Mr. BREAUX (for himself, Mr. Hatch, Mr. Baucus, Mr. Bond, Mr. Burns, Ms.
Collins, Mr. Harkin, Mr. Kohl, Ms. Landrieu, Mrs. Lincoln, Mr. Nelson of
Florida, Mr. Rockefeller, Mr. Santorum, Mr. Smith, Mr. Jeffords, Mr. Miller,
and Ms. Stabenow) introduced the following bill; which was read twice and
referred to the Committee on Finance
A BILL
To promote elder justice, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE- This Act may be cited as the `Elder Justice Act'.
(b) 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. Patient abuse prevention.
Sec. 103. Increasing the number of health care professionals with geriatric
training.
Sec. 104. Supporting the long-term care ombudsman program.
Sec. 105. Establishment of office of adult protective services.
Sec. 106. Assuring safety of residents when nursing facilities close.
TITLE II--DEPARTMENT OF JUSTICE
Sec. 201. Definitions; rule.
Sec. 202. Model State laws and practices.
Sec. 203. Office of elder justice of the department of justice.
Sec. 204. Grants under the social security act.
Sec. 205. Victim advocacy grants.
Sec. 206. Supporting local prosecutors in elder justice matters.
Sec. 207. Supporting State prosecutors in elder justice matters.
Sec. 208. Supporting Federal cases involving elder justice.
Sec. 209. Community policing.
Sec. 210. Supporting law enforcement in elder justice matters.
Sec. 211. Evaluations.
Sec. 212. Authorization of appropriations.
Sec. 213. Cause of action for elder abuse and neglect.
Sec. 214. Civil actions for elder abuse and neglect.
TITLE III--TAX PROVISIONS
Sec. 301. Long-term care facility worker employment tax credit.
SEC. 2. FINDINGS.
Congress finds the following:
(1) 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.
(2) Each year, anywhere between 500,000 and 5,000,000 elders in the
United States are abused, neglected, or exploited.
(3) Elder abuse, neglect, and exploitation have no boundaries, and
cross all racial, social class, gender, and geographic lines.
(4) 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.
(5) There is a general dearth of data as to the nature and scope of
elder abuse, neglect, and exploitation.
(6) 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.
(7) 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.
(8) The Federal Government has been slow to respond to the needs of
victims of elder abuse, neglect, and exploitation or to undertake prevention
efforts.
(9) 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.
(10) 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.
(11) 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.
(12) The Federal Government should provide leadership and assist States
and communities in their efforts to protect elders in the United States
by--
(A) promoting coordinated planning among all levels of government;
(B) generating and sharing knowledge relevant to protecting elders;
(C) providing leadership to combat the abuse, neglect, and exploitation
of the Nation's elders; and
(D) providing resources to States and communities to promote elder
justice.
(13) The problem of elder abuse, neglect, and exploitation requires
a comprehensive approach that--
(A) integrates the work of health, legal, and social service agencies
and organizations;
(B) emphasizes the need for prevention, reporting, investigation, assessment,
treatment, and prosecution of elder abuse, neglect, and exploitation at
all levels of government;
(C) 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;
(D) is sensitive to ethnic and cultural diversity;
(E) 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
(F) balances adults' right to self-determination with society's responsibility
to protect elders and vulnerable adults.
(14) The human, social, and economic cost of elder abuse, neglect,
and exploitation is high and includes unnecessary expenditures of medicare
and medicaid funds.
(15) 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.
(16) All elements of society in the United States have a shared responsibility
in responding to a national problem of elder abuse, neglect, and exploitation.
SEC. 3. PURPOSES.
The purposes of this Act are as follows:
(1) 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.
(2) 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 assure 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.
(3) To bring a comprehensive multi-disciplinary approach to elder justice.
(4) To set in motion research and data collection to fill gaps in knowledge
about elder abuse, neglect, and exploitation.
(5) 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.
(6) 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.
(7) 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.
(8) 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.
(9) 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.
(10) To promote collaborative efforts and diminish overlap and gaps
in efforts in developing the important field of elder justice.
TITLE I--DEPARTMENT OF HEALTH AND HUMAN SERVICES
SEC. 101. 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:
`TITLE XXII--ELDER JUSTICE
`SEC. 2201. DEFINITIONS; RULE.
`(a) DEFINITIONS- In this title:
`(1) 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.
`(2) ADULT PROTECTIVE SERVICES- The term `adult protective services'
means those services provided to elders and to people age 18 and older
with disabilities who are, or who are in danger of being, abused, neglected,
or exploited, who are unable to protect themselves, or who have no one
to assist them adequately. The term includes services such as disseminating
reports of adult abuse, neglect or exploitation, investigating those reports,
case planning, monitoring, evaluation, providing 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.
`(3) 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.
`(4) DIRECT CARE- The term `direct care' means care by an employee
or contractor who provides assistance or long-term care services to a recipient.
`(5) ELDER- The term `elder' means an individual age 60 or older.
`(6) ELDER JUSTICE- The term `elder justice' means--
`(A) 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
`(B) from an individual perspective, the recognition of an elder's
rights, including the right to be free of abuse, neglect, and exploitation.
`(7) 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.
`(8) 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, gain, or that results in depriving
an elder of rightful access to, or use of, benefits, resources, belongings,
or assets.
`(9) 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.
`(10) GRANT- The term `grant' includes a contract, cooperative agreement,
or other mechanism for providing financial assistance.
`(11) GRANTING AUTHORITY- The term `granting authority' means the Secretary
of Health and Human Services, the Attorney General, or the Secretary of
Health and Human Services and the Attorney General jointly, as appropriate.
`(12) GUARDIANSHIP- The term `guardianship' means--
`(A) 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 decisionmaker;
`(B) the manner in which the court-appointed surrogate carries out
duties to the individual and the court; or
`(C) the manner in which the court exercises oversight of the surrogate.
`(13) INDIAN- The term `Indian' means a person who is a member of an
Indian tribe.
`(14) 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.
`(15) KNOWINGLY- The term `knowingly' has the meaning given such term
in section 3729(b) of title 31, United States Code.
`(16) 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.
`(17) LONG-TERM CARE-
`(A) IN GENERAL- The term `long-term care' means a wide range of supportive
and health services for individuals who need assistance because the individuals
have a loss of capacity for self-care due to illness, disability, or vulnerability.
`(B) NEED FOR ASSISTANCE- For purposes of subparagraph (A), a need
for assistance is often measured in terms of the capability to engage in
activities of daily living, including eating, dressing, bathing, and management
of one's financial affairs.
`(18) LONG-TERM CARE FACILITY- The term `long-term care facility' means
a residential care provider that arranges for, or directly provides, long-term
care.
`(19) NEGLECT- The term `neglect' means--
`(A) 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
`(B) self-neglect.
`(20) NURSING FACILITY- The term `nursing facility' has the meaning
given such term under section 1919(a).
`(21) 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--
(A) obtaining essential food, clothing, shelter, and medical care;
(B) obtaining goods and services necessary to maintain physical health,
mental health, or general safety; or
(C) managing one's own financial affairs.
`(22) SERIOUS BODILY INJURY-
`(A) IN GENERAL- The term `serious bodily injury' means an injury--
`(i) involving extreme physical pain;
`(ii) involving substantial risk of death;
`(iii) involving protracted loss or impairment of the function of a
bodily member, organ, or mental faculty; or
`(iv) requiring medical intervention such as surgery, hospitalization,
or physical rehabilitation.
`(B) 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.
`(23) SOCIAL- The term `social', when used with respect to a service,
includes adult protective services.
`(24) STATE- The term `State' means any of the several States, the
District of Columbia, the Commonwealth of Puerto Rico, and any other possession
or territory of the United States.
`(25) 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 (42 U.S.C. 3058g(a)(2)).
`(26) 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--
`(A) areas or groups that are geographically isolated (such as isolated
in a rural area);
`(B) racial and ethnic minority populations; and
`(C) populations underserved because of special needs (such as language
barriers, disabilities, alien status, or age).
`(27) VULNERABLE ADULT- The term `vulnerable adult' means an adult,
age 18 or older, who needs protections and programs that are the same as
or similar to protections and programs for elders, including an adult who,
due to a developmental, cognitive, psychological, physical, or other type
of disability, may be abused, neglected, or exploited.
`(b) RULE- The Secretary may determine, in an appropriate case, that
a provision of this title that applies to elders also applies to vulnerable
adults.
`Subtitle A--Federal Elder Justice System
`SEC. 2211. OFFICE OF ELDER JUSTICE OF THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES.
`(a) ESTABLISHMENT- There is established within the Department of Health
and Human Services under the Assistant Secretary for Aging an Office of
Elder Justice.
`(b) DIRECTOR-
`(1) 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.
`(2) DUTIES- The Director of the Office of Elder Justice shall--
`(A)(i) develop objectives, priorities, policy, 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;
`(ii) implement the overall policy and a strategy to carry out the
plan described in clause (i); and
`(iii) hire personnel to assist the director in carrying out the policy,
program, and administrative activities related to the duties under clauses
(i) and (ii);
`(B) provide advice to the Secretary on elder justice issues; and
`(C) coordinate activities with the Senior Advisor on Elder Justice.
`(3) REPORTING RELATIONSHIP- The Director of the Office of Elder Justice
shall report to the Assistant Secretary for Aging.
`(4) 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.
`(c) SENIOR ADVISOR-
`(1) APPOINTMENT- The Secretary shall appoint a Senior Advisor on Elder
Justice, from among individuals with experience and expertise in elder
justice issues.
`(2) DUTIES- The Senior Advisor on Elder Justice shall--
`(A) coordinate elder justice activities among all relevant divisions,
offices, and components of the Department of Health and Human Services;
`(B) serve as the chairperson of the Intra-Agency Elder Justice Steering
Committee established under section 2212; and
`(C) provide advice to the Secretary on elder justice issues.
`(3) LOCATION- The Senior Advisor on Elder Justice shall be located
in the Office of the Secretary.
`(4) POSITION- The position of the Senior Advisor on Elder Justice
shall be a Senior Executive
Service position, as defined in section 3132 of title 5, United States
Code.
`SEC. 2212. HEALTH AND HUMAN SERVICES INTRA-AGENCY ELDER JUSTICE STEERING
COMMITTEE.
`(a) IN GENERAL- There is established within the Department of Health
and Human Services an Intra-Agency Elder Justice Steering Committee (in
this section referred to as the `steering committee') to coordinate the
elder justice programs and policy of the Department of Health and Human
Services.
`(b) MEMBERSHIP- The steering committee shall be composed of representatives,
appointed by the Secretary, from--
`(1) the Administration on Aging;
`(2) the National Institute on Aging;
`(3) the Centers for Medicare & Medicaid Services;
`(4) the Centers for Disease Control and Prevention;
`(5) the Agency for Healthcare Research and Quality;
`(6) the Administration for Children and Families, including a representative
who works in adult protective services;
`(7) the Office of the Assistant Secretary for Planning and Evaluation;
`(8) the Health Resources and Services Administration;
`(9) the Substance Abuse and Mental Health Services Administration;
`(10) the Indian Health Service; and
`(11) such other offices or divisions within the Department of Health
and Human Services as the Secretary determines appropriate.
`(c) DUTIES- The steering committee shall coordinate elder justice
matters for the Department of Health and Human Services to enhance programs
and collaborations and to avoid unnecessary duplication of efforts.
`SEC. 2213. ELDER JUSTICE COORDINATING COUNCIL.
`(a) ESTABLISHMENT- There is established a committee to be known as
the Elder Justice Coordinating Council (in this section referred to as
the `Council').
`(b) MEMBERSHIP- The Council shall be composed of the following:
`(1) The Secretary (or the Secretary's designee).
`(2) The Attorney General (or the Attorney General's designee).
`(3) A representative, appointed by the head of the Federal department
or agency, or other entity, involved from--
`(A) the Department of Housing and Urban Development;
`(B) the Department of Education;
`(C) the Department of Labor;
`(D) the Department of Transportation;
`(E) the Department of the Treasury;
`(F) the Office of Management and Budget;
`(G) the Office of the Surgeon General;
`(H) the Social Security Administration;
`(I) the Food and Drug Administration;
`(J) the Federal Trade Commission;
`(K) the Department of Commerce;
`(L) the Pension Benefit Guaranty Corporation;
`(M) the Securities and Exchange Commission;
`(N) the Commodity Futures Trading Commission;
`(O) the Board of Governors of the Federal Reserve System;
`(P) the Office of the Comptroller of the Currency;
`(Q) the Federal Deposit Insurance Corporation;
`(R) the Federal Bureau of Investigation;
`(S) the Centers for Disease Control and Prevention;
`(T) the Secret Service;
`(U) the National Institute on Aging;
`(V) the Internal Revenue Service; and
`(W) the United States Postal Service.
`(4) A representative appointed by the Board of Directors of the Legal
Services Corporation from the Legal Services Corporation.
`(5) A representative appointed by the President from--
`(A) the State Justice Institute;
`(B) the National Research Council of the National Academy of Sciences;
and
`(C) the Institute of Medicine of the National Academy of Sciences.
`(6) Representatives from other Federal agencies, appointed by the
heads of the Federal agencies with responsibilities or programs relating
to elder abuse, neglect, and exploitation as determined appropriate by
the Secretary and the Attorney General.
`(7) One representative from each State, representing State and local
governments, appointed by the President from among persons designated by
the Governor of such State due to expertise in, and active work in, the
area of elder justice.
`(8) The members of the advisory board established under section 2214.
`(c) PERIOD OF APPOINTMENT; VACANCIES- Members shall be appointed for
terms of 3 years. Any vacancy in the Council shall not affect its powers,
but shall be filled in the same manner as the original appointment was
made.
`(d) CO-CHAIRPERSONS- The Council shall be co-chaired by the Secretary
and the Attorney General (or their designees).
`(e) MEETINGS-
`(1) IN GENERAL- The Council shall meet at least 2 times per year as
determined by the co-chairpersons.
`(2) ELDER JUSTICE SUMMIT-
`(A) IN GENERAL- One of the meetings described in paragraph (1) shall
be an Elder
Justice Summit to review the state of elder justice, including--
`(i) a summary presentation directly to the Secretary and the Attorney
General regarding--
`(I) the nature and dimension of the problems of elder abuse, neglect,
and exploitation;
`(II) Federal, State, local, and private efforts in elder justice;
`(III) challenges to be faced in elder justice;
`(IV) promising practices in elder justice; and
`(V) plans and priorities for the future in elder justice;
`(ii) additional presentations to address in greater detail those topics
described in clause (i); and
`(iii) presentations on such other topics as the Council determines
appropriate.
`(B) PARTICIPANTS- Additional participants, in addition to the members
of the Council, to be invited to the Elder Justice Summit shall include--
`(i) experts in the fields of elder abuse, neglect, and exploitation,
selected by the co-chairpersons;
`(ii) the chairman and ranking member of the Special Committee on Aging
of the Senate;
`(iii) designees of the Speaker of the House of Representatives and
the minority leader of the House of Representatives; and
`(iv) governmental representatives invited jointly by the co-chairpersons,
including--
`(I) 1 representative from the Federal Government;
`(II) 1 representative from a State government; and
`(III) 1 representative from a local government.
`(C) ADDITIONAL OBSERVERS- Additional observers of the Elder Justice
Summit may include representatives of Federal, State, and local public
and private entities, as well as experts and members of the public designated
by the Council to be observers.
`(3) OTHER MEETINGS- In addition to the meeting described in paragraph
(2), the Council shall have at least 1 additional meeting per year in order
to--
`(A) conduct an in-depth analysis of the numerous phenomena that make
up elder abuse, neglect, and exploitation;
`(B) permit participants to highlight promising practices, exchange
information about addressing challenges, and identify needs and priorities;
and
`(C) determine a procedure for examining and eliciting national elder
justice issues and priorities in order to guide the Council.
`(f) DUTIES-
`(1) IN GENERAL- The Council shall make recommendations for the coordination
of activities, relating to elder abuse, neglect, and exploitation and other
crimes against elders, to the Department of Health and Human Services,
the Department of Justice, and other relevant Federal, State, local, and
private agencies and entities.
`(2) REPORT- Not later than 2 years after the date of enactment of
the Elder Justice Act and every 2 years thereafter, the Council shall provide
to Congress a report that--
`(A) describes the activities of, accomplishments of, and challenges
faced by--
`(i) the Council; and
`(ii) the entities represented on the Council; and
`(B) makes recommendations for legislation, model laws, or other appropriate
action.
`(g) POWERS OF THE COUNCIL-
`(1) HEARINGS- The Council may hold such hearings, sit and act at such
times and places, take such testimony, and receive such evidence as the
Council considers advisable to carry out this section.
`(2) INFORMATION FROM FEDERAL AGENCIES- 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-chairpersons
of the Council, the head of such department or agency shall furnish such
information to the Council.
`(3) 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.
`(h) TRAVEL EXPENSES- The members of the Council, and the participants
in and observers of the Elder Justice Summit shall not receive compensation
for the performance of services for the council. The members shall be allowed,
and the participants may 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 and the Attorney General may accept the voluntary and
uncompensated services of the members and the participants.
`(i) 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.
`(j) EFFECTIVE DATE- Section 14 of the Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the Council.
`SEC. 2214. ADVISORY BOARD ON ELDER ABUSE, NEGLECT, AND EXPLOITATION.
`(a) 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, the Elder
Justice Coordinating Council established under section 2213, and the appropriate
committees of Congress.
`(b) SOLICITATION OF NOMINATIONS- The Secretary and the Attorney General
shall jointly publish a notice in the Federal Register soliciting nominations
for the appointment of members of the advisory board under subsection (c).
`(c) COMPOSITION- The advisory board shall be composed of members appointed
jointly by the Secretary and the Attorney General, from the general public
who are individuals with experience and expertise in elder abuse, neglect,
and exploitation prevention, intervention, treatment, law enforcement,
or research, with due consideration to representation of ethnic or racial
minorities and diverse geographic areas, including individuals who represent--
`(1) social service providers (including State and local agencies with
the statutory responsibility for adult protective services);
`(2) health care providers (including geriatrics, emergency medicine,
and nursing and mental health professionals);
`(3) legal professionals (including law enforcement and the judiciary);
`(4) gerontologists;
`(5) psychologists;
`(6) State and local government;
`(7) organizations providing services to elders and disabled persons;
`(8) volunteer groups;
`(9) elder rights advocates;
`(10) family groups;
`(11) experts in adult fiduciary relationships, and those serving as
or monitoring fiduciaries, including guardians; and
`(12) individuals in forensics-related positions (including coroners
and forensic pathologists).
`(d) VACANCIES- Members shall be appointed for terms of 3 years. 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.
`(e) ELECTION OF OFFICERS- The advisory board shall elect a chairperson
and vice chairperson from among the members of the advisory board. The
advisory board shall elect its initial chairperson and vice chairperson
at its initial meeting.
`(f) 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--
`(1) information on the status of Federal, State, and local public
and private elder justice activities;
`(B) 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
`(C) activities relating to adult fiduciary systems, including guardianship
and other fiduciary arrangements;
`(3) recommendations for specific modifications needed in 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;
`(4) recommendations for the most effective coordinated national data
collection with respect to elder justice, and elder abuse, neglect, and
exploitation; and
`(5) recommendations for a multidisciplinary strategic plan to guide
the effective and efficient development of the elder justice area.
`(g) POWERS OF THE ADVISORY BOARD-
`(1) HEARINGS- The advisory board may hold such hearings, sit and act
at such times and places, take such testimony, and receive such evidence
as the advisory board considers advisable to carry out this section.
`(2) INFORMATION FROM FEDERAL AGENCIES- 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 co-chairpersons of the advisory board, the head of such department
or agency shall furnish such information to the advisory board.
`(3) 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.
`(4) 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.
`(h) 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.
`(i) 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.
`(j) EFFECTIVE DATE- Section 14 of the Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the advisory board.
`Subtitle B--Activities to Promote Elder Justice
`SEC. 2221. DATA COLLECTION AND DISSEMINATION.
`(a) ELDER JUSTICE RESOURCE CENTER-
`(1) ESTABLISHMENT- The Secretary, after consultation with the Attorney
General, shall establish within the Office of Elder Justice (established
under this title), 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.
`(2) DUTIES- The Center shall--
`(A) 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;
`(B) provide, in a user-friendly manner, information on--
`(i) ways to promote autonomy in the face of aging or diminishing capacity
and mobility;
`(ii) how to avoid becoming a victim of elder abuse, neglect, or exploitation;
and
`(iii) advance planning and how to avoid the need for a fiduciary;
`(C) provide links and references to other sources of information;
`(D) 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;
`(E) solicit public comment and comment from the advisory board established
under section 2214 on the activities of the Center;
`(F) establish a toll-free number for information and referrals;
`(G) coordinate activities with resource centers and clearinghouses
on elder justice topics; and
`(H) 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.
`(3) COORDINATION OF AVAILABLE RESOURCES- In establishing the Center
under this subsection the Secretary, after consultation with the Attorney
General, shall--
`(A) consult with other Federal agencies that operate similar resource
centers;
`(B) consult with private entities that operate resource centers or
clearinghouses on elder justice related topics;
`(C) consult with the head of each agency participating in the Elder
Justice Coordinating Council established under section 2213, 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
`(D) solicit public comment on the components of such Center.
`(4) NATIONAL ELDER JUSTICE LIBRARY-
`(A) 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--
`(i) brochures and pamphlets;
`(ii) video and computer-based resources;
`(iii) books; and
`(iv) training materials.
`(B) 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.
`(C) 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.
`(D) DUTIES-
`(i) ADDITIONAL MATERIALS- The Library shall--
`(I) collect data on materials that would be appropriate for such library;
`(II) make efforts to identify and obtain appropriate materials; and
`(III) identify and obtain materials relating to effective methods
of conducting training and providing technical assistance relating to elder
justice, including conducting the
training and providing the assistance for underserved populations.
`(ii) 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.
`(b) COLLECTION OF UNIFORM NATIONAL DATA ON ELDER ABUSE, NEGLECT, AND
EXPLOITATION-
`(1) 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.
`(2) PHASE I-
`(A) 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--
`(i) develop a method for collecting national data regarding elder
abuse, neglect, and exploitation; and
`(ii) 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--
`(I) the distinct manner in which each discipline receives and maintains
information; and
`(II) 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.
`(B) 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.
`(3) PHASE II-
`(A) 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.
`(B) 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.
`(4) PHASE III-
`(A) 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--
`(i) 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
`(ii) 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.
`(B) DATA COLLECTION GRANTS-
`(i) AUTHORIZATION- The Director is authorized to award grants to States
to improve data collection activities relating to elder abuse, neglect,
and exploitation.
`(ii) AMOUNT- The amount of funds provided under each grant awarded
to a State under this subsection shall not exceed $200,000, to be distributed
in accordance with clause (v).
`(iii) APPLICATION- Each State desiring a grant under this subparagraph
shall submit to the Director an application at such time, in such manner,
and containing such information as the Director may require.
`(iv) 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).
`(v) FUNDING-
`(I) FIRST YEAR- For the first fiscal year in which a State receives
grant funds under this subsection the Director shall initially distribute
50 percent of such funds. The Director shall distribute the remaining funds
at the end of the calendar year that begins during that fiscal year, if
the Director determines that the State has properly reported data required
under this subsection for the calendar year.
`(II) SUBSEQUENT YEARS- Except as provided in subclause (I), the Director
shall distribute grant funds to a State under this subsection for a fiscal
year if the Director determines that the State properly reported data required
under this subsection for the calendar year that ends during that fiscal
year.
`(C) REQUIRED INFORMATION- Each report submitted under this paragraph
shall receive an identifier beginning with a 2-letter State code, and a
2-letter year code, and such numbers as the Director determines to be appropriate.
Each individual report shall be assigned a new identifier, even if a victim
described in the report is reported to have been victimized more than once.
If the State submits a report for more than one discipline, the State shall
submit a combined report to avoid double counting. The State shall note
in each report whether an event was ongoing or occurred in distinct separate
episodes.
`(5) REPORT- Not later than 1 year after the date of enactment of the
Elder Justice Act and annually thereafter, the Director shall prepare and
submit to the appropriate committees of Congress, including to the Special
Committee on Aging of the Senate, a report regarding activities conducted
under this subsection.
`(6) REGULATIONS- The Secretary shall promulgate such regulations as
are necessary to carry out this subsection.
`SEC. 2222. ENHANCING RESEARCH AND TRAINING AND STRENGTHENING SERVICES,
SYSTEMS, AND PREVENTION.
`(a) 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--
`(1) physical, psychological, and emotional abuse and neglect by family
and other in-home caregivers;
`(2) physical, psychological, and emotional abuse and neglect of residents
in institutional and other residential care facilities;
`(3) elder sexual abuse;
`(4) domestic violence in later life;
`(5) financial fraud and exploitation; and
`(6) self-neglect.
`(b) CENTERS OF EXCELLENCE-
`(1) 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 2214, 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.
`(2) AUTHORIZED ACTIVITIES- The Centers of Excellence established with
funds provided under paragraph (1) shall conduct the following activities:
`(A) 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.
`(B) 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 under this title.
`(C) 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.
`(3) ADDITIONAL ACTIVITIES- The Centers of Excellence established under
paragraph (1) may conduct activities including the following:
`(A) Carrying out a study to determine the national incidence and prevalence
of elder abuse, neglect, and exploitation in all settings.
`(B) 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--
`(i) a screening tool to determine whether a particular elder is at
risk for becoming, or is, a victim;
`(ii) a screening tool to measure whether caregivers are at risk of
committing elder abuse, neglect, or exploitation;
`(iii) a screening tool to measure whether families are at risk for
elder abuse, neglect, and exploitation; and
`(iv) 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.
`(C) Carrying out various types of intervention research.
`(D) Identifying steps that can be taken (and replicated) to make homes,
neighborhoods, communities, and facilities safer for elders, and to enhance
their sense of security in all kinds of environments.
`(E) Researching successful fiduciary practices and systems to enhance
the well-being of persons with diminished capacity.
`(4) COLLABORATION AND ACCESS TO RECORDS- In awarding a grant under
this subsection the Secretary shall--
`(A) 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
`(B) 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 subsection.
`(5) EXCELLENCE ADVISORY COMMITTEE-
`(A) COMMITTEE ESTABLISHED- There is established in the Department
of Health and Human Services an Excellence Advisory Committee (in this
subsection referred to as the `Committee').
`(B) MEMBERSHIP- The Committee shall be composed of individuals appointed
by the Secretary with a demonstrated interest and expertise in research,
education, and clinical activities related to elder abuse, neglect, and
exploitation, or individuals with related experience in essential fields
such as epidemiology or forensic pathology, including--
`(i) representatives from private entities; and
`(ii) representatives from Federal and State agencies, including--
`(I) researchers;
`(II) health care practitioners;
`(III) policy experts; and
`(IV) other individuals appropriate to promote useful research, training,
and clinical practice.
`(C) PERIOD OF APPOINTMENT; VACANCIES- Members shall be appointed for
terms of 3 years. Any vacancy in the Committee shall not affect its powers,
but shall be filled in the same manner as the original appointment was
made.
`(D) DUTIES- The Committee shall coordinate with the Advisory Board
established under section 2214 and shall make recommendations to the Secretary,
the Attorney
General, the Elder Justice Coordinating Council established under section
2213, and the Centers of Excellence established under this subsection concerning--
`(i) facilitating the coordination of the activities of the Centers
of Excellence established under this subsection;
`(ii) developing procedures and mechanisms for data sharing between
such Centers of Excellence; and
`(iii) ensuring that such Centers of Excellence have similar systems
and research and reporting procedures in order to facilitate the sharing
of data.
`(E) TRAVEL EXPENSES- The members of the Committee shall not receive
compensation for the performance of services for the committee, 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 Committee. Notwithstanding
section 1342 of title 31, United States Code, the Secretary may accept
the voluntary and uncompensated services of members of the Committee.
`(F) DETAIL OF GOVERNMENT EMPLOYEES- Any Federal Government employee
may be detailed to the Committee without reimbursement, and such detail
shall be without interruption or loss of civil service status or privilege.
`(G) TERMINATION- Section 14 of the Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the Committee.
`(c) SAFE HAVEN AND LEGAL ADVOCACY GRANTS-
`(1) SAFE HAVEN GRANTS-
`(A) 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.
`(B) AUTHORIZED ACTIVITIES- Grant funds awarded pursuant to subparagraph
(A) shall be used to establish safe havens that--
`(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 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.
`(2) LEGAL ADVOCACY GRANTS-
`(A) GRANTS AUTHORIZED- The Secretary, after consultation with the
Attorney General, may award grants--
`(i) 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
`(ii) to provide assistance for such services by awarding grants for
demonstration projects in diverse communities.
`(B) AUTHORIZED ACTIVITIES- Grant funds awarded pursuant to subparagraph
(A) shall be used to provide--
`(i) court-appointed advocates;
`(ii) authorized fiduciaries, including public guardians;
`(iii) monitoring and oversight of fiduciaries;
`(iv) legal services; and
`(v) such other services as the Secretary, after consultation with
the Attorney General, determines appropriate.
`(d) GRANTS TO ENHANCE VOLUNTEER SERVICES- 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.
`(e) MULTIDISCIPLINARY EFFORTS-
`(1) GRANTS- The Secretary may award grants to fund various multidisciplinary
elder justice activities, including the following:
`(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 State coordinating councils modeled after the national
Elder Justice Coordinating Council established under section 2213. 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.
`(C) 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').
`(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 and communities.
`(E) Carrying out other interdisciplinary or multidisciplinary efforts
as determined by the Secretary to be appropriate.
`(2) INTRADISCIPLINARY REVIEW-
`(A) 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 intradisciplinary review 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).
`(B) GOAL- The goals of the study described in subparagraph (A) include--
`(i) 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
`(ii) 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.
`(f) TRAINING GRANTS-
`(1) 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.
`(2) AUTHORIZED ACTIVITIES-
`(A) 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.
`(B) TARGETED DISCIPLINES- Groups representing disciplines that will
be targeted for training through grants awarded under paragraph (1) include--
`(i) physicians (geriatricians, family physicians, internists, emergency
physicians, forensic pathologists and medical examiners, psychiatrists,
and other specialists), and medical residents, interns, and fellows;
`(ii) nurses and nurse's aides, including geriatric nurse practitioners,
directors of nursing, and Sexual Abuse Nurse Examiners (SANE) nurses;
`(iii) social workers;
`(iv) public health and safety professionals including Emergency Medical
Services professionals;
`(v) therapists, including creative arts, occupational, speech, and
physical therapists;
`(vi) State surveyors (who survey nursing facilities and other long-term
care facilities);
`(vii) long-term care facility and hospital staff;
`(viii) coroners and funeral home operators;
`(ix) Federal, State, and local offices with responsibility for elder
justice or long-term care matters;
`(x) employees or contractors of State and local agencies with responsibility
for training persons who provide adult protective services;
`(xi) State Long-Term Care Ombudsmen;
`(xii) victim advocates and advocates for elders and individuals with
disabilities;
`(xiii) individuals involved in volunteer organizations (including
faith-based organizations) who are involved in issues of elder abuse, neglect,
and exploitation;
`(xiv) police officers, sheriffs, detectives, firefighters, Federal
and State investigators, public safety officers, and corrections personnel;
`(xv) Federal, State, and local prosecutors, attorneys in private practice
involved in elder justice issues, and judges and court employees;
`(xvi) TRIADs (federally recognized partnerships of elders, sheriff
departments, and the American Association of Retired Persons);
`(xvii) elder service officers;
`(xviii) 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;
`(xix) students in professional and paraprofessional schools, internships,
fellowships, and other training programs in a relevant profession;
`(xx) fiduciaries, including guardians, conservators, and agents under
powers of attorney; and
`(xxi) staff and volunteers of domestic violence and child abuse and
neglect programs.
`(g) PILOT PROJECT TO EVALUATE UTILITY OF SERVICES TO ELDERS IN NEED-
The Secretary, acting through the Director of the Office of Elder Justice
in the Department of Health and Human Services, and after consultation
with the Director of the Office of Elder Justice in the Department of Justice,
is authorized to award grants to develop and implement pilot projects designed
to ameliorate gaps in basic elder justice-related health, social, or protective
services, with the goal of identifying what types of services are most
useful to elders in need, and in what contexts the services are useful.
`(h) INCREASING THE NUMBER OF HEALTH CARE PROFESSIONALS WITH GERIATRIC
TRAINING- The Secretary shall establish programs to increase--
`(1) 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
`(2) the number of such professionals who provide health care related
to geriatrics.
`(i) SPECIAL NEEDS GRANTS-
`(1) 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.
`(2) POPULATIONS INCLUDED- The grant funds awarded pursuant to paragraph
(1) shall be used to fund programs including the following:
`(A) 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--
`(i) strategies to decrease isolation;
`(ii) training for informal caregivers and fiduciaries;
`(iii) 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;
`(iv) training for volunteers to serve in rural communities; and
`(v) strategies on the use of advance planning to avoid the need for
a guardian or other fiduciary.
`(B) MINORITY POPULATIONS- Programs designed to meet the needs of elders
in minority populations, including culturally and linguistically appropriate
programs.
`(C) 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.
`(j) PUBLIC AWARENESS GRANTS-
`(1) GRANTS AUTHORIZED- The Secretary and the Attorney General, after
consultation with the advisory board established under section 2214 and
the coordinating council established under section 2213, 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.
`(2) AUTHORIZED ACTIVITIES- Grant funds awarded under paragraph (1)
shall be used for activities including the following:
`(A) Raising public awareness regarding financial schemes that target
elders.
`(B) Pilot testing of the effectiveness of various types of multimedia
campaigns in raising awareness about--
`(i) the types of elder abuse, neglect, and exploitation;
`(ii) steps to take if an individual suspects elder abuse, neglect,
or exploitation has occurred; and
`(iii) ways to prevent elder abuse, neglect, or exploitation.
`(k) ELDER JUSTICE INNOVATION FUND- 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, that might not otherwise be funded or pursued
in the absence of a grant under this subsection.
`SEC. 2223. STUDIES.
`(a) ROLES OF ENTITIES RESPONDING TO ELDER ABUSE, NEGLECT, AND EXPLOITATION-
`(1) IN GENERAL- The Secretary of Health and Human Services 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--
`(A) State and local agencies with the responsibility for adult protective
services;
`(B) the State Long-Term Care Ombudsmen;
`(C) law enforcement (including prosecutors);
`(D) fiduciaries;
`(E) judges and other court personnel; and
`(F) such other social and protective service, advocacy, and protection
organizations as the Secretary and the Attorney General determine to be
appropriate.
`(2) GOALS- The goals of the study authorized in paragraph (1) (which
may be conducted in distinct sections, if there is overall coordination)
are--
`(A) to identify gaps in detection of, investigation of, and intervention
in elder abuse, neglect, and exploitation;
`(B) to improve the response to elder abuse, neglect, and exploitation;
and
`(C) to reduce elder victimization and its consequences by assessing
and improving the systems created to address reports of the problems.
`(3) AUTHORIZED ACTIVITIES- In conducting the study authorized in paragraph
(1), the Director shall--
`(A) conduct an evaluation of--
`(i) how the social and protective service, advocacy, protection, judicial,
and law enforcement entities and systems are operating;
`(ii) the interplay and allocation of responsibilities among those
entities;
`(iii) how that allocation differs from community to community and
State to State; and
`(iv) how those differences impact the population intended to be protected
by the entities and systems;
`(B) make recommendations on how to clarify the roles (at the national
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
`(C) 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).
`(b) FAMILY ELDER ABUSE, NEGLECT, AND EXPLOITATION STUDY-
`(1) 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.
`(2) 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.
`SEC. 2224. FORENSIC MARKERS, METHODOLOGIES, AND TRAINING.
`(a) FORENSIC CENTERS-
`(1) 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.
`(2) 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) and with the Excellence Advisory Committee described
in section 2222(b)(5). Such coordination shall include ongoing communication
among the entities, the Centers of Excellence, and the Excellence Advisory
Committee. The entities shall adhere to the procedures and mechanisms developed
by the Excellence Advisory Committee including procedures and mechanisms
relating to the sharing of data.
`(3) 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.
`(4) MOBILE CENTERS- The Secretary shall make 6 of the grants described
in paragraph (1) to appropriate entities to establish and operate mobile
forensic centers.
`(5) USE OF FUNDS-
`(A) 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,
a crime was committed, to conduct research to describe and disseminate
information on--
`(i) forensic markers that indicate a case in which elder abuse, neglect,
or exploitation may have occurred; and
`(ii) 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.
`(B) 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.
`(C) 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.
`(b) TRAINING TO DEVELOP EXPERTISE IN GERIATRIC FORENSICS-
`(1) FELLOWSHIP PROGRAMS-
`(A) IN GENERAL- The Secretary shall provide fellowships to eligible
individuals, to enable the individuals to obtain training through a standard
forensic science training program.
`(B) ELIGIBLE INDIVIDUALS- To be eligible to receive a fellowship under
this paragraph, an individual shall be a physician who--
`(i) is board certified or board eligible in internal medicine or family
practice;
`(ii) has completed a program in geriatrics that meets such criteria
as the Secretary may prescribe; and
`(iii) 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).
`(C) TEAM TRAINING- An individual who receives a fellowship under this
paragraph shall provide training in forensic geriatrics to interdisciplinary
teams of health care professionals.
`(2) OTHER PROGRAMS- The Secretary shall establish programs, and make
grants to carry out the programs, to provide forensic training to experienced
geriatricians.
`Subtitle C--Increasing Security, Quality, and Consumer Information for
Long-Term Care
`CHAPTER 1--INCREASING SECURITY FOR LONG-TERM CARE
`SEC. 2231. REPORTING TO LAW ENFORCEMENT OF CRIMES OCCURRING IN FEDERALLY
FUNDED LONG-TERM CARE FACILITIES.
`(a) DETERMINATION AND NOTIFICATION-
`(1) DETERMINATION- Except as provided in paragraph (2), the owner
or operator of each long-term care facility that receives Federal funds
shall annually determine if the facility received an amount of Federal
funds that was not less than $10,000 during the past year.
`(2) SINGLE POSITIVE DETERMINATION- The owner or operator shall make
the determination for a year unless the owner or operator determined that
the facility received that amount during any previous year.
`(3) NOTIFICATION- If the owner or operator determines that the facility
received that amount during any year, the owner or operator shall annually
notify each individual described in subsection (b) of the obligation to
comply with subsection (b).
`(b) REPORTING REQUIREMENT-
`(1) IN GENERAL- 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 subsection (a)(3) 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.
`(2) TIMING- If the events that cause the suspicion--
`(A) result in serious bodily injury, the individual shall report the
suspicion immediately, but not later than 2 hours after forming the suspicion;
and
`(B) do not result in serious bodily injury, the individual shall report
the suspicion not later than 24 hours after forming the suspicion.
`(c) PENALTY-
`(1) IN GENERAL- If an individual described in subsection (b) violates
subsection (b)--
`(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
`(B) the Secretary shall classify the individual as an excluded individual,
for a period of not more than 3 years.
`(2) INCREASED HARM- If an individual described in subsection (b) violates
subsection (b), and the violation exacerbates the harm to the victim of
the crime or results in harm to another person--
`(A) the individual shall be fined not more than $200,000 or subject
to a civil money penalty of not more than $200,000; and
`(B) the Secretary shall classify the individual as an excluded individual,
for a period of not more than 3 years.
`(3) 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 funds under
the medicare program under title XVIII or the medicaid program under title
XIX.
`(4) EXTENUATING CIRCUMSTANCES- The Secretary may take into account
the financial burden on providers with underserved populations in determining
the penalty.
`(d) REGULATIONS- The Secretary, after consulting with the Attorney
General, shall issue regulations to carry out this section.
`CHAPTER 2--IMPROVING THE QUALITY OF LONG-TERM CARE
`SEC. 2241. GRANTS AND INCENTIVES TO ENHANCE LONG-TERM CARE STAFFING.
`(a) 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 subsection
(b) and (c), to provide incentives for individuals to train for, seek,
and maintain employment providing direct care in a long-term care facility.
`(b) SPECIFIC PROGRAMS TO ENHANCE TRAINING, RECRUITMENT, AND RETENTION
OF STAFF-
`(1) 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.
`(2) CAREER LADDERS AND WAGE OR BENEFIT INCREASES TO INCREASE STAFFING
IN LONG-TERM CARE FACILITIES-
`(A) IN GENERAL- The Administrator shall make grants to eligible entities
to carry out programs through which the entities--
`(i) 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
`(ii) provide, or make arrangements with employers to provide, bonuses
or other increased compensation or benefits to employees who achieve certification
under such a program.
`(B) 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.
`(c) SPECIFIC PROGRAMS TO IMPROVE MANAGEMENT PRACTICES-
`(1) 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.
`(2) USE OF FUNDS- An organization that receives a grant under paragraph
(1) shall use funds made available through the grant--
`(A) to provide training and technical assistance regarding management
practices, that are for employees that provide direct care in a long-term
care facility, and that are demonstrated to promote retention of those
employees, 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;
`(ii) the establishment of motivational and thoughtful work organization
practices;
`(iii) the creation of a workplace culture that respects and values
caregivers and their needs;
`(iv) 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
`(v) 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
`(B) 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.
`(3) 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.
`(d) 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.
`(e) ACCOUNTABILITY MEASURES- The Administrator shall develop accountability
measures to assure 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 and stability in the long-term care
workforce.
`(f) COMPLIANCE WITH APPLICABLE LAWS- In order to receive funds under
this section, an eligible entity shall comply with all applicable laws,
regulations, and guidelines.
`SEC. 2242. COLLABORATIVE EFFORTS TO ENHANCE COMMUNICATION ON PROMOTING
QUALITY OF AND PREVENTING ABUSE AND NEGLECT IN LONG-TERM CARE.
`(a) 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.
`(b) 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.
`(c) 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.
`SEC. 2243. COLLABORATIVE EFFORTS TO DEVELOP CONSENSUS AROUND THE MANAGEMENT
OF CERTAIN QUALITY-RELATED FACTORS.
`(a) 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
2214, may 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.
`(b) USE OF FUNDS- An entity that receives a grant under this section
shall--
`(1) establish a multidisciplinary panel to address a specific subject;
and
`(2) 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.
`(c) 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.
`CHAPTER 3--INCREASING CONSUMER INFORMATION ABOUT LONG-TERM CARE
`SEC. 2251. LONG-TERM CARE CONSUMER CLEARINGHOUSE.
`(a) 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.
`(b) 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 websites and other resources that
provide information) about--
`(1) obtaining the services of, and employing, caregivers who provide
long-term care at an individual's home; and
`(2) options for residential long-term care, such as--
`(A)(i) the type of care provided by nursing facilities; and
`(ii) the type of care provided by group homes and other residential
long-term care facilities that are not nursing facilities;
`(B) 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.
and 1396 et seq.); and
`(C) 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.
`(c) 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.
`SEC. 2252. CONSUMER INFORMATION ABOUT THE CONTINUUM OF RESIDENTIAL LONG-TERM
CARE FACILITIES.
`(a) STUDY-
`(1) 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.
`(2) SPECIFIC TOPICS- The entity conducting the study shall--
`(A) develop definitions for classes of the residential long-term care
facilities described in paragraph (1); and
`(B) collect information on the prices of, level of services provided
by, oversight and enforcement provisions of, and admission and discharge
criteria of, the facilities.
`(b) REPORT- The Director of the Agency for Healthcare Research and
Quality shall prepare a report containing the results of the study, and
submit the report to the Elder Justice Coordinating Council established
under section 2213, the Committee on Ways and Means of the House of Representatives,
and the Special Committee on Aging of the Senate.
`Subtitle D--Administration
`SEC. 2261. EVALUATIONS.
`(a) GRANTS-
`(1) IN GENERAL- In making a grant under a provision of this title
(other than this section), the granting authority shall--
`(A) require the recipient of the grant to--
`(i) reserve a portion of the funds made available through the grant;
and
`(ii) use the reserved funds to conduct an evaluation of the other
activities carried out through the grant; or
`(B)(i) reserve a portion of the funds available for the grant; and
`(ii) use the reserved funds to provide assistance to an eligible entity
to conduct an evaluation of the activities carried out through the grant.
`(2) 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).
`(3) APPLICATIONS-
`(A) SUBMISSION-
`(i) 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.
`(ii) 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.
`(B) 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.
`(b) 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.
`(c) 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.
`SEC. 2262. HUMAN SUBJECT RESEARCH.
`(a) 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.
`(b) GUIDELINES- The Secretary of Health and Human Services, through
the Director of the National Institute on Aging, after consultation with
the Director of the Office for Human Research Protections and the Excellence
Advisory Committee established under section 2222(b)(5), shall promulgate
guidelines to assist researchers working in the area of elder abuse, neglect,
and exploitation, with issues relating to human subject protections.
`SEC. 2263. REGULATIONS.
`The Secretary may issue such regulations as may be necessary to carry
out this title.
`SEC. 2264. AUTHORIZATION OF APPROPRIATIONS.
`There are authorized to be appropriated to carry out this title such
sums as may be necessary for each of fiscal years 2004 through 2010.'.
SEC. 102. PATIENT ABUSE PREVENTION.
(a) ESTABLISHMENT OF PROGRAM TO PREVENT ABUSE OF NURSING FACILITY RESIDENTS-
(1) SCREENING OF SKILLED NURSING FACILITY AND NURSING FACILITY EMPLOYEE
APPLICANTS-
(A) 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:
`(8) Screening of skilled nursing facility workers-
`(A) BACKGROUND CHECKS ON APPLICANTS- Subject to subparagraph (B)(ii),
before hiring a skilled nursing facility worker, a skilled nursing facility
shall--
`(i) give the worker written notice that the facility is required to
perform
background checks with respect to applicants;
`(ii) require, as a condition of employment, that such worker--
`(I) provide a written statement disclosing any conviction for a relevant
crime;
`(II) provide a statement signed by the worker authorizing the facility
to request the search and exchange of criminal records;
`(III) provide in person to the facility a copy of the worker's fingerprints
or thumb print, depending upon available technology; and
`(IV) provide any other identification information the Secretary may
specify in regulation; and
`(iii) request through the appropriate State agency that the State
initiate a State and national criminal background check on such worker
in accordance with the provisions of subsection (e)(6) and submit to such
State agency the information described in subclauses (II) through (IV)
of clause (ii).
`(B) Prohibition on hiring of abusive workers-
`(i) IN GENERAL- A skilled nursing facility may not knowingly employ
any skilled nursing facility worker who has any conviction for a relevant
crime.
`(ii) PROVISIONAL EMPLOYMENT- After complying with the requirements
of clauses (i) and (ii) of subparagraph (A), a skilled nursing facility
may provide for a provisional period of employment for a skilled nursing
facility worker pending completion of the check against the background
check described under subparagraph (A)(iii). Subject to clause (iii), such
facility shall maintain direct supervision of the covered individual during
the worker's provisional period of employment.
`(iii) EXCEPTION FOR SMALL RURAL SKILLED NURSING FACILITIES- In the
case of a small rural skilled nursing facility (as defined by the Secretary),
the Secretary shall provide, by regulation after consultation with providers
of skilled nursing facility services and entities representing beneficiaries
of such services, for an appropriate level of supervision with respect
to any provisional employees employed by the facility in accordance with
clause (ii). Such regulation should encourage the provision of direct supervision
of such employees whenever practicable with respect to such a facility
and if such supervision would not impose an unreasonable cost or other
burden on the facility.
`(C) REPORTING REQUIREMENTS- A skilled nursing facility shall report
to the State any instance in which the facility determines that a skilled
nursing facility worker has committed an act of resident neglect or abuse
or misappropriation of resident property in the course of employment by
the facility.
`(D) USE OF INFORMATION-
`(i) IN GENERAL- A skilled nursing facility that obtains information
about a skilled nursing facility worker pursuant to subparagraph (A)(iii)
may use such information only for the purpose of determining the suitability
of the worker for employment.
`(ii) IMMUNITY FROM LIABILITY- A skilled nursing facility that, in
denying employment for an applicant (including during the period described
in subparagraph (B)(ii)), reasonably relies upon information about such
applicant provided by the State pursuant to subsection (e)(6) shall not
be liable in any action brought by such applicant based on the employment
determination resulting from the information.
`(iii) CRIMINAL PENALTY- Whoever knowingly violates the provisions
of clause (i) shall be fined in accordance with title 18, United States
Code, imprisoned for not more than 2 years, or both.
`(E) CIVIL PENALTY-
`(i) 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--
`(I) for the first such violation, $2,000; and
`(II) for the second and each subsequent violation within any 5-year
period, $5,000.
`(ii) KNOWING RETENTION OF WORKER- In addition to any civil penalty
under clause (i), a skilled nursing facility that--
`(I) knowingly continues to employ a skilled nursing facility worker
in violation of subparagraph (A) or (B); or
`(II) knowingly fails to report a skilled nursing facility worker under
subparagraph (C),
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.
`(F) DEFINITIONS- In this paragraph:
`(i) CONVICTION FOR A RELEVANT CRIME- The term `conviction for a relevant
crime' means any Federal or State criminal conviction for--
`(I) any offense described in paragraphs (1) through (4) of section
1128(a); and
`(II) such other types of offenses as the Secretary may specify in
regulations, taking into account the severity and relevance of such offenses,
and after consultation with representatives of long-term care providers,
representatives of long-term care employees, consumer advocates, and appropriate
Federal and State officials.
`(ii) DISQUALIFYING INFORMATION- The term `disqualifying information'
means information about a conviction for a relevant crime.
`(iii) SKILLED NURSING FACILITY WORKER- The term `skilled nursing facility
worker' means any individual (other than a volunteer) that has 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 such 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.'.
(B) 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:
`(8) Screening of nursing facility workers-
`(A) BACKGROUND CHECKS ON APPLICANTS- Subject to subparagraph (B)(ii),
before hiring a nursing facility worker, a nursing facility shall--
`(i) give the worker written notice that the facility is required to
perform background checks with respect to applicants;
`(ii) require, as a condition of employment, that such worker--
`(I) provide a written statement disclosing any conviction for a relevant
crime;
`(II) provide a statement signed by the worker authorizing the facility
to request the search and exchange of criminal records;
`(III) provide in person to the facility a copy of the worker's fingerprints
or thumb print, depending upon available technology; and
`(IV) provide any other identification information the Secretary may
specify in regulation; and
`(iii) request through the appropriate State agency that the State
initiate a State and national criminal background check on such worker
in accordance with the provisions of subsection (e)(8) and submit to such
State agency the information described in subclauses (II) through (IV)
of clause (ii).
`(B) PROHIBITION ON HIRING-
`(i) IN GENERAL- A nursing facility may not knowingly employ any nursing
facility worker who has any conviction for a relevant crime.
`(ii) PROVISIONAL EMPLOYMENT- After complying with the requirements
of clauses (i) and (ii) of subparagraph (A), a nursing facility may provide
for a provisional period of employment for a nursing facility worker pending
completion of the check against the background check described under subparagraph
(A)(iii). Subject to clause (iii), such facility shall maintain direct
supervision of the worker during the worker's provisional period of employment.
`(iii) EXCEPTION FOR SMALL RURAL NURSING FACILITIES- In the case of
a small rural nursing facility (as defined by the Secretary), the Secretary
shall provide, by regulation after consultation with providers of nursing
facility services and entities representing beneficiaries of such services,
for an appropriate level of supervision with respect to any provisional
employees employed by the facility in accordance with clause (ii). Such
regulation should encourage the provision of direct supervision of such
employees whenever practicable with respect to such a facility and if such
supervision would not impose an unreasonable cost or other burden on the
facility.
`(C) REPORTING REQUIREMENTS- A nursing facility shall report to the
State any instance in which the facility determines that a nursing facility
worker has committed an act of resident neglect or abuse or misappropriation
of resident property in the course of employment by the facility.
`(D) USE OF INFORMATION-
`(i) IN GENERAL- A nursing facility that obtains information about
a nursing facility worker pursuant to subparagraph (A)(iii) may use such
information only for the purpose of determining the suitability of the
worker for employment.
`(ii) IMMUNITY FROM LIABILITY- A nursing facility that, in denying
employment for an applicant (including during the period described in subparagraph
(B)(ii)), reasonably relies upon information about such applicant provided
by the State pursuant to subsection (e)(8) shall not be liable in any action
brought by such applicant based on the employment determination resulting
from the information.
`(iii) CRIMINAL PENALTY- Whoever knowingly violates the provisions
of clause (i) shall be fined in accordance with title 18, United States
Code, imprisoned for not more than 2 years, or both.
`(E) CIVIL PENALTY-
`(i) 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--
`(I) for the first such violation, $2,000; and
`(II) for the second and each subsequent violation within any 5-year
period, $5,000.
`(ii) KNOWING RETENTION OF WORKER- In addition to any civil penalty
under clause (i), a nursing facility that--
`(I) knowingly continues to employ a nursing facility worker in violation
of subparagraph (A) or (B); or
`(II) knowingly fails to report a nursing facility worker under subparagraph
(C),
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.
`(F) DEFINITIONS- In this paragraph:
`(i) CONVICTION FOR A RELEVANT CRIME- The term `conviction for a relevant
crime' means any Federal or State criminal conviction for--
`(I) any offense described in paragraphs (1) through (4) of section
1128(a); and
`(II) such other types of offenses as the Secretary may specify in
regulations, taking into account the severity and relevance of such offenses,
and after consultation with representatives of long-term care providers,
representatives of long-term care employees, consumer advocates, and appropriate
Federal and State officials.
`(ii) DISQUALIFYING INFORMATION- The term `disqualifying information'
means information about a conviction for a relevant crime.
`(iii) NURSING FACILITY WORKER- The term `nursing facility worker'
means any individual (other than a volunteer) that has 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 such 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.'.
(C) FEDERAL RESPONSIBILITIES-
(i) DEVELOPMENT OF STANDARD FEDERAL AND STATE BACKGROUND CHECK FORM-
The Secretary of Health and Human Services, after consultation with the
Attorney General and representatives of appropriate State agencies, shall
develop a model form that an applicant for employment at a nursing facility
may complete and Federal and State agencies may use to conduct the criminal
background checks required under sections 1819(b)(8) and 1919(b)(8) of
the Social Security Act (42 U.S.C. 1395i-3(b), 1396r(b)) (as added by this
section).
(ii) PERIODIC EVALUATION- The Secretary of Health and Human Services,
after consultation with the Attorney General, periodically shall evaluate
the background check system imposed under sections 1819(b)(8) and 1919(b)(8)
of the Social Security Act (42 U.S.C. 1395i-3(b), 1396r(b)) (as added by
this section) and shall implement changes, as necessary, based on available
technology, to make the background check system more efficient and able
to provide a more immediate response to long-term care providers using
the system.
(D) NO PREEMPTION OF STRICTER STATE LAWS- Nothing in section 1819(b)(8)
or 1919(b)(8) of the Social Security Act (42 U.S.C. 1395i-3(b)(8), 1396r(b)(8))
(as so added) shall be construed to supersede any provision of State law
that--
(i) specifies a relevant crime for purposes of prohibiting the employment
of an individual at a long-term care facility that is not included in the
list of such crimes specified in such sections or in regulations promulgated
by the Secretary of Health and Human Services to carry out such sections;
or
(ii) requires a long-term care facility (as so defined) to conduct
a background check prior to employing an individual in an employment position
that is not included in the positions for which a background check is required
under such sections.
(E) TECHNICAL AMENDMENTS- Effective as if included in the enactment
of section 941 of the Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000 (114 Stat. 2763A-585), as enacted into law by
section 1(a)(6) of Public Law 106-554, sections 1819(b) and 1919(b) of
the Social Security Act (42 U.S.C. 1395i-3(b), 1396r(b)), as amended by
such section 941 (as so enacted into law) are each amended by redesignating
the paragraph (8) added by such section as paragraph (9).
(2) FEDERAL AND STATE REQUIREMENTS CONCERNING BACKGROUND CHECKS-
(A) MEDICARE- Section 1819(e) of the Social Security Act (42 U.S.C.
1395i-3(e)) is amended by adding at the end the following:
`(6) Federal and state requirements concerning criminal background
checks on skilled nursing facility employees-
`(A) IN GENERAL- Upon receipt of a request by a skilled nursing facility
pursuant to subsection (b)(8) that is accompanied by the information described
in subclauses (II) through (IV) of subsection (b)(8)(A)(ii), a State, after
checking appropriate State records and finding no disqualifying information
(as defined in subsection (b)(8)(F)(ii)), shall immediately submit such
request and information to the Attorney General and shall request the Attorney
General to conduct a search and exchange of records with respect to the
individual as described in subparagraph (B).
`(B) SEARCH AND EXCHANGE OF RECORDS BY ATTORNEY GENERAL- Upon receipt
of a submission pursuant to subparagraph (A), the Attorney General shall
direct a search of the records of the Federal Bureau of Investigation for
any criminal history records corresponding to the fingerprints and other
positive identification information submitted. The Attorney General shall
provide any corresponding information resulting from the search to the
State.
`(C) STATE REPORTING OF INFORMATION TO SKILLED NURSING FACILITY- Upon
receipt of the information provided by the Attorney General pursuant to
subparagraph (B), the State shall--
`(i) review the information to determine whether the individual has
any conviction for a relevant crime (as defined in subsection (b)(8)(F)(i));
and
`(ii) immediately report to the skilled nursing facility in writing
the results of such review.
`(D) Fees for performance of criminal background checks-
`(i) Authority to charge fees-
`(I) ATTORNEY GENERAL- The Attorney General may charge a fee to any
State requesting a search and exchange of records pursuant to this paragraph
and subsection (b)(8) for conducting the search and providing the records.
The amount of such fee shall not exceed the lesser of the actual cost of
such activities or $50. Such fees shall be available to the Attorney General,
or, in the Attorney General's discretion, to the Federal Bureau of Investigation
until expended.
`(II) STATE- A State may charge a skilled nursing facility a fee for
initiating the criminal background check under this paragraph and subsection
(b)(8), including fees charged by the Attorney General, and for performing
the review and report required by subparagraph (C). The amount of such
fee shall not exceed the actual cost of such activities.
`(ii) PROHIBITION ON CHARGING APPLICANTS OR EMPLOYEES- An entity may
not impose on an applicant for employment or an employee any charges relating
to the performance of a background check under this paragraph.
`(E) REGULATIONS-
`(i) IN GENERAL- In addition to the Secretary's authority to promulgate
regulations under this title, the Attorney General, after consultation
with the Secretary, may promulgate such regulations as are necessary to
carry out the Attorney General's responsibilities under this paragraph
and subsection (b)(9), including regulations regarding the security confidentiality,
accuracy, use, destruction, and dissemination of information, audits and
recordkeeping, and the imposition of fees.
`(ii) APPEAL PROCEDURES- The Attorney General, after consultation with
the Secretary, shall promulgate such regulations as are necessary to establish
procedures by which an applicant or employee may appeal or dispute the
accuracy of the information obtained in a background check conducted under
this paragraph. Appeals shall be limited to instances in which an applicant
or employee is incorrectly identified as the subject of the background
check, or when information about the applicant or employee has not been
updated to reflect changes in the applicant's or employee's criminal record.
`(F) REPORT- Not later than 2 years after the date of enactment of
this paragraph, the Attorney General shall submit a report to Congress
on--
`(i) the number of requests for searches and exchanges of records made
under this section;
`(ii) the disposition of such requests; and
`(iii) the cost of responding to such requests.'.
(B) MEDICAID- Section 1919(e) of the Social Security Act (42 U.S.C.
1396r(e)) is amended by adding at the end the following:
`(8) Federal and state requirements concerning criminal background
checks on nursing facility employees-
`(A) IN GENERAL- Upon receipt of a request by a nursing facility pursuant
to subsection (b)(8) that is accompanied by the information described in
subclauses (II) through (IV) of subsection (b)(8)(A)(ii), a State, after
checking appropriate State records and finding no disqualifying information
(as defined in subsection (b)(8)(F)(ii)), shall immediately submit such
request and information to the Attorney General and shall request the Attorney
General to conduct a search and exchange of records with respect to the
individual as described in subparagraph (B).
`(B) SEARCH AND EXCHANGE OF RECORDS BY ATTORNEY GENERAL- Upon receipt
of a submission pursuant to subparagraph (A), the Attorney General shall
direct a search of the records of the Federal Bureau of Investigation for
any criminal history records corresponding to the fingerprints and other
positive identification information submitted. The Attorney General shall
provide any corresponding information resulting from the search to the
State.
`(C) STATE REPORTING OF INFORMATION TO NURSING FACILITY- Upon receipt
of the information provided by the Attorney General pursuant to subparagraph
(B), the State shall--
`(i) review the information to determine whether the individual has
any conviction for a relevant crime (as defined in subsection (b)(8)(F)(i));
and
`(ii) immediately report to the nursing facility in writing the results
of such review.
`(D) Fees for performance of criminal background checks-
`(i) Authority to charge fees-
`(I) ATTORNEY GENERAL- The Attorney General may charge a fee to any
State requesting a search and exchange of records pursuant to this paragraph
and subsection (b)(8) for conducting the search and providing the records.
The amount of such fee shall not exceed the lesser of the actual cost of
such activities or $50. Such fees shall be available to the Attorney General,
or, in the Attorney General's discretion, to the Federal Bureau of Investigation,
until expended.
`(II) STATE- A State may charge a nursing facility a fee for initiating
the criminal background check under this paragraph and subsection (b)(8),
including fees charged by the Attorney General, and for performing the
review and report required by subparagraph (C). The amount of such fee
shall not exceed the actual cost of such activities.
`(ii) PROHIBITION ON CHARGING APPLICANTS OR EMPLOYEES- An entity may
not impose on an applicant for employment or an employee any charges relating
to the performance of a background check under this paragraph.
`(E) REGULATIONS-
`(i) IN GENERAL- In addition to the Secretary's authority to promulgate
regulations under this title, the Attorney General, after consultation
with the Secretary, may promulgate such regulations as are necessary to
carry out the Attorney General's responsibilities under this paragraph
and subsection (b)(8), including regulations regarding the security, confidentiality,
accuracy, use, destruction, and dissemination of information, audits and
recordkeeping, and the imposition of fees.
`(ii) APPEAL PROCEDURES- The Attorney General, after consultation with
the Secretary, shall promulgate such regulations as are necessary to establish
procedures by which an applicant or employee may appeal or dispute the
accuracy of the information obtained in a background check conducted under
this paragraph. Appeals shall be limited to instances in which an applicant
or employee is incorrectly identified as the subject of the background
check, or when information about the applicant or employee has not been
updated to reflect changes in the applicant's or employee's criminal record.
`(F) REPORT- Not later than 2 years after the date of enactment of
this paragraph, the Attorney General shall submit a report to Congress
on--
`(i) the number of requests for searches and exchanges of records made
under this section;
`(ii) the disposition of such requests; and
`(iii) the cost of responding to such requests.'.
(3) APPLICATION TO OTHER ENTITIES PROVIDING HOME HEALTH OR LONG-TERM
CARE SERVICES-
(A) MEDICARE- Part D 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
ANY PROVIDER OF SERVICES OR OTHER ENTITY PROVIDING HOME HEALTH OR LONG-TERM
CARE SERVICES
`SEC. 1897. (a) IN GENERAL- The requirements of subsections (b)(8)
and (e)(6) of section 1819 shall apply to any provider of services or any
other entity that is eligible to be paid under this title for providing
home health services,
hospice care (including routine home care and other services included in
hospice care under this title), or long-term care services to an individual
entitled to benefits under part A or enrolled under part B, including an
individual provided with a Medicare+Choice plan offered by a Medicare+Choice
organization under part C (in this section referred to as a `medicare beneficiary').
`(b) SUPERVISION OF PROVISIONAL EMPLOYEES-
`(1) IN GENERAL- With respect to an entity that provides home health
services, such entity shall be considered to have satisfied the requirements
of section 1819(b)(8)(B)(ii) or 1919(b)(8)(B)(ii) if the entity meets such
requirements for supervision of provisional employees of the entity as
the Secretary shall, by regulation, specify in accordance with paragraph
(2).
`(2) REQUIREMENTS- The regulations required under paragraph (1) shall
provide the following:
`(A) Supervision of a provisional employee shall consist of ongoing,
good faith, verifiable efforts by the supervisor of the provisional employee
to conduct monitoring and oversight activities to ensure the safety of
a medicare beneficiary.
`(B) For purposes of subparagraph (A), monitoring and oversight activities
may include (but are not limited to) the following:
`(i) Follow-up telephone calls to the medicare beneficiary.
`(ii) Unannounced visits to the medicare beneficiary's home while the
provisional employee is serving the medicare beneficiary.
`(iii) To the extent practicable, limiting the provisional employee's
duties to serving only those medicare beneficiaries in a home or setting
where another family member or resident of the home or setting of the medicare
beneficiary is present.
`(C) In promulgating such regulations, the Secretary shall take into
account the staffing and geographic issues faced by small rural entities
(as defined by the Secretary) that provide home health services, hospice
care (including routine home care and other services included in hospice
care under this title), or other long-term care services. Such regulations
should encourage the provision of monitoring and oversight activities whenever
practicable with respect to such an entity, and if such activities would
not impose an unreasonable cost or other burden on the entity.'.
(B) MEDICAID- Section 1902(a) of the Social Security Act (42 U.S.C.
1396a) is amended--
(i) in paragraph (64), by striking `and' at the end;
(ii) in paragraph (65), by striking the period and inserting `; and';
and
(iii) by inserting after paragraph (65) the following:
`(66) provide that any entity that is eligible to be paid under the
State plan for providing home health services, hospice care (including
routine home care and other services included in hospice care under title
XVIII), or long-term care services for which medical assistance is available
under the State plan to individuals requiring long-term care complies with
the requirements of subsections (b)(8) and (e)(8) of section 1919 and section
1897(b) (in the same manner as such section applies to a medicare beneficiary).'.
(b) PREVENTION AND TRAINING DEMONSTRATION PROJECT-
(1) ESTABLISHMENT- The Secretary of Health and Human Services shall
establish a demonstration program to provide grants to develop information
on best practices in patient abuse prevention training (including behavior
training and interventions) for managers and staff of hospital and health
care facilities.
(2) ELIGIBILITY- To be eligible to receive a grant under paragraph
(1), an entity shall be a public or private nonprofit entity and prepare
and submit to the Secretary of Health and Human Services an application
at such time, in such manner, and containing such information as the Secretary
may require.
(3) USE OF FUNDS- Amounts received under a grant under this subsection
shall be used to--
(A) examine ways to improve collaboration between State health care
survey and provider certification agencies, long-term care ombudsman programs,
the long-term care industry, and local community members;
(B) examine patient care issues relating to regulatory oversight, community
involvement, and facility staffing and management with a focus on staff
training, staff stress management, and staff supervision;
(C) examine the use of patient abuse prevention training programs by
long-term care entities, including the training program developed by the
National Association of Attorneys General, and the extent to which such
programs are used; and
(D) identify and disseminate best practices for preventing and reducing
patient abuse.
(4) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated
to carry out this subsection such sums as may be necessary.
(c) SENSE OF THE SENATE REGARDING THE ESTABLISHMENT OF A NATIONAL BACKGROUND
CHECK SYSTEM FOR LONG-TERM CARE EMPLOYEES-
(1) FINDINGS- The Senate makes the following findings:
(A) Nearly 1,500,000 Americans reside in 17,000 nursing homes throughout
the Nation, and the vast majority of nursing homes participate in the medicare
and medicaid programs.
(B) The Federal Government spent $82,100,000,000 through the medicare
and
medicaid programs in fiscal year 2000 for long-term care services.
(C) The impending retirement of the baby boom generation will greatly
increase the demand and need for quality long-term care, and it is incumbent
on Congress and the President to ensure that medicare and medicaid beneficiaries
are protected from abuse, neglect, and mistreatment.
(D) On July 30, 2001, the minority staff of the special investigations
division of the Committee on Government Reform of the House of Representatives
issued a report which found that in the past 2 years, over 30 percent of
nursing homes in the United States were cited for a physical, sexual, or
verbal abuse violation that had the potential to harm residents, and nearly
10 percent of nursing homes had violations that caused actual harm to residents.
(E) Although the majority of long-term care facilities do an excellent
job in caring for elderly and disabled patients, incidents of abuse and
neglect and mistreatment do occur at an unacceptable rate and are not limited
to nursing homes alone.
(F) Without a national background check system to screen applicants
for employment, all long-term care providers, including nursing facilities,
home health, home care, and hospice providers, are at risk for hiring workers
with a history of abuse and violence.
(G) A March 2002 report by the General Accounting Office found that
few prosecutions and criminal convictions result from allegations of abuse
in nursing homes.
(H) Federal law requires all States to maintain a nurse aide registry
which includes any substantiated findings of abuse committed by nurse aides
in nursing homes.
(I) In March 2002, the General Accounting Office testified before the
Special Committee on Aging of the Senate that the existing State registries
contained significant gaps because many nursing home employees are not
included in the registries and the registries do not track abuses committed
in other States.
(J) A 1998 report from the Office of the Inspector General of the Department
of Health and Human Services entitled `Safeguarding Long-Term Care Residents'
recommended establishing a national registry of abusive long-term care
workers to be checked by all long-term care facilities before hiring an
employee.
(2) SENSE OF THE SENATE- It is the Sense of the Senate that Congress
should pass legislation that will--
(A) require the Secretary of Health and Human Services to establish
a national registry of abusive long-term care workers that will incorporate
abuse information from all existing State nurse aide registries, and expand
information included in the State registries and the national registry
to include abuse information about all employees of all long-term care
providers that receive funding through the medicare or medicaid programs
(42 U.S.C. 1395 et seq.; 1396 et seq.);
(B) require all long-term care providers, before hiring a potential
employee, to conduct checks of both the national registry and criminal
conviction records maintained by the Federal Bureau of Investigation, and
prohibit long-term care providers from hiring potential employees with
relevant abuse and criminal histories;
(C) require the Secretary of Health and Human Services and the Attorney
General to develop an efficient system for long-term care providers to
use to check both the national registry and the criminal conviction records
maintained by the Federal Bureau of Investigation before hiring an employee;
and
(D) ensure adequate safeguards to protect the privacy and accuracy
of information regarding applicants for employment being checked through
the national registry and the criminal conviction records maintained by
the Federal Bureau of Investigation.
(d) EFFECTIVE DATE-
(1) IN GENERAL- Except as provided in paragraph (2), this section and
the amendments made by this section shall take effect on the date that
is 6 months after the effective date of final regulations promulgated to
carry out this section and such amendments.
(2) SENSE OF THE SENATE- Subsection (c) shall take effect on the date
of enactment of this section.
SEC. 103. INCREASING THE NUMBER OF HEALTH CARE PROFESSIONALS WITH GERIATRIC
TRAINING.
Section 338C of the Public Health Service Act (42 U.S.C. 254m) is amended
by adding at the end the following:
`(f) For purposes of this section and section 338B, the term `obligated
service', with respect to an individual who has entered into a written
contract with the Secretary under section 338B, includes any period in
which the individual is enrolled and participating in an accredited (as
determined by the Secretary) educational program that provides geriatric
training. Upon the completion of such training, such individual, after
consultation with the Secretary, shall provide geriatric services as appropriate
during the remainder of such individual's period of obligated service.'.
SEC. 104. SUPPORTING THE LONG-TERM CARE OMBUDSMAN PROGRAM.
Section 712(h) of the Older Americans Act of 1965 (42 U.S.C. 3058g(h))
is amended--
(1) in paragraph (8), by striking `; and' and inserting a semicolon;
(2) in paragraph (9), by striking the period and inserting `; and';
and
(3) by adding at the end the following:
`(10) 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).'.
SEC. 105. ESTABLISHMENT OF OFFICE OF ADULT PROTECTIVE SERVICES.
(a) IN GENERAL- 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:
`OFFICE OF ADULT PROTECTIVE SERVICES
`SEC. 1150A. (a) IN GENERAL- There is established within the Department
of Health and Human Services, within the Administration on Children and
Families, the Office of Adult Protective Services (in this section referred
to as the `Office'). The Office shall be headed by a Director, who shall
be appointed by the Secretary.
`(b) DUTIES- The Office shall--
`(1) provide necessary funding and support to State and local adult
protective services offices that investigate reports of abuse, neglect,
and exploitation of elders;
`(2) annually collect and disseminate data relating to the abuse, exploitation,
and neglect of elderly individuals in coordination with the Centers for
Disease Control and Prevention efforts to collect national data under section
2221(b);
`(3) develop and disseminate best practices regarding, and provide
training on, carrying out protective services for elders;
`(4) in conjunction with the necessary experts, conduct research related
to the provision of such protective services;
`(5) provide technical assistance to States and other entities that
provide or fund the provision of such protective services, including through
grants made under title XX;
`(6) participate in the Intra-Agency Elder Justice Steering Committee
established under section 2212; and
`(7) coordinate activities with the Office of Elder Justice established
under section 2211 and with other Federal and State agencies that have
responsibility for issues related to elder justice.
`(c) APPROPRIATIONS- There are appropriated such sums as may be necessary
to carry out this section.'.
(b) EFFECTIVE DATE- The amendments made by this section take effect
90 days after the date of enactment of the Elder Justice Act.
SEC. 106. ASSURING SAFETY OF RESIDENTS WHEN NURSING FACILITIES CLOSE.
(a) 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:
`(D) NOTIFICATION OF FACILITY CLOSURE-
`(i) IN GENERAL- A skilled nursing facility shall--
`(I) 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;
`(II) 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
`(III) 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.
`(ii) SANCTIONS- Any person owning a skilled nursing facility that
fails to comply with the requirements of clause (i) shall be subject to--
`(I) a civil monetary penalty of up to $1,000,000;
`(II) exclusion from participation in the programs under this Act (in
accordance with the procedures of section 1128); and
`(III) any other applicable civil monetary penalties and assessments.
`(iii) 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.'.
(b) 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:
`(G) NOTIFICATION OF FACILITY CLOSURE-
`(i) IN GENERAL- A nursing facility shall--
`(I) 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;
`(II) 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
`(III) 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.
`(ii) SANCTIONS- Any person owning a nursing facility that fails to
comply with the requirements of clause (i) shall be subject to--
`(I) a civil monetary penalty of up to $1,000,000;
`(II) exclusion from participation in the programs under this Act (in
accordance with the procedures of section 1128); and
`(III) any other applicable civil monetary penalties and assessments.
`(iii) 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.'.
(c) REGULATIONS- The Secretary, after consulting with the Attorney
General, shall issue regulations to carry out this section.
TITLE II--DEPARTMENT OF JUSTICE
SEC. 201. DEFINITIONS; RULE.
(a) DEFINITIONS- In this title the terms `abuse', `elder', `elder justice',
`exploitation', `fiduciary', `grant', `granting authority', `guardianship',
`knowingly', `law enforcement', `neglect', `serious bodily injury', `social',
`State', and `vulnerable adult' have the meanings given such terms in title
XXII of the Social Security Act.
(b) RULE- The Attorney General may determine, in an appropriate case,
that a provision of this title that applies to elders also applies to vulnerable
adults.
SEC. 202. MODEL STATE LAWS AND PRACTICES.
(a) IN GENERAL- The Attorney General, after consultation with the Secretary
of Health and Human Services, shall--
(1) conduct a study and prepare a report of the findings of that study
of State laws and practices relating to elder abuse, neglect, and exploitation
and provide such report or periodic reports to the Elder Justice Resource
Center established under section 2221 of the Social Security Act, to be
made available to the public; and
(2) 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--
(A) provides recommendations on a comprehensive description and comparative
analysis of the State laws and practices; and
(B) provides recommended models for State laws and practices based
on an analysis of the most effective State laws and practices, including
recommendations with respect to the definitions referred to in subsection
(b)(1).
(b) STATE LAWS AND PRACTICES- The Attorney General shall examine State
laws and practices under subsection (a) on issues including--
(1) definitions of `elder', `abuse', `neglect', and `exploitation',
and related terms;
(2) mandatory reporting laws, with respect to--
(A) who is a mandated reporter;
(B) to whom must they report and within what timeframe; and
(C) any consequences for nonreporting;
(3) evidentiary, procedural, sentencing, choice of remedies, and data
retention issues relating to pursuing cases relating to elder abuse, neglect,
and exploitation;
(4) laws requiring immediate reporting of all nursing home deaths to
the county coroner or to some other individual or entity;
(5) fiduciary laws, including guardianship and power of attorney laws;
(6) laws that permit or encourage banks and bank employees to prevent
and report suspected elder abuse, neglect, and exploitation;
(7) laws that may impede research on elder abuse, neglect, and exploitation;
(8) practices relating to the enforcement of laws relating to elder
abuse, neglect, and exploitation; and
(9) practices relating to other aspects of elder justice.
SEC. 203. OFFICE OF ELDER JUSTICE OF THE DEPARTMENT OF JUSTICE.
(a) ESTABLISHMENT- There is established within the Department of Justice
under the Assistant Attorney General, Office of Justice Programs, an Office
of Elder Justice.
(b) DIRECTOR-
(1) 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.
(2) DUTIES- The Director of the Office of Elder Justice shall--
(A)(i) develop objectives, priorities, policy, 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;
(ii) implement the overall policy and a strategy to carry out the plan
described in clause (i); and
(iii) hire personnel to assist the director in carrying out the policy,
program, and administrative activities related to the duties under clauses
(i) and (ii);
(B) provide advice to the Attorney General on elder justice issues;
and
(C) coordinate activities with the Senior Counsel on Elder Justice.
(3) REPORTING RELATIONSHIP- The Director of the Office of Elder Justice
shall have the same reporting relationship with the Attorney General and
the Assistant Attorney General, Office of Justice Programs, as the directors
of the other offices headed by presidential appointees within the Office
of Justice Programs.
(4) 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.
(c) SENIOR COUNSEL-
(1) APPOINTMENT- The Attorney General shall appoint a Senior Counsel
on Elder Justice, from among individuals with experience and expertise
in elder justice issues.
(2) DUTIES- The Senior Counsel on Elder Justice shall--
(A) coordinate elder justice activities among--
(i) the Office of Elder Justice;
(ii) other offices (including bureaus) within the Office of Justice
Programs that are involved with elder justice issues;
(iii) litigating divisions with cases relating to elder justice matters;
(iv) the Executive Office of United States Attorneys and the United
States Attorneys' offices; and
(v) any other office or division of the Department of Justice that
the Attorney General considers appropriate for such coordination; and
(B) provide advice to the Attorney General on elder justice issues.
(3) LOCATION- The Senior Counsel on Elder Justice shall be located
in--
(A) the Office of the Attorney General;
(B) the Office of the Deputy Attorney General; or
(C) the Office of the Associate Attorney General.
(4) POSITION- The position of the Senior Counsel on Elder Justice shall
be a Senior Executive Service position, as defined in section 3132 of title
5, United States Code.
(5) STAFF- The Senior Counsel on Elder Justice may appoint and terminate
1 full-time employee to enable the Senior Counsel to perform the duties
described in paragraph (2). The Senior Counsel on Elder Justice may fix
the compensation of the employee in accord with chapter 51 and subchapter
III of chapter 53 of title 5, United States Code, relating to classification
of positions and General Schedule pay rates.
(6) RELATION TO OTHER LAW- The positions described in paragraphs (4)
and (5), and the salary for the positions, shall be in addition to the
total number of positions and the total amount of salary provided for in
Public Law 107-77.
SEC. 204. GRANTS UNDER THE SOCIAL SECURITY ACT.
The Attorney General is authorized to award grants under subsections
(a), (c)(1), (c)(2), (d), (e)(1), (f), (h), and (i) of section 2222 and
under section 2224 of the Social Security Act in accordance with such subsections.
SEC. 205. VICTIM ADVOCACY GRANTS.
(a) GRANTS AUTHORIZED- The Attorney General, after consultation with
the Secretary of Health and Human Services, may award grants to eligible
entities to study the special needs of victims of elder abuse, neglect,
and exploitation.
(b) 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.
SEC. 206. SUPPORTING LOCAL PROSECUTORS IN ELDER JUSTICE MATTERS.
(a) GRANT AUTHORIZED- The Attorney General, after consultation with
the Director of 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
the funding of 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 other similarly situated entity to advise
and support local prosecutors nationwide in their pursuit of cases involving
elder abuse, neglect, and exploitation.
(b) DUTIES- The Center created under subsection (a) shall, among other
things--
(1) collaborate with experts in elder abuse, neglect, and exploitation;
(2) collaborate with the Advisory Board created by section 2214 of
the Social Security Act; and
(3) 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.
SEC. 207. SUPPORTING STATE PROSECUTORS IN ELDER JUSTICE MATTERS.
(a) IN GENERAL- The Attorney General shall, after consultation with
the Secretary of Health and Human Services, 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.
(b) CREATING SPECIALIZED POSITIONS- Grants under this section may be
made for--
(1) the establishment of specially designated elder justice positions
or units; or
(2) 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
other similarly situated entity.
SEC. 208. SUPPORTING FEDERAL CASES INVOLVING ELDER JUSTICE.
(a) SUPPORT AND ASSISTANCE-
(1) IN GENERAL- The Attorney General shall support cases relating to
elder justice.
(2) 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.
(3) RESOURCE GROUP- The Attorney General may fund through the Executive
Office of United States Attorneys for a Resource Group to assist prosecutors
throughout the Nation in pursuing failure of care and other cases relating
to elder justice matters.
(b) 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.
SEC. 209. COMMUNITY POLICING.
(a) GRANT AUTHORIZED- The Attorney General, after consultation with
the Secretary of the Department of Health and Human Services, shall establish
a grant program to develop community policing and other law enforcement
efforts to make communities safer for elders living in all settings.
(b) SPECIAL ELDER UNITS- The Attorney General, after consultation with
the Secretary of Health and Human Services, shall establish a grant program
to support--
(1) special elder units and officers;
(2) in rural areas with fewer law enforcement personnel, a specially
trained elder officer;
(3) programs, including the Alzheimer Association's `Safe Return Program'
or other similar program; and
(4) training, technical assistance, policy development, multidisciplinary
coordination, and other support and programs relating to elder justice.
SEC. 210. SUPPORTING LAW ENFORCEMENT IN ELDER JUSTICE MATTERS.
The Attorney General shall, after consultation with the Secretary of
Health and Human Services, 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 front line 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.
SEC. 211. EVALUATIONS.
(a) GRANTS-
(1) IN GENERAL- In making a grant under a provision of this title (other
than this section), the granting authority shall--
(A) require the recipient of the grant to--
(i) reserve a portion of the funds made available through the grant;
and
(ii) use the reserved funds to conduct an evaluation of the other activities
carried out through the grant; or
(B)(i) reserve a portion of the funds available for the grant; and
(ii) use the reserved funds to provide assistance to an eligible entity
to conduct an evaluation of the activities carried out through the grant.
(2) 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).
(3) APPLICATIONS-
(A) SUBMISSION-
(i) 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.
(ii) 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.
(B) REVIEW AND ASSISTANCE- 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 2214 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. If the reviewers
determine that the methodology is inadequate, 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. 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.
(b) 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.
(c) 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.
SEC. 212. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as are necessary
for fiscal years 2004 through 2010 to carry out this title.
SEC. 213. CAUSE OF ACTION FOR ELDER ABUSE AND NEGLECT.
(a) IN GENERAL- Part I of title 18, United States Code, is amended
by adding after chapter 27 the following:
`CHAPTER 28--ELDER ABUSE AND NEGLECT
`Sec.
`571. Harm to residents of nursing facilities.
`Sec. 571. Harm to residents of nursing facilities
`(a) DEFINITIONS- In this section:
`(1) ENTITY- The term `entity' means--
`(A) any nursing facility (including facilities that do not exclusively
provide nursing care);
`(B) any entity that manages a nursing facility; or
`(C) any entity that owns, directly or indirectly, a controlling interest
or a 50 percent or greater interest in 1 or more nursing facilities.
`(2) NEGLECT- The term `neglect' means the failure of a caregiver (as
defined in section 2201 of the Social Security Act) to provide the goods
or services that are necessary to avoid physical harm, disability, mental
anguish, or mental illness.
`(3) NURSING FACILITY- The term `nursing facility' means both a nursing
facility (as defined in section 1919(a) of the Social Security Act) and
a skilled nursing facility as defined in section 1819(a) of the Social
Security Act (42 U.S.C. 1395i-3(a).
`(4) PERSON- The term `person' has the same meaning as in section 921(a)(1)
of this title.
`(b) OFFENSE-
`(1) IN GENERAL- It shall be unlawful for any person or entity to,
with the intent to cause injury or with reckless disregard for the safety
of human life, act or fail to act, if such act or omission results in--
`(A) serious bodily injury to 1 or more residents of a nursing facility;
and
`(B) abuse or neglect of an additional 2 or more residents of the same
nursing facility.
`(2) PENALTY FOR INDIVIDUAL- Any individual who violates paragraph
(1) shall be--
`(A) imprisoned for not more than 20 years and, if death results, shall
be imprisoned for any term of years or for life; and
`(B) fined in accordance with section 3571.
`(3) OTHER PENALTY- Any entity or person, other than an individual,
that violates paragraph (1) shall be fined not more than $3,000,000 per
nursing facility involved.'.
(b) HEALTH CARE OFFENSE- Section 24(a)(1) of title 18, United States
Code, is amended by inserting `571,' before `669,'.
(c) TECHNICAL AND CONFORMING AMENDMENT- The table of chapters for part
I of title 18, United States Code, is amended by inserting after the item
relating to chapter 27 the following:
571'.
SEC. 214. CIVIL ACTIONS FOR ELDER ABUSE AND NEGLECT.
(a) DEFINITIONS- In this section:
(1) ENTITY-
(A) IN GENERAL- The term `entity' means--
(i) any nursing facility (including facilities that do not exclusively
provide nursing care);
(ii) any entity that manages a nursing facility; or
(iii) any entity that owns, directly or indirectly, a controlling interest
or a 50 percent or greater interest in 1 or more nursing facilities.
(B) ADDITIONAL ENTITIES- The term shall include States, localities,
and political subdivisions thereof.
(2) NEGLECT- The term `neglect' means the failure of a caregiver (as
defined in section 2201 of the Social Security Act, as added by this Act)
to provide the goods or services that are necessary to avoid physical harm,
disability, mental anguish, or mental illness.
(3) NURSING FACILITY- The term `nursing facility' means both a nursing
facility (as defined in section 1919(a) of the Social Security Act (42
U.S.C. 1396r(a))) and a skilled nursing facility as defined in section
1819(a) of the Social Security Act.
(4) PERSON- The term `person' has the same meaning as in section 921(a)(1)
of title 18, United States Code.
(5) OTHER TERMS- The terms `abuse', `State', and `serious bodily injury'
shall have the meanings given those terms in section 2201 of the Social
Security Act.
(b) CIVIL ACTIONS BROUGHT BY THE ATTORNEY GENERAL-
(1) IN GENERAL- The Attorney General may bring an action under this
subsection against any person or entity that knowingly, or in reckless
disregard for the safety of human life, acts or fails to act, if such act
or omission results in serious bodily injury to 1 or more residents of
a nursing facility and in abuse or neglect of an additional 2 or more residents
of the same nursing facility.
(2) CIVIL PENALTY- A person or entity that acts or fails to act as
described in paragraph (1) shall be liable to the United States for a civil
penalty of--
(A) in the case of an individual (other than an owner, operator, officer,
or manager of such a nursing facility, such as a nurse or a certified nurse's
aide) up to $50,000 for each violation of this subsection;
(B) in the case of an individual who is an owner, operator, officer,
or manager of such a nursing facility, up to $500,000 for each violation
of this subsection;
(C) in the case of a violation of this subsection involving a single
nursing facility, that facility, or its management company, up to $3,000,000
for that facility for such violation; and
(D) in the case of a violation of this subsection at 2 or more nursing
facilities with common ownership or under common management, up to $6,000,000
for each entity that owns such facilities where there were such violations.
The amount shall be set by the district court, depending on the number
of residents who suffered abuse or neglect, the severity of the injury
to residents relating to abuse or neglect, and the number of resident deaths
relating to abuse or neglect at the facilities in violation of this subsection.
(3) OTHER APPROPRIATE RELIEF- If the Attorney General has reason to
believe that a person or entity is engaging in or is about to engage in
an act or omission that results in or has the potential for resulting in
serious bodily injury to 1 or more residents of a nursing facility and
in abuse or neglect of an additional 2 or more residents of the same nursing
facility, the Attorney General may petition an appropriate United States
district court for appropriate equitable and declaratory relief to eliminate
the circumstances giving rise to the actual or potential harm.
(3) PROCEDURES-
(A) IN GENERAL- A subpoena requiring the attendance of a witness at
a trial or hearing conducted under this subsection may be served at any
place in the United States.
(B) LIMITATION- An action brought under paragraph (1) may not be brought
more than 6 years after the date on which the violation of this subsection
occurred, except that the time for filing is tolled during the period when
the right of action was not known and reasonably could not have been known
by an official of the United States charged with responsibility to act
in the circumstances.
(C) STANDARD OF PROOF- The United States shall be required to prove
all actions under this subsection by a preponderance of the evidence.
(D) CIVIL INVESTIGATIVE DEMAND PROCEDURES- The civil investigative
demand procedures set forth in The Antitrust Civil Process Act (15 U.S.C.
1511 et seq.) may be used in investigations and actions pursued under this
subsection.
(d) RELATIONSHIP TO OTHER LAWS- This section is not intended to supplant
or otherwise bar any existing equitable, common law, or criminal or civil
statutory remedies possessed by the United States, including under the
False Claims Act (31 U.S.C. 33729-3733). The Federal Rules of Civil Procedure
shall apply to actions brought under subsection (b).
(e) NO PRIVATE CAUSE OF ACTION- Nothing in this title creates a private
cause of action or in any other way increases the liability of any person
under any other law.
TITLE III--TAX PROVISIONS
SEC. 301. LONG-TERM CARE FACILITY WORKER EMPLOYMENT TAX CREDIT.
(a) WORK OPPORTUNITY TAX CREDIT-
(1) 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:
`(I) a qualified long-term care facility worker.'.
(2) 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:
`(10) QUALIFIED LONG-TERM CARE FACILITY WORKER- The term `qualified
long-term care facility worker' means any individual who--
`(A) is hired by a long-term care facility (as defined in section 2201
of the Social Security Act, and
`(B) is certified by the designated local agency as being qualified
to provide long-term care (as defined in section 2201 of such Act) at such
facility.'.
(b) EFFECTIVE DATE- The amendments made by this section shall apply
to individuals who begin work for the employer after the date of enactment
of this Act.
