice Statistics; (3) Disseminating information about best 
practices and providing training to carry out activities 
related to the abuse, neglect and exploitation of elders (and, 
in the discretion of the Secretary, vulnerable adults); (4) In 
conjunction with experts in the field, conducting research 
related to elder abuse, neglect and exploitation; and (5) 
Providing technical assistance to States and eligible entities 
which provide or fund such elder justice services.

    SECTION 4. ESTABLISHES A NEW COMPETITIVE GRANT WITHIN THE OLDER 
 AMERICANS ACT TO STATES TO STRENGTHEN LONG-TERM CARE AND OTHER ELDER 
                            JUSTICE PROGRAMS

    Sec. 751 sets forth definitions for: caregiver, direct 
care, elder, elder justice, eligible entity, fiduciary, grant, 
law enforcement, long term care, loss of capacity for self-
care, long-term care facility, nursing facility, state legal 
assistance developer, and state long-term care ombudsman.
    Sec. 752 grants authority to the Assistant Secretary to 
award grants to States and Indian tribes to strengthen long-
term care and assist other elder justice programs.
    States and Indian tribes may apply for such grants and use 
those funds to award grants to eligible entities: (1) For the 
prevention, detection, assessment and treatment of, 
intervention in, investigation of, and response to elder abuse, 
neglect, and exploitation; (2) To examine various types of 
elder shelters ('safe havens') and to test various shelter 
models for establishing safe havens that recognize autonomy, 
self-determination, and fully protect the due process rights of 
elders; (3) To establish or continue volunteer programs that 
focus on issues of elder abuse, neglect and exploitation or to 
provide related services; (4) To support multi-disciplinary 
elder justice activities including supporting and studying team 
approaches for bringing a coordinated multi-disciplinary or 
interdisciplinary response to elder abuse, neglect and 
exploitation or establishing a State coordinating council; (5) 
To provide training and cross-training for individuals to 
ensure coordination and collaboration with respect to issues of 
elder abuse, neglect, and exploitation; (6) To address 
underserved populations of elders; (7) To provide individuals 
with incentives to train for, seek and maintain employment in 
direct care work in long-term care facilities; (8) To encourage 
the establishment of partnerships to develop collaborative and 
innovative approaches to improve the quality of long-term care 
and abuse prevention; (9) To establish multi-disciplinary 
panels to address and develop best practices concerning methods 
of improving long-term care quality and addressing abuse in 
long-term care facilities;
    Administrative cap: States or tribes who receive a grant 
under this section may not use more than 5% of the funds to pay 
for administrative expenses.
    Non-supplantation: Funds made available under this section 
may only be used to supplement, not supplant other Federal, 
State and local, including tribal, public funds expended to 
provide such protective services described in this section.
    Maintenance of Effort: Using grants under this section, 
States and Indian Tribes are required to maintain expenditures 
for elder justice activities at a level at least equal to 
expenditures maintained the preceding fiscal year.
    Evaluation: Directs the Assistant Secretary to evaluate 
activities funded under this section to determine activities 
for which such funds may be used. The Assistant Secretary shall 
also develop accountability measures to ensure that all funded 
activities are effective and that activities funded under 
section 752(c)(7) in addition to being effective, benefit 
eligible employees and increase stability of the long-term care 
workforce.
    Compliance with Applicable Laws: All entities receiving 
funds under this section shall comply with all applicable laws, 
regulations and guidelines.
    Eligible partnerships: As used in this section eligible 
partnerships means a multidisciplinary community partnership 
consisting of eligible entities or appropriate individuals. 
This may include representatives from nursing facilities, State 
legal assistance developers, State Long Term Care Ombudsmen, 
advocates for residents of long term care facilities, the State 
agency with responsibility for adult protective services as 
well as other interested parties and individuals.
    Authorization: Authorizes such sums as may be necessary for 
each of fiscal years 2005 through 2008.

                       X. Changes in Existing Law

    In compliance with rule XXVI of paragraph 12 of the 
Standing Rules of the Senate, the following provides a print of 
the statute or the part or section thereof to be amended or 
replaced (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italic, existing law 
in which no change is proposed is shown in roman):

OLDER AMERICANS ACT OF 1965

           *       *       *       *       *       *       *


                              DEFINITIONS

    Sec. 102. For the purposes of this Act--
          (1) * * *

           *       *       *       *       *       *       *

          [(24) The term ``exploitation'' means the illegal or 
        improper act or process of an individual, including a 
        caregiver, using the resources of an older individual 
        for monetary or personal benefit, profit, or gain.'']
          (24) The term ``exploitation'' means the fraudulent 
        or otherwise illegal, unauthorized, or improper act or 
        process of an individual, including a caregiver or 
        fiduciary (as such terms are defined in section 751), 
        that uses the resources of an older individual for 
        monetary or personal benefit, profit, or gain, or that 
        results in depriving an older individual of rightful 
        access to, or use of, benefits, resources, belongings, 
        or assets.

           *       *       *       *       *       *       *

          [(34) The term ``neglect'' means--
                  (A) the failure to provide for oneself the 
                goods or services that are necessary to avoid 
                physical harm, mental anguish, or mental 
                illness; or
                  (B) the failure of a caregiver to provide the 
                goods or services.]
          (34) The term ``neglect'' means--
                  (A) the intentional, deliberate, or knowing 
                failure of a caregiver or fiduciary (as such 
                terms are defined in section 751) to provide 
                the goods or services that are necessary to 
                maintain the health or safety of an older 
                individual; or
                  (B) an adult's inability, due to physical, 
                mental, or cognitive impairment or diminished 
                capacity, to perform essential self-care tasks 
                including--
                          (i) obtaining essential food, 
                        clothing, shelter, and medical care;
                          (ii) obtaining gods and services 
                        necessary to maintain physical health, 
                        mental health, or general safety; or
                          (iii) managing one's own financial 
                        affairs.

           *       *       *       *       *       *       *


                   TITLE II--ADMINISTRATION ON AGING

                ESTABLISHMENT OF ADMINISTRATION ON AGING

    Sec. 201. (a) * * *

           *       *       *       *       *       *       *

    (e)(1) In this subsection, the terms defined in section 751 
shall have the meanings given those terms in that section.
    (2) The Secretary is authorized to establish or designate 
within the Administration (as defined in section 102) an Office 
of Elder Abuse Prevention and Services.
    (3) It shall be the duty of the Assistant Secretary, acting 
through the head of the Office of Elder Abuse Prevention and 
Services to--
          (A) develop objectives, priorities, policy, and a 
        long-term plan for--
                  (i) carrying out elder justice programs and 
                activities relating to--
                          (I) elder abuse prevention, 
                        detection, treatment, and intervention, 
                        and response;
                          (II) training of individuals 
                        regarding the matters described in 
                        subclause (I); and
                          (III) the improvement of the elder 
                        justice system in the United States;
                  (ii) collecting and disseminating data 
                annually relating to the abuse, neglect, and 
                exploitation of elders (and, in the discretion 
                of the Secretary, vulnerable adults) in 
                coordination with the efforts of the Bureau of 
                Justice Statistics of the Office of Justice 
                Programs of the Department of Justice to 
                collect national data;
                  (iii) disseminating information concerning 
                best practices regarding, and providing 
                training on, carrying out activities related to 
                abuse, neglect, and exploitation of elders 
                (and, in the discretion of the Secretary, 
                vulnerable adults);
                  (iv) in conjunction with the necessary 
                experts, conducting research related to abuse, 
                neglect, and exploitation of elders (and, in 
                the discretion of the Secretary, vulnerable 
                adults); and
                  (v) providing technical assistance to States 
                and other eligible entities that provide or 
                fund the provision of the services described in 
                subtitle B of title VII;
          (B) implement the overall policy and a strategy to 
        carry out the plan described in subparagraph (A); and
          (C) provide advice to the Secretary on elder justice 
        issues and administer such programs relating to elder 
        abuse, neglect, and exploitation as the Secretary 
        determines to be appropriate.
    (4) The Secretary, acting through the Assistant Secretary, 
may issue such regulations as may be necessary to carry out 
this subsection and subtitle B of title VII.

TITLE VII--ALLOTMENTS FOR VULNERABLE ELDER RIGHTS PROTECTION ACTIVITIES

                      Subtitle A--State Provisions

                  CHAPTER 1--GENERAL STATE PROVISIONS


SEC. 701. ESTABLISHMENT.

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                   Subtitle B--Elder Justice Programs

SEC. 751. DEFINITIONS.

    In this subtitle:
          (1) 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.
          (2) Direct care.--The term ``direct care'' means care 
        by an employee or contractor who provides assistance or 
        long-term care services to a recipient.
          (3) Elder.--The term ``elder'' means an older 
        individual, as defined in section 102.
          (4) Elder justice.--The term ``elder justice'' 
        means--
                  (A) efforts to prevent, detect, treat, 
                intervene in, and respond to elder abuse, 
                neglect, and exploitation and to protect elders 
                with diminished capacity while maximizing their 
                autonomy; and
                  (B) from an individual perspective, the 
                recognition of an elder's rights, including the 
                right to be free of abuse, neglect, and 
                exploitation.
          (5) 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.
          (6) Fiduciary.--The term ``fiduciary''--
                  (A) means a person or entity with the legal 
                responsibility--
                          (i) to make decisions on behalf of 
                        and for the benefit of another person; 
                        and
                          (ii) to act in good faith and with 
                        fairness; and
                  (B) 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.
          (7) Grant.--The term ``grant'' includes a contract, 
        cooperative agreement, or other mechanism for providing 
        financial assistance.
          (8) Law enforcement.--The term ``law enforcement'' 
        means the full range of potential responders to elder 
        abuse, neglect, and exploitation including--
                  (A) police, sheriffs, detectives, public 
                safety officers, and corrections personnel;
                  (B) prosecutors;
                  (C) medical examiners;
                  (D) investigators; and
                  (E) coroners.
          (9) Long-term care.--
                  (A) 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.
                  (B) Loss of capacity for self-care.--For 
                purposes of subparagraph (A), the term ``loss 
                of capacity for self-care means an inability to 
                engage effectively in activities of daily 
                living, including eating, dressing, bathing, 
                and management of one's financial affairs.
          (10) Long-term care facility.--The term ``long-term 
        care facility'' means a residential care provider that 
        arranges for, or directly provides, long-term care.
          (11) Nursing facility.--The term ``nursing facility'' 
        has the meaning given such term under section 1919(a) 
        of the Social Security Act (42 U.S.C. 1396r(a)).
          (12) State legal assistance developer.--The term 
        ``State legal assistance developer'' means an 
        individual described in section 731.
          (13) 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).

SEC. 752. STATE GRANTS TO STRENGTHEN LONG-TERM CARE AND PROVIDE 
                    ASSISTANCE FOR ELDER JUSTICE PROGRAMS.

    (a) Grants.--The Assistant Secretary may award grants to 
States and Indian tribes to enable the States and tribes to 
strengthen long-term care and provide assistance for elder 
justice programs.
    (b) Application.--To be eligible to receive a grant under 
this subtitle, a State or Indian tribe shall submit an 
application to the Assistant Secretary at such time, in such 
manner, and containing such information as the Assistant 
Secretary may require.
    (c) Use of Funds.--A State or Indian tribe that receives a 
grant under this subtitle may use the funds made available 
through the grant to award grants--
          (1) to eligible entities for the prevention, 
        detection, assessment, and treatment of, intervention 
        in, investigation of, and response to elder abuse, 
        neglect, and exploitation;
          (2) to eligible entities to examine various types of 
        elder shelters (in this paragraph referred to as ``safe 
        haven''), and to test various safe haven models for 
        establishing safe havens (at home or elsewhere), that--
                  (A) recognize autonomy and self-
                determination, and fully protect the due 
                process rights of elders; and
                  (B)(i) provide a comprehensive, culturally 
                sensitive, and multidisciplinary team response 
                to allegations of elder abuse, neglect, or 
                exploitation;
                  (ii) provide a dedicated, elder-friendly 
                setting;
                  (iii) have the capacity to meet the needs of 
                elders for care; and
                  (iv) provide various services including--
                          (I) nursing and forensic evaluation;
                          (II) therapeutic intervention;
                          (III) victim support and advocacy; 
                        and
                          (IV) case review and assistance to 
                        make the elders 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;
          (3) to eligible entities to establish or continue 
        volunteer programs that focus on the issues of elder 
        abuse, neglect, and exploitation, or to provide related 
        services;
          (4) to eligible entities to support multidisciplinary 
        elder justice activities, such as--
                  (A) 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;
                  (B) establishing a State or tribal 
                coordinating council, which shall identify the 
                individual State's or Indian tribe's needs and 
                provide the Secretary with information and 
                recommendations relating to efforts by the 
                State or Indian tribe to combat elder abuse, 
                neglect, and exploitation;
                  (C) providing training, technical assistance, 
                and other methods of support to groups carrying 
                out multidisciplinary efforts at the State or 
                Indian tribe level (referred to in some States 
                as ``State Working Group'');
                  (D) 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, Indian tribes, and communities; 
                or
                  (E) carrying out such other interdisciplinary 
                or multidisciplinary efforts as the Assistant 
                Secretary determines to be appropriate;
          (5) to eligible entities to provide training for 
        individuals with respect to issues of elder abuse, 
        neglect, and exploitation, consisting of--
                  (A) training within a discipline; or
                  (B) cross-training activities that permit 
                individuals in multiple disciplines to train 
                together, fostering communication, coordinating 
                efforts, and ensuring collaboration;
          (6) to eligible entities to address underserved 
        populations of elders, such as--
                  (A) elders living in rural locations;
                  (B) elders in minority populations; or
                  (C) low-income elders;
          (7) to eligible entities to provide incentives for 
        individuals to train for, seek, and maintain employment 
        providing direct care in a long-term care facility, 
        such as--
                  (A) to eligible entities to provide 
                incentives to participants in programs carried 
                out under part A of title IV, and section 
                403(a)(5), of the Social Security Act (42 
                U.S.C. 601 et seq., 603(a)(5)) to train for and 
                seek employment providing direct care in a 
                long-term care facility;
                  (B) to long-term care facilities to carry out 
                programs through which the facilities--
                          (i) offer, to employees who provide 
                        direct care to residents of a long-term 
                        care facility, continuing training and 
                        varying levels of professional 
                        certification, based on observed 
                        clinical care practices and the amount 
                        of time the employees spend providing 
                        direct care; and
                          (ii) provide or make arrangements 
                        with employers to provide, bonuses or 
                        other increased compensation or 
                        benefits to employees who achieve 
                        professional certification under such a 
                        program; or
                  (C) to long-term care facilities to enable 
                the facilities to provide training and 
                technical assistance to eligible employees 
                regarding management practices using methods 
                that are demonstrated to promote retention of 
                employees of the facilities, such as--
                          (i) 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; or
                          (ii) 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;
          (8) to encourage the establishment of eligible 
        partnerships to develop collaborative and innovative 
        approaches to improve the quality of, including 
        preventing abuse, neglect, and exploitation in, long-
        term care; or
          (9) to eligible entities to establish 
        multidisciplinary panels to address and develop best 
        practices concerning methods of--
                  (A) improving the quality of long-term care; 
                and
                  (B) addressing abuse, including resident-to-
                resident abuse, in long-term care.
    (d) Administrative Expenses.--A State or Indian tribe that 
receives a grant under this section shall not use more than 5 
percent of the funds made available through the grant to pay 
for administrative expenses.
    (e) Supplement not Supplant.--Funds made available pursuant 
to this section shall be used to supplement and not supplant 
other Federal, State, and local (including tribal) funds 
expended to provide activities described in subsection (c).
    (f) Maintenance of Effort.--The State or Indian tribe, in 
using the proceeds of a grant received under this section, 
shall maintain the expenditures of the State or tribe for 
activities described in subsection (c) at a level equal to not 
less than the level of such expenditures maintained by the 
State or tribe for the fiscal year preceding the fiscal year 
for which the grant is received.
    (g) Accountability Measures.--The Assistant Secretary shall 
develop accountability measures to ensure the effectiveness of 
the activities conducted using funds made available under this 
section, including accountability measures to ensure that the 
activities described in subsection (c)(7) benefit eligible 
employees and increase the stability of the long-term care 
workforce.
    (h) Evaluating Programs.--The Assistant Secretary shall 
evaluate the activities conducted using funds made available 
under this section and shall use the results of such evaluation 
to determine the activities for which funds made available 
under this section may be used.
    (i) Compliance With Applicable Laws.--In order to receive 
funds under this section, an entity shall comply with all 
applicable laws, regulations, and guidelines.
    (j) Eligible Partnerships.--In subsection (c)(8), the term 
``eligible partnership'' means a multidisciplinary community 
partnership consisting of eligible entities or appropriate 
individuals, such as a partnership consisting of 
representatives in a community of nursing facility providers, 
State legal assistance developers, 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 eligible entities and 
appropriate individuals.
    (k) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section such sums as may 
be necessary for each of fiscal years 2005 through 2008.

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        Subtitle [B] C--Native American Organization Provisions

SEC. [751] 761. NATIVE AMERICAN PROGRAM.

    [(a)] Establishment.--* * *

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                   Subtitle [C] D--General Provisions

SEC. [761] 771. DEFINITIONS.

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SEC. [762] 772. ADMINISTRATION.

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SEC. [763] 773. TECHNICAL ASSISTANCE.

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SEC. [764] 774. AUDITS.

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