39–010

Calendar No. 780

108TH CONGRESS REPORT " SENATE ! 2d Session 108–391

ACT FOR ELDER JUSTICE

OCTOBER 7, 2004.—Ordered to be printed 

Mr. GREGG, from the Committee on Health, Education, Labor, and 

Pensions, submitted the following 

R E P O R T 

[To accompany S. 2940]

The Committee on Health, Education, Labor, and Pensions, reported an original bill (S. 2940) to amend the Older Americans Act 

of 1965 to assist States in preventing, detecting, treating, intervening in, and responding to elder abuse, neglect, and exploitation, 

and for other purposes, having considered the same, reports favorably thereon without amendment and recommends that the bill do 

pass.

CONTENTS 

Page 

I. Purpose and Summary of the Bill ................................................................ 1

II. Background and Need for Legislation .......................................................... 2

III. Legislative History and Committee Action .................................................. 3

IV. Explanation of Legislation and Committee Views ...................................... 5

V. Statement of Administration Policy ............................................................. 6

VI. Cost Estimate ................................................................................................. 7

VII. Application of Law to the Legislative Branch ............................................. 9

VIII. Regulatory Impact Statement ....................................................................... 9

IX. Section-by-Section Analysis .......................................................................... 9

X. Changes in Existing Law .............................................................................. 11 

I. PURPOSE AND SUMMARY OF THE BILL

The Act for Elder Justice amends the Older Americans Act of 

1965 (OAA) by authorizing the creation of an Office on Elder Abuse 

Prevention and Services and by creating a new Subtitle B—Elder 

Justice Programs under which a new grant is established to assist 

States in preventing, detecting, treating, intervening in, and responding to elder abuse, neglect, and exploitation. 

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In order to accomplish this, the bill focuses on five areas: (1) assistance to States and communities in their efforts to protect elders 

in developing a comprehensive, multi-disciplinary approach to elder 

justice; (2) promoting research and data collection that fill knowledge gaps about elder abuse, neglect and exploitation; (3) supporting innovative and effective activities of service providers designed to address elder abuse issues; (4) assistance to States, Indian Tribes and local service providers in the development of shortand long-term strategic plans for the development and coordination 

of elder justice research, programs, studies, and training; and (5) 

promoting collaborative efforts to diminish overlap and gaps in developing the field of elder justice. 

II. BACKGROUND AND NEED FOR LEGISLATION

The proportion of the United States population age 60 years or 

older will drastically increase in the next 30 years as 77,000,000 

baby boomers approach retirement and old age. Each year, anywhere between 500,000 and 5,000,000 elders in the United States 

are abused, neglected, or exploited. This variance reflects the unfortunate fact that there is a general lack of comprehensive data 

on such abuse, with 500,000 reflecting the number being reported 

and a significantly higher number of cases that goes unreported. 

Elder abuse, neglect, and exploitation have no boundaries, and 

cross all racial, social class, gender, and geographic lines. Victims 

of elder abuse, neglect, and exploitation are not only subject to injury from mistreatment and neglect, they are also 3.1 times more 

likely to die at an earlier age than expected than elders who were 

not victims of such maltreatment. 

The primary Federal statute addressing the issue of elder advocacy and elder justice is the Older Americans Act. First enacted in 

1965, the Older Americans Act remains the main vehicle for the organization and delivery of social and nutrition services to senior 

citizens. The Act established the Administration on Aging (AoA) 

and also a state grant program for community planning and services programs, as well as authority for research, demonstration, 

and training programs in the field of aging. 

The act sets out a range of social policy objectives that aim to 

improve the lives of all older Americans, including sufficient income in retirement, the best possible physical and mental health, 

employment opportunity, and ample long-term care services, to 

name a few. 

Today the Administration on Aging remains the chief Federal 

agency advocate for elder Americans as it operates the National 

Center on Elder Abuse, the National Eldercare Locator Service, the 

National Long-Term Care Ombudsman Resource Center, the National Aging Information Center, and the Pension Counseling and 

Information Program. 

Grants to State and area agencies on aging enable local advocates to act on behalf of and to coordinate programs for older Americans. Such grants account for 69% of total Older Americans Act 

funds in FY2004 ($1.243 billion out of $1.798 billion). This grant

program supports 56 State agencies on aging, 655 area agencies on 

aging, and more than 29,000 service providers. 

The act has been amended 14 times in 35 years. The 1992 

amendments restructured some of the act’s programs and created 

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a new Title VII to combine and develop the programs that address 

elder rights protection which were previously authorized under 

Title III, including the long-term care ombudsman program and 

programs to prevent elder abuse, neglect and exploitation. The Act 

for Elder Justice aims to fill gaps in existing authorities and 

strengthen the Administration on Aging so that elder abuse, neglect and exploitation may be better prevented, addressed, and 

treated. 

Programs addressing other difficult issues such as domestic violence and child abuse and neglect have demonstrated the need for 

a multi-faceted law, combining public health, social service, and 

law enforcement approaches. For over 20 years, Congress has been 

presented with facts and testimony calling for a coordinated Federal effort to combat elder abuse, neglect, and exploitation. The 

Federal Government has been slow to respond to the needs of the 

victims or to undertake prevention efforts. No Federal law has been 

enacted that comprehensively addresses the issues of elder abuse, 

neglect, and exploitation and there are limited resources available 

to those in the field directly dealing with these issues. 

The Act for Elder Justice builds on the important role played by 

the Federal Government in promoting research, training, public 

safety, data collection, the identification, development, and dissemination of promising health care, social, and protective services, and 

law enforcement practices, relating to child abuse and neglect, domestic violence, and violence against women. It is our view that the 

Federal Government should promote similar efforts and protections 

relating to elder abuse, neglect, and exploitation. 

To this end, the Act for Elder Justice seeks to (1) promote coordinated planning among all levels of government; (2) promote the 

generating and sharing of knowledge relevant to protecting elders; 

(3) provide leadership to combat the abuse, neglect, and exploitation of the Nation’s elders; and (4) provide resources to States 

and communities to promote elder justice. 

III. LEGISLATIVE HISTORY AND COMMITTEE ACTION

On September 22, 2004 the Senate Committee on Health, Education, Labor, and Pensions considered and passed the Act for 

Elder Justice by voice vote. 

HEARINGS AND TESTIMONY—SUMMARY OF WITNESSES

The Subcommittee on Aging of the Committee on Health, Education, Labor, and Pensions held three hearings on elder abuse, neglect and exploitation in the 108th Congress. 

The following witnesses testified at a Tuesday, August 19, 2003, 

Aging Subcommittee field hearing in Kansas City, Missouri entitled ‘‘Elder Justice and Protection: Stopping the Abuse.’’ 

Tom Klammer from Kansas City, Missouri, is the son of Walter 

Leonard Klammer who was a victim of poor care and abuse in 

nursing homes in Missouri. 

Tony DeWitt is an attorney with Bartimus, Frickleton, Robertson 

& Obetz, PC in Jefferson City, Missouri. He discussed the problem 

of elder abuse and the lack of adequate remedies for seniors. He 

identified insufficient staffing levels and low wages as a part of the 

root of abuse in nursing homes. 

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Todd Graves, United States Attorney for the Western District of 

Missouri, discussed successful cases handled by the Western District of Missouri that involved egregious instances of painful injuries and unhealthy conditions suffered by elderly residents as a result of gross neglect on the part of nursing home operators. His office took an innovative approach by filing civil actions against the 

nursing home operators under the Federal False Claims Act. His 

office used the Federal False Claims Act to prosecute a civil fraud 

against the government, rather than an actual elder abuse because 

there is no actual elder abuse law at the Federal level. One lawsuit 

alleged that these instances of patient harm and abuse were attributed, in large part, to the nursing home’s failure to provide adequate staff to meeting the needs of nursing home residents. This 

particular nursing home was so severely understaffed that it could 

not possibly have provided the level of patient care it was obligated 

to provide for reimbursement under the Medicare and Medicaid 

programs. Aware of these staff shortages and still billing Medicare 

and Medicaid for services it clearly had not adequately provided, 

this nursing home was knowingly submitting false and fraudulent 

claims to the Medicare and Medicaid programs and thus violating 

the Federal False Claim Act. 

Paul Vescovo, Sheriff, Clay County Sheriffs Department, discussed that the majority of elder abuse and neglect occurs in the 

home at the hands of family members or paid care givers. He described the unique challenges investigating elder abuse poses for 

law enforcement and the need for social services agencies to assist 

law enforcement in adequately responding in cases of elder abuse 

and assisting victims. He also discussed the need for more education of the public on elder abuse and neglect. He cited that public 

education and media coverage concerning domestic violence and 

child abuse had made the public more knowledgeable and proactive 

in the reporting of such abuse and had garnered support for funding for programs to combat such abuse. 

Norma Collins, Associate State Director for Advocacy, AARP, discussed the need for more public awareness and prevention activities to combat elder abuse and neglect. She also raised the need to 

improve the quality of investigation, enforcement and prosecution 

in cases of abuse and neglect as well as the need to improve the 

early detection of warning signs through encouragement of wider 

reporting of abuse.

The following witnesses testified at a Wednesday, August 20, 

2003, Aging Subcommittee Field Hearing in St. Louis, Missouri, 

entitled ‘‘Elder Justice and Protection: Stopping the Abuse.’’ 

Martha Ballanot from St. Louis, Missouri, is the daughter of 

Burton Reese who was a victim of abuse in a nursing home in Missouri. 

Francis (Steve) Stevich from St. Louis, Missouri, is the husband 

of Patricia Stevich who was the victim of neglect in a nursing home 

in Missouri that led to death. 

Ray Gruender, United States Attorney for the Eastern District of 

Missouri, outlined the difficulties and complexities of prosecuting 

abuse and neglect cases from the U.S. Attorney’s office. 

Jim Gregory, First Assistant Prosecuting Attorney in St. Charles 

County, discussed the prosecution of elder abuse that occurred at 

Claywest House Healthcare in St. Charles, Missouri. During his inVerDate jul 14 2003 21:48 Oct 19, 2004 Jkt 039010 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\SR391.XXX SR391
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vestigations of nursing home practices he discovered that facilities 

utilize various corporate entities to limit their individual liability 

and that nursing home operators take advantage of every possible 

loophole to avoid reporting suspected abuse. He discussed that 

those charged with licensing and inspection of facilities are not 

trained in criminal investigations and therefore, many suspected 

abuses are simply not reported. He called for a requirement that 

suspected abuse be reported to law enforcement authorities, in addition to the state licensing authority. 

JoAnne Polowy, Missouri Representative of the Association for 

the Protection of the Elderly, raised concerns about the effectiveness of Missouri’s abuse reporting system and the lack of response 

and proper investigation of reported cases of abuse. 

The following witnesses testified at a Thursday, October 30, 

2003, Aging Subcommittee Hearing entitled ‘‘Elder Justice and Protection: Stopping the Financial Abuse.’’ 

Richmond Chambers from Chevy Chase, Maryland was a victim 

of financial exploitation and he shared his personal experience with 

the committee. 

J. Joseph Curran, Jr., Attorney General from the State of Maryland Attorney, discussed the role of law enforcement and the difficulties that exist in identifying and prosecuting financial abuse 

and exploitation. 

Carol Scott, Missouri Long Term Care Ombudsman and President of the National Association of Long Term Care Ombudsman, 

shared Missouri specific cases of financial abuse and exploitation 

that have occurred in a long term care setting or residential setting 

as well the Ombudsman’s role as an advocate within the state on 

behalf of victims of financial abuse. 

Robert Blancato, President of the National Committee for the 

Prevention of Elder Abuse, defined the magnitude of the problem 

of financial abuse. In addition, because he serves as coordinator of 

the Elder Justice Coalition, a coalition of over 190 organizational 

members that advocate on behalf of the Elder Justice Act, he provided background on the Coalition and expressed their support of 

legislative action on Elder Justice legislation. 

W. Lee Hammond, Board Member of the AARP, discussed the 

consumer protection as well as outreach and education activities 

that AARP offers to their membership. 

IV. EXPLANATION OF BILL AND COMMITTEE VIEWS

1. PURPOSE OF THE BILL

The committee is aware that the Senate Finance Committee has 

passed a comprehensive bill, S. 333, addressing elder justice issues. 

The HELP Committee bill was designed to address two issues within our committee’s jurisdiction, the creation of an Office on Elder 

Abuse Prevention and Services and the creation of a competitive 

State grant. Both of these issues had been included in S. 333 but 

were removed and referred to the HELP Committee on jurisdictional grounds. The HELP Committee bill was designed to complement rather than be a substitute to S. 333. The committee looks 

forward to working with the Finance Committee to secure passage 

of both bills. 

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2. OFFICE OF ELDER ABUSE PREVENTION AND SERVICES

The Administration on Aging remains the chief Federal agency 

advocate for elder Americans, operating the National Center on 

Elder Abuse, the National Eldercare Locator Service, the National 

Long-Term Care Ombudsman Resource Center, the National Aging 

Information Center, and the Pension Counseling and Information 

Program. The committee supports the establishment of an office on 

Elder Abuse, Prevention and Services to facilitate better coordination of these services to more effectively address issues around 

elder justice. Therefore, the committee has given the Secretary of 

HHS the statutory authority to establish an office on Elder Abuse 

Prevention and Services. 

3. ELIGIBLE GRANTEES

The committee intends that entities eligible to compete for funding for the new competitive grant program contained in the Act for 

Elder Justice include public and private organizations (including 

community-based and faith-based organizations) that are engaged 

in and have expertise in issues relating to elder justice. 

V. STATEMENT OF ADMINISTRATION POLICY

THE SECRETARY OF HEALTH AND HUMAN SERVICES, Washington, DC, September 21, 2004. 

Hon. JUDD GREGG, Chairman, Committee on Health, Education, Labor, and Pensions, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: This letter conveys the views of the Department of Health and Human Services on the committee’s draft 

bill, the ‘‘Act for Elder Justice’’. The bill authorizes grants to States 

and Indian tribes for a comprehensive range of services, including 

elder shelters, multidisciplinary teams, and training. We support 

the objectives of this legislation. It enhances the existing authority 

of this Department’s Administration on Aging (AoA) to raise awareness about elder abuse, promote coordination, and support intervention efforts. 

Current authority under the Older Americans Act of 1965 (OAA) 

permits States to develop and carry out programs for the prevention and treatment of elder abuse, including providing public education and outreach, conducting training, and ensuring the coordination of elder rights programs. The AoA also provides funding 

under the OAA for the National Center on Elder Abuse, which provides information to the public and offers training and technical assistance to State units on aging and protective services programs 

for the elderly. 

The bill calls for AoA to develop priorities and a long-term plan 

for supporting State and local protective services programs, including providing them with training, technical assistance, and information on best practices. This provision reinforces the role AoA 

plays in providing these and other elder rights programs with support and guidance. 

The bill authorizes grants to States and Indian tribes for specific 

abuse prevention efforts, such as support for cross-training activities and volunteer programs that focus on the issue of elder abuse. 

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We do not object to clarifying and expanding the types of activities 

that States and Indian tribes may undertake. 

While we support the committee’s desire to amend the OAA to 

further strengthen this Department’s efforts to prevent and address elder abuse through this draft legislation, we believe it would 

be more appropriate to make these and other enhancements to the 

Act in the broader context of the reauthorization next year. However, we do not object to enactment of this legislation. 

The Office of Management and Budget advises that there is no 

objection to the transmittal of this report. 

Sincerely, 

TOMMY G. THOMPSON, Secretary. 

VI. COST ESTIMATE

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, October 7, 2004. 

Hon. JUDD GREGG,

Chairman, Committee on Health, Education, Labor, and Pensions, 

U.S. Senate, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for the Act for Elder Justice. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Christina Hawley Sadoti. 

Sincerely, 

ELIZABETH M. ROBINSON

(For Douglas Holtz-Eakin, Director). 

Enclosure.

Act for Elder Justice 

Summary: This legislation would authorize an Office on Elder 

Abuse Prevention and Services within the Administration on Aging 

in the Department of Health and Human Services (HHS). In addition, the bill would authorize grants to states for the purpose of 

strengthening long-term care and providing assistance for elder 

justice programs. CBO estimates that the bill would authorize appropriations of $210 million for fiscal year 2005 and $877 million 

over the 2005–2009 period, including adjustments for inflation. Assuming appropriation of the estimated amounts, CBO estimates 

that implementing the bill would cost $27 million in fiscal year 

2005 and $768 million over the 2005–2009 period. Enacting the bill 

would not affect direct spending or receipts. 

The bill contains no intergovernmental or private-sector mandates as defined by the Unfunded Mandates Reform Act (UMRA). 

State, local, and tribal governments would be eligible for grants authorized by the bill, and the costs of any requirements tied to those 

grants would be incurred voluntarily. 

Estimated cost to the Federal Government: The estimated budgetary impact of the Act for Elder Justice is summarized in the following table. The costs of this legislation fall within budget function 500 (education, training, employment, and social services).

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By fiscal year, in millions of dollars—

2005 2006 2007 2008 2009

CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Office of Elder Abuse Prevention and Services: 

Estimated Authorization Level ................................................................................. 10 10 11 11 11

Estimated Outlays .................................................................................................... 7 10 11 11 11

State Grants: 

Estimated Authorization Level ................................................................................. 200 204 208 212 0

Estimated Outlays .................................................................................................... 20 120 182 206 189

Total Changes: 

Estimated Authorization Level ................................................................................. 210 214 219 223 11

Estimated Outlays .................................................................................................... 27 130 193 217 200

Basis of estimate: For this estimate, CBO assumes that the bill 

will be enacted near the start of fiscal year 2005 and that the necessary amounts will be appropriated for each year. The estimated 

outlays are based on the spending patterns of activities similar in 

nature to those authorized under this bill. 

Office of Elder Abuse Prevention and Services 

The bill would establish a federal Office of Elder Abuse Prevention and Services within HHS’ Administration on Aging. The office 

would carry out elder justice programs and activities; collect data 

relating to the abuse, exploitation, and neglect of elderly people; 

and conduct research, develop best practices, and provide technical 

assistance to states and other entities. This office would be added 

to the existing Administration on Aging, for which there is a permanent authorization of appropriations of such sums as may be 

necessary. Based on recent appropriations for similar activities 

dealing with the administration of child abuse and neglect programs. CBO estimates that authorizations for these activities 

would total $10 million for fiscal year 2005 and $54 million for the 

2005–2009 period. 

State Grants 

The bill would authorize the appropriation of such sums as may 

be necessary for fiscal years 2005 through 2008 for grants to states 

and Indian tribes for strengthening long-term care and assisting 

with elder justice programs—including the prevention, detection, 

assessment, treatment of, intervention in, and investigation of 

elder abuse, neglect, and exploitation. Based on recent appropriations for similar activities dealing with child abuse and neglect and 

the number of elderly persons relative to the number of children, 

CBO estimates that authorizations for these activities would total 

$200 million for fiscal year 2005 and $823 million for the 2005–

2008 period. 

Intergovernmental and private-sector impact: The bill contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. The bill would authorize grants to state, local, and tribal 

governments for prevention and intervention programs, elder shelters, volunteer programs, training, and multidisciplinary and collaborative programs tied to elder abuse, neglect, and exploitation. 

The costs of any requirements tied to these grants would be incurred voluntarily. 

Previous CBO estimate: On September 27, 2004, CBO provided 

an estimate for S. 333, the Elder Justice Act of 2004, as ordered 

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reported by the Senate Committee on Finance on September 20, 

2004. S. 333 differs in scope from this bill, and contains specific 

(rather than ‘‘such sums’’) authorizations for fiscal years 2006 

through 2009. CBO estimated that S. 333 would cost $763 million 

over the 2006–2009 period. 

Estimate prepared by: Federal Costs: Christina Hawley Sadoti. 

Impact on State, Local, and Tribal Governments: Leo Lex. Impact 

on the Private Sector: Meena Fernandes. 

Estimate approved by: Peter H. Fontaine, Deputy Assistant Director for Budget Analysis.

VII. APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

Section 102(b)(3) of Public Law 104–1, the Congressional Accountability Act (CAA) requires a description of the application of 

this bill to the legislative branch. This bill does not amend any act 

that applies to the legislative branch. 

VIII. REGULATORY IMPACT STATEMENT

The Committee has determined that there will be de minimus 

changes in the regulatory burden imposed by this bill. 

IX. SECTION-BY-SECTION ANALYSIS

SECTION 1. SHORT TITLE

This Act may be cited as the ‘‘Act for Elder Justice.’’ 

SECTION 2. STATEMENT OF PURPOSE

The purposes of this Act are as follows: (1) To assist States, Indian Tribes and communities in their efforts to protect elders by 

developing a comprehensive, multi-disciplinary approach to elder 

justice; (2) To promote research and data collection to fill gaps in 

knowledge about elder abuse, neglect and exploitation; (3) To support innovative and effective activities of service providers designed 

to address elder abuse issues; (4) To assist States, Indian Tribes 

and local service providers in the development of short- and longterm strategic plans for the development and coordination of elder 

justice research, programs, studies, and training; and (5) To promote collaborative efforts and diminish overlap and gaps in developing the field of elder justice. 

SECTION 3. AUTHORIZES THE ESTABLISHMENT OF AN OFFICE OF ELDER

ABUSE PREVENTION AND SERVICES

Amends Sec. 201 of OAA to authorize the establishment of an Office of Elder Abuse Prevention and Services within the Administration on Aging. Directs the Assistant Secretary to, through the Director of the office, develop objectives, priorities, policy and a longterm plan for: (1) Carrying out elder justice programs related to 

abuse prevention, detection, treatment, evaluation, intervention 

and response; training; and overall improvement of the elder justice system; (2) Collecting and disseminating data annually on 

abuse, exploitation and neglect of elders (and, at the discretion of 

the Secretary other vulnerable adults) in coordination with DOJ’s 

Bureau of Justice Statistics; (3) Disseminating information about 

best practices and providing training to carry out activities related 

10

to the abuse, neglect and exploitation of elders (and, in the discretion of the Secretary, vulnerable adults); (4) In conjunction with experts in the field, conducting research related to elder abuse, neglect and exploitation; and (5) Providing technical assistance to 

States and eligible entities which provide or fund such elder justice 

services. 

SECTION 4. ESTABLISHES A NEW COMPETITIVE GRANT WITHIN THE

OLDER AMERICANS ACT TO STATES TO STRENGTHEN LONG-TERM

CARE AND OTHER ELDER JUSTICE PROGRAMS

Sec. 751 sets forth definitions for: caregiver, direct care, elder, 

elder justice, eligible entity, fiduciary, grant, law enforcement, long 

term care, loss of capacity for self-care, long-term care facility, 

nursing facility, state legal assistance developer, and state longterm care ombudsman. 

Sec. 752 grants authority to the Assistant Secretary to award 

grants to States and Indian tribes to strengthen long-term care and 

assist other elder justice programs. 

States and Indian tribes may apply for such grants and use those 

funds to award grants to eligible entities: (1) For the prevention, 

detection, assessment and treatment of, intervention in, investigation of, and response to elder abuse, neglect, and exploitation; (2) 

To examine various types of elder shelters (’safe havens’) and to 

test various shelter models for establishing safe havens that recognize autonomy, self-determination, and fully protect the due process rights of elders; (3) To establish or continue volunteer programs 

that focus on issues of elder abuse, neglect and exploitation or to 

provide related services; (4) To support multi-disciplinary elder justice activities including supporting and studying team approaches 

for bringing a coordinated multi-disciplinary or interdisciplinary response to elder abuse, neglect and exploitation or establishing a 

State coordinating council; (5) To provide training and cross-training for individuals to ensure coordination and collaboration with respect to issues of elder abuse, neglect, and exploitation; (6) To address underserved populations of elders; (7) To provide individuals 

with incentives to train for, seek and maintain employment in direct care work in long-term care facilities; (8) To encourage the establishment of partnerships to develop collaborative and innovative 

approaches to improve the quality of long-term care and abuse prevention; (9) To establish multi-disciplinary panels to address and 

develop best practices concerning methods of improving long-term 

care quality and addressing abuse in long-term care facilities; 

Administrative cap: States or tribes who receive a grant under 

this section may not use more than 5% of the funds to pay for administrative expenses. 

Non-supplantation: Funds made available under this section may 

only be used to supplement, not supplant other Federal, State and 

local, including tribal, public funds expended to provide such protective services described in this section. 

Maintenance of Effort: Using grants under this section, States 

and Indian Tribes are required to maintain expenditures for elder 

justice activities at a level at least equal to expenditures maintained the preceding fiscal year. 

Evaluation: Directs the Assistant Secretary to evaluate activities 

funded under this section to determine activities for which such 

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funds may be used. The Assistant Secretary shall also develop accountability measures to ensure that all funded activities are effective and that activities funded under section 752(c)(7) in addition 

to being effective, benefit eligible employees and increase stability 

of the long-term care workforce. 

Compliance with Applicable Laws: All entities receiving funds 

under this section shall comply with all applicable laws, regulations and guidelines. 

Eligible partnerships: As used in this section eligible partnerships means a multidisciplinary community partnership consisting 

of eligible entities or appropriate individuals. This may include representatives from nursing facilities, State legal assistance developers, State Long Term Care Ombudsmen, advocates for residents 

of long term care facilities, the State agency with responsibility for 

adult protective services as well as other interested parties and individuals. 

Authorization: Authorizes such sums as may be necessary for 

each of fiscal years 2005 through 2008.

X. CHANGES IN EXISTING LAW

In compliance with rule XXVI of paragraph 12 of the Standing 

Rules of the Senate, the following provides a print of the statute 

or the part or section thereof to be amended or replaced (existing 

law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed 

is shown in roman): 

OLDER AMERICANS ACT OF 1965

* * * * * * *

DEFINITIONS

SEC. 102. For the purposes of this Act—

(1) * * *

* * * * * * *

ø(24) The term ‘‘exploitation’’ means the illegal or improper 

act or process of an individual, including a caregiver, using the 

resources of an older individual for monetary or personal benefit, profit, or gain.’’¿

(24) The term ‘‘exploitation’’ means the fraudulent or otherwise illegal, unauthorized, or improper act or process of an individual, including a caregiver or fiduciary (as such terms are 

defined in section 751), that uses the resources of an older individual for monetary or personal benefit, profit, or gain, or that 

results in depriving an older individual of rightful access to, or 

use of, benefits, resources, belongings, or assets. 

* * * * * * *

ø(34) The term ‘‘neglect’’ means—

(A) the failure to provide for oneself the goods or services 

that are necessary to avoid physical harm, mental anguish, or mental illness; or 

(B) the failure of a caregiver to provide the goods or 

services.¿

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(34) The term ‘‘neglect’’ means—

(A) the intentional, deliberate, or knowing failure of a 

caregiver or fiduciary (as such terms are defined in section 

751) to provide the goods or services that are necessary to 

maintain the health or safety of an older individual; or 

(B) an adult’s inability, due to physical, mental, or cognitive impairment or diminished capacity, to perform essential self-care tasks including—

(i) obtaining essential food, clothing, shelter, and 

medical care; 

(ii) obtaining gods and services necessary to maintain physical health, mental health, or general safety; 

or 

(iii) managing one’s own financial affairs. 

* * * * * * *

TITLE II—ADMINISTRATION ON AGING 

ESTABLISHMENT OF ADMINISTRATION ON AGING

SEC. 201. (a) * * *

* * * * * * *

(e)(1) In this subsection, the terms defined in section 751 shall 

have the meanings given those terms in that section. 

(2) The Secretary is authorized to establish or designate within 

the Administration (as defined in section 102) an Office of Elder 

Abuse Prevention and Services. 

(3) It shall be the duty of the Assistant Secretary, acting through 

the head of the Office of Elder Abuse Prevention and Services to—

(A) develop objectives, priorities, policy, and a long-term plan 

for—

(i) carrying out elder justice programs and activities relating to—

(I) elder abuse prevention, detection, treatment, and 

intervention, and response; 

(II) training of individuals regarding the matters described in subclause (I); and 

(III) the improvement of the elder justice system in 

the United States; 

(ii) collecting and disseminating data annually relating 

to the abuse, neglect, and exploitation of elders (and, in the 

discretion of the Secretary, vulnerable adults) in coordination with the efforts of the Bureau of Justice Statistics of 

the Office of Justice Programs of the Department of Justice 

to collect national data; 

(iii) disseminating information concerning best practices 

regarding, and providing training on, carrying out activities related to abuse, neglect, and exploitation of elders 

(and, in the discretion of the Secretary, vulnerable adults); 

(iv) in conjunction with the necessary experts, conducting 

research related to abuse, neglect, and exploitation of elders 

(and, in the discretion of the Secretary, vulnerable adults); 

and 

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(v) providing technical assistance to States and other eligible entities that provide or fund the provision of the services described in subtitle B of title VII; 

(B) implement the overall policy and a strategy to carry out 

the plan described in subparagraph (A); and 

(C) provide advice to the Secretary on elder justice issues and 

administer such programs relating to elder abuse, neglect, and 

exploitation as the Secretary determines to be appropriate. 

(4) The Secretary, acting through the Assistant Secretary, may 

issue such regulations as may be necessary to carry out this subsection and subtitle B of title VII.

TITLE VII—ALLOTMENTS FOR VULNERABLE 

ELDER RIGHTS PROTECTION ACTIVITIES 

Subtitle A—State Provisions 

CHAPTER 1—GENERAL STATE PROVISIONS 

SEC. 701. ESTABLISHMENT. 

* * * * * * *

Subtitle B—Elder Justice Programs 

SEC. 751. DEFINITIONS. 

In this subtitle: 

(1) CAREGIVER.—The term ‘‘caregiver’’ means an individual 

who has the responsibility for the care of an elder, either voluntarily, by contract, by receipt of payment for care, or as a result 

of the operation of law and means a family member or other individual who provides (on behalf of such individual or of a 

public or private agency, organization, or institution) compensated or uncompensated care to an elder. 

(2) DIRECT CARE.—The term ‘‘direct care’’ means care by an 

employee or contractor who provides assistance or long-term 

care services to a recipient. 

(3) ELDER.—The term ‘‘elder’’ means an older individual, as 

defined in section 102. 

(4) ELDER JUSTICE.—The term ‘‘elder justice’’ means—

(A) efforts to prevent, detect, treat, intervene in, and respond to elder abuse, neglect, and exploitation and to protect elders with diminished capacity while maximizing 

their autonomy; and 

(B) from an individual perspective, the recognition of an 

elder’s rights, including the right to be free of abuse, neglect, and exploitation. 

(5) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ means a 

State or local government agency, Indian tribe, or any other 

public or private entity, that is engaged in and has expertise in 

issues relating to elder justice. 

(6) FIDUCIARY.—The term ‘‘fiduciary’’—

(A) means a person or entity with the legal responsibility—

14

(i) to make decisions on behalf of and for the benefit 

of another person; and 

(ii) to act in good faith and with fairness; and 

(B) includes a trustee, a guardian, a conservator, an executor, an agent under a financial power of attorney or 

health care power of attorney, or a representative payee. 

(7) GRANT.—The term ‘‘grant’’ includes a contract, cooperative 

agreement, or other mechanism for providing financial assistance. 

(8) LAW ENFORCEMENT.—The term ‘‘law enforcement’’ means 

the full range of potential responders to elder abuse, neglect, 

and exploitation including—

(A) police, sheriffs, detectives, public safety officers, and 

corrections personnel; 

(B) prosecutors; 

(C) medical examiners; 

(D) investigators; and 

(E) coroners. 

(9) LONG-TERM CARE.—

(A) IN GENERAL.—The term ‘‘long-term care’’ means supportive and health services specified by the Secretary for individuals who need assistance because the individuals have 

a loss of capacity for self-care due to illness, disability, or 

vulnerability. 

(B) LOSS OF CAPACITY FOR SELF-CARE.—For purposes of 

subparagraph (A), the term ‘‘loss of capacity for self-care 

means an inability to engage effectively in activities of daily 

living, including eating, dressing, bathing, and management of one’s financial affairs. 

(10) LONG-TERM CARE FACILITY.—The term ‘‘long-term care 

facility’’ means a residential care provider that arranges for, or 

directly provides, long-term care. 

(11) NURSING FACILITY.—The term ‘‘nursing facility’’ has the 

meaning given such term under section 1919(a) of the Social 

Security Act (42 U.S.C. 1396r(a)). 

(12) STATE LEGAL ASSISTANCE DEVELOPER.—The term ‘‘State 

legal assistance developer’’ means an individual described in 

section 731. 

(13) STATE LONG-TERM CARE OMBUDSMAN.—The term ‘‘State 

Long-term Care Ombudsman’’ means the State Long-Term Care 

Ombudsman described in section 712(a)(2). 

SEC. 752. STATE GRANTS TO STRENGTHEN LONG-TERM CARE AND 

PROVIDE ASSISTANCE FOR ELDER JUSTICE PROGRAMS. 

(a) GRANTS.—The Assistant Secretary may award grants to States 

and Indian tribes to enable the States and tribes to strengthen longterm care and provide assistance for elder justice programs. 

(b) APPLICATION.—To be eligible to receive a grant under this subtitle, a State or Indian tribe shall submit an application to the Assistant Secretary at such time, in such manner, and containing such 

information as the Assistant Secretary may require. 

(c) USE OF FUNDS.—A State or Indian tribe that receives a grant 

under this subtitle may use the funds made available through the 

grant to award grants—

15

(1) to eligible entities for the prevention, detection, assessment, and treatment of, intervention in, investigation of, and response to elder abuse, neglect, and exploitation; 

(2) to eligible entities to examine various types of elder shelters (in this paragraph referred to as ‘‘safe haven’’), and to test 

various safe haven models for establishing safe havens (at home 

or elsewhere), that—

(A) recognize autonomy and self-determination, and fully 

protect the due process rights of elders; and 

(B)(i) provide a comprehensive, culturally sensitive, and 

multidisciplinary team response to allegations of elder 

abuse, neglect, or exploitation; 

(ii) provide a dedicated, elder-friendly setting; 

(iii) have the capacity to meet the needs of elders for care; 

and 

(iv) provide various services including—

(I) nursing and forensic evaluation; 

(II) therapeutic intervention; 

(III) victim support and advocacy; and 

(IV) case review and assistance to make the elders 

safer at home or to find appropriate placement in safer 

environments, including shelters, and, in some circumstances long-term care facilities, other residential 

care facilities, and hospitals; 

(3) to eligible entities to establish or continue volunteer programs that focus on the issues of elder abuse, neglect, and exploitation, or to provide related services; 

(4) to eligible entities to support multidisciplinary elder justice activities, such as—

(A) supporting and studying team approaches for bringing a coordinated multidisciplinary or interdisciplinary response to elder abuse, neglect, and exploitation, including 

a response from individuals in social service, health care, 

public safety, and legal disciplines; 

(B) establishing a State or tribal coordinating council, 

which shall identify the individual State’s or Indian tribe’s 

needs and provide the Secretary with information and recommendations relating to efforts by the State or Indian 

tribe to combat elder abuse, neglect, and exploitation; 

(C) providing training, technical assistance, and other 

methods of support to groups carrying out multidisciplinary efforts at the State or Indian tribe level (referred to 

in some States as ‘‘State Working Group’’); 

(D) broadening and studying various models for elder fatality and serious injury review teams, to make recommendations about their composition, protocols, functions, timing, roles, and responsibilities, with a goal of producing models and information that will allow for replication based on the needs of other States, Indian tribes, and 

communities; or 

(E) carrying out such other interdisciplinary or multidisciplinary efforts as the Assistant Secretary determines to 

be appropriate; 

16

(5) to eligible entities to provide training for individuals with 

respect to issues of elder abuse, neglect, and exploitation, consisting of—

(A) training within a discipline; or 

(B) cross-training activities that permit individuals in 

multiple disciplines to train together, fostering communication, coordinating efforts, and ensuring collaboration; 

(6) to eligible entities to address underserved populations of 

elders, such as—

(A) elders living in rural locations; 

(B) elders in minority populations; or 

(C) low-income elders;

(7) to eligible entities to provide incentives for individuals to 

train for, seek, and maintain employment providing direct care 

in a long-term care facility, such as—

(A) to eligible entities to provide incentives to participants 

in programs carried out under part A of title IV, and section 403(a)(5), of the Social Security Act (42 U.S.C. 601 et 

seq., 603(a)(5)) to train for and seek employment providing 

direct care in a long-term care facility; 

(B) to long-term care facilities to carry out programs 

through which the facilities—

(i) offer, to employees who provide direct care to residents of a long-term care facility, continuing training 

and varying levels of professional certification, based 

on observed clinical care practices and the amount of 

time the employees spend providing direct care; and 

(ii) provide or make arrangements with employers to 

provide, bonuses or other increased compensation or 

benefits to employees who achieve professional certification under such a program; or 

(C) to long-term care facilities to enable the facilities to 

provide training and technical assistance to eligible employees regarding management practices using methods 

that are demonstrated to promote retention of employees of 

the facilities, such as—

(i) the establishment of basic human resource policies 

that reward high performance, including policies that 

provide for improved wages and benefits on the basis 

of job reviews; or 

(ii) the establishment of other programs that promote 

the provision of high quality care, such as a continuing 

education program that provides additional hours of 

training, including on-the-job training, for employees 

who are certified nurse aides; 

(8) to encourage the establishment of eligible partnerships to 

develop collaborative and innovative approaches to improve the 

quality of, including preventing abuse, neglect, and exploitation 

in, long-term care; or 

(9) to eligible entities to establish multidisciplinary panels to 

address and develop best practices concerning methods of—

(A) improving the quality of long-term care; and 

(B) addressing abuse, including resident-to-resident 

abuse, in long-term care. 

17

(d) ADMINISTRATIVE EXPENSES.—A State or Indian tribe that receives a grant under this section shall not use more than 5 percent 

of the funds made available through the grant to pay for administrative expenses. 

(e) SUPPLEMENT NOT SUPPLANT.—Funds made available pursuant to this section shall be used to supplement and not supplant 

other Federal, State, and local (including tribal) funds expended to 

provide activities described in subsection (c). 

(f) MAINTENANCE OF EFFORT.—The State or Indian tribe, in using 

the proceeds of a grant received under this section, shall maintain 

the expenditures of the State or tribe for activities described in subsection (c) at a level equal to not less than the level of such expenditures maintained by the State or tribe for the fiscal year preceding 

the fiscal year for which the grant is received. 

(g) ACCOUNTABILITY MEASURES.—The Assistant Secretary shall 

develop accountability measures to ensure the effectiveness of the activities conducted using funds made available under this section, including accountability measures to ensure that the activities described in subsection (c)(7) benefit eligible employees and increase 

the stability of the long-term care workforce. 

(h) EVALUATING PROGRAMS.—The Assistant Secretary shall evaluate the activities conducted using funds made available under this 

section and shall use the results of such evaluation to determine the 

activities for which funds made available under this section may be 

used. 

(i) COMPLIANCE WITH APPLICABLE LAWS.—In order to receive 

funds under this section, an entity shall comply with all applicable 

laws, regulations, and guidelines. 

(j) ELIGIBLE PARTNERSHIPS.—In subsection (c)(8), the term ‘‘eligible partnership’’ means a multidisciplinary community partnership 

consisting of eligible entities or appropriate individuals, such as a 

partnership consisting of representatives in a community of nursing 

facility providers, State legal assistance developers, advocates for 

residents of long-term care facilities, State Long-Term Care Ombudsmen, surveyors, the State agency with responsibility for adult 

protective services, the State agency with responsibility for licensing 

long-term care facilities, law enforcement agencies, courts, family 

councils, residents, certified nurse aides, registered nurses, physicians, and other eligible entities and appropriate individuals. 

(k) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to 

be appropriated to carry out this section such sums as may be necessary for each of fiscal years 2005 through 2008. 

* * * * * * *

Subtitle øB¿ C—Native American Organization 

Provisions 

SEC. ø751¿ 761. NATIVE AMERICAN PROGRAM. 

ø(a)¿ ESTABLISHMENT.—* * *

* * * * * * *

18

Subtitle øC¿ D—General Provisions 

SEC. ø761¿ 771. DEFINITIONS. 

* * * * * * *

SEC. ø762¿ 772. ADMINISTRATION. 

* * * * * * *

SEC. ø763¿ 773. TECHNICAL ASSISTANCE. 

* * * * * * *

SEC. ø764¿ 774. AUDITS. 

* * * * * * *

Æ