[House Report 116-535]
[From the U.S. Government Publishing Office]


116th Congress }                                          { Report
                        HOUSE OF REPRESENTATIVES
  2d Session   }                                          { 116-535

======================================================================
 
       PROMOTING ALZHEIMER'S AWARENESS TO PREVENT ELDER ABUSE ACT

                                _______
                                

 September 24, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

    Mr. Nadler, from the Committee on the Judiciary, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 6813]

    The Committee on the Judiciary, to whom was referred the 
bill (H.R. 6813) to amend the Elder Abuse Prevention and 
Prosecution Act to improve the prevention of elder abuse and 
exploitation of individuals with Alzheimer's disease and 
related dementias, having considered the same, reports 
favorably thereon without amendment and recommends that the 
bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for the Legislation..........................     2
Committee Consideration..........................................     4
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
New Budget Authority and Tax Expenditures and Congressional 
  Budget Office Cost Estimate....................................     4
Duplication of Federal Programs..................................     4
Performance Goals and Objectives.................................     5
Advisory on Earmarks.............................................     5
Section-by-Section Analysis......................................     5
Changes in Existing Law Made by the Bill, as Reported............     6

                          Purpose and Summary

    H.R. 6813, the ``Promoting Alzheimer's Awareness to Prevent 
Elder Abuse Act,'' would require the Department of Justice's 
Elder Justice Coordinator to develop best practices and 
training materials for professionals treating, protecting and 
caring for people living with Alzheimer's and related 
dementias. This legislation will build upon existing 
requirements for training materials by requiring the Elder 
Justice Coordinator to engage in greater consultation with 
relevant entities and stakeholders. Specifically, H.R. 6813 
requires that, in the preparation of training materials, the 
Elder Justice Coordinator consult with the Secretary of Health 
and Human Services, State, local, and Tribal adult protective 
services, aging, social, and human services agencies, as well 
as Federal, State, local, and Tribal law enforcement agencies. 
In addition, the bill adds a new requirement that the Elder 
Justice Coordinator consult, as appropriate, with nationally 
recognized nonprofit associations with relevant expertise when 
creating or updating guides and training materials. H.R. 6813 
also requires the Elder Justice Coordinator to develop specific 
training materials in the evaluation of evidence in cases where 
the victims and witnesses have Alzheimer's disease or related 
dementias.

                Background and Need for the Legislation

    More than 5.8 million Americans are currently living with 
Alzheimer's or dementia--more than 1 in 10 people 65 or 
older.\1\ By 2050, the number of people age 65 and older with 
Alzheimer's dementia is projected to reach 13.8 million.\2\ 
Approximately one in 10 seniors aged 60 and older have 
experienced some form of elder abuse, and among those with 
Alzheimer's and related dementias, some estimates are over 50 
percent.\3\ Research suggests that the 2.5 million vulnerable 
individuals in residential care settings are at much higher 
risk for abuse and neglect than older persons who live at 
home.\4\ However, one study estimated that only 1 in 14 cases 
of abuse are reported to authorities.\5\ The toll of abuse 
brings serious consequences. According to the National Council 
on Aging, seniors who have been abused have a 300% higher risk 
of death when compared to those who have not been 
mistreated.\6\
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    \1\Hebert LE, Weuve J, Scherr PA, Evans DA., Alzheimer disease in 
the United States (2010-2050) estimated using the 2010 Census, 
Neurology (2013), https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3719424/.
    \2\Id.
    \3\National Center on Elder Abuse, Statistics & Data (Sept. 2020), 
https://ncea.acl.gov/What-We-Do/Research/Statistics-and-Data.aspx#16.
    \4\Richard J. Bonnie & Robert B. Wallace, National Research 
Council, Panel to Review Risk and Prevalence of Elder Abuse and 
Neglect, (2003), https://www.ncbi.nlm.nih.gov/books/NBK98802/.
    \5\Id.
    \6\XinQi Dong, MD, Melissa Simon, MD, MPH, et al., Elder Self-
neglect and Abuse and Mortality Risk in a Community-Dwelling 
Population, JAMA (Oct. 2010), https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC2965589/.
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    During the pandemic resulting from Covid-19 in 2020, people 
living with Alzheimer's and other forms of dementia face even 
greater risk to their health and safety. Approximately seven 
out of ten residents in long-term care facilities have some 
form of cognitive impairment, with 29 percent having mild 
impairment, 23 percent moderate impairment, and 19 percent 
severe impairment.\7\ According to one study, over 50% of 
nursing home staff admitted to mistreating (e.g. physical 
violence, mental abuse, neglect) older patients within the 
prior year.\8\ With social isolation measures limiting contact 
with family members and other visitors, these individuals are 
at even greater risk of abuse and exploitation.
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    \7\Sheryl Zimmerman, Philip D. Sloane, and David Reed, Dementia 
Prevalence And Care In Assisted Living, HEALTH AFFAIRS, VOL. 33, NO. 4: 
THE LONG REACH OF ALZHEIMER'S DISEASE (April 2014) https://
www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1255.
    \8\National Center on Elder Abuse, Research Brief: Long-Term Care 
Facilities, (2012), https://ncea.acl.gov/NCEA/media/docs/Abuse-of-
Residents-of-Long-Term-Care-Facilities-(2012)_1.pdf.
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    On October 18, 2017, Congress enacted the Elder Abuse 
Prevention and Prosecution Act of 2017 to address the need for 
better data collection on elder abuse.\9\ Several federal 
agencies currently collect elder abuse data on an ongoing 
basis. Two distinct data sets include the National Adult 
Mistreatment Report System (NAMRS) (which collects state-level 
adult protective services data) and the Financial Crimes 
Enforcement Network (FinCEN) (which collects data on suspected 
elder financial exploitation submitted by financial 
institutions).\10\
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    \9\Pub.L. 115-70, 131 Stat. 1208 (2017).
    \10\Department of Justice Elder Justice Initiative, https://
www.justice.gov/elderjustice/eappa.
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    Although many cases may go unreported, NAMRS reflects data 
on elder abuse cases reported to state and local authorities. 
Based on the most current reported data, neglect comprised the 
highest percentage across types of elder abuse, followed by 
financial exploitation.\11\
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    \11\Id.
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    Financial exploitation causes large economic losses for 
elders, families, businesses, and government programs.\12\ Even 
though a vast number of cases go unreported, financial 
exploitation of seniors is becoming the most prevalent form of 
elder abuse.\13\ A key factor that makes the elderly more 
susceptible to financial exploitation is cognitive decline.\14\ 
According to FinCen data analyzed by the Consumer Financial 
Protection Bureau, financial exploitation lasts longer than 
average in cases where the targeted person has a diminished 
cognitive capacity.\15\ This population is particularly 
vulnerable to scams as their condition makes it more difficult 
for them to communicate the crimes to law enforcement or to 
seek critical assistance from first responders or other social 
services personnel.
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    \12\Connolly, M.T., Brandl, B., & Breckman, R., The Elder Justice 
Roadmap: A Stakeholder Initiative to Respond to an Emerging Health, 
Justice, Financial and Social Crisis (2014), https://www.justice.gov/
file/852856/download.
    \13\Stephen Deane, Securities & Exchange Commission, Elder 
Financial Exploitation: Why is it a concern, what regulators are doing 
about it, and looking ahead (June 2018), https://www.sec.gov/files/
elder-financial-exploitation.pdf.
    \14\Id.
    \15\Consumer Financial Protection Bureau, Suspicious Activity 
Reports on Elder Financial Exploitation: Issues and Trends, at 22 (Feb. 
2019), https://s3.amazonaws.com/files.consumerfinance.gov/f/documents/
cfpb_suspicious-activity-reports-elder-financial-
exploitation_report.pdf.
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    People living with Alzheimer's or dementia may also have 
difficulty understanding or explaining situations; and their 
behaviors may be misunderstood as uncooperative, disruptive or 
combative. The Elder Abuse Prevention and Prosecution Act 
required the Justice Department to create training materials to 
help criminal justice, health care, and social services 
personnel assess and respond to elder abuse cases. Under the 
Act, the Elder Justice Coordinator is responsible for 
evaluating training models to determine best practices and 
creating or compiling and making publicly available replication 
guides and training materials for law enforcement officers, 
first responders, social workers, prosecutors, judges, 
individuals working in victim services, adult protective 
services, medical personnel, mental health personnel, financial 
services personnel, and any other individuals that encounter 
and support people living with Alzheimer's and other types of 
dementia.
    This legislation will build upon existing requirements for 
training materials by requiring the Elder Justice Coordinator 
to engage in greater consultation with relevant entities and 
stakeholders. H.R. 6813 would also require further training 
materials relating to victims and witnesses who have 
Alzheimer's disease and related dementias. One study determined 
that a significant subset of individuals with dementia 
illnesses could reliably report on emotional events and were 
even able to report details of the event accurately and to 
recall the same event with the same accuracy after a short time 
delay.\16\ Crime victims with dementia should be evaluated for 
their ability to remember emotional events in order to 
determine whether they can provide testimony about the criminal 
events. This legislation would require the Elder Justice 
Coordinator to develop specific training materials to support 
individuals evaluating witness and working with crime victims 
in these types of cases.
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    \16\Aileen Wiglesworth, Ph.D., Laura Mosqueda, M.D., People with 
Dementia as Witnesses to Emotional Events, NCJRS (April 2011), https://
www.ncjrs.gov/pdffiles1/nij/grants/234132.pdf.
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                        Committee Consideration

    On September 15, 2020, the Committee met in open session 
and ordered the bill, H.R. 6813, favorably reported, by a voice 
vote, a quorum being present.

                            Committee Votes

    No recorded votes occurred during the Committee's 
consideration of H.R. 6813.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

  New Budget Authority and Tax Expenditures and Congressional Budget 
                          Office Cost Estimate

    With respect to the requirements of clause 3(c)(2) of rule 
XIII of the Rules of the House of Representatives and section 
308(a) of the Congressional Budget Act of 1974 and with respect 
to requirements of clause (3)(c)(3) of rule XIII of the Rules 
of the House of Representatives and section 402 of the 
Congressional Budget Act of 1974, the Committee has requested 
but not received a cost estimate for this bill from the 
Director of Congressional Budget Office (CBO). The Committee 
has requested but not received from the Director of the CBO a 
statement as to whether this bill contains any new budget 
authority, spending authority, credit authority, or an increase 
or decrease in revenues or tax expenditures.

                    Duplication of Federal Programs

    No provision of H.R. 6813 establishes or reauthorizes a 
program of the Federal government known to be duplicative of 
another federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                    Performance Goals and Objectives

    The Committee states that pursuant to clause 3(c)(4) of 
rule XIII of the Rules of the House of Representatives, H.R. 
6813 would facilitate the Federal government's ability to 
develop best practices and training materials for professionals 
treating, protecting and caring for people living with 
Alzheimer's and related dementias.

                          Advisory on Earmarks

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 6813 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                      Section-by-Section Analysis

    The following discussion describes the bill as reported by 
the Committee.
    Sec. 1. Short title. This section establishes the short 
title of the bill as the ``Promoting Alzheimer's Awareness to 
Prevent Elder Abuse Act.''
    Sec. 2 Addressing Alzheimer's Disease in best practices. 
Section 2 addresses best practices to assist individuals with 
Alzheimer's disease. This section would expand the current 
provisions of the Elder Abuse Prevention and Prosecution Act to 
include any special considerations for witnesses who have 
Alzheimer's disease and related dementias.
    Under current law, the Elder Justice Coordinator is 
responsible for evaluating training models to determine best 
practices and creating or compiling and making publicly 
available replication guides and training materials for the 
wide range of individuals whose work may bring them in contact 
with this specific population. This section would require these 
materials to address evidentiary issues and other legal issues 
relating to witnesses who have Alzheimer's disease and related 
dementias.
    Section 2 would further address the need to include victims 
and witnesses who have Alzheimer's disease and related 
dementias when assessing, responding to, and interacting with 
victims and witnesses in elder abuse cases, including in 
administrative, civil, and criminal judicial proceedings. 
Section 2 also requires that, in the preparation of training 
materials, the Elder Justice Coordinator consults with the 
Secretary of Health and Human Services, State, local, and 
Tribal adult protective services, aging, social, and human 
services agencies, as well as Federal, State, local, and Tribal 
law enforcement agencies. In addition, the bill adds a new 
requirement that the Elder Justice Coordinator consult, as 
appropriate, with nationally recognized nonprofit associations 
with relevant expertise when creating or updating guides and 
training materials.
    Sec. 3 Report on outreach. This section would amend the 
current reporting requirements of the Elder Abuse Prevention 
and Prosecution Act by requiring the Attorney General to 
include a link to the publicly available best practices and the 
replication guides and training materials created or compiled 
under the Act's requirements. The additional reporting 
requirements take effect two years after the enactment date of 
the Act. Following the initial report, the Justice Department's 
would be required to report to Congress on an annual basis.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

               ELDER ABUSE PREVENTION AND PROSECUTION ACT



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       TITLE I--SUPPORTING FEDERAL CASES INVOLVING ELDER JUSTICE

SEC. 101. SUPPORTING FEDERAL CASES INVOLVING ELDER JUSTICE.

  (a) Support and Assistance.--
          (1) Elder justice coordinators.--The Attorney General 
        shall designate in each Federal judicial district not 
        less than one Assistant United States Attorney to serve 
        as the Elder Justice Coordinator for the district, who, 
        in addition to any other responsibilities, shall be 
        responsible for--
                  (A) serving as the legal counsel for the 
                Federal judicial district on matters relating 
                to elder abuse;
                  (B) prosecuting, or assisting in the 
                prosecution of, elder abuse cases;
                  (C) conducting public outreach and awareness 
                activities relating to elder abuse; and
                  (D) ensuring the collection of data required 
                to be collected under section 202.
          (2) Investigative support.--The Attorney General, in 
        consultation with the Director of the Federal Bureau of 
        Investigation, shall, with respect to crimes relating 
        to elder abuse, ensure the implementation of a regular 
        and comprehensive training program to train agents of 
        the Federal Bureau of Investigation in the 
        investigation and prosecution of such crimes and the 
        enforcement of laws related to elder abuse, which shall 
        include--
                  (A) specialized strategies for communicating 
                with and assisting elder abuse victims; and
                  (B) relevant forensic training relating to 
                elder abuse.
          (3) Resource group.--The Attorney General, through 
        the Executive Office for United States Attorneys, shall 
        ensure the operation of a resource group to facilitate 
        the sharing of knowledge, experience, sample pleadings 
        and other case documents, training materials, and any 
        other resources to assist prosecutors throughout the 
        United States in pursuing cases relating to elder 
        abuse.
          (4) Designated elder justice working group or 
        subcommittee to the attorney general's advisory 
        committee of united states attorneys.--Not later than 
        60 days after the date of enactment of this Act, the 
        Attorney General, in consultation with the Director of 
        the Executive Office for United States Attorneys, shall 
        establish a subcommittee or working group to the 
        Attorney General's Advisory Committee of United States 
        Attorneys, as established under section 0.10 of title 
        28, Code of Federal Regulations, or any successor 
        thereto, for the purposes of advising the Attorney 
        General on policies of the Department of Justice 
        relating to elder abuse.
  (b) Department of Justice Elder Justice Coordinator.--[Not 
later than]
          (1) In general._Not later than  60 days after the 
        date of enactment of this Act, the Attorney General 
        shall designate an Elder Justice Coordinator within the 
        Department of Justice who, in addition to any other 
        responsibilities, shall be responsible for--
                  [(1)] (A) coordinating and supporting the law 
                enforcement efforts and policy activities for 
                the Department of Justice on elder justice 
                issues;
                  [(2)] (B) evaluating training models to 
                determine best practices and creating or 
                compiling and making publicly available 
                replication guides and training materials for 
                law enforcement officers, prosecutors, judges, 
                emergency responders, individuals working in 
                victim services, adult protective services, 
                social services, and public safety, medical 
                personnel, mental health personnel, financial 
                services personnel, and any other individuals 
                whose work may bring them in contact with elder 
                abuse regarding how to--
                          [(A)] (i) conduct investigations in 
                        elder abuse cases;
                          [(B)] (ii) address evidentiary issues 
                        and other legal issues, including 
                        witnesses who have Alzheimer's disease 
                        and related dementias; and
                          [(C)] (iii) appropriately assess, 
                        respond to, and interact with victims 
                        and witnesses in [elder abuse cases,] 
                        elder abuse cases (including victims 
                        and witnesses who have Alzheimer's 
                        disease and related dementias), 
                        including in administrative, civil, and 
                        criminal judicial proceedings; and
                  [(3)] (C) carrying out such other duties as 
                the Attorney General determines necessary in 
                connection with enhancing the understanding, 
                prevention, and detection of, and response to, 
                elder abuse.
          (2) Training materials.--
                  (A) In general.--In creating or compiling 
                replication guides and training materials under 
                paragraph (1)(B), the Elder Justice Coordinator 
                shall consult with the Secretary of Health and 
                Human Services, State, local, and Tribal adult 
                protective services, aging, social, and human 
                services agencies, Federal, State, local, and 
                Tribal law enforcement agencies, and nationally 
                recognized nonprofit associations with relevant 
                expertise, as appropriate.
                  (B) Updating.--The Elder Justice Coordinator 
                shall--
                          (i) review the best practices 
                        identified and replication guides and 
                        training materials created or compiled 
                        under paragraph (1)(B) to determine if 
                        the replication guides or training 
                        materials require updating; and
                          (ii) perform any necessary updating 
                        of the replication guides or training 
                        materials.
  (c) Federal Trade Commission.--
          (1) Federal trade commission elder justice 
        coordinator.--Not later than 60 days after the date of 
        enactment of this Act, the Chairman of the Federal 
        Trade Commission shall designate within the Bureau of 
        Consumer Protection of the Federal Trade Commission an 
        Elder Justice Coordinator who, in addition to any other 
        responsibilities, shall be responsible for--
                  (A) coordinating and supporting the 
                enforcement and consumer education efforts and 
                policy activities of the Federal Trade 
                Commission on elder justice issues; and
                  (B) serving as, or ensuring the availability 
                of, a central point of contact for individuals, 
                units of local government, States, and other 
                Federal agencies on matters relating to the 
                enforcement and consumer education efforts and 
                policy activities of the Federal Trade 
                Commission on elder justice issues.
          (2) Reports to congress.--Not later than 1 year after 
        the date of enactment of this Act, and once every year 
        thereafter, the Chairman of the Federal Trade 
        Commission and the Attorney General shall each submit 
        to the Committee on the Judiciary of the Senate and the 
        Committee on the Judiciary of the House of 
        Representatives [a report detailing] a report--
                  (A) detailing  the enforcement actions taken 
                by the Federal Trade Commission and the 
                Department of Justice, respectively, over the 
                preceding year in each case in which not less 
                than one victim was an elder or that involved a 
                financial scheme or scam that was either 
                targeted directly toward or largely affected 
                elders, including--
                          [(A)] (i) the name of the district 
                        where the case originated;
                          [(B)] (ii) the style of the case, 
                        including the case name and number;
                          [(C)] (iii) a description of the 
                        scheme or scam; and
                          [(D)] (iv) the outcome of the case.
                  (B) with respect to the report by the 
                Attorney General, including a link to the 
                publicly available best practices identified 
                under subsection (b)(1)(B) and the replication 
                guides and training materials created or 
                compiled under such subsection.
  (d) Use of Appropriated Funds.--No additional funds are 
authorized to be appropriated to carry out this section.

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