II 

Calendar No. 1029 

110TH CONGRESS 

2D SESSION S. 1070 

[Report No. 110–470] 

To amend the Social Security Act to enhance the social security of the 

Nation by ensuring adequate public-private infrastructure and to resolve 

to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, 

and exploitation, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 29, 2007 

Mr. HATCH (for himself, Mrs. LINCOLN, Mr. SMITH, Mr. KOHL, Mr. BOND, 

Mrs. CLINTON, Mr. SPECTER, Mr. BROWN, Ms. COLLINS, Mrs. BOXER, 

Mr. LIEBERMAN, Mr. BAYH, Mr. SALAZAR, Mr. NELSON of Florida, Ms. 

STABENOW, Mr. BIDEN, Mr. REED, Mr. KERRY, Mr. OBAMA, Mr. SCHUMER, Mr. ENZI, Mr. CHAMBLISS, Mr. ROCKEFELLER, Ms. SNOWE, Mr. 

WYDEN, Mr. DURBIN, Mr. BINGAMAN, Mrs. MURRAY, Ms. CANTWELL, 

Mrs. DOLE, Mr. CASEY, and Ms. MIKULSKI) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

SEPTEMBER 18 (legislative day, SEPTEMBER 17), 2008 

Reported by Mr. BAUCUS, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

A BILL 

To amend the Social Security Act to enhance the social 

security of the Nation by ensuring adequate public-private infrastructure and to resolve to prevent, detect, 

treat, intervene in, and prosecute elder abuse, neglect, 

and exploitation, and for other purposes. 


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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Elder Justice Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Purposes. 

Sec. 4. Definitions. 

Sec. 5. Elder Justice. 

‘‘Subtitle 2—Elder Justice 

‘‘Sec. 2011. Definitions. 

‘‘Sec. 2012. General provisions. 

‘‘PART A—NATIONAL COORDINATION OF ELDER JUSTICE ACTIVITIES AND

RESEARCH

‘‘SUBPART 1—ELDER JUSTICE COORDINATING COUNCIL AND ADVISORY BOARD

ON ELDER ABUSE, NEGLECT, AND EXPLOITATION

‘‘Sec. 2021. Elder Justice Coordinating Council. 

‘‘Sec. 2022. Advisory Board on Elder Abuse, Neglect, and Exploitation. 

‘‘Sec. 2023. Research protections. 

‘‘Sec. 2024. Authorization of appropriations. 

‘‘SUBPART 2—ELDER ABUSE, NEGLECT, AND EXPLOITATION FORENSIC

CENTERS

‘‘Sec. 2031. Establishment and support of elder abuse, neglect, and Exploitation forensic Centers. 

‘‘PART B—PROGRAMS TO PROMOTE ELDER JUSTICE

‘‘Sec. 2041. Enhancement of long-term care. 

‘‘Sec. 2042. Adult protective services functions and grant programs. 

‘‘Sec. 2043. Long-term care ombudsman program grants and training. 

‘‘Sec. 2044. Provision of information regarding, and evaluations of, elder 

justice programs. 

‘‘Sec. 2045. Report. 

8 SEC. 2. FINDINGS. 

9 Congress finds the following: 


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1 (1) The proportion of the United States popu2 lation age 60 years or older will drastically increase 

3 in the next 30 years as more than 76,000,000 baby 

4 boomers approach retirement and old age. 

5 (2) Each year, anywhere between 500,000 and 

6 5,000,000 elders in the United States are abused, 

7 neglected, or exploited. 

8 (3) Elder abuse, neglect, and exploitation have 

9 no boundaries, and cross all racial, social class, gen10 der, and geographic lines. 

11 (4) Victims of elder abuse, neglect, and exploi12 tation are not only subject to injury from mistreat13 ment and neglect, they are also 3.1 times more likely 

14 than elders who were not victims of elder abuse, ne15 glect, and exploitation to die at an earlier age than 

16 expected. 

17 (5) There is a general dearth of data as to the 

18 nature and scope of elder abuse, neglect, and exploi19 tation. In recognition of the need to improve data 

20 collection efforts with respect to elder abuse, neglect, 

21 and exploitation, Congress required the Secretary of 

22 Health and Human Services to conduct a study by 

23 the end of 2008 on establishing a uniform national 

24 database on elder abuse under section 405 of title 


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1 IV of Division C of the Tax Relief and Health Care 

2 Act of 2006 (Public Law 109–432). 

3 (6) Despite the dearth of data in the field, ex4 perts agree that most cases of elder abuse, neglect, 

5 and exploitation are never reported and that abuse, 

6 neglect, and exploitation shorten a victim’s life, often 

7 triggering a downward spiral of an otherwise pro8 ductive, self-sufficient elder’s life. Programs address9 ing other difficult issues such as domestic violence 

10 and child abuse and neglect have demonstrated the 

11 need for a multifaceted law, combining public health, 

12 social service, and law enforcement approaches. 

13 (7) For over 20 years, Congress has been pre14 sented with facts and testimony calling for a coordi15 nated Federal effort to combat elder abuse, neglect, 

16 and exploitation. 

17 (8) The Federal Government has been slow to 

18 respond to the needs of victims of elder abuse, ne19 glect, and exploitation or to undertake prevention ef20 forts. 

21 (9) No Federal law has been enacted that ade22 quately and comprehensively addresses the issues of 

23 elder abuse, neglect, and exploitation and there are 

24 very limited resources available to those in the field 

25 that directly deal with the issues. 


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1 (10) Differences in State laws and practices in 

2 the areas of elder abuse, neglect, and exploitation 

3 lead to significant disparities in prevention, protec4 tive and social services, treatment systems, and law 

5 enforcement, and lead to other inequities. 

6 (11) The Federal Government has played an 

7 important role in promoting research, training, pub8 lic safety, and data collection, and the identification, 

9 development, and dissemination of promising health 

10 care, social, and protective services, and law enforce11 ment practices, relating to child abuse and neglect, 

12 domestic violence, and violence against women. The 

13 Federal Government should promote similar efforts 

14 and protections relating to elder abuse, neglect, and 

15 exploitation. 

16 (12) The Federal Government should provide 

17 leadership and assist States and communities in 

18 their efforts to protect elders in the United States 

19 by— 

20 (A) promoting coordinated planning among 

21 all levels of government; 

22 (B) generating and sharing knowledge rel23 evant to protecting elders; 


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1 (C) providing leadership to combat the 

2 abuse, neglect, and exploitation of the Nation’s 

3 elders; and 

4 (D) providing resources to States and com5 munities to promote elder justice. 

6 (13) The problem of elder abuse, neglect, and 

7 exploitation requires a comprehensive approach 

8 that— 

9 (A) integrates the work of health, legal, 

10 and social service agencies and organizations; 

11 (B) emphasizes the need for prevention, re12 porting, investigation, assessment, treatment, 

13 and prosecution of elder abuse, neglect, and ex14 ploitation at all levels of government; 

15 (C) ensures that sufficient numbers of 

16 properly trained personnel with specialized 

17 knowledge are in place to— 

18 (i) treat, assess, and provide services 

19 relating to elder abuse, neglect, and exploi20 tation; and 

21 (ii) carry out elder protection duties; 

22 (D) is sensitive to ethnic and cultural di23 versity; 

24 (E) recognizes the role of mental health, 

25 disability, dementia, substance abuse, medicaVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6401 E:\BILLS\S1070.RS S1070

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1 tion mismanagement, and family dysfunction 

2 problems in increasing and exacerbating elder 

3 abuse, neglect, and exploitation; and 

4 (F) balances elders’ right to self-deter5 mination with society’s responsibility to protect 

6 elders. 

7 (14) The human, social, and economic cost of 

8 elder abuse, neglect, and exploitation is high and in9 cludes unnecessary expenditures of funds from many 

10 public programs. 

11 (15) The failure to coordinate activities relating 

12 to, and comprehensively prevent and treat, elder 

13 abuse, neglect, and exploitation threatens the future 

14 and well-being of millions of elders in the United 

15 States. 

16 (16) All elements of society in the United 

17 States have a shared responsibility in responding to 

18 a national problem of elder abuse, neglect, and ex19 ploitation. 

20 SEC. 3. PURPOSES. 

21 The purposes of this Act are as follows: 

22 (1) To enhance the social security of the Nation 

23 by ensuring adequate public-private infrastructure 

24 and resolving to prevent, detect, treat, understand, 


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1 and intervene in, and where appropriate, aid in the 

2 prosecution of, elder abuse, neglect, and exploitation. 

3 (2) To bring a comprehensive approach to pre4 venting and combating elder abuse, neglect, and ex5 ploitation, a long invisible problem that afflicts the 

6 most vulnerable among the aging population of the 

7 United States. 

8 (3) To raise the issue of elder abuse, neglect, 

9 and exploitation to national attention, and to create 

10 the infrastructure at the Federal, State, and local 

11 levels, to ensure that individuals and organizations 

12 on the front lines, who are fighting elder abuse, ne13 glect, and exploitation with scarce resources and 

14 fragmented systems, have the resources and infor15 mation needed to carry out their fight. 

16 (4) To bring a comprehensive multidisciplinary 

17 approach to elder justice. 

18 (5) To set in motion research and data collec19 tion to fill gaps in knowledge about elder abuse, ne20 glect, and exploitation. 

21 (6) To supplement the activities of service pro22 viders and programs, to enhance training, and to le23 verage scarce resources efficiently, in order to ensure 

24 that elder justice receives the attention it deserves as 

25 the Nation’s population ages. 


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1 (7) To recognize and address the role of mental 

2 health, disability, dementia, substance abuse, medi3 cation mismanagement, and family dysfunction prob4 lems in increasing and exacerbating elder abuse, ne5 glect, and exploitation. 

6 (8) To create short- and long-term strategic 

7 plans for the development and coordination of elder 

8 justice research, programs, studies, training, and 

9 other efforts nationwide. 

10 (9) To promote collaborative efforts and dimin11 ish overlap and gaps in efforts in developing the im12 portant field of elder justice. 

13 (10) To honor and respect the right of all indi14 viduals with diminished capacity to decisionmaking 

15 autonomy, self-determination, and dignity of choice. 

16 (11) To respect the wishes of individuals with 

17 diminished capacity and their family members in 

18 providing supportive services and care plans in19 tended to protect elders from abuse, neglect (includ20 ing self-neglect), and exploitation. 

21 SEC. 4. DEFINITIONS. 

22 Except as otherwise specifically provided, any term 

23 that is defined in section 2011 of the Social Security Act 

24 (as added by section 5(a)) and is used in this Act has 

25 the meaning given such term by such section. 


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1 SEC. 5. ELDER JUSTICE. 

2 (a) ELDER JUSTICE.— 

3 (1) IN GENERAL.—Title XX of the Social Secu4 rity Act (42 U.S.C. 1397 et seq.) is amended— 

5 (A) in the heading, by inserting ‘‘AND 

6 ELDER JUSTICE’’ after ‘‘SOCIAL 

7 SERVICES’’; 

8 (B) by inserting before section 2001 the 

9 following: 

10 ‘‘Subtitle 1—Block Grants to States 

11 for Social Services’’; 

12 and 

13 (C) by adding at the end the following: 

14 ‘‘Subtitle 2—Elder Justice 

15 ‘‘SEC. 2011. DEFINITIONS. 

16 ‘‘In this subtitle: 

17 ‘‘(1) ABUSE.—The term ‘abuse’ means the 

18 knowing infliction of physical or psychological harm 

19 or the knowing deprivation of goods or services that 

20 are necessary to meet essential needs or to avoid 

21 physical or psychological harm. 

22 ‘‘(2) ADULT PROTECTIVE SERVICES.—The term 

23 ‘adult protective services’ means such services pro24 vided to adults as the Secretary may specify and in25 cludes services such as— 


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1 ‘‘(A) disseminating reports of adult abuse, 

2 neglect, or exploitation; 

3 ‘‘(B) investigating the reports described in 

4 subparagraph (A); 

5 ‘‘(C) case planning, monitoring, evaluation, 

6 and other case work and services; and 

7 ‘‘(D) providing, arranging for, or facili8 tating the provision of medical, social service, 

9 economic, legal, housing, law enforcement, or 

10 other protective, emergency, or support services. 

11 ‘‘(3) CAREGIVER.—The term ‘caregiver’ means 

12 an individual who has the responsibility for the care 

13 of an elder, either voluntarily, by contract, by receipt 

14 of payment for care, or as a result of the operation 

15 of law, and means a family member or other indi16 vidual who provides (on behalf of such individual or 

17 of a public or private agency, organization, or insti18 tution) compensated or uncompensated care to an 

19 elder who needs supportive services in any setting. 

20 ‘‘(4) DIRECT CARE.—The term ‘direct care’ 

21 means care by an employee or contractor who pro22 vides assistance or long-term care services to a re23 cipient. 

24 ‘‘(5) ELDER.—The term ‘elder’ means an indi25 vidual age 60 or older. 


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1 ‘‘(6) ELDER JUSTICE.—The term ‘elder justice’ 

2 means— 

3 ‘‘(A) from a societal perspective, efforts 

4 to— 

5 ‘‘(i) prevent, detect, treat, intervene 

6 in, and prosecute elder abuse, neglect, and 

7 exploitation; and 

8 ‘‘(ii) protect elders with diminished 

9 capacity while maximizing their autonomy; 

10 and 

11 ‘‘(B) from an individual perspective, the 

12 recognition of an elder’s rights, including the 

13 right to be free of abuse, neglect, and exploi14 tation. 

15 ‘‘(7) ELIGIBLE ENTITY.—The term ‘eligible en16 tity’ means a State or local government agency, In17 dian tribe or tribal organization, or any other public 

18 or private entity that is engaged in and has expertise 

19 in issues relating to elder justice or in a field nec20 essary to promote elder justice efforts. 

21 ‘‘(8) EXPLOITATION.—The term ‘exploitation’ 

22 means the fraudulent or otherwise illegal, unauthor23 ized, or improper act or process of an individual, in24 cluding a caregiver or fiduciary, that uses the re25 sources of an elder for monetary or personal benefit, 


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1 profit, or gain, or that results in depriving an elder 

2 of rightful access to, or use of, benefits, resources, 

3 belongings, or assets. 

4 ‘‘(9) FIDUCIARY.—The term ‘fiduciary’— 

5 ‘‘(A) means a person or entity with the 

6 legal responsibility— 

7 ‘‘(i) to make decisions on behalf of 

8 and for the benefit of another person; and 

9 ‘‘(ii) to act in good faith and with 

10 fairness; and 

11 ‘‘(B) includes a trustee, a guardian, a con12 servator, an executor, an agent under a finan13 cial power of attorney or health care power of 

14 attorney, or a representative payee. 

15 ‘‘(10) GRANT.—The term ‘grant’ includes a 

16 contract, cooperative agreement, or other mechanism 

17 for providing financial assistance. 

18 ‘‘(11) GUARDIANSHIP.—The term ‘guardian19 ship’ means— 

20 ‘‘(A) the process by which a State court 

21 determines that an adult individual lacks capac22 ity to make decisions about self-care and prop23 erty, and appoints another individual or entity 

24 known as a guardian, as a conservator, or by a 

25 similar term, as a surrogate decisionmaker; 


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1 ‘‘(B) the manner in which the court-ap2 pointed surrogate decisionmaker carries out du3 ties to the individual and the court; or 

4 ‘‘(C) the manner in which the court exer5 cises oversight of the surrogate decisionmaker. 

6 ‘‘(12) INDIAN TRIBE.— 

7 ‘‘(A) IN GENERAL.—The term ‘Indian 

8 tribe’ has the meaning given such term in sec9 tion 4 of the Indian Self-Determination and 

10 Education Assistance Act (25 U.S.C. 450b). 

11 ‘‘(B) INCLUSION OF PUEBLO AND

12 RANCHERIA.—The term ‘Indian tribe’ includes 

13 any Pueblo or Rancheria. 

14 ‘‘(13) LAW ENFORCEMENT.—The term ‘law en15 forcement’ means the full range of potential re16 sponders to elder abuse, neglect, and exploitation in17 cluding— 

18 ‘‘(A) police, sheriffs, detectives, public safe19 ty officers, and corrections personnel; 

20 ‘‘(B) prosecutors; 

21 ‘‘(C) medical examiners; 

22 ‘‘(D) investigators; and 

23 ‘‘(E) coroners. 

24 ‘‘(14) LONG-TERM CARE.— 


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1 ‘‘(A) IN GENERAL.—The term ‘long-term 

2 care’ means supportive and health services spec3 ified by the Secretary for individuals who need 

4 assistance because the individuals have a loss of 

5 capacity for self-care due to illness, disability, 

6 or vulnerability. 

7 ‘‘(B) LOSS OF CAPACITY FOR SELF8 CARE.—For purposes of subparagraph (A), the 

9 term ‘loss of capacity for self-care’ means an in10 ability to engage in 1 or more activities of daily 

11 living, including eating, dressing, bathing, and 

12 management of one’s financial affairs. 

13 ‘‘(15) LONG-TERM CARE FACILITY.—The term 

14 ‘long-term care facility’ means a residential care pro15 vider that arranges for, or directly provides, long16 term care. 

17 ‘‘(16) NEGLECT.—The term ‘neglect’ means— 

18 ‘‘(A) the failure of a caregiver or fiduciary 

19 to provide the goods or services that are nec20 essary to maintain the health or safety of an 

21 elder; or 

22 ‘‘(B) self-neglect. 

23 ‘‘(17) NURSING FACILITY.— 


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1 ‘‘(A) IN GENERAL.—The term ‘nursing fa2 cility’ has the meaning given such term under 

3 section 1919(a). 

4 ‘‘(B) INCLUSION OF SKILLED NURSING FA5 CILITY.—The term ‘nursing facility’ includes a 

6 skilled nursing facility (as defined in section 

7 1819(a)). 

8 ‘‘(18) SELF-NEGLECT.—The term ‘self-neglect’ 

9 means an adult’s inability, due to physical or mental 

10 impairment or diminished capacity, to perform es11 sential self-care tasks including— 

12 ‘‘(A) obtaining essential food, clothing, 

13 shelter, and medical care; 

14 ‘‘(B) obtaining goods and services nec15 essary to maintain physical health, mental 

16 health, or general safety; or 

17 ‘‘(C) managing one’s own financial affairs. 

18 ‘‘(19) SERIOUS BODILY INJURY.— 

19 ‘‘(A) IN GENERAL.—The term ‘serious 

20 bodily injury’ means an injury— 

21 ‘‘(i) involving extreme physical pain; 

22 ‘‘(ii) involving substantial risk of 

23 death; 


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1 ‘‘(iii) involving protracted loss or im2 pairment of the function of a bodily mem3 ber, organ, or mental faculty; or 

4 ‘‘(iv) requiring medical intervention 

5 such as surgery, hospitalization, or phys6 ical rehabilitation. 

7 ‘‘(B) CRIMINAL SEXUAL ABUSE.—Serious 

8 bodily injury shall be considered to have oc9 curred if the conduct causing the injury is con10 duct described in section 2241 (relating to ag11 gravated sexual abuse) or 2242 (relating to sex12 ual abuse) of title 18, United States Code, or 

13 any similar offense under State law. 

14 ‘‘(20) SOCIAL.—The term ‘social’, when used 

15 with respect to a service, includes adult protective 

16 services. 

17 ‘‘(21) STATE LEGAL ASSISTANCE DEVEL18 OPER.—The term ‘State legal assistance developer’ 

19 means an individual described in section 731 of the 

20 Older Americans Act of 1965. 

21 ‘‘(22) STATE LONG-TERM CARE OMBUDSMAN.— 

22 The term ‘State Long-Term Care Ombudsman’ 

23 means the State Long-Term Care Ombudsman de24 scribed in section 712(a)(2) of the Older Americans 

25 Act of 1965. 


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1 ‘‘SEC. 2012. GENERAL PROVISIONS. 

2 ‘‘(a) PROTECTION OF PRIVACY.—In pursuing activi3 ties under this subtitle, the Secretary shall ensure the pro4 tection of individual health privacy consistent with the reg5 ulations promulgated under section 264(c) of the Health 

6 Insurance Portability and Accountability Act of 1996 and 

7 applicable State and local privacy regulations. 

8 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sub9 title shall be construed to interfere with or abridge an el10 der’s right to practice his or her religion through reliance 

11 on prayer alone for healing when this choice— 

12 ‘‘(1) is contemporaneously expressed, either 

13 orally or in writing, with respect to a specific illness 

14 or injury which the elder has at the time of the deci15 sion by an elder who is competent at the time of the 

16 decision; 

17 ‘‘(2) is previously set forth in a living will, 

18 health care proxy, or other advance directive docu19 ment that is validly executed and applied under 

20 State law; or 

21 ‘‘(3) may be unambiguously deduced from the 

22 elder’s life history. 


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1 ‘‘PART A—NATIONAL COORDINATION OF ELDER 

2 JUSTICE ACTIVITIES AND RESEARCH 

3 ‘‘Subpart 1—Elder Justice Coordinating Council and 

4 Advisory Board on Elder Abuse, Neglect, and Ex5 ploitation 

6 ‘‘SEC. 2021. ELDER JUSTICE COORDINATING COUNCIL. 

7 ‘‘(a) ESTABLISHMENT.—There is established within 

8 the Office of the Secretary an Elder Justice Coordinating 

9 Council (in this section referred to as the ‘Council’). 

10 ‘‘(b) MEMBERSHIP.— 

11 ‘‘(1) IN GENERAL.—The Council shall be com12 posed of the following members: 

13 ‘‘(A) The Secretary (or the Secretary’s 

14 designee). 

15 ‘‘(B) The Attorney General (or the Attor16 ney General’s designee). 

17 ‘‘(C) The head of each Federal department 

18 or agency or other governmental entity identi19 fied by the Chair referred to in subsection (d) 

20 as having responsibilities, or administering pro21 grams, relating to elder abuse, neglect, and ex22 ploitation. 

23 ‘‘(2) REQUIREMENT.—Each member of the 

24 Council shall be an officer or employee of the Fed25 eral Government. 


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1 ‘‘(c) VACANCIES.—Any vacancy in the Council shall 

2 not affect its powers, but shall be filled in the same man3 ner as the original appointment was made. 

4 ‘‘(d) CHAIR.—The member described in subsection 

5 (b)(1)(A) shall be Chair of the Council. 

6 ‘‘(e) MEETINGS.—The Council shall meet at least 2 

7 times per year, as determined by the Chair. 

8 ‘‘(f) DUTIES.— 

9 ‘‘(1) IN GENERAL.—The Council shall make 

10 recommendations to the Secretary for the coordina11 tion of activities of the Department of Health and 

12 Human Services, the Department of Justice, and 

13 other relevant Federal, State, local, and private 

14 agencies and entities, relating to elder abuse, ne15 glect, and exploitation and other crimes against el16 ders. 

17 ‘‘(2) REPORT.—Not later than the date that is 

18 2 years after the date of enactment of the Elder 

19 Justice Act and every 2 years thereafter, the Council 

20 shall submit to the Committee on Finance of the 

21 Senate and the Committee on Ways and Means and 

22 the Committee on Energy and Commerce of the 

23 House of Representatives a report that— 

24 ‘‘(A) describes the activities and accom25 plishments of, and challenges faced by— 


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1 ‘‘(i) the Council; and 

2 ‘‘(ii) the entities represented on the 

3 Council; and 

4 ‘‘(B) makes such recommendations for leg5 islation, model laws, or other action as the 

6 Council determines to be appropriate. 

7 ‘‘(g) POWERS OF THE COUNCIL.— 

8 ‘‘(1) INFORMATION FROM FEDERAL AGEN9 CIES.—Subject to the requirements of section 

10 2012(a), the Council may secure directly from any 

11 Federal department or agency such information as 

12 the Council considers necessary to carry out this sec13 tion. Upon request of the Chair of the Council, the 

14 head of such department or agency shall furnish 

15 such information to the Council. 

16 ‘‘(2) POSTAL SERVICES.—The Council may use 

17 the United States mails in the same manner and 

18 under the same conditions as other departments and 

19 agencies of the Federal Government. 

20 ‘‘(h) TRAVEL EXPENSES.—The members of the 

21 Council shall not receive compensation for the perform22 ance of services for the Council. The members shall be 

23 allowed travel expenses, including per diem in lieu of sub24 sistence, at rates authorized for employees of agencies 

25 under subchapter I of chapter 57 of title 5, United States 


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1 Code, while away from their homes or regular places of 

2 business in the performance of services for the Council. 

3 Notwithstanding section 1342 of title 31, United States 

4 Code, the Secretary may accept the voluntary and uncom5 pensated services of the members of the Council. 

6 ‘‘(i) DETAIL OF GOVERNMENT EMPLOYEES.—Any 

7 Federal Government employee may be detailed to the 

8 Council without reimbursement, and such detail shall be 

9 without interruption or loss of civil service status or privi10 lege. 

11 ‘‘(j) STATUS AS PERMANENT COUNCIL.—Section 14 

12 of the Federal Advisory Committee Act (5 U.S.C. App.) 

13 shall not apply to the Council. 

14 ‘‘SEC. 2022. ADVISORY BOARD ON ELDER ABUSE, NEGLECT, 

15 AND EXPLOITATION. 

16 ‘‘(a) ESTABLISHMENT.—There is established a board 

17 to be known as the ‘Advisory Board on Elder Abuse, Ne18 glect, and Exploitation’ (in this section referred to as the 

19 ‘Advisory Board’) to create short- and long-term multi20 disciplinary strategic plans for the development of the field 

21 of elder justice and to make recommendations to the Elder 

22 Justice Coordinating Council established under section 

23 2021. 

24 ‘‘(b) COMPOSITION.—The Advisory Board shall be 

25 composed of 27 members appointed by the Secretary from 


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1 among members of the general public who are individuals 

2 with experience and expertise in elder abuse, neglect, and 

3 exploitation prevention, detection, treatment, intervention, 

4 or prosecution. 

5 ‘‘(c) SOLICITATION OF NOMINATIONS.—The Sec6 retary shall publish a notice in the Federal Register solic7 iting nominations for the appointment of members of the 

8 Advisory Board under subsection (b). 

9 ‘‘(d) TERMS.— 

10 ‘‘(1) IN GENERAL.—Each member of the Advi11 sory Board shall be appointed for a term of 3 years, 

12 except that, of the members first appointed— 

13 ‘‘(A) 9 shall be appointed for a term of 3 

14 years; 

15 ‘‘(B) 9 shall be appointed for a term of 2 

16 years; and 

17 ‘‘(C) 9 shall be appointed for a term of 1 

18 year. 

19 ‘‘(2) VACANCIES.— 

20 ‘‘(A) IN GENERAL.—Any vacancy on the 

21 Advisory Board shall not affect its powers, but 

22 shall be filled in the same manner as the origi23 nal appointment was made. 

24 ‘‘(B) FILLING UNEXPIRED TERM.—An in25 dividual chosen to fill a vacancy shall be apVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6401 E:\BILLS\S1070.RS S1070

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1 pointed for the unexpired term of the member 

2 replaced. 

3 ‘‘(3) EXPIRATION OF TERMS.—The term of any 

4 member shall not expire before the date on which 

5 the member’s successor takes office. 

6 ‘‘(e) ELECTION OF OFFICERS.—The Advisory Board 

7 shall elect a Chair and Vice Chair from among its mem8 bers. The Advisory Board shall elect its initial Chair and 

9 Vice Chair at its initial meeting. 

10 ‘‘(f) DUTIES.— 

11 ‘‘(1) ENHANCE COMMUNICATION ON PRO12 MOTING QUALITY OF, AND PREVENTING ABUSE AND

13 NEGLECT IN, LONG-TERM CARE.—The Advisory 

14 Board shall develop collaborative and innovative ap15 proaches to improve the quality of, including pre16 venting abuse and neglect in, long-term care. 

17 ‘‘(2) COLLABORATIVE EFFORTS TO DEVELOP

18 CONSENSUS AROUND THE MANAGEMENT OF CER19 TAIN QUALITY-RELATED FACTORS.— 

20 ‘‘(A) IN GENERAL.—The Advisory Board 

21 shall establish multidisciplinary panels to ad22 dress, and develop consensus on, subjects relat23 ing to improving the quality of long-term care. 

24 At least 1 such panel shall address, and develop 


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1 consensus on, methods for managing resident2 to-resident abuse in long-term care. 

3 ‘‘(B) ACTIVITIES CONDUCTED.—The multi4 disciplinary panels established under subpara5 graph (A) shall examine relevant research and 

6 data, identify best practices with respect to the 

7 subject of the panel, determine the best way to 

8 carry out those best practices in a practical and 

9 feasible manner, and determine an effective 

10 manner of distributing information on such 

11 subject. 

12 ‘‘(3) REPORT.—Not later than the date that is 

13 18 months after the date of enactment of the Elder 

14 Justice Act, and annually thereafter, the Advisory 

15 Board shall prepare and submit to the Elder Justice 

16 Coordinating Council, the Committee on Finance of 

17 the Senate, and the Committee on Ways and Means 

18 and the Committee on Energy and Commerce of the 

19 House of Representatives a report containing— 

20 ‘‘(A) information on the status of Federal, 

21 State, and local public and private elder justice 

22 activities; 

23 ‘‘(B) recommendations (including rec24 ommended priorities) regarding— 


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1 ‘‘(i) elder justice programs, research, 

2 training, services, practice, enforcement, 

3 and coordination; 

4 ‘‘(ii) coordination between entities 

5 pursuing elder justice efforts and those in6 volved in related areas that may inform or 

7 overlap with elder justice efforts, such as 

8 activities to combat violence against women 

9 and child abuse and neglect; and 

10 ‘‘(iii) activities relating to adult fidu11 ciary systems, including guardianship and 

12 other fiduciary arrangements; 

13 ‘‘(C) recommendations for specific modi14 fications needed in Federal and State laws (in15 cluding regulations) or for programs, research, 

16 and training to enhance prevention, detection, 

17 and treatment (including diagnosis) of, inter18 vention in (including investigation of), and 

19 prosecution of elder abuse, neglect, and exploi20 tation; 

21 ‘‘(D) recommendations on methods for the 

22 most effective coordinated national data collec23 tion with respect to elder justice, and elder 

24 abuse, neglect, and exploitation; and 


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1 ‘‘(E) recommendations for a multidisci2 plinary strategic plan to guide the effective and 

3 efficient development of the field of elder jus4 tice. 

5 ‘‘(g) POWERS OF THE ADVISORY BOARD.— 

6 ‘‘(1) INFORMATION FROM FEDERAL AGEN7 CIES.—Subject to the requirements of section 

8 2012(a), the Advisory Board may secure directly 

9 from any Federal department or agency such infor10 mation as the Advisory Board considers necessary to 

11 carry out this section. Upon request of the Chair of 

12 the Advisory Board, the head of such department or 

13 agency shall furnish such information to the Advi14 sory Board. 

15 ‘‘(2) SHARING OF DATA AND REPORTS.—The 

16 Advisory Board may request from any entity pur17 suing elder justice activities under the Elder Justice 

18 Act or an amendment made by that Act, any data, 

19 reports, or recommendations generated in connection 

20 with such activities. 

21 ‘‘(3) POSTAL SERVICES.—The Advisory Board 

22 may use the United States mails in the same man23 ner and under the same conditions as other depart24 ments and agencies of the Federal Government. 


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1 ‘‘(h) TRAVEL EXPENSES.—The members of the Advi2 sory Board shall not receive compensation for the perform3 ance of services for the Advisory Board. The members 

4 shall be allowed travel expenses for up to 4 meetings per 

5 year, including per diem in lieu of subsistence, at rates 

6 authorized for employees of agencies under subchapter I 

7 of chapter 57 of title 5, United States Code, while away 

8 from their homes or regular places of business in the per9 formance of services for the Advisory Board. Notwith10 standing section 1342 of title 31, United States Code, the 

11 Secretary may accept the voluntary and uncompensated 

12 services of the members of the Advisory Board. 

13 ‘‘(i) DETAIL OF GOVERNMENT EMPLOYEES.—Any 

14 Federal Government employee may be detailed to the Ad15 visory Board without reimbursement, and such detail shall 

16 be without interruption or loss of civil service status or 

17 privilege. 

18 ‘‘(j) STATUS AS PERMANENT ADVISORY COM19 MITTEE.—Section 14 of the Federal Advisory Committee 

20 Act (5 U.S.C. App.) shall not apply to the advisory board. 

21 ‘‘SEC. 2023. RESEARCH PROTECTIONS. 

22 ‘‘(a) GUIDELINES.—The Secretary shall promulgate 

23 guidelines to assist researchers working in the area of 

24 elder abuse, neglect, and exploitation, with issues relating 

25 to human subject protections. 


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1 ‘‘(b) DEFINITION OF LEGALLY AUTHORIZED REP2 RESENTATIVE FOR APPLICATION OF REGULATIONS.—For 

3 purposes of the application of subpart A of part 46 of title 

4 45, Code of Federal Regulations, to research conducted 

5 under this subpart, the term ‘legally authorized represent6 ative’ means, unless otherwise provided by law, the indi7 vidual or judicial or other body authorized under the appli8 cable law to consent to medical treatment on behalf of an9 other person. 

10 ‘‘SEC. 2024. AUTHORIZATION OF APPROPRIATIONS. 

11 ‘‘There are authorized to be appropriated to carry out 

12 this subpart— 

13 ‘‘(1) for fiscal year 2008, $6,500,000; and 

14 ‘‘(2) for each of fiscal years 2009 through 

15 2011, $7,000,000. 

16 ‘‘Subpart 2—Elder Abuse, Neglect, and Exploitation 

17 Forensic Centers 

18 ‘‘SEC. 2031. ESTABLISHMENT AND SUPPORT OF ELDER 

19 ABUSE, NEGLECT, AND EXPLOITATION FO20 RENSIC CENTERS. 

21 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

22 with the Attorney General, shall make grants to eligible 

23 entities to establish and operate stationary and mobile fo24 rensic centers, to develop forensic expertise regarding, and 


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1 provide services relating to, elder abuse, neglect, and ex2 ploitation. 

3 ‘‘(b) STATIONARY FORENSIC CENTERS.—The Sec4 retary shall make 4 of the grants described in subsection 

5 (a) to institutions of higher education with demonstrated 

6 expertise in forensics or commitment to preventing or 

7 treating elder abuse, neglect, or exploitation, to establish 

8 and operate stationary forensic centers. 

9 ‘‘(c) MOBILE CENTERS.—The Secretary shall make 

10 6 of the grants described in subsection (a) to appropriate 

11 entities to establish and operate mobile forensic centers. 

12 ‘‘(d) AUTHORIZED ACTIVITIES.— 

13 ‘‘(1) DEVELOPMENT OF FORENSIC MARKERS

14 AND METHODOLOGIES.—An eligible entity that re15 ceives a grant under this section shall use funds 

16 made available through the grant to assist in deter17 mining whether abuse, neglect, or exploitation oc18 curred and whether a crime was committed and to 

19 conduct research to describe and disseminate infor20 mation on— 

21 ‘‘(A) forensic markers that indicate a case 

22 in which elder abuse, neglect, or exploitation 

23 may have occurred; and 

24 ‘‘(B) methodologies for determining, in 

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1 gency service, social and protective services, and 

2 legal service providers should intervene and 

3 when the providers should report the case to 

4 law enforcement authorities. 

5 ‘‘(2) DEVELOPMENT OF FORENSIC EXPER6 TISE.—An eligible entity that receives a grant under 

7 this section shall use funds made available through 

8 the grant to develop forensic expertise regarding 

9 elder abuse, neglect, and exploitation in order to 

10 provide medical and forensic evaluation, therapeutic 

11 intervention, victim support and advocacy, case re12 view, and case tracking. 

13 ‘‘(3) COLLECTION OF EVIDENCE.—The Sec14 retary, in coordination with the Attorney General, 

15 shall use data made available by grant recipients 

16 under this section to develop the capacity of geriatric 

17 health care professionals and law enforcement to col18 lect forensic evidence, including collecting forensic 

19 evidence relating to a potential determination of 

20 elder abuse, neglect, or exploitation. 

21 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

22 under this section, an entity shall submit an application 

23 to the Secretary at such time, in such manner, and con24 taining such information as the Secretary may require. 


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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this sec3 tion— 

4 ‘‘(1) for fiscal year 2008, $4,000,000; 

5 ‘‘(2) for fiscal year 2009, $6,000,000; and 

6 ‘‘(3) for each of fiscal years 2010 and 2011, 

7 $8,000,000. 

8 ‘‘PART B—PROGRAMS TO PROMOTE ELDER 

9 JUSTICE 

10 ‘‘SEC. 2041. ENHANCEMENT OF LONG-TERM CARE. 

11 ‘‘(a) GRANTS AND INCENTIVES FOR LONG-TERM

12 CARE STAFFING.— 

13 ‘‘(1) IN GENERAL.—The Secretary shall carry 

14 out activities, including activities described in para15 graphs (2) and (3), to provide incentives for individ16 uals to train for, seek, and maintain employment 

17 providing direct care in a long-term care facility. 

18 ‘‘(2) SPECIFIC PROGRAMS TO ENHANCE TRAIN19 ING, RECRUITMENT, AND RETENTION OF STAFF.— 

20 ‘‘(A) COORDINATION WITH SECRETARY OF

21 LABOR TO RECRUIT AND TRAIN LONG-TERM

22 CARE STAFF.—The Secretary shall coordinate 

23 activities under this subsection with the Sec24 retary of Labor in order to provide incentives 

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1 ment providing direct care in a long-term care 

2 facility. 

3 ‘‘(B) CAREER LADDERS AND WAGE OR

4 BENEFIT INCREASES TO INCREASE STAFFING IN

5 LONG-TERM CARE FACILITIES.— 

6 ‘‘(i) IN GENERAL.—The Secretary 

7 shall make grants to long-term care facili8 ties to carry out programs through which 

9 the facilities— 

10 ‘‘(I) offer, to employees who pro11 vide direct care to residents of a long12 term care facility, continuing training 

13 and varying levels of certification, 

14 based on observed clinical care prac15 tices and the amount of time the em16 ployees spend providing direct care; 

17 and 

18 ‘‘(II) provide, or make arrange19 ments to provide, bonuses or other in20 creased compensation or benefits to 

21 employees who achieve certification 

22 under such a program. 

23 ‘‘(ii) APPLICATION.—To be eligible to 

24 receive a grant under this subparagraph, a 

25 long-term care facility shall submit an apVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6401 E:\BILLS\S1070.RS S1070

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1 plication to the Secretary at such time, in 

2 such manner, and containing such infor3 mation as the Secretary may require 

4 (which may include evidence of consulta5 tion with the State in which the long-term 

6 care facility is located with respect to car7 rying out activities funded under the 

8 grant). 

9 ‘‘(iii) AUTHORITY TO LIMIT NUMBER

10 OF APPLICANTS.—Nothing in this subpara11 graph shall be construed as prohibiting the 

12 Secretary from limiting the number of ap13 plicants for a grant under this subpara14 graph. 

15 ‘‘(3) SPECIFIC PROGRAMS TO IMPROVE MAN16 AGEMENT PRACTICES.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall 

18 make grants to long-term care facilities to en19 able the facilities to provide training and tech20 nical assistance to eligible employees. 

21 ‘‘(B) AUTHORIZED ACTIVITIES.—A long22 term care facility that receives a grant under 

23 subparagraph (A) shall use funds made avail24 able through the grant to provide training and 

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1 garding management practices using methods 

2 that are demonstrated to promote retention of 

3 individuals who provide direct care to residents 

4 of the long-term care facility, such as— 

5 ‘‘(i) the establishment of standard 

6 human resource policies that reward high 

7 performance, including policies that pro8 vide for improved wages and benefits on 

9 the basis of job reviews; 

10 ‘‘(ii) the establishment of motivational 

11 and thoughtful work organization prac12 tices; 

13 ‘‘(iii) the creation of a workplace cul14 ture that respects and values caregivers 

15 and their needs; 

16 ‘‘(iv) the promotion of a workplace 

17 culture that respects the rights of residents 

18 of a long-term care facility and results in 

19 improved care for the residents; and 

20 ‘‘(v) the establishment of other pro21 grams that promote the provision of high 

22 quality care, such as a continuing edu23 cation program that provides additional 

24 hours of training, including on-the-job 


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1 training, for employees who are certified 

2 nurse aides. 

3 ‘‘(C) APPLICATION.—To be eligible to re4 ceive a grant under this paragraph, a long-term 

5 care facility shall submit an application to the 

6 Secretary at such time, in such manner, and 

7 containing such information as the Secretary 

8 may require (which may include evidence of 

9 consultation with the State in which the long10 term care facility is located with respect to car11 rying out activities funded under the grant). 

12 ‘‘(D) AUTHORITY TO LIMIT NUMBER OF

13 APPLICANTS.—Nothing in this paragraph shall 

14 be construed as prohibiting the Secretary from 

15 limiting the number of applicants for a grant 

16 under this paragraph. 

17 ‘‘(E) ELIGIBLE EMPLOYEE DEFINED.—In 

18 this paragraph, the term ‘eligible employee’ 

19 means an individual who establishes or imple20 ments management practices applicable with re21 spect to individuals who provide direct care to 

22 residents of a long-term care facility and in23 cludes administrators, directors of nursing, 

24 staff developers, and charge nurses. 


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1 ‘‘(4) ACCOUNTABILITY MEASURES.—The Sec2 retary shall develop accountability measures to en3 sure that the activities conducted using funds made 

4 available under this subsection benefit eligible em5 ployees and increase the stability of the long-term 

6 care workforce. 

7 ‘‘(b) INFORMATICS SYSTEMS GRANT PROGRAM.— 

8 ‘‘(1) GRANTS AUTHORIZED.—The Secretary is 

9 authorized to make grants to long-term care facili10 ties for the purpose of assisting such entities in off11 setting the costs related to purchasing, leasing, de12 veloping, and implementing standardized clinical 

13 health care informatics systems designed to improve 

14 patient safety and reduce adverse events and health 

15 care complications resulting from medication errors. 

16 ‘‘(2) USE OF GRANT FUNDS.—Funds provided 

17 under grants under this subsection may be used for 

18 any of the following: 

19 ‘‘(A) Purchasing, leasing, and installing 

20 computer software and hardware, including 

21 handheld computer technologies. 

22 ‘‘(B) Making improvements to existing 

23 computer software and hardware. 


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1 ‘‘(C) Making upgrades and other improve2 ments to existing computer software and hard3 ware to enable e-prescribing. 

4 ‘‘(D) Providing education and training to 

5 eligible long-term care facility staff on the use 

6 of technology to implement the electronic trans7 mission of prescription and patient information. 

8 ‘‘(3) APPLICATION.—To be eligible to receive a 

9 grant under this subsection, a long-term care facility 

10 shall submit an application to the Secretary at such 

11 time, in such manner, and containing such informa12 tion as the Secretary may require (which may in13 clude evidence of consultation with the State in 

14 which the long-term care facility is located with re15 spect to carrying out activities funded under the 

16 grant). 

17 ‘‘(4) AUTHORITY TO LIMIT NUMBER OF APPLI18 CANTS.—Nothing in this subsection shall be con19 strued as prohibiting the Secretary from limiting the 

20 number of applicants for a grant under this sub21 section. 

22 ‘‘(5) ACCOUNTABILITY MEASURES.—The Sec23 retary shall develop accountability measures to en24 sure that the activities conducted using funds made 

25 available under this subsection help improve patient 


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1 safety and reduce adverse events and health care 

2 complications resulting from medication errors. 

3 ‘‘(c) INCLUSION OF ADJUDICATED CRIMES ON NURS4 ING HOME COMPARE WEBSITE.—Not later than 1 year 

5 after the date of enactment of the Elder Justice Act, the 

6 Secretary shall ensure that the Department of Health and 

7 Human Services includes, as part of the information pro8 vided for comparison of nursing facilities on the official 

9 Internet website of the Federal Government for Medicare 

10 beneficiaries (commonly referred to as the ‘Nursing Home 

11 Compare’ Medicare website), the number of adjudicated 

12 instances of criminal violations by a nursing facility or 

13 crimes committed by an employee of a nursing facility— 

14 ‘‘(1) that were committed inside of the facility; 

15 and 

16 ‘‘(2) with respect to such instances of violations 

17 or crimes committed outside of the facility, that 

18 were the violations or crimes of elder abuse, neglect, 

19 and exploitation, criminal sexual abuse of an elder, 

20 or other violations or crimes that resulted in the se21 rious bodily injury of an elder. 

22 ‘‘(d) DEVELOPMENT OF CONSUMER RIGHTS INFOR23 MATION PAGE ON NURSING HOME COMPARE WEBSITE.— 

24 Not later than 1 year after the date of enactment of the 

25 Elder Justice Act, the Secretary shall ensure that the DeVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6401 E:\BILLS\S1070.RS S1070

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1 partment of Health and Human Services, as part of the 

2 information provided for comparison of nursing facilities 

3 on the Nursing Home Compare Medicare website develops 

4 and includes a consumer rights information page that con5 tains links to descriptions of, and information with respect 

6 to, the following: 

7 ‘‘(1) The documentation on nursing facilities 

8 that is available to the public. 

9 ‘‘(2) General information and tips on choosing 

10 a nursing facility that meets the needs of the indi11 vidual. 

12 ‘‘(3) General information on consumer rights 

13 with respect to nursing facilities. 

14 ‘‘(4) The nursing facility survey process (on a 

15 national and State-specific basis). 

16 ‘‘(5) On a State-specific basis, the services 

17 available through the State long-term care ombuds18 man for such State. 

19 ‘‘(e) DEVELOPMENT AND ADOPTION OF STANDARDS

20 FOR TRANSACTIONS INVOLVING CLINICAL DATA BY

21 LONG-TERM CARE FACILITIES.— 

22 ‘‘(1) STANDARDS.—The Secretary shall develop 

23 and adopt uniform open electronic standards for 

24 transactions involving clinical data by long-term care 


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1 facilities. Such standards shall include messaging 

2 and nomenclature standards. 

3 ‘‘(2) COMPATIBILITY WITH OTHER STAND4 ARDS.—The standards developed and adopted under 

5 paragraph (1) shall be compatible with standards es6 tablished under part C of title XI, standards estab7 lished under subsections (b)(2)(B)(i) and (e)(4) of 

8 section 1860D–4, and with general health informa9 tion technology standards. 

10 ‘‘(3) ELECTRONIC SUBMISSION OF DATA TO

11 THE SECRETARY.— 

12 ‘‘(A) IN GENERAL.—Not later than 10 

13 years after the date of enactment of the Elder 

14 Justice Act, the Secretary shall have procedures 

15 in place to accept the optional electronic sub16 mission of clinical data by long-term care facili17 ties pursuant to the standards developed and 

18 adopted under paragraph (1). 

19 ‘‘(B) RULE OF CONSTRUCTION.—Nothing 

20 in this subsection shall be construed to require 

21 a long-term care facility to submit clinical data 

22 electronically to the Secretary. 

23 ‘‘(f) REGULATIONS.—The Secretary shall promulgate 

24 regulations to carry out subsections (c), (d), and (e) of 

25 this section. Such regulations shall require a State, as a 


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1 condition of the receipt of funds under this part, to con2 duct such data collection and reporting as the Secretary 

3 determines are necessary to satisfy the requirements of 

4 such subsections. 

5 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this sec7 tion— 

8 ‘‘(1) for fiscal year 2008, $20,000,000; 

9 ‘‘(2) for fiscal year 2009, $17,500,000; and 

10 ‘‘(3) for each of fiscal years 2010 and 2011, 

11 $15,000,000. 

12 ‘‘SEC. 2042. ADULT PROTECTIVE SERVICES FUNCTIONS AND 

13 GRANT PROGRAMS. 

14 ‘‘(a) SECRETARIAL RESPONSIBILITIES.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall ensure 

16 that the Department of Health and Human Serv17 ices— 

18 ‘‘(A) provides funding authorized by this 

19 part to State and local adult protective services 

20 offices that investigate reports of the abuse, ne21 glect, and exploitation of elders; 

22 ‘‘(B) collects and disseminates data annu23 ally relating to the abuse, exploitation, and ne24 glect of elders in coordination with the Depart25 ment of Justice; 


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1 ‘‘(C) develops and disseminates informa2 tion on best practices regarding, and provides 

3 training on, carrying out adult protective serv4 ices; 

5 ‘‘(D) conducts research related to the pro6 vision of adult protective services; and 

7 ‘‘(E) provides technical assistance to 

8 States and other entities that provide or fund 

9 the provision of adult protective services, in10 cluding through grants made under subsections 

11 (b) and (c). 

12 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated to carry out 

14 this subsection, $3,000,000 for fiscal year 2008 and 

15 $4,000,000 for each of fiscal years 2009 through 

16 2011. 

17 ‘‘(b) GRANTS TO ENHANCE THE PROVISION OF

18 ADULT PROTECTIVE SERVICES.— 

19 ‘‘(1) ESTABLISHMENT.—There is established an 

20 adult protective services grant program under which 

21 the Secretary shall annually award grants to States 

22 in the amounts calculated under paragraph (2) for 

23 the purposes of enhancing adult protective services 

24 provided by States and local units of government. 

25 ‘‘(2) AMOUNT OF PAYMENT.— 


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1 ‘‘(A) IN GENERAL.—Subject to the avail2 ability of appropriations and subparagraphs (B) 

3 and (C), the amount paid to a State for a fiscal 

4 year under the program under this subsection 

5 shall equal the amount appropriated for that 

6 year to carry out this subsection multiplied by 

7 the percentage of the total number of elders 

8 who reside in the United States who reside in 

9 that State. 

10 ‘‘(B) GUARANTEED MINIMUM PAYMENT

11 AMOUNT.— 

12 ‘‘(i) 50 STATES.—Subject to clause 

13 (ii), if the amount determined under sub14 paragraph (A) for a State for a fiscal year 

15 is less than 0.75 percent of the amount ap16 propriated for such year, the Secretary 

17 shall increase such determined amount so 

18 that the total amount paid under this sub19 section to the State for the year is equal 

20 to 0.75 percent of the amount so appro21 priated. 

22 ‘‘(ii) TERRITORIES.—In the case of a 

23 State other than 1 of the 50 States, clause 

24 (i) shall be applied as if each reference to 

25 ‘0.75’ were a reference to ‘0.1’. 


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1 ‘‘(C) PRO RATA REDUCTIONS.—The Sec2 retary shall make such pro rata reductions to 

3 the amounts described in subparagraph (A) as 

4 are necessary to comply with the requirements 

5 of subparagraph (B). 

6 ‘‘(3) AUTHORIZED ACTIVITIES.— 

7 ‘‘(A) ADULT PROTECTIVE SERVICES.— 

8 Funds made available pursuant to this sub9 section may only be used by States and local 

10 units of government to provide adult protective 

11 services and may not be used for any other pur12 pose. 

13 ‘‘(B) USE BY AGENCY.—Each State receiv14 ing funds pursuant to this subsection shall pro15 vide such funds to the agency or unit of State 

16 government having legal responsibility for pro17 viding adult protective services within the State. 

18 ‘‘(C) SUPPLEMENT NOT SUPPLANT.—Each 

19 State or local unit of government shall use 

20 funds made available pursuant to this sub21 section to supplement and not supplant other 

22 Federal, State, and local public funds expended 

23 to provide adult protective services in the State. 

24 ‘‘(4) STATE REPORTS.—Each State receiving 

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1 retary, at such time and in such manner as the Sec2 retary may require, a report on the number of elders 

3 served by the grants awarded under this subsection. 

4 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

5 There are authorized to be appropriated to carry out 

6 this subsection, $100,000,000 for each of fiscal 

7 years 2008 through 2011. 

8 ‘‘(c) STATE DEMONSTRATION PROGRAMS.— 

9 ‘‘(1) ESTABLISHMENT.—The Secretary shall 

10 award grants to States for the purposes of con11 ducting demonstration programs in accordance with 

12 paragraph (2). 

13 ‘‘(2) DEMONSTRATION PROGRAMS.—Funds 

14 made available pursuant to this subsection may be 

15 used by States and local units of government to con16 duct demonstration programs that test— 

17 ‘‘(A) training modules developed for the 

18 purpose of detecting or preventing elder abuse; 

19 ‘‘(B) methods to detect or prevent financial 

20 exploitation of elders; 

21 ‘‘(C) methods to detect elder abuse; 

22 ‘‘(D) whether training on elder abuse 

23 forensics enhances the detection of elder abuse 

24 by employees of the State or local unit of gov25 ernment; or 


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1 ‘‘(E) other matters relating to the detec2 tion or prevention of elder abuse. 

3 ‘‘(3) APPLICATION.—To be eligible to receive a 

4 grant under this subsection, a State shall submit an 

5 application to the Secretary at such time, in such 

6 manner, and containing such information as the Sec7 retary may require. 

8 ‘‘(4) STATE REPORTS.—Each State that re9 ceives funds under this subsection shall submit a re10 port to the Secretary at such time, in such manner, 

11 and containing such information as the Secretary 

12 may require on the results of the demonstration pro13 gram conducted by the State using funds made 

14 available under this subsection. 

15 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

16 There are authorized to be appropriated to carry out 

17 this subsection, $25,000,000 for each of fiscal years 

18 2008 through 2011. 

19 ‘‘SEC. 2043. LONG-TERM CARE OMBUDSMAN PROGRAM 

20 GRANTS AND TRAINING. 

21 ‘‘(a) GRANTS TO SUPPORT THE LONG-TERM CARE

22 OMBUDSMAN PROGRAM.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall make 

24 grants to eligible entities with relevant expertise and 

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1 cilities or long-term care ombudsman programs and 

2 responsibilities, for the purpose of— 

3 ‘‘(A) improving the capacity of State long4 term care ombudsman programs to respond to 

5 and resolve complaints about abuse and neglect; 

6 ‘‘(B) conducting pilot programs with State 

7 long-term care ombudsman offices or local om8 budsman entities; and 

9 ‘‘(C) providing support for such State 

10 long-term care ombudsman programs and such 

11 pilot programs (such as through the establish12 ment of a national long-term care ombudsman 

13 resource center). 

14 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

15 There are authorized to be appropriated to carry out 

16 this subsection— 

17 ‘‘(A) for fiscal year 2008, $5,000,000; 

18 ‘‘(B) for fiscal year 2009, $7,500,000; and 

19 ‘‘(C) for each of fiscal years 2010 and 

20 2011, $10,000,000. 

21 ‘‘(b) OMBUDSMAN TRAINING PROGRAMS.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall estab23 lish programs to provide and improve ombudsman 

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1 ploitation for national organizations and State long2 term care ombudsman programs. 

3 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

4 There are authorized to be appropriated to carry out 

5 this subsection, for each of fiscal years 2008 

6 through 2011, $10,000,000. 

7 ‘‘SEC. 2044. PROVISION OF INFORMATION REGARDING, AND 

8 EVALUATIONS OF, ELDER JUSTICE PRO9 GRAMS. 

10 ‘‘(a) PROVISION OF INFORMATION.—To be eligible to 

11 receive a grant under this part, an applicant shall agree— 

12 ‘‘(1) except as provided in paragraph (2), to 

13 provide the eligible entity conducting an evaluation 

14 under subsection (b) of the activities funded through 

15 the grant with such information as the eligible entity 

16 may require in order to conduct such evaluation; or 

17 ‘‘(2) in the case of an applicant for a grant 

18 under section 2041(b), to provide the Secretary with 

19 such information as the Secretary may require to 

20 conduct an evaluation or audit under subsection (c). 

21 ‘‘(b) USE OF ELIGIBLE ENTITIES TO CONDUCT

22 EVALUATIONS.— 

23 ‘‘(1) EVALUATIONS REQUIRED.—Except as pro24 vided in paragraph (2), the Secretary shall— 


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1 ‘‘(A) reserve a portion (not less than 2 per2 cent) of the funds appropriated with respect to 

3 each program carried out under this part; and 

4 ‘‘(B) use the funds reserved under sub5 paragraph (A) to provide assistance to eligible 

6 entities to conduct evaluations of the activities 

7 funded under each program carried out under 

8 this part. 

9 ‘‘(2) INFORMATICS SYSTEMS GRANT PROGRAM

10 NOT INCLUDED.—The provisions of this subsection 

11 shall not apply to the informatics systems grant pro12 gram under section 2041(b). 

13 ‘‘(3) AUTHORIZED ACTIVITIES.—A recipient of 

14 assistance described in paragraph (1)(B) shall use 

15 the funds made available through the assistance to 

16 conduct a validated evaluation of the effectiveness of 

17 the activities funded under a program carried out 

18 under this part. 

19 ‘‘(4) APPLICATIONS.—To be eligible to receive 

20 assistance under paragraph (1)(B), an entity shall 

21 submit an application to the Secretary at such time, 

22 in such manner, and containing such information as 

23 the Secretary may require, including a proposal for 

24 the evaluation. 


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1 ‘‘(5) REPORTS.—Not later than a date specified 

2 by the Secretary, an eligible entity receiving assist3 ance under paragraph (1)(B) shall submit to the 

4 Secretary, the Committee on Ways and Means and 

5 the Committee on Energy and Commerce of the 

6 House of Representatives, and the Committee on Fi7 nance of the Senate a report containing the results 

8 of the evaluation conducted using such assistance to9 gether with such recommendations as the entity de10 termines to be appropriate. 

11 ‘‘(c) EVALUATIONS AND AUDITS OF INFORMATICS

12 SYSTEMS GRANT PROGRAM BY THE SECRETARY.— 

13 ‘‘(1) EVALUATIONS.—The Secretary shall con14 duct an evaluation of the activities funded under the 

15 informatics systems grant program under section 

16 2041(b). Such evaluation shall include an evaluation 

17 of whether the funding provided under the grant is 

18 expended only for the purposes for which it is made. 

19 ‘‘(2) AUDITS.—The Secretary shall conduct ap20 propriate audits of grants made under section 

21 2041(b). 

22 ‘‘SEC. 2045. REPORT. 

23 ‘‘Not later than October 1, 2011, the Secretary shall 

24 submit to the Elder Justice Coordinating Council, the 

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1 ergy and Commerce of the House of Representatives, and 

2 the Committee on Finance of the Senate a report— 

3 ‘‘(1) compiling, summarizing, and analyzing the 

4 information contained in the State reports submitted 

5 under subsections (b)(4) and (c)(4) of section 2042; 

6 and 

7 ‘‘(2) containing such recommendations for legis8 lative or administrative action as the Secretary de9 termines to be appropriate.’’. 

10 (2) OPTION FOR STATE PLAN UNDER PROGRAM

11 FOR TEMPORARY ASSISTANCE FOR NEEDY FAMI12 LIES.— 

13 (A) IN GENERAL.—Section 402(a)(1)(B) of 

14 the Social Security Act (42 U.S.C. 

15 602(a)(1)(B)) is amended by adding at the end 

16 the following new clause: 

17 ‘‘(v) The document shall indicate 

18 whether the State intends to assist individ19 uals to train for, seek, and maintain em20 ployment— 

21 ‘‘(I) providing direct care in a 

22 long-term care facility (as such terms 

23 are defined under section 2011); or 

24 ‘‘(II) in other occupations related 

25 to elder care determined appropriate 


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1 by the State for which the State iden2 tifies an unmet need for service per3 sonnel, 

4 and, if so, shall include an overview of such 

5 assistance.’’. 

6 (B) EFFECTIVE DATE.—The amendment 

7 made by subparagraph (A) shall take effect on 

8 October 1, 2008. 

9 (b) PROTECTING RESIDENTS OF LONG-TERM CARE

10 FACILITIES.— 

11 (1) NATIONAL TRAINING INSTITUTE FOR SUR12 VEYORS.— 

13 (A) IN GENERAL.—The Secretary of 

14 Health and Human Services shall enter into a 

15 contract with an entity for the purpose of estab16 lishing and operating a National Training Insti17 tute for Federal and State surveyors. Such In18 stitute shall provide and improve the training of 

19 surveyors with respect to investigating allega20 tions of abuse, neglect, and misappropriation of 

21 property in programs and long-term care facili22 ties that receive payments under title XVIII or 

23 XIX of the Social Security Act. 

24 (B) ACTIVITIES CARRIED OUT BY THE IN25 STITUTE.—The contract entered into under 


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1 subparagraph (A) shall require the Institute es2 tablished and operated under such contract to 

3 carry out the following activities: 

4 (i) Assess the extent to which State 

5 agencies use specialized surveyors for the 

6 investigation of reported allegations of 

7 abuse, neglect, and misappropriation of 

8 property in such programs and long-term 

9 care facilities. 

10 (ii) Evaluate how the competencies of 

11 surveyors may be improved to more effec12 tively investigate reported allegations of 

13 such abuse, neglect, and misappropriation 

14 of property, and provide feedback to Fed15 eral and State agencies on the evaluations 

16 conducted. 

17 (iii) Provide a national program of 

18 training, tools, and technical assistance to 

19 Federal and State surveyors on inves20 tigating reports of such abuse, neglect, and 

21 misappropriation of property. 

22 (iv) Develop and disseminate informa23 tion on best practices for the investigation 

24 of such abuse, neglect, and misappropria25 tion of property. 


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1 (v) Assess the performance of State 

2 complaint intake systems, in order to en3 sure that the intake of complaints occurs 

4 24 hours per day, 7 days a week (including 

5 holidays). 

6 (vi) To the extent approved by the 

7 Secretary of Health and Human Services, 

8 provide a national 24 hours per day, 7 

9 days a week (including holidays), back-up 

10 system to State complaint intake systems 

11 in order to ensure optimum national re12 sponsiveness to complaints of such abuse, 

13 neglect, and misappropriation of property. 

14 (vii) Analyze and report annually on 

15 the following: 

16 (I) The total number and sources 

17 of complaints of such abuse, neglect, 

18 and misappropriation of property. 

19 (II) The extent to which such 

20 complaints are referred to law en21 forcement agencies. 

22 (III) General results of Federal 

23 and State investigations of such com24 plaints. 


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1 (viii) Conduct a national study of the 

2 cost to State agencies of conducting com3 plaint investigations of skilled nursing fa4 cilities and nursing facilities under sections 

5 1819 and 1919, respectively, of the Social 

6 Security Act (42 U.S.C. 1395i–3; 1396r), 

7 and making recommendations to the Sec8 retary of Health and Human Services with 

9 respect to options to increase the efficiency 

10 and cost-effectiveness of such investiga11 tions. 

12 (C) AUTHORIZATION.—There are author13 ized to be appropriated to carry out this para14 graph, for the period of fiscal years 2008 

15 through 2011, $12,000,000. 

16 (2) GRANTS TO STATE SURVEY AGENCIES.— 

17 (A) IN GENERAL.—The Secretary of 

18 Health and Human Services shall make grants 

19 to State agencies that perform surveys of 

20 skilled nursing facilities or nursing facilities 

21 under sections 1819 or 1919, respectively, of 

22 the Social Security Act (42 U.S.C. 1395i–3; 

23 1395r). 

24 (B) USE OF FUNDS.—A grant awarded 

25 under subparagraph (A) shall be used for the 


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1 purpose of designing and implementing com2 plaint investigations systems that— 

3 (i) promptly prioritize complaints in 

4 order to ensure a rapid response to the 

5 most serious and urgent complaints; 

6 (ii) respond to complaints with opti7 mum effectiveness and timeliness; and 

8 (iii) optimize the collaboration be9 tween local authorities, consumers, and 

10 providers, including— 

11 (I) such State agency; 

12 (II) the State Long-Term Care 

13 Ombudsman; 

14 (III) local law enforcement agen15 cies; 

16 (IV) advocacy and consumer or17 ganizations; 

18 (V) State aging units; 

19 (VI) Area Agencies on Aging; 

20 and 

21 (VII) other appropriate entities. 

22 (C) AUTHORIZATION.—There are author23 ized to be appropriated to carry out this para24 graph, for each of fiscal years 2008 through 

25 2011, $5,000,000. 


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1 (3) REPORTING OF CRIMES AND ENSURING

2 SAFETY OF RESIDENTS WHEN FEDERALLY FUNDED

3 LONG-TERM CARE FACILITIES CLOSE.—Part A of 

4 title XI of the Social Security Act (42 U.S.C. 1301 

5 et seq.) is amended by adding at the end the fol6 lowing new sections: 

7 ‘‘REPORTING TO LAW ENFORCEMENT OF CRIMES OCCUR8 RING IN FEDERALLY FUNDED LONG-TERM CARE FA9 CILITIES

10 ‘‘SEC. 1150A. (a) DETERMINATION AND NOTIFICA11 TION.— 

12 ‘‘(1) DETERMINATION.—The owner or operator 

13 of each long-term care facility that receives Federal 

14 funds under this Act shall annually determine 

15 whether the facility received at least $10,000 in such 

16 Federal funds during the preceding year. 

17 ‘‘(2) NOTIFICATION.—If the owner or operator 

18 determines under paragraph (1) that the facility re19 ceived at least $10,000 in such Federal funds during 

20 the preceding year, such owner or operator shall an21 nually notify each covered individual (as defined in 

22 paragraph (3)) of that individual’s obligation to 

23 comply with the reporting requirements described in 

24 subsection (b). 

25 ‘‘(3) COVERED INDIVIDUAL DEFINED.—In this 

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1 dividual who is an owner, operator, employee, man2 ager, agent, or contractor of a long-term care facility 

3 that is the subject of a determination described in 

4 paragraph (1). 

5 ‘‘(b) REPORTING REQUIREMENTS.— 

6 ‘‘(1) IN GENERAL.—Each covered individual 

7 shall report to the Secretary and 1 or more law en8 forcement entities for the political subdivision in 

9 which the facility is located any reasonable suspicion 

10 of a crime (as defined by the law of the applicable 

11 political subdivision) against any individual who is a 

12 resident of, or is receiving care from, the facility. 

13 ‘‘(2) TIMING.—If the events that cause the sus14 picion— 

15 ‘‘(A) result in serious bodily injury, the in16 dividual shall report the suspicion immediately, 

17 but not later than 2 hours after forming the 

18 suspicion; and 

19 ‘‘(B) do not result in serious bodily injury, 

20 the individual shall report the suspicion not 

21 later than 24 hours after forming the suspicion. 

22 ‘‘(c) PENALTIES.— 

23 ‘‘(1) IN GENERAL.—If a covered individual vio24 lates subsection (b)— 


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1 ‘‘(A) the covered individual shall be subject 

2 to a civil money penalty of not more than 

3 $200,000; or 

4 ‘‘(B) the Secretary shall classify the cov5 ered individual as an excluded individual, for a 

6 period of not more than 3 years. 

7 ‘‘(2) INCREASED HARM.—If a covered indi8 vidual violates subsection (b) and the violation exac9 erbates the harm to the victim of the crime or re10 sults in harm to another individual— 

11 ‘‘(A) the covered individual shall be subject 

12 to a civil money penalty of not more than 

13 $300,000; and 

14 ‘‘(B) the Secretary shall classify the cov15 ered individual as an excluded individual, for a 

16 period of not more than 3 years. 

17 ‘‘(3) EXCLUDED INDIVIDUAL.—During any pe18 riod for which a covered individual is classified as an 

19 excluded individual under paragraph (1)(B) or 

20 (2)(B), a long-term care facility that employs such 

21 individual shall be ineligible to receive Federal funds 

22 under this Act. 

23 ‘‘(4) EXTENUATING CIRCUMSTANCES.— 

24 ‘‘(A) IN GENERAL.—The Secretary may 

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1 viders with underserved populations in deter2 mining any penalty to be imposed under this 

3 subsection. 

4 ‘‘(B) UNDERSERVED POPULATION DE5 FINED.—In this paragraph, the term ‘under6 served population’ means the population of an 

7 area designated by the Secretary as an area 

8 with a shortage of elder justice programs or a 

9 population group designated by the Secretary 

10 as having a shortage of such programs. Such 

11 areas or groups designated by the Secretary 

12 may include— 

13 ‘‘(i) areas or groups that are geo14 graphically isolated (such as isolated in a 

15 rural area); 

16 ‘‘(ii) racial and ethnic minority popu17 lations; and 

18 ‘‘(iii) populations underserved because 

19 of special needs (such as language barriers, 

20 disabilities, alien status, or age). 

21 ‘‘(d) ADDITIONAL PENALTIES FOR RETALIATION.— 

22 ‘‘(1) IN GENERAL.—A long-term care facility 

23 may not— 

24 ‘‘(A) discharge, demote, suspend, threaten, 

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1 ment-related benefit to an employee, or in any 

2 other manner discriminate against an employee 

3 in the terms and conditions of employment be4 cause of lawful acts done by the employee; or 

5 ‘‘(B) file a complaint or a report against a 

6 nurse or other employee with the appropriate 

7 State professional disciplinary agency because 

8 of lawful acts done by the nurse or employee, 

9 for making a report, causing a report to be made, 

10 or for taking steps in furtherance of making a report 

11 pursuant to subsection (b)(1). 

12 ‘‘(2) PENALTIES FOR RETALIATION.—If a long13 term care facility violates subparagraph (A) or (B) 

14 of paragraph (1) the facility shall be subject to a 

15 civil money penalty of not more than $200,000 or 

16 the Secretary may classify the entity as an excluded 

17 entity for a period of 2 years pursuant to section 

18 1128(b), or both. 

19 ‘‘(3) REQUIREMENT TO POST NOTICE.—Each 

20 long-term care facility shall post conspicuously in an 

21 appropriate location a sign (in a form specified by 

22 the Secretary) specifying the rights of employees 

23 under this section. Such sign shall include a state24 ment that an employee may file a complaint with the 

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1 lates the provisions of this subsection and informa2 tion with respect to the manner of filing such a com3 plaint. 

4 ‘‘(e) PROCEDURE.—The provisions of section 1128A 

5 (other than subsections (a) and (b) and the second sen6 tence of subsection (f)) shall apply to a civil money penalty 

7 under this section in the same manner as such provisions 

8 apply to a penalty or proceeding under section 1128A(a). 

9 ‘‘(f) DEFINITIONS.—In this section, the terms ‘elder 

10 justice’, ‘long-term care facility’, and ‘law enforcement’ 

11 have the meanings given those terms in section 2011. 

12 ‘‘ENSURING SAFETY OF RESIDENTS WHEN FEDERALLY

13 FUNDED LONG-TERM CARE FACILITIES CLOSE

14 ‘‘SEC. 1150B. (a) IN GENERAL.— 

15 ‘‘(1) NOTIFICATION OF FACILITY CLOSURE.— 

16 Subject to paragraph (2), if the owner or operator 

17 determines under section 1150A(a)(1) that a long18 term care facility received at least $10,000 in Fed19 eral funds under this Act during the preceding year, 

20 the owner or operator of the facility shall— 

21 ‘‘(A) submit to the Secretary and the ap22 propriate State regulatory agency written notifi23 cation of an impending closure not later than 

24 the date that is 60 days prior to the date of 

25 such closure; 


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1 ‘‘(B) include in the notice a plan for the 

2 transfer and adequate relocation of the resi3 dents of the facility prior to closure, including 

4 assurances that the residents will be transferred 

5 to the most appropriate facility in terms of 

6 quality, services, and location; and 

7 ‘‘(C) not later than 10 days after the facil8 ity closure, submit to the Secretary and the ap9 propriate State agency information identifying 

10 where residents of the closed facility were trans11 ferred and on what date. 

12 ‘‘(2) EXCEPTION WHERE THE SECRETARY HAS

13 ISSUED A TERMINATION NOTICE.—In the case of a 

14 long-term care facility described in paragraph (1) for 

15 which the Secretary has issued a termination notice 

16 for the facility to close by not later than 15 days 

17 after the issuance of such notice, the Secretary shall 

18 establish requirements for the notification, transfer, 

19 and adequate relocation of residents within an ap20 propriate timeframe. 

21 ‘‘(b) SANCTIONS.—Any person owning or operating 

22 a long-term care facility that fails to comply with the re23 quirements of subsection (a) shall be subject to— 

24 ‘‘(1) a civil monetary penalty of up to 

25 $1,000,000; 


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1 ‘‘(2) exclusion from participation in the pro2 grams under this Act (in accordance with the proce3 dures of section 1128); and 

4 ‘‘(3) any other applicable civil monetary pen5 alties and assessments. 

6 ‘‘(c) PROCEDURE.—The provisions of section 1128A 

7 (other than subsections (a) and (b) and the second sen8 tence of subsection (f)) shall apply to a civil money penalty 

9 or assessment under this section in the same manner as 

10 such provisions apply to a penalty or proceeding under 

11 section 1128A(a). 

12 ‘‘(d) DEFINITION.—In this section, the term ‘long13 term care facility’ has the meaning given that term in sec14 tion 2011.’’. 

15 (4) REPORT TO CONGRESS ON PILOT PROGRAM

16 FOR NATIONAL AND STATE BACKGROUND CHECKS

17 ON DIRECT PATIENT ACCESS EMPLOYEES OF LONG18 TERM CARE FACILITIES OR PROVIDERS.—Not later 

19 than the date that is 6 months after the completion 

20 of the pilot program for national and State back21 ground checks on direct patient access employees of 

22 long-term care facilities or providers established 

23 under section 307 of the Medicare Prescription 

24 Drug, Improvement, and Modernization Act of 2003 

25 (42 U.S.C. 1395aa note), the Secretary shall submit 


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1 to the Committee on Finance of the Senate and the 

2 Committee on Ways and Means and the Committee 

3 on Energy and Commerce of the House of Rep4 resentatives a report containing the results of the 

5 evaluation required under subsection (e) of such sec6 tion of such Act, together with recommendations for 

7 such legislation and administrative action as the 

8 Secretary determines appropriate. 

9 (c) NATIONAL NURSE AIDE REGISTRY.— 

10 (1) DEFINITION OF NURSE AIDE.—In this sub11 section, the term ‘‘nurse aide’’ has the meaning 

12 given that term in sections 1819(b)(5)(F) and 

13 1919(b)(5)(F) of the Social Security Act (42 U.S.C. 

14 1395i–3(b)(5)(F); 1396r(b)(5)(F)). 

15 (2) STUDY AND REPORT.— 

16 (A) IN GENERAL.—The Secretary, in con17 sultation with appropriate government agencies 

18 and private sector organizations, shall conduct 

19 a study on establishing a national nurse aide 

20 registry. 

21 (B) AREAS EVALUATED.—The study con22 ducted under this subsection shall include an 

23 evaluation of— 

24 (i) who should be included in the reg25 istry; 


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1 (ii) how such a registry would comply 

2 with Federal and State privacy laws and 

3 regulations; 

4 (iii) how data would be collected for 

5 the registry; 

6 (iv) what entities and individuals 

7 would have access to the data collected; 

8 (v) how the registry would provide ap9 propriate information regarding violations 

10 of Federal and State law by individuals in11 cluded in the registry; 

12 (vi) how the functions of a national 

13 nurse aide registry would be coordinated 

14 with the pilot program for national and 

15 State background checks on direct patient 

16 access employees of long-term care facili17 ties or providers established under section 

18 307 of the Medicare Prescription Drug, 

19 Improvement, and Modernization Act of 

20 2003 (Public Law 108–173); and 

21 (vii) how the information included in 

22 State nurse aide registries developed and 

23 maintained under sections 1819(e)(2) and 

24 1919(e)(2) of the Social Security Act (42 

25 U.S.C. 1395i–3(e)(2); 1396r(e)(2)(2)) 


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1 would be provided as part of a national 

2 nurse aide registry. 

3 (C) CONSIDERATIONS.—In conducting the 

4 study and preparing the report required under 

5 this subsection, the Secretary shall take into 

6 consideration the findings and conclusions of 

7 relevant reports and other relevant resources, 

8 including the following: 

9 (i) The Department of Health and 

10 Human Services Office of Inspector Gen11 eral Report, Nurse Aide Registries: State 

12 Compliance and Practices (February 

13 2005). 

14 (ii) The General Accounting Office 

15 (now known as the Government Account16 ability Office) Report, Nursing Homes: 

17 More Can Be Done to Protect Residents 

18 from Abuse (March 2002). 

19 (iii) The Department of Health and 

20 Human Services Office of the Inspector 

21 General Report, Nurse Aide Registries: 

22 Long-Term Care Facility Compliance and 

23 Practices (July 2005). 

24 (iv) The Department of Health and 

25 Human Services Health Resources and 


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1 Services Administration Report, Nursing 

2 Aides, Home Health Aides, and Related 

3 Health Care Occupations—National and 

4 Local Workforce Shortages and Associated 

5 Data Needs (2004)(in particular with re6 spect to chapter 7 and appendix F). 

7 (v) The 2001 Report to CMS from 

8 the School of Rural Public Health, Texas 

9 A&M University, Preventing Abuse and 

10 Neglect in Nursing Homes: The Role of 

11 Nurse Aide Registries. 

12 (vi) Information included in State 

13 nurse aide registries developed and main14 tained under sections 1819(e)(2) and 

15 1919(e)(2) of the Social Security Act (42 

16 U.S.C. 1395i–3(e)(2); 1396r(e)(2)(2)). 

17 (D) REPORT.—Not later than 18 months 

18 after the date of enactment of this Act, the Sec19 retary shall submit a report to the Elder Jus20 tice Coordinating Council, the Committee on 

21 Finance of the Senate, and the Committee on 

22 Ways and Means and the Committee on Energy 

23 and Commerce of the House of Representatives 

24 containing the findings and recommendations of 

25 the study conducted under this paragraph. 


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1 (E) FUNDING LIMITATION.—Funding for 

2 the study conducted under this subsection shall 

3 not exceed $500,000. 

4 (3) CONGRESSIONAL ACTION.—After receiving 

5 the report submitted by the Secretary under para6 graph (2)(D), the Committee on Finance of the Sen7 ate and the Committee on Ways and Means and the 

8 Committee on Energy and Commerce of the House 

9 of Representatives shall, as they deem appropriate, 

10 take action based on the recommendations contained 

11 in the report. 

12 (4) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated such sums 

14 as are necessary for the purpose of carrying out this 

15 subsection. 

16 (d) CONFORMING AMENDMENTS.— 

17 (1) TITLE XX.—Title XX of the Social Security 

18 Act (42 U.S.C. 1397 et seq.), as amended by section 

19 5(a), is amended— 

20 (A) in the heading of section 2001, by 

21 striking ‘‘TITLE’’ and inserting ‘‘SUBTITLE’’; 

22 and 

23 (B) in subtitle 1, by striking ‘‘this title’’ 

24 each place it appears and inserting ‘‘this sub25 title’’. 


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1 (2) TITLE IV.—Title IV of the Social Security 

2 Act (42 U.S.C. 601 et seq.) is amended— 

3 (A) in section 404(d)— 

4 (i) in paragraphs (1)(A), (2)(A), and 

5 (3)(B), by inserting ‘‘subtitle 1 of’’ before 

6 ‘‘title XX’’ each place it appears; 

7 (ii) in the heading of paragraph (2), 

8 by inserting ‘‘SUBTITLE OF’’ before ‘‘TITLE

9 XX’’; and 

10 (iii) in the heading of paragraph 

11 (3)(B), by inserting ‘‘SUBTITLE OF’’ before 

12 ‘‘TITLE XX’’; and 

13 (B) in sections 422(b), 471(a)(4), 

14 472(h)(1), and 473(b)(2), by inserting ‘‘subtitle 

15 1 of’’ before ‘‘title XX’’ each place it appears. 

16 (3) TITLE XI.—Title XI of the Social Security 

17 Act (42 U.S.C. 1301 et seq.) is amended— 

18 (A) in section 1128(h)(3)— 

19 (i) by inserting ‘‘subtitle 1 of’’ before 

20 ‘‘title XX’’; and 

21 (ii) by striking ‘‘such title’’ and in22 serting ‘‘such subtitle’’; and 

23 (B) in section 1128A(i)(1), by inserting 

24 ‘‘subtitle 1 of’’ before ‘‘title XX’’. 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Elder Justice Act of 2008’’. 

4 (b) TABLE OF CONTENTS.—The table of contents of this 

5 Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Purposes. 

Sec. 4. Definitions. 

Sec. 5. Elder Justice. 

‘‘Subtitle 2—Elder Justice 

‘‘Sec. 2011. Definitions. 

‘‘Sec. 2012. General provisions. 

‘‘PART A—NATIONAL COORDINATION OF ELDER JUSTICE ACTIVITIES AND

RESEARCH

‘‘SUBPART 1—ELDER JUSTICE COORDINATING COUNCIL AND ADVISORY BOARD

ON ELDER ABUSE, NEGLECT, AND EXPLOITATION

‘‘Sec. 2021. Elder Justice Coordinating Council. 

‘‘Sec. 2022. Advisory Board on Elder Abuse, Neglect, and Exploitation. 

‘‘Sec. 2023. Research protections. 

‘‘Sec. 2024. Authorization of appropriations. 

‘‘SUBPART 2—ELDER ABUSE, NEGLECT, AND EXPLOITATION FORENSIC CENTERS

‘‘Sec. 2031. Establishment and support of elder abuse, neglect, and Exploitation forensic Centers. 

‘‘PART B—PROGRAMS TO PROMOTE ELDER JUSTICE

‘‘Sec. 2041. Enhancement of long-term care. 

‘‘Sec. 2042. Adult protective services functions and grant programs. 

‘‘Sec. 2043. Long-term care ombudsman program grants and training. 

‘‘Sec. 2044. Provision of information regarding, and evaluations of, elder 

justice programs. 

‘‘Sec. 2045. Report. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) The proportion of the United States popu9 lation age 60 years or older will drastically increase 


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1 in the next 30 years as more than 76,000,000 baby 

2 boomers approach retirement and old age. 

3 (2) Each year, anywhere between 500,000 and 

4 5,000,000 elders in the United States are abused, ne5 glected, or exploited. 

6 (3) Elder abuse, neglect, and exploitation have 

7 no boundaries, and cross all racial, social class, gen8 der, and geographic lines. 

9 (4) Victims of elder abuse, neglect, and exploi10 tation are not only subject to injury from mistreat11 ment and neglect, they are also 3.1 times more likely 

12 than elders who were not victims of elder abuse, ne13 glect, and exploitation to die at an earlier age than 

14 expected. 

15 (5) There is a general dearth of data as to the 

16 nature and scope of elder abuse, neglect, and exploi17 tation. In recognition of the need to improve data col18 lection efforts with respect to elder abuse, neglect, and 

19 exploitation, Congress required the Secretary of 

20 Health and Human Services to conduct a study by 

21 the end of 2008 on establishing a uniform national 

22 database on elder abuse under section 405 of title IV 

23 of Division C of the Tax Relief and Health Care Act 

24 of 2006 (Public Law 109–432). 


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1 (6) Despite the dearth of data in the field, ex2 perts agree that most cases of elder abuse, neglect, and 

3 exploitation are never reported and that abuse, ne4 glect, and exploitation shorten a victim’s life, often 

5 triggering a downward spiral of an otherwise produc6 tive, self-sufficient elder’s life. Programs addressing 

7 other difficult issues such as domestic violence and 

8 child abuse and neglect have demonstrated the need 

9 for a multifaceted law, combining public health, so10 cial service, and law enforcement approaches. 

11 (7) For over 20 years, Congress has been pre12 sented with facts and testimony calling for a coordi13 nated Federal effort to combat elder abuse, neglect, 

14 and exploitation. 

15 (8) The Federal Government has been slow to re16 spond to the needs of victims of elder abuse, neglect, 

17 and exploitation or to undertake prevention efforts. 

18 (9) No Federal law has been enacted that ade19 quately and comprehensively addresses the issues of 

20 elder abuse, neglect, and exploitation and there are 

21 very limited resources available to those in the field 

22 that directly deal with the issues. 

23 (10) Differences in State laws and practices in 

24 the areas of elder abuse, neglect, and exploitation lead 

25 to significant disparities in prevention, protective 


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1 and social services, treatment systems, and law en2 forcement, and lead to other inequities. 

3 (11) The Federal Government has played an im4 portant role in promoting research, training, public 

5 safety, and data collection, and the identification, de6 velopment, and dissemination of promising health 

7 care, social, and protective services, and law enforce8 ment practices, relating to child abuse and neglect, 

9 domestic violence, and violence against women. The 

10 Federal Government should promote similar efforts 

11 and protections relating to elder abuse, neglect, and 

12 exploitation. 

13 (12) The Federal Government should provide 

14 leadership and assist States and communities in their 

15 efforts to protect elders in the United States by— 

16 (A) promoting coordinated planning among 

17 all levels of government; 

18 (B) generating and sharing knowledge rel19 evant to protecting elders; 

20 (C) providing leadership to combat the 

21 abuse, neglect, and exploitation of the Nation’s 

22 elders; and 

23 (D) providing resources to States and com24 munities to promote elder justice. 


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1 (13) The problem of elder abuse, neglect, and ex2 ploitation requires a comprehensive approach that— 

3 (A) integrates the work of health, legal, and 

4 social service agencies and organizations; 

5 (B) emphasizes the need for prevention, re6 porting, investigation, assessment, treatment, 

7 and prosecution of elder abuse, neglect, and ex8 ploitation at all levels of government; 

9 (C) ensures that sufficient numbers of prop10 erly trained personnel with specialized knowledge 

11 are in place to— 

12 (i) treat, assess, and provide services 

13 relating to elder abuse, neglect, and exploi14 tation; and 

15 (ii) carry out elder protection duties; 

16 (D) is sensitive to ethnic and cultural diver17 sity; 

18 (E) recognizes the role of mental health, dis19 ability, dementia, substance abuse, medication 

20 mismanagement, and family dysfunction prob21 lems in increasing and exacerbating elder abuse, 

22 neglect, and exploitation; and 

23 (F) balances elders’ right to self-determina24 tion with society’s responsibility to protect el25 ders. 


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1 (14) The human, social, and economic cost of 

2 elder abuse, neglect, and exploitation is high and in3 cludes unnecessary expenditures of funds from many 

4 public programs. 

5 (15) The failure to coordinate activities relating 

6 to, and comprehensively prevent and treat, elder 

7 abuse, neglect, and exploitation threatens the future 

8 and well-being of millions of elders in the United 

9 States. 

10 (16) All elements of society in the United States 

11 have a shared responsibility in responding to a na12 tional problem of elder abuse, neglect, and exploi13 tation. 

14 SEC. 3. PURPOSES. 

15 The purposes of this Act are as follows: 

16 (1) To enhance the social security of the Nation 

17 by ensuring adequate public-private infrastructure 

18 and resolving to prevent, detect, treat, understand, 

19 and intervene in, and where appropriate, aid in the 

20 prosecution of, elder abuse, neglect, and exploitation. 

21 (2) To bring a comprehensive approach to pre22 venting and combating elder abuse, neglect, and ex23 ploitation, a long invisible problem that afflicts the 

24 most vulnerable among the aging population of the 

25 United States. 


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1 (3) To raise the issue of elder abuse, neglect, and 

2 exploitation to national attention, and to create the 

3 infrastructure at the Federal, State, and local levels, 

4 to ensure that individuals and organizations on the 

5 front lines, who are fighting elder abuse, neglect, and 

6 exploitation with scarce resources and fragmented sys7 tems, have the resources and information needed to 

8 carry out their fight. 

9 (4) To bring a comprehensive multidisciplinary 

10 approach to elder justice. 

11 (5) To set in motion research and data collection 

12 to fill gaps in knowledge about elder abuse, neglect, 

13 and exploitation. 

14 (6) To supplement the activities of service pro15 viders and programs, to enhance training, and to le16 verage scarce resources efficiently, in order to ensure 

17 that elder justice receives the attention it deserves as 

18 the Nation’s population ages. 

19 (7) To recognize and address the role of mental 

20 health, disability, dementia, substance abuse, medica21 tion mismanagement, and family dysfunction prob22 lems in increasing and exacerbating elder abuse, ne23 glect, and exploitation. 

24 (8) To create short- and long-term strategic 

25 plans for the development and coordination of elder 


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1 justice research, programs, studies, training, and 

2 other efforts nationwide. 

3 (9) To promote collaborative efforts and dimin4 ish overlap and gaps in efforts in developing the im5 portant field of elder justice. 

6 (10) To honor and respect the right of all indi7 viduals with diminished capacity to decisionmaking 

8 autonomy, self-determination, and dignity of choice. 

9 (11) To respect the wishes of individuals with di10 minished capacity and their family members in pro11 viding supportive services and care plans intended to 

12 protect elders from abuse, neglect (including self-ne13 glect), and exploitation. 

14 SEC. 4. DEFINITIONS. 

15 Except as otherwise specifically provided, any term 

16 that is defined in section 2011 of the Social Security Act 

17 (as added by section 5(a)) and is used in this Act has the 

18 meaning given such term by such section. 

19 SEC. 5. ELDER JUSTICE. 

20 (a) ELDER JUSTICE.— 

21 (1) IN GENERAL.—Title XX of the Social Secu22 rity Act (42 U.S.C. 1397 et seq.) is amended— 

23 (A) in the heading, by inserting ‘‘AND 

24 ELDER JUSTICE’’ after ‘‘SOCIAL 

25 SERVICES’’; 


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1 (B) by inserting before section 2001 the fol2 lowing: 

3 ‘‘Subtitle 1—Block Grants to States 

4 for Social Services’’; 

5 and 

6 (C) by adding at the end the following: 

7 ‘‘Subtitle 2—Elder Justice 

8 ‘‘SEC. 2011. DEFINITIONS. 

9 ‘‘In this subtitle: 

10 ‘‘(1) ABUSE.—The term ‘abuse’ means the know11 ing infliction of physical or psychological harm or the 

12 knowing deprivation of goods or services that are nec13 essary to meet essential needs or to avoid physical or 

14 psychological harm. 

15 ‘‘(2) ADULT PROTECTIVE SERVICES.—The term 

16 ‘adult protective services’ means such services pro17 vided to adults as the Secretary may specify and in18 cludes services such as— 

19 ‘‘(A) disseminating reports of adult abuse, 

20 neglect, or exploitation; 

21 ‘‘(B) investigating the reports described in 

22 subparagraph (A); 

23 ‘‘(C) case planning, monitoring, evaluation, 

24 and other case work and services; and 


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1 ‘‘(D) providing, arranging for, or facili2 tating the provision of medical, social service, 

3 economic, legal, housing, law enforcement, or 

4 other protective, emergency, or support services. 

5 ‘‘(3) CAREGIVER.—The term ‘caregiver’ means 

6 an individual who has the responsibility for the care 

7 of an elder, either voluntarily, by contract, by receipt 

8 of payment for care, or as a result of the operation 

9 of law, and means a family member or other indi10 vidual who provides (on behalf of such individual or 

11 of a public or private agency, organization, or insti12 tution) compensated or uncompensated care to an 

13 elder who needs supportive services in any setting. 

14 ‘‘(4) DIRECT CARE.—The term ‘direct care’ 

15 means care by an employee or contractor who pro16 vides assistance or long-term care services to a recipi17 ent. 

18 ‘‘(5) ELDER.—The term ‘elder’ means an indi19 vidual age 60 or older. 

20 ‘‘(6) ELDER JUSTICE.—The term ‘elder justice’ 

21 means— 

22 ‘‘(A) from a societal perspective, efforts to— 

23 ‘‘(i) prevent, detect, treat, intervene in, 

24 and prosecute elder abuse, neglect, and ex25 ploitation; and 


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1 ‘‘(ii) protect elders with diminished ca2 pacity while maximizing their autonomy; 

3 and 

4 ‘‘(B) from an individual perspective, the 

5 recognition of an elder’s rights, including the 

6 right to be free of abuse, neglect, and exploi7 tation. 

8 ‘‘(7) ELIGIBLE ENTITY.—The term ‘eligible enti9 ty’ means a State or local government agency, Indian 

10 tribe or tribal organization, or any other public or 

11 private entity that is engaged in and has expertise in 

12 issues relating to elder justice or in a field necessary 

13 to promote elder justice efforts. 

14 ‘‘(8) EXPLOITATION.—The term ‘exploitation’ 

15 means the fraudulent or otherwise illegal, unauthor16 ized, or improper act or process of an individual, in17 cluding a caregiver or fiduciary, that uses the re18 sources of an elder for monetary or personal benefit, 

19 profit, or gain, or that results in depriving an elder 

20 of rightful access to, or use of, benefits, resources, be21 longings, or assets. 

22 ‘‘(9) FIDUCIARY.—The term ‘fiduciary’— 

23 ‘‘(A) means a person or entity with the 

24 legal responsibility— 


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1 ‘‘(i) to make decisions on behalf of and 

2 for the benefit of another person; and 

3 ‘‘(ii) to act in good faith and with 

4 fairness; and 

5 ‘‘(B) includes a trustee, a guardian, a con6 servator, an executor, an agent under a financial 

7 power of attorney or health care power of attor8 ney, or a representative payee. 

9 ‘‘(10) GRANT.—The term ‘grant’ includes a con10 tract, cooperative agreement, or other mechanism for 

11 providing financial assistance. 

12 ‘‘(11) GUARDIANSHIP.—The term ‘guardianship’ 

13 means— 

14 ‘‘(A) the process by which a State court de15 termines that an adult individual lacks capacity 

16 to make decisions about self-care and property, 

17 and appoints another individual or entity 

18 known as a guardian, as a conservator, or by a 

19 similar term, as a surrogate decisionmaker; 

20 ‘‘(B) the manner in which the court-ap21 pointed surrogate decisionmaker carries out du22 ties to the individual and the court; or 

23 ‘‘(C) the manner in which the court exer24 cises oversight of the surrogate decisionmaker. 

25 ‘‘(12) INDIAN TRIBE.— 


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1 ‘‘(A) IN GENERAL.—The term ‘Indian tribe’ 

2 has the meaning given such term in section 4 of 

3 the Indian Self-Determination and Education 

4 Assistance Act (25 U.S.C. 450b). 

5 ‘‘(B) INCLUSION OF PUEBLO AND

6 RANCHERIA.—The term ‘Indian tribe’ includes 

7 any Pueblo or Rancheria. 

8 ‘‘(13) LAW ENFORCEMENT.—The term ‘law en9 forcement’ means the full range of potential respond10 ers to elder abuse, neglect, and exploitation includ11 ing— 

12 ‘‘(A) police, sheriffs, detectives, public safety 

13 officers, and corrections personnel; 

14 ‘‘(B) prosecutors; 

15 ‘‘(C) medical examiners; 

16 ‘‘(D) investigators; and 

17 ‘‘(E) coroners. 

18 ‘‘(14) LONG-TERM CARE.— 

19 ‘‘(A) IN GENERAL.—The term ‘long-term 

20 care’ means supportive and health services speci21 fied by the Secretary for individuals who need 

22 assistance because the individuals have a loss of 

23 capacity for self-care due to illness, disability, or 

24 vulnerability. 


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1 ‘‘(B) LOSS OF CAPACITY FOR SELF-CARE.— 

2 For purposes of subparagraph (A), the term ‘loss 

3 of capacity for self-care’ means an inability to 

4 engage in 1 or more activities of daily living, in5 cluding eating, dressing, bathing, and manage6 ment of one’s financial affairs. 

7 ‘‘(15) LONG-TERM CARE FACILITY.—The term 

8 ‘long-term care facility’ means a residential care pro9 vider that arranges for, or directly provides, long10 term care. 

11 ‘‘(16) NEGLECT.—The term ‘neglect’ means— 

12 ‘‘(A) the failure of a caregiver or fiduciary 

13 to provide the goods or services that are nec14 essary to maintain the health or safety of an 

15 elder; or 

16 ‘‘(B) self-neglect. 

17 ‘‘(17) NURSING FACILITY.— 

18 ‘‘(A) IN GENERAL.—The term ‘nursing fa19 cility’ has the meaning given such term under 

20 section 1919(a). 

21 ‘‘(B) INCLUSION OF SKILLED NURSING FA22 CILITY.—The term ‘nursing facility’ includes a 

23 skilled nursing facility (as defined in section 

24 1819(a)). 


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1 ‘‘(18) SELF-NEGLECT.—The term ‘self-neglect’ 

2 means an adult’s inability, due to physical or mental 

3 impairment or diminished capacity, to perform essen4 tial self-care tasks including— 

5 ‘‘(A) obtaining essential food, clothing, shel6 ter, and medical care; 

7 ‘‘(B) obtaining goods and services necessary 

8 to maintain physical health, mental health, or 

9 general safety; or 

10 ‘‘(C) managing one’s own financial affairs. 

11 ‘‘(19) SERIOUS BODILY INJURY.— 

12 ‘‘(A) IN GENERAL.—The term ‘serious bod13 ily injury’ means an injury— 

14 ‘‘(i) involving extreme physical pain; 

15 ‘‘(ii) involving substantial risk of 

16 death; 

17 ‘‘(iii) involving protracted loss or im18 pairment of the function of a bodily mem19 ber, organ, or mental faculty; or 

20 ‘‘(iv) requiring medical intervention 

21 such as surgery, hospitalization, or physical 

22 rehabilitation. 

23 ‘‘(B) CRIMINAL SEXUAL ABUSE.—Serious 

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1 duct described in section 2241 (relating to aggra2 vated sexual abuse) or 2242 (relating to sexual 

3 abuse) of title 18, United States Code, or any 

4 similar offense under State law. 

5 ‘‘(20) SOCIAL.—The term ‘social’, when used 

6 with respect to a service, includes adult protective 

7 services. 

8 ‘‘(21) STATE LEGAL ASSISTANCE DEVELOPER.— 

9 The term ‘State legal assistance developer’ means an 

10 individual described in section 731 of the Older 

11 Americans Act of 1965. 

12 ‘‘(22) STATE LONG-TERM CARE OMBUDSMAN.— 

13 The term ‘State Long-Term Care Ombudsman’ means 

14 the State Long-Term Care Ombudsman described in 

15 section 712(a)(2) of the Older Americans Act of 1965. 

16 ‘‘SEC. 2012. GENERAL PROVISIONS. 

17 ‘‘(a) PROTECTION OF PRIVACY.—In pursuing activi18 ties under this subtitle, the Secretary shall ensure the pro19 tection of individual health privacy consistent with the reg20 ulations promulgated under section 264(c) of the Health In21 surance Portability and Accountability Act of 1996 and ap22 plicable State and local privacy regulations. 

23 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sub24 title shall be construed to interfere with or abridge an elder’s 


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1 right to practice his or her religion through reliance on 

2 prayer alone for healing when this choice— 

3 ‘‘(1) is contemporaneously expressed, either oral4 ly or in writing, with respect to a specific illness or 

5 injury which the elder has at the time of the decision 

6 by an elder who is competent at the time of the deci7 sion; 

8 ‘‘(2) is previously set forth in a living will, 

9 health care proxy, or other advance directive docu10 ment that is validly executed and applied under State 

11 law; or 

12 ‘‘(3) may be unambiguously deduced from the el13 der’s life history. 

14 ‘‘PART A—NATIONAL COORDINATION OF ELDER 

15 JUSTICE ACTIVITIES AND RESEARCH 

16 ‘‘Subpart 1—Elder Justice Coordinating Council and 

17 Advisory Board on Elder Abuse, Neglect, and Ex18 ploitation 

19 ‘‘SEC. 2021. ELDER JUSTICE COORDINATING COUNCIL. 

20 ‘‘(a) ESTABLISHMENT.—There is established within 

21 the Office of the Secretary an Elder Justice Coordinating 

22 Council (in this section referred to as the ‘Council’). 

23 ‘‘(b) MEMBERSHIP.— 

24 ‘‘(1) IN GENERAL.—The Council shall be com25 posed of the following members: 


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1 ‘‘(A) The Secretary (or the Secretary’s des2 ignee). 

3 ‘‘(B) The Attorney General (or the Attorney 

4 General’s designee). 

5 ‘‘(C) The head of each Federal department 

6 or agency or other governmental entity identified 

7 by the Chair referred to in subsection (d) as hav8 ing responsibilities, or administering programs, 

9 relating to elder abuse, neglect, and exploitation. 

10 ‘‘(2) REQUIREMENT.—Each member of the Coun11 cil shall be an officer or employee of the Federal Gov12 ernment. 

13 ‘‘(c) VACANCIES.—Any vacancy in the Council shall 

14 not affect its powers, but shall be filled in the same manner 

15 as the original appointment was made. 

16 ‘‘(d) CHAIR.—The member described in subsection 

17 (b)(1)(A) shall be Chair of the Council. 

18 ‘‘(e) MEETINGS.—The Council shall meet at least 2 

19 times per year, as determined by the Chair. 

20 ‘‘(f) DUTIES.— 

21 ‘‘(1) IN GENERAL.—The Council shall make rec22 ommendations to the Secretary for the coordination of 

23 activities of the Department of Health and Human 

24 Services, the Department of Justice, and other rel25 evant Federal, State, local, and private agencies and 


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1 entities, relating to elder abuse, neglect, and exploi2 tation and other crimes against elders. 

3 ‘‘(2) REPORT.—Not later than the date that is 2 

4 years after the date of enactment of the Elder Justice 

5 Act of 2008 and every 2 years thereafter, the Council 

6 shall submit to the Committee on Finance of the Sen7 ate and the Committee on Ways and Means and the 

8 Committee on Energy and Commerce of the House of 

9 Representatives a report that— 

10 ‘‘(A) describes the activities and accomplish11 ments of, and challenges faced by— 

12 ‘‘(i) the Council; and 

13 ‘‘(ii) the entities represented on the 

14 Council; and 

15 ‘‘(B) makes such recommendations for legis16 lation, model laws, or other action as the Council 

17 determines to be appropriate. 

18 ‘‘(g) POWERS OF THE COUNCIL.— 

19 ‘‘(1) INFORMATION FROM FEDERAL AGENCIES.— 

20 Subject to the requirements of section 2012(a), the 

21 Council may secure directly from any Federal depart22 ment or agency such information as the Council con23 siders necessary to carry out this section. Upon re24 quest of the Chair of the Council, the head of such deVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00090 Fmt 6652 Sfmt 6203 E:\BILLS\S1070.RS S1070

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1 partment or agency shall furnish such information to 

2 the Council. 

3 ‘‘(2) POSTAL SERVICES.—The Council may use 

4 the United States mails in the same manner and 

5 under the same conditions as other departments and 

6 agencies of the Federal Government. 

7 ‘‘(h) TRAVEL EXPENSES.—The members of the Council 

8 shall not receive compensation for the performance of serv9 ices for the Council. The members shall be allowed travel 

10 expenses, including per diem in lieu of subsistence, at rates 

11 authorized for employees of agencies under subchapter I of 

12 chapter 57 of title 5, United States Code, while away from 

13 their homes or regular places of business in the performance 

14 of services for the Council. Notwithstanding section 1342 

15 of title 31, United States Code, the Secretary may accept 

16 the voluntary and uncompensated services of the members 

17 of the Council. 

18 ‘‘(i) DETAIL OF GOVERNMENT EMPLOYEES.—Any 

19 Federal Government employee may be detailed to the Coun20 cil without reimbursement, and such detail shall be without 

21 interruption or loss of civil service status or privilege. 

22 ‘‘(j) STATUS AS PERMANENT COUNCIL.—Section 14 of 

23 the Federal Advisory Committee Act (5 U.S.C. App.) shall 

24 not apply to the Council. 


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1 ‘‘SEC. 2022. ADVISORY BOARD ON ELDER ABUSE, NEGLECT, 

2 AND EXPLOITATION. 

3 ‘‘(a) ESTABLISHMENT.—There is established a board 

4 to be known as the ‘Advisory Board on Elder Abuse, Neglect, 

5 and Exploitation’ (in this section referred to as the ‘Advi6 sory Board’) to create short- and long-term multidisci7 plinary strategic plans for the development of the field of 

8 elder justice and to make recommendations to the Elder 

9 Justice Coordinating Council established under section 

10 2021. 

11 ‘‘(b) COMPOSITION.—The Advisory Board shall be 

12 composed of 27 members appointed by the Secretary from 

13 among members of the general public who are individuals 

14 with experience and expertise in elder abuse, neglect, and 

15 exploitation prevention, detection, treatment, intervention, 

16 or prosecution. 

17 ‘‘(c) SOLICITATION OF NOMINATIONS.—The Secretary 

18 shall publish a notice in the Federal Register soliciting 

19 nominations for the appointment of members of the Advi20 sory Board under subsection (b). 

21 ‘‘(d) TERMS.— 

22 ‘‘(1) IN GENERAL.—Each member of the Advi23 sory Board shall be appointed for a term of 3 years, 

24 except that, of the members first appointed— 

25 ‘‘(A) 9 shall be appointed for a term of 3 

26 years; 


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1 ‘‘(B) 9 shall be appointed for a term of 2 

2 years; and 

3 ‘‘(C) 9 shall be appointed for a term of 1 

4 year. 

5 ‘‘(2) VACANCIES.— 

6 ‘‘(A) IN GENERAL.—Any vacancy on the 

7 Advisory Board shall not affect its powers, but 

8 shall be filled in the same manner as the original 

9 appointment was made. 

10 ‘‘(B) FILLING UNEXPIRED TERM.—An indi11 vidual chosen to fill a vacancy shall be ap12 pointed for the unexpired term of the member re13 placed. 

14 ‘‘(3) EXPIRATION OF TERMS.—The term of any 

15 member shall not expire before the date on which the 

16 member’s successor takes office. 

17 ‘‘(e) ELECTION OF OFFICERS.—The Advisory Board 

18 shall elect a Chair and Vice Chair from among its members. 

19 The Advisory Board shall elect its initial Chair and Vice 

20 Chair at its initial meeting. 

21 ‘‘(f) DUTIES.— 

22 ‘‘(1) ENHANCE COMMUNICATION ON PROMOTING

23 QUALITY OF, AND PREVENTING ABUSE AND NEGLECT

24 IN, LONG-TERM CARE.—The Advisory Board shall de25 velop collaborative and innovative approaches to imVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6203 E:\BILLS\S1070.RS S1070

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1 prove the quality of, including preventing abuse and 

2 neglect in, long-term care. 

3 ‘‘(2) COLLABORATIVE EFFORTS TO DEVELOP

4 CONSENSUS AROUND THE MANAGEMENT OF CERTAIN

5 QUALITY-RELATED FACTORS.— 

6 ‘‘(A) IN GENERAL.—The Advisory Board 

7 shall establish multidisciplinary panels to ad8 dress, and develop consensus on, subjects relating 

9 to improving the quality of long-term care. At 

10 least 1 such panel shall address, and develop con11 sensus on, methods for managing resident-to-resi12 dent abuse in long-term care. 

13 ‘‘(B) ACTIVITIES CONDUCTED.—The multi14 disciplinary panels established under subpara15 graph (A) shall examine relevant research and 

16 data, identify best practices with respect to the 

17 subject of the panel, determine the best way to 

18 carry out those best practices in a practical and 

19 feasible manner, and determine an effective man20 ner of distributing information on such subject. 

21 ‘‘(3) REPORT.—Not later than the date that is 

22 18 months after the date of enactment of the Elder 

23 Justice Act of 2008, and annually thereafter, the Ad24 visory Board shall prepare and submit to the Elder 

25 Justice Coordinating Council, the Committee on FiVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00094 Fmt 6652 Sfmt 6203 E:\BILLS\S1070.RS S1070

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1 nance of the Senate, and the Committee on Ways and 

2 Means and the Committee on Energy and Commerce 

3 of the House of Representatives a report containing— 

4 ‘‘(A) information on the status of Federal, 

5 State, and local public and private elder justice 

6 activities; 

7 ‘‘(B) recommendations (including rec8 ommended priorities) regarding— 

9 ‘‘(i) elder justice programs, research, 

10 training, services, practice, enforcement, 

11 and coordination; 

12 ‘‘(ii) coordination between entities pur13 suing elder justice efforts and those involved 

14 in related areas that may inform or overlap 

15 with elder justice efforts, such as activities 

16 to combat violence against women and child 

17 abuse and neglect; and 

18 ‘‘(iii) activities relating to adult fidu19 ciary systems, including guardianship and 

20 other fiduciary arrangements; 

21 ‘‘(C) recommendations for specific modifica22 tions needed in Federal and State laws (includ23 ing regulations) or for programs, research, and 

24 training to enhance prevention, detection, and 

25 treatment (including diagnosis) of, intervention 


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1 in (including investigation of), and prosecution 

2 of elder abuse, neglect, and exploitation; 

3 ‘‘(D) recommendations on methods for the 

4 most effective coordinated national data collec5 tion with respect to elder justice, and elder abuse, 

6 neglect, and exploitation; and 

7 ‘‘(E) recommendations for a multidisci8 plinary strategic plan to guide the effective and 

9 efficient development of the field of elder justice. 

10 ‘‘(g) POWERS OF THE ADVISORY BOARD.— 

11 ‘‘(1) INFORMATION FROM FEDERAL AGENCIES.— 

12 Subject to the requirements of section 2012(a), the Ad13 visory Board may secure directly from any Federal 

14 department or agency such information as the Advi15 sory Board considers necessary to carry out this sec16 tion. Upon request of the Chair of the Advisory 

17 Board, the head of such department or agency shall 

18 furnish such information to the Advisory Board. 

19 ‘‘(2) SHARING OF DATA AND REPORTS.—The Ad20 visory Board may request from any entity pursuing 

21 elder justice activities under the Elder Justice Act of 

22 2008 or an amendment made by that Act, any data, 

23 reports, or recommendations generated in connection 

24 with such activities. 


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1 ‘‘(3) POSTAL SERVICES.—The Advisory Board 

2 may use the United States mails in the same manner 

3 and under the same conditions as other departments 

4 and agencies of the Federal Government. 

5 ‘‘(h) TRAVEL EXPENSES.—The members of the Advi6 sory Board shall not receive compensation for the perform7 ance of services for the Advisory Board. The members shall 

8 be allowed travel expenses for up to 4 meetings per year, 

9 including per diem in lieu of subsistence, at rates author10 ized for employees of agencies under subchapter I of chapter 

11 57 of title 5, United States Code, while away from their 

12 homes or regular places of business in the performance of 

13 services for the Advisory Board. Notwithstanding section 

14 1342 of title 31, United States Code, the Secretary may ac15 cept the voluntary and uncompensated services of the mem16 bers of the Advisory Board. 

17 ‘‘(i) DETAIL OF GOVERNMENT EMPLOYEES.—Any 

18 Federal Government employee may be detailed to the Advi19 sory Board without reimbursement, and such detail shall 

20 be without interruption or loss of civil service status or 

21 privilege. 

22 ‘‘(j) STATUS AS PERMANENT ADVISORY COMMITTEE.— 

23 Section 14 of the Federal Advisory Committee Act (5 U.S.C. 

24 App.) shall not apply to the advisory board. 


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1 ‘‘SEC. 2023. RESEARCH PROTECTIONS. 

2 ‘‘(a) GUIDELINES.—The Secretary shall promulgate 

3 guidelines to assist researchers working in the area of elder 

4 abuse, neglect, and exploitation, with issues relating to 

5 human subject protections. 

6 ‘‘(b) DEFINITION OF LEGALLY AUTHORIZED REP7 RESENTATIVE FOR APPLICATION OF REGULATIONS.—For 

8 purposes of the application of subpart A of part 46 of title 

9 45, Code of Federal Regulations, to research conducted 

10 under this subpart, the term ‘legally authorized representa11 tive’ means, unless otherwise provided by law, the indi12 vidual or judicial or other body authorized under the appli13 cable law to consent to medical treatment on behalf of an14 other person. 

15 ‘‘SEC. 2024. AUTHORIZATION OF APPROPRIATIONS. 

16 ‘‘There are authorized to be appropriated to carry out 

17 this subpart— 

18 ‘‘(1) for fiscal year 2009, $6,500,000; and 

19 ‘‘(2) for each of fiscal years 2010 through 2012, 

20 $7,000,000. 


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1 ‘‘Subpart 2—Elder Abuse, Neglect, and Exploitation 

2 Forensic Centers 

3 ‘‘SEC. 2031. ESTABLISHMENT AND SUPPORT OF ELDER 

4 ABUSE, NEGLECT, AND EXPLOITATION FO5 RENSIC CENTERS. 

6 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

7 with the Attorney General, shall make grants to eligible en8 tities to establish and operate stationary and mobile foren9 sic centers, to develop forensic expertise regarding, and pro10 vide services relating to, elder abuse, neglect, and exploi11 tation. 

12 ‘‘(b) STATIONARY FORENSIC CENTERS.—The Sec13 retary shall make 4 of the grants described in subsection 

14 (a) to institutions of higher education with demonstrated 

15 expertise in forensics or commitment to preventing or treat16 ing elder abuse, neglect, or exploitation, to establish and 

17 operate stationary forensic centers. 

18 ‘‘(c) MOBILE CENTERS.—The Secretary shall make 6 

19 of the grants described in subsection (a) to appropriate enti20 ties to establish and operate mobile forensic centers. 

21 ‘‘(d) AUTHORIZED ACTIVITIES.— 

22 ‘‘(1) DEVELOPMENT OF FORENSIC MARKERS AND

23 METHODOLOGIES.—An eligible entity that receives a 

24 grant under this section shall use funds made avail25 able through the grant to assist in determining wheth26 er abuse, neglect, or exploitation occurred and whether 


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1 a crime was committed and to conduct research to de2 scribe and disseminate information on— 

3 ‘‘(A) forensic markers that indicate a case 

4 in which elder abuse, neglect, or exploitation 

5 may have occurred; and 

6 ‘‘(B) methodologies for determining, in such 

7 a case, when and how health care, emergency 

8 service, social and protective services, and legal 

9 service providers should intervene and when the 

10 providers should report the case to law enforce11 ment authorities. 

12 ‘‘(2) DEVELOPMENT OF FORENSIC EXPERTISE.— 

13 An eligible entity that receives a grant under this sec14 tion shall use funds made available through the grant 

15 to develop forensic expertise regarding elder abuse, ne16 glect, and exploitation in order to provide medical 

17 and forensic evaluation, therapeutic intervention, vic18 tim support and advocacy, case review, and case 

19 tracking. 

20 ‘‘(3) COLLECTION OF EVIDENCE.—The Secretary, 

21 in coordination with the Attorney General, shall use 

22 data made available by grant recipients under this 

23 section to develop the capacity of geriatric health care 

24 professionals and law enforcement to collect forensic 

25 evidence, including collecting forensic evidence relatVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6203 E:\BILLS\S1070.RS S1070

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1 ing to a potential determination of elder abuse, ne2 glect, or exploitation. 

3 ‘‘(e) APPLICATION.—To be eligible to receive a grant 

4 under this section, an entity shall submit an application 

5 to the Secretary at such time, in such manner, and con6 taining such information as the Secretary may require. 

7 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There are 

8 authorized to be appropriated to carry out this section— 

9 ‘‘(1) for fiscal year 2009, $4,000,000; 

10 ‘‘(2) for fiscal year 2010, $6,000,000; and 

11 ‘‘(3) for each of fiscal years 2011 and 2012, 

12 $8,000,000. 

13 ‘‘PART B—PROGRAMS TO PROMOTE ELDER 

14 JUSTICE 

15 ‘‘SEC. 2041. ENHANCEMENT OF LONG-TERM CARE. 

16 ‘‘(a) GRANTS AND INCENTIVES FOR LONG-TERM CARE

17 STAFFING.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall carry 

19 out activities, including activities described in para20 graphs (2) and (3), to provide incentives for individ21 uals to train for, seek, and maintain employment 

22 providing direct care in a long-term care facility. 

23 ‘‘(2) SPECIFIC PROGRAMS TO ENHANCE TRAIN24 ING, RECRUITMENT, AND RETENTION OF STAFF.— 


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1 ‘‘(A) COORDINATION WITH SECRETARY OF

2 LABOR TO RECRUIT AND TRAIN LONG-TERM CARE

3 STAFF.—The Secretary shall coordinate activities 

4 under this subsection with the Secretary of Labor 

5 in order to provide incentives for individuals to 

6 train for and seek employment providing direct 

7 care in a long-term care facility. 

8 ‘‘(B) CAREER LADDERS AND WAGE OR BEN9 EFIT INCREASES TO INCREASE STAFFING IN

10 LONG-TERM CARE FACILITIES.— 

11 ‘‘(i) IN GENERAL.—The Secretary shall 

12 make grants to long-term care facilities to 

13 carry out programs through which the fa14 cilities— 

15 ‘‘(I) offer, to employees who pro16 vide direct care to residents of a long17 term care facility, continuing training 

18 and varying levels of certification, 

19 based on observed clinical care prac20 tices and the amount of time the em21 ployees spend providing direct care; 

22 and 

23 ‘‘(II) provide, or make arrange24 ments to provide, bonuses or other in25 creased compensation or benefits to emVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6203 E:\BILLS\S1070.RS S1070

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1 ployees who achieve certification under 

2 such a program. 

3 ‘‘(ii) APPLICATION.—To be eligible to 

4 receive a grant under this subparagraph, a 

5 long-term care facility shall submit an ap6 plication to the Secretary at such time, in 

7 such manner, and containing such informa8 tion as the Secretary may require (which 

9 may include evidence of consultation with 

10 the State in which the long-term care facil11 ity is located with respect to carrying out 

12 activities funded under the grant). 

13 ‘‘(iii) AUTHORITY TO LIMIT NUMBER

14 OF APPLICANTS.—Nothing in this subpara15 graph shall be construed as prohibiting the 

16 Secretary from limiting the number of ap17 plicants for a grant under this subpara18 graph. 

19 ‘‘(3) SPECIFIC PROGRAMS TO IMPROVE MANAGE20 MENT PRACTICES.— 

21 ‘‘(A) IN GENERAL.—The Secretary shall 

22 make grants to long-term care facilities to enable 

23 the facilities to provide training and technical 

24 assistance to eligible employees. 


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1 ‘‘(B) AUTHORIZED ACTIVITIES.—A long2 term care facility that receives a grant under 

3 subparagraph (A) shall use funds made available 

4 through the grant to provide training and tech5 nical assistance to eligible employees regarding 

6 management practices using methods that are 

7 demonstrated to promote retention of individuals 

8 who provide direct care to residents of the long9 term care facility, such as— 

10 ‘‘(i) the establishment of standard 

11 human resource policies that reward high 

12 performance, including policies that provide 

13 for improved wages and benefits on the 

14 basis of job reviews; 

15 ‘‘(ii) the establishment of motivational 

16 and thoughtful work organization practices; 

17 ‘‘(iii) the creation of a workplace cul18 ture that respects and values caregivers and 

19 their needs; 

20 ‘‘(iv) the promotion of a workplace cul21 ture that respects the rights of residents of 

22 a long-term care facility and results in im23 proved care for the residents; and 

24 ‘‘(v) the establishment of other pro25 grams that promote the provision of high 


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1 quality care, such as a continuing edu2 cation program that provides additional 

3 hours of training, including on-the-job 

4 training, for employees who are certified 

5 nurse aides. 

6 ‘‘(C) APPLICATION.—To be eligible to re7 ceive a grant under this paragraph, a long-term 

8 care facility shall submit an application to the 

9 Secretary at such time, in such manner, and 

10 containing such information as the Secretary 

11 may require (which may include evidence of con12 sultation with the State in which the long-term 

13 care facility is located with respect to carrying 

14 out activities funded under the grant). 

15 ‘‘(D) AUTHORITY TO LIMIT NUMBER OF AP16 PLICANTS.—Nothing in this paragraph shall be 

17 construed as prohibiting the Secretary from lim18 iting the number of applicants for a grant under 

19 this paragraph. 

20 ‘‘(E) ELIGIBLE EMPLOYEE DEFINED.—In 

21 this paragraph, the term ‘eligible employee’ 

22 means an individual who establishes or imple23 ments management practices applicable with re24 spect to individuals who provide direct care to 

25 residents of a long-term care facility and inVerDate Aug 31 2005 02:11 Sep 19, 2008 Jkt 069200 PO 00000 Frm 00105 Fmt 6652 Sfmt 6203 E:\BILLS\S1070.RS S1070

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1 cludes administrators, directors of nursing, staff 

2 developers, and charge nurses. 

3 ‘‘(4) ACCOUNTABILITY MEASURES.—The Sec4 retary shall develop accountability measures to ensure 

5 that the activities conducted using funds made avail6 able under this subsection benefit eligible employees 

7 and increase the stability of the long-term care work8 force. 

9 ‘‘(b) INFORMATICS SYSTEMS GRANT PROGRAM.— 

10 ‘‘(1) GRANTS AUTHORIZED.—The Secretary is 

11 authorized to make grants to long-term care facilities 

12 for the purpose of assisting such entities in offsetting 

13 the costs related to purchasing, leasing, developing, 

14 and implementing standardized clinical health care 

15 informatics systems designed to improve patient safe16 ty and reduce adverse events and health care com17 plications resulting from medication errors. 

18 ‘‘(2) USE OF GRANT FUNDS.—Funds provided 

19 under grants under this subsection may be used for 

20 any of the following: 

21 ‘‘(A) Purchasing, leasing, and installing 

22 computer software and hardware, including 

23 handheld computer technologies. 

24 ‘‘(B) Making improvements to existing com25 puter software and hardware. 


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1 ‘‘(C) Making upgrades and other improve2 ments to existing computer software and hard3 ware to enable e-prescribing. 

4 ‘‘(D) Providing education and training to 

5 eligible long-term care facility staff on the use of 

6 technology to implement the electronic trans7 mission of prescription and patient information. 

8 ‘‘(3) APPLICATION.—To be eligible to receive a 

9 grant under this subsection, a long-term care facility 

10 shall submit an application to the Secretary at such 

11 time, in such manner, and containing such informa12 tion as the Secretary may require (which may in13 clude evidence of consultation with the State in which 

14 the long-term care facility is located with respect to 

15 carrying out activities funded under the grant). 

16 ‘‘(4) AUTHORITY TO LIMIT NUMBER OF APPLI17 CANTS.—Nothing in this subsection shall be construed 

18 as prohibiting the Secretary from limiting the num19 ber of applicants for a grant under this subsection. 

20 ‘‘(5) ACCOUNTABILITY MEASURES.—The Sec21 retary shall develop accountability measures to ensure 

22 that the activities conducted using funds made avail23 able under this subsection help improve patient safety 

24 and reduce adverse events and health care complica25 tions resulting from medication errors. 


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1 ‘‘(c) INCLUSION OF ADJUDICATED CRIMES ON NURS2 ING HOME COMPARE WEBSITE.—Not later than 1 year 

3 after the date of enactment of the Elder Justice Act of 2008, 

4 the Secretary shall ensure that the Department of Health 

5 and Human Services includes, as part of the information 

6 provided for comparison of nursing facilities on the official 

7 Internet website of the Federal Government for Medicare 

8 beneficiaries (commonly referred to as the ‘Nursing Home 

9 Compare’ Medicare website), the number of adjudicated in10 stances of criminal violations by a nursing facility or 

11 crimes committed by an employee of a nursing facility— 

12 ‘‘(1) that were committed inside of the facility; 

13 and 

14 ‘‘(2) with respect to such instances of violations 

15 or crimes committed outside of the facility, that were 

16 the violations or crimes of elder abuse, neglect, and 

17 exploitation, criminal sexual abuse of an elder, or 

18 other violations or crimes that resulted in the serious 

19 bodily injury of an elder. 

20 ‘‘(d) DEVELOPMENT OF CONSUMER RIGHTS INFORMA21 TION PAGE ON NURSING HOME COMPARE WEBSITE.—Not 

22 later than 1 year after the date of enactment of the Elder 

23 Justice Act of 2008, the Secretary shall ensure that the De24 partment of Health and Human Services, as part of the 

25 information provided for comparison of nursing facilities 


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1 on the Nursing Home Compare Medicare website develops 

2 and includes a consumer rights information page that con3 tains links to descriptions of, and information with respect 

4 to, the following: 

5 ‘‘(1) The documentation on nursing facilities 

6 that is available to the public. 

7 ‘‘(2) General information and tips on choosing a 

8 nursing facility that meets the needs of the indi9 vidual. 

10 ‘‘(3) General information on consumer rights 

11 with respect to nursing facilities. 

12 ‘‘(4) The nursing facility survey process (on a 

13 national and State-specific basis). 

14 ‘‘(5) On a State-specific basis, the services avail15 able through the State long-term care ombudsman for 

16 such State. 

17 ‘‘(e) DEVELOPMENT AND ADOPTION OF STANDARDS

18 FOR TRANSACTIONS INVOLVING CLINICAL DATA BY LONG19 TERM CARE FACILITIES.— 

20 ‘‘(1) STANDARDS.—The Secretary shall develop 

21 and adopt uniform open electronic standards for 

22 transactions involving clinical data by long-term care 

23 facilities. Such standards shall include messaging and 

24 nomenclature standards. 


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1 ‘‘(2) COMPATIBILITY WITH OTHER STANDARDS.— 

2 The standards developed and adopted under para3 graph (1) shall be compatible with standards estab4 lished under part C of title XI, standards established 

5 under subsections (b)(2)(B)(i) and (e)(4) of section 

6 1860D–4, and with general health information tech7 nology standards. 

8 ‘‘(3) ELECTRONIC SUBMISSION OF DATA TO THE

9 SECRETARY.— 

10 ‘‘(A) IN GENERAL.—Not later than 10 years 

11 after the date of enactment of the Elder Justice 

12 Act of 2008, the Secretary shall have procedures 

13 in place to accept the optional electronic submis14 sion of clinical data by long-term care facilities 

15 pursuant to the standards developed and adopted 

16 under paragraph (1). 

17 ‘‘(B) RULE OF CONSTRUCTION.—Nothing in 

18 this subsection shall be construed to require a 

19 long-term care facility to submit clinical data 

20 electronically to the Secretary. 

21 ‘‘(f) REGULATIONS.—The Secretary shall promulgate 

22 regulations to carry out subsections (c), (d), and (e) of this 

23 section. Such regulations shall require a State, as a condi24 tion of the receipt of funds under this part, to conduct such 


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1 data collection and reporting as the Secretary determines 

2 are necessary to satisfy the requirements of such subsections. 

3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

4 are authorized to be appropriated to carry out this sec5 tion— 

6 ‘‘(1) for fiscal year 2009, $20,000,000; 

7 ‘‘(2) for fiscal year 2010, $17,500,000; and 

8 ‘‘(3) for each of fiscal years 2011 and 2012, 

9 $15,000,000. 

10 ‘‘SEC. 2042. ADULT PROTECTIVE SERVICES FUNCTIONS AND 

11 GRANT PROGRAMS. 

12 ‘‘(a) SECRETARIAL RESPONSIBILITIES.— 

13 ‘‘(1) IN GENERAL.—The Secretary shall ensure 

14 that the Department of Health and Human Serv15 ices— 

16 ‘‘(A) provides funding authorized by this 

17 part to State and local adult protective services 

18 offices that investigate reports of the abuse, ne19 glect, and exploitation of elders; 

20 ‘‘(B) collects and disseminates data annu21 ally relating to the abuse, exploitation, and ne22 glect of elders in coordination with the Depart23 ment of Justice; 


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1 ‘‘(C) develops and disseminates information 

2 on best practices regarding, and provides train3 ing on, carrying out adult protective services; 

4 ‘‘(D) conducts research related to the provi5 sion of adult protective services; and 

6 ‘‘(E) provides technical assistance to States 

7 and other entities that provide or fund the provi8 sion of adult protective services, including 

9 through grants made under subsections (b) and 

10 (c). 

11 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

12 There are authorized to be appropriated to carry out 

13 this subsection, $3,000,000 for fiscal year 2009 and 

14 $4,000,000 for each of fiscal years 2010 through 2012. 

15 ‘‘(b) GRANTS TO ENHANCE THE PROVISION OF ADULT

16 PROTECTIVE SERVICES.— 

17 ‘‘(1) ESTABLISHMENT.—There is established an 

18 adult protective services grant program under which 

19 the Secretary shall annually award grants to States 

20 in the amounts calculated under paragraph (2) for 

21 the purposes of enhancing adult protective services 

22 provided by States and local units of government. 

23 ‘‘(2) AMOUNT OF PAYMENT.— 

24 ‘‘(A) IN GENERAL.—Subject to the avail25 ability of appropriations and subparagraphs (B) 


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1 and (C), the amount paid to a State for a fiscal 

2 year under the program under this subsection 

3 shall equal the amount appropriated for that 

4 year to carry out this subsection multiplied by 

5 the percentage of the total number of elders who 

6 reside in the United States who reside in that 

7 State. 

8 ‘‘(B) GUARANTEED MINIMUM PAYMENT

9 AMOUNT.— 

10 ‘‘(i) 50 STATES.—Subject to clause (ii), 

11 if the amount determined under subpara12 graph (A) for a State for a fiscal year is 

13 less than 0.75 percent of the amount appro14 priated for such year, the Secretary shall 

15 increase such determined amount so that the 

16 total amount paid under this subsection to 

17 the State for the year is equal to 0.75 per18 cent of the amount so appropriated. 

19 ‘‘(ii) TERRITORIES.—In the case of a 

20 State other than 1 of the 50 States, clause 

21 (i) shall be applied as if each reference to 

22 ‘0.75’ were a reference to ‘0.1’. 

23 ‘‘(C) PRO RATA REDUCTIONS.—The Sec24 retary shall make such pro rata reductions to the 

25 amounts described in subparagraph (A) as are 


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1 necessary to comply with the requirements of 

2 subparagraph (B). 

3 ‘‘(3) AUTHORIZED ACTIVITIES.— 

4 ‘‘(A) ADULT PROTECTIVE SERVICES.— 

5 Funds made available pursuant to this sub6 section may only be used by States and local 

7 units of government to provide adult protective 

8 services and may not be used for any other pur9 pose. 

10 ‘‘(B) USE BY AGENCY.—Each State receiv11 ing funds pursuant to this subsection shall pro12 vide such funds to the agency or unit of State 

13 government having legal responsibility for pro14 viding adult protective services within the State. 

15 ‘‘(C) SUPPLEMENT NOT SUPPLANT.—Each 

16 State or local unit of government shall use funds 

17 made available pursuant to this subsection to 

18 supplement and not supplant other Federal, 

19 State, and local public funds expended to provide 

20 adult protective services in the State. 

21 ‘‘(4) STATE REPORTS.—Each State receiving 

22 funds under this subsection shall submit to the Sec23 retary, at such time and in such manner as the Sec24 retary may require, a report on the number of elders 

25 served by the grants awarded under this subsection. 


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1 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated to carry out 

3 this subsection, $100,000,000 for each of fiscal years 

4 2009 through 2012. 

5 ‘‘(c) STATE DEMONSTRATION PROGRAMS.— 

6 ‘‘(1) ESTABLISHMENT.—The Secretary shall 

7 award grants to States for the purposes of conducting 

8 demonstration programs in accordance with para9 graph (2). 

10 ‘‘(2) DEMONSTRATION PROGRAMS.—Funds made 

11 available pursuant to this subsection may be used by 

12 States and local units of government to conduct dem13 onstration programs that test— 

14 ‘‘(A) training modules developed for the 

15 purpose of detecting or preventing elder abuse; 

16 ‘‘(B) methods to detect or prevent financial 

17 exploitation of elders; 

18 ‘‘(C) methods to detect elder abuse; 

19 ‘‘(D) whether training on elder abuse 

20 forensics enhances the detection of elder abuse by 

21 employees of the State or local unit of govern22 ment; or 

23 ‘‘(E) other matters relating to the detection 

24 or prevention of elder abuse. 


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1 ‘‘(3) APPLICATION.—To be eligible to receive a 

2 grant under this subsection, a State shall submit an 

3 application to the Secretary at such time, in such 

4 manner, and containing such information as the Sec5 retary may require. 

6 ‘‘(4) STATE REPORTS.—Each State that receives 

7 funds under this subsection shall submit a report to 

8 the Secretary at such time, in such manner, and con9 taining such information as the Secretary may re10 quire on the results of the demonstration program 

11 conducted by the State using funds made available 

12 under this subsection. 

13 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

14 There are authorized to be appropriated to carry out 

15 this subsection, $25,000,000 for each of fiscal years 

16 2009 through 2012. 

17 ‘‘SEC. 2043. LONG-TERM CARE OMBUDSMAN PROGRAM 

18 GRANTS AND TRAINING. 

19 ‘‘(a) GRANTS TO SUPPORT THE LONG-TERM CARE

20 OMBUDSMAN PROGRAM.— 

21 ‘‘(1) IN GENERAL.—The Secretary shall make 

22 grants to eligible entities with relevant expertise and 

23 experience in abuse and neglect in long-term care fa24 cilities or long-term care ombudsman programs and 

25 responsibilities, for the purpose of— 


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1 ‘‘(A) improving the capacity of State long2 term care ombudsman programs to respond to 

3 and resolve complaints about abuse and neglect; 

4 ‘‘(B) conducting pilot programs with State 

5 long-term care ombudsman offices or local om6 budsman entities; and 

7 ‘‘(C) providing support for such State long8 term care ombudsman programs and such pilot 

9 programs (such as through the establishment of 

10 a national long-term care ombudsman resource 

11 center). 

12 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

13 There are authorized to be appropriated to carry out 

14 this subsection— 

15 ‘‘(A) for fiscal year 2009, $5,000,000; 

16 ‘‘(B) for fiscal year 2010, $7,500,000; and 

17 ‘‘(C) for each of fiscal years 2011 and 2012, 

18 $10,000,000. 

19 ‘‘(b) OMBUDSMAN TRAINING PROGRAMS.— 

20 ‘‘(1) IN GENERAL.—The Secretary shall establish 

21 programs to provide and improve ombudsman train22 ing with respect to elder abuse, neglect, and exploi23 tation for national organizations and State long-term 

24 care ombudsman programs. 


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1 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated to carry out 

3 this subsection, for each of fiscal years 2009 through 

4 2012, $10,000,000. 

5 ‘‘SEC. 2044. PROVISION OF INFORMATION REGARDING, AND 

6 EVALUATIONS OF, ELDER JUSTICE PRO7 GRAMS. 

8 ‘‘(a) PROVISION OF INFORMATION.—To be eligible to 

9 receive a grant under this part, an applicant shall agree— 

10 ‘‘(1) except as provided in paragraph (2), to pro11 vide the eligible entity conducting an evaluation 

12 under subsection (b) of the activities funded through 

13 the grant with such information as the eligible entity 

14 may require in order to conduct such evaluation; or 

15 ‘‘(2) in the case of an applicant for a grant 

16 under section 2041(b), to provide the Secretary with 

17 such information as the Secretary may require to 

18 conduct an evaluation or audit under subsection (c). 

19 ‘‘(b) USE OF ELIGIBLE ENTITIES TO CONDUCT EVAL20 UATIONS.— 

21 ‘‘(1) EVALUATIONS REQUIRED.—Except as pro22 vided in paragraph (2), the Secretary shall— 

23 ‘‘(A) reserve a portion (not less than 2 per24 cent) of the funds appropriated with respect to 

25 each program carried out under this part; and 


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1 ‘‘(B) use the funds reserved under subpara2 graph (A) to provide assistance to eligible enti3 ties to conduct evaluations of the activities fund4 ed under each program carried out under this 

5 part. 

6 ‘‘(2) INFORMATICS SYSTEMS GRANT PROGRAM

7 NOT INCLUDED.—The provisions of this subsection 

8 shall not apply to the informatics systems grant pro9 gram under section 2041(b). 

10 ‘‘(3) AUTHORIZED ACTIVITIES.—A recipient of 

11 assistance described in paragraph (1)(B) shall use the 

12 funds made available through the assistance to con13 duct a validated evaluation of the effectiveness of the 

14 activities funded under a program carried out under 

15 this part. 

16 ‘‘(4) APPLICATIONS.—To be eligible to receive as17 sistance under paragraph (1)(B), an entity shall sub18 mit an application to the Secretary at such time, in 

19 such manner, and containing such information as the 

20 Secretary may require, including a proposal for the 

21 evaluation. 

22 ‘‘(5) REPORTS.—Not later than a date specified 

23 by the Secretary, an eligible entity receiving assist24 ance under paragraph (1)(B) shall submit to the Sec25 retary, the Committee on Ways and Means and the 


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1 Committee on Energy and Commerce of the House of 

2 Representatives, and the Committee on Finance of the 

3 Senate a report containing the results of the evalua4 tion conducted using such assistance together with 

5 such recommendations as the entity determines to be 

6 appropriate. 

7 ‘‘(c) EVALUATIONS AND AUDITS OF INFORMATICS SYS8 TEMS GRANT PROGRAM BY THE SECRETARY.— 

9 ‘‘(1) EVALUATIONS.—The Secretary shall con10 duct an evaluation of the activities funded under the 

11 informatics systems grant program under section 

12 2041(b). Such evaluation shall include an evaluation 

13 of whether the funding provided under the grant is 

14 expended only for the purposes for which it is made. 

15 ‘‘(2) AUDITS.—The Secretary shall conduct ap16 propriate audits of grants made under section 

17 2041(b). 

18 ‘‘SEC. 2045. REPORT. 

19 ‘‘Not later than October 1, 2012, the Secretary shall 

20 submit to the Elder Justice Coordinating Council, the Com21 mittee on Ways and Means and the Committee on Energy 

22 and Commerce of the House of Representatives, and the 

23 Committee on Finance of the Senate a report— 

24 ‘‘(1) compiling, summarizing, and analyzing the 

25 information contained in the State reports submitted 


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1 under subsections (b)(4) and (c)(4) of section 2042; 

2 and 

3 ‘‘(2) containing such recommendations for legis4 lative or administrative action as the Secretary deter5 mines to be appropriate.’’. 

6 (2) OPTION FOR STATE PLAN UNDER PROGRAM

7 FOR TEMPORARY ASSISTANCE FOR NEEDY FAMI8 LIES.— 

9 (A) IN GENERAL.—Section 402(a)(1)(B) of 

10 the Social Security Act (42 U.S.C. 602(a)(1)(B)) 

11 is amended by adding at the end the following 

12 new clause: 

13 ‘‘(v) The document shall indicate 

14 whether the State intends to assist individ15 uals to train for, seek, and maintain em16 ployment— 

17 ‘‘(I) providing direct care in a 

18 long-term care facility (as such terms 

19 are defined under section 2011); or 

20 ‘‘(II) in other occupations related 

21 to elder care determined appropriate 

22 by the State for which the State identi23 fies an unmet need for service per24 sonnel, 


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1 and, if so, shall include an overview of such 

2 assistance.’’. 

3 (B) EFFECTIVE DATE.—The amendment 

4 made by subparagraph (A) shall take effect on 

5 January 1, 2009. 

6 (b) PROTECTING RESIDENTS OF LONG-TERM CARE

7 FACILITIES.— 

8 (1) NATIONAL TRAINING INSTITUTE FOR SUR9 VEYORS.— 

10 (A) IN GENERAL.—The Secretary of Health 

11 and Human Services shall enter into a contract 

12 with an entity for the purpose of establishing 

13 and operating a National Training Institute for 

14 Federal and State surveyors. Such Institute shall 

15 provide and improve the training of surveyors 

16 with respect to investigating allegations of abuse, 

17 neglect, and misappropriation of property in 

18 programs and long-term care facilities that re19 ceive payments under title XVIII or XIX of the 

20 Social Security Act. 

21 (B) ACTIVITIES CARRIED OUT BY THE IN22 STITUTE.—The contract entered into under sub23 paragraph (A) shall require the Institute estab24 lished and operated under such contract to carry 

25 out the following activities: 


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1 (i) Assess the extent to which State 

2 agencies use specialized surveyors for the in3 vestigation of reported allegations of abuse, 

4 neglect, and misappropriation of property 

5 in such programs and long-term care facili6 ties. 

7 (ii) Evaluate how the competencies of 

8 surveyors may be improved to more effec9 tively investigate reported allegations of 

10 such abuse, neglect, and misappropriation 

11 of property, and provide feedback to Federal 

12 and State agencies on the evaluations con13 ducted. 

14 (iii) Provide a national program of 

15 training, tools, and technical assistance to 

16 Federal and State surveyors on inves17 tigating reports of such abuse, neglect, and 

18 misappropriation of property. 

19 (iv) Develop and disseminate informa20 tion on best practices for the investigation 

21 of such abuse, neglect, and misappropria22 tion of property. 

23 (v) Assess the performance of State 

24 complaint intake systems, in order to ensure 

25 that the intake of complaints occurs 24 


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1 hours per day, 7 days a week (including 

2 holidays). 

3 (vi) To the extent approved by the Sec4 retary of Health and Human Services, pro5 vide a national 24 hours per day, 7 days a 

6 week (including holidays), back-up system 

7 to State complaint intake systems in order 

8 to ensure optimum national responsiveness 

9 to complaints of such abuse, neglect, and 

10 misappropriation of property. 

11 (vii) Analyze and report annually on 

12 the following: 

13 (I) The total number and sources 

14 of complaints of such abuse, neglect, 

15 and misappropriation of property. 

16 (II) The extent to which such com17 plaints are referred to law enforcement 

18 agencies. 

19 (III) General results of Federal 

20 and State investigations of such com21 plaints. 

22 (viii) Conduct a national study of the 

23 cost to State agencies of conducting com24 plaint investigations of skilled nursing fa25 cilities and nursing facilities under sections 


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1 1819 and 1919, respectively, of the Social 

2 Security Act (42 U.S.C. 1395i–3; 1396r), 

3 and making recommendations to the Sec4 retary of Health and Human Services with 

5 respect to options to increase the efficiency 

6 and cost-effectiveness of such investigations. 

7 (C) AUTHORIZATION.—There are authorized 

8 to be appropriated to carry out this paragraph, 

9 for the period of fiscal years 2009 through 2012, 

10 $12,000,000. 

11 (2) GRANTS TO STATE SURVEY AGENCIES.— 

12 (A) IN GENERAL.—The Secretary of Health 

13 and Human Services shall make grants to State 

14 agencies that perform surveys of skilled nursing 

15 facilities or nursing facilities under sections 

16 1819 or 1919, respectively, of the Social Security 

17 Act (42 U.S.C. 1395i–3; 1395r). 

18 (B) USE OF FUNDS.—A grant awarded 

19 under subparagraph (A) shall be used for the 

20 purpose of designing and implementing com21 plaint investigations systems that— 

22 (i) promptly prioritize complaints in 

23 order to ensure a rapid response to the most 

24 serious and urgent complaints; 


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1 (ii) respond to complaints with opti2 mum effectiveness and timeliness; and 

3 (iii) optimize the collaboration between 

4 local authorities, consumers, and providers, 

5 including— 

6 (I) such State agency; 

7 (II) the State Long-Term Care 

8 Ombudsman; 

9 (III) local law enforcement agen10 cies; 

11 (IV) advocacy and consumer orga12 nizations; 

13 (V) State aging units; 

14 (VI) Area Agencies on Aging; and 

15 (VII) other appropriate entities. 

16 (C) AUTHORIZATION.—There are authorized 

17 to be appropriated to carry out this paragraph, 

18 for each of fiscal years 2009 through 2012, 

19 $5,000,000. 

20 (3) REPORTING OF CRIMES AND ENSURING SAFE21 TY OF RESIDENTS WHEN FEDERALLY FUNDED LONG22 TERM CARE FACILITIES CLOSE.—Part A of title XI of 

23 the Social Security Act (42 U.S.C. 1301 et seq.) is 

24 amended by adding at the end the following new sec25 tions: 


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1 ‘‘REPORTING TO LAW ENFORCEMENT OF CRIMES OCCUR2 RING IN FEDERALLY FUNDED LONG-TERM CARE FA3 CILITIES

4 ‘‘SEC. 1150A. (a) DETERMINATION AND NOTIFICA5 TION.— 

6 ‘‘(1) DETERMINATION.—The owner or operator of 

7 each long-term care facility that receives Federal 

8 funds under this Act shall annually determine wheth9 er the facility received at least $10,000 in such Fed10 eral funds during the preceding year. 

11 ‘‘(2) NOTIFICATION.—If the owner or operator 

12 determines under paragraph (1) that the facility re13 ceived at least $10,000 in such Federal funds during 

14 the preceding year, such owner or operator shall an15 nually notify each covered individual (as defined in 

16 paragraph (3)) of that individual’s obligation to com17 ply with the reporting requirements described in sub18 section (b). 

19 ‘‘(3) COVERED INDIVIDUAL DEFINED.—In this 

20 section, the term ‘covered individual’ means each in21 dividual who is an owner, operator, employee, man22 ager, agent, or contractor of a long-term care facility 

23 that is the subject of a determination described in 

24 paragraph (1). 

25 ‘‘(b) REPORTING REQUIREMENTS.— 


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1 ‘‘(1) IN GENERAL.—Each covered individual 

2 shall report to the Secretary and 1 or more law en3 forcement entities for the political subdivision in 

4 which the facility is located any reasonable suspicion 

5 of a crime (as defined by the law of the applicable po6 litical subdivision) against any individual who is a 

7 resident of, or is receiving care from, the facility. 

8 ‘‘(2) TIMING.—If the events that cause the sus9 picion— 

10 ‘‘(A) result in serious bodily injury, the in11 dividual shall report the suspicion immediately, 

12 but not later than 2 hours after forming the sus13 picion; and 

14 ‘‘(B) do not result in serious bodily injury, 

15 the individual shall report the suspicion not 

16 later than 24 hours after forming the suspicion. 

17 ‘‘(c) PENALTIES.— 

18 ‘‘(1) IN GENERAL.—If a covered individual vio19 lates subsection (b)— 

20 ‘‘(A) the covered individual shall be subject 

21 to a civil money penalty of not more than 

22 $200,000; or 

23 ‘‘(B) the Secretary shall classify the covered 

24 individual as an excluded individual, for a pe25 riod of not more than 3 years. 


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1 ‘‘(2) INCREASED HARM.—If a covered individual 

2 violates subsection (b) and the violation exacerbates 

3 the harm to the victim of the crime or results in harm 

4 to another individual— 

5 ‘‘(A) the covered individual shall be subject 

6 to a civil money penalty of not more than 

7 $300,000; and 

8 ‘‘(B) the Secretary shall classify the covered 

9 individual as an excluded individual, for a pe10 riod of not more than 3 years. 

11 ‘‘(3) EXCLUDED INDIVIDUAL.—During any pe12 riod for which a covered individual is classified as an 

13 excluded individual under paragraph (1)(B) or 

14 (2)(B), a long-term care facility that employs such 

15 individual shall be ineligible to receive Federal funds 

16 under this Act. 

17 ‘‘(4) EXTENUATING CIRCUMSTANCES.— 

18 ‘‘(A) IN GENERAL.—The Secretary may take 

19 into account the financial burden on providers 

20 with underserved populations in determining 

21 any penalty to be imposed under this subsection. 

22 ‘‘(B) UNDERSERVED POPULATION DE23 FINED.—In this paragraph, the term ‘under24 served population’ means the population of an 

25 area designated by the Secretary as an area with 


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1 a shortage of elder justice programs or a popu2 lation group designated by the Secretary as hav3 ing a shortage of such programs. Such areas or 

4 groups designated by the Secretary may in5 clude— 

6 ‘‘(i) areas or groups that are geo7 graphically isolated (such as isolated in a 

8 rural area); 

9 ‘‘(ii) racial and ethnic minority popu10 lations; and 

11 ‘‘(iii) populations underserved because 

12 of special needs (such as language barriers, 

13 disabilities, alien status, or age). 

14 ‘‘(d) ADDITIONAL PENALTIES FOR RETALIATION.— 

15 ‘‘(1) IN GENERAL.—A long-term care facility 

16 may not— 

17 ‘‘(A) discharge, demote, suspend, threaten, 

18 harass, or deny a promotion or other employ19 ment-related benefit to an employee, or in any 

20 other manner discriminate against an employee 

21 in the terms and conditions of employment be22 cause of lawful acts done by the employee; or 

23 ‘‘(B) file a complaint or a report against a 

24 nurse or other employee with the appropriate 


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1 State professional disciplinary agency because of 

2 lawful acts done by the nurse or employee, 

3 for making a report, causing a report to be made, or 

4 for taking steps in furtherance of making a report 

5 pursuant to subsection (b)(1). 

6 ‘‘(2) PENALTIES FOR RETALIATION.—If a long7 term care facility violates subparagraph (A) or (B) of 

8 paragraph (1) the facility shall be subject to a civil 

9 money penalty of not more than $200,000 or the Sec10 retary may classify the entity as an excluded entity 

11 for a period of 2 years pursuant to section 1128(b), 

12 or both. 

13 ‘‘(3) REQUIREMENT TO POST NOTICE.—Each 

14 long-term care facility shall post conspicuously in an 

15 appropriate location a sign (in a form specified by 

16 the Secretary) specifying the rights of employees 

17 under this section. Such sign shall include a state18 ment that an employee may file a complaint with the 

19 Secretary against a long-term care facility that vio20 lates the provisions of this subsection and information 

21 with respect to the manner of filing such a complaint. 

22 ‘‘(e) PROCEDURE.—The provisions of section 1128A 

23 (other than subsections (a) and (b) and the second sentence 

24 of subsection (f)) shall apply to a civil money penalty under 


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1 this section in the same manner as such provisions apply 

2 to a penalty or proceeding under section 1128A(a). 

3 ‘‘(f) DEFINITIONS.—In this section, the terms ‘elder 

4 justice’, ‘long-term care facility’, and ‘law enforcement’ have 

5 the meanings given those terms in section 2011. 

6 ‘‘ENSURING SAFETY OF RESIDENTS WHEN FEDERALLY

7 FUNDED LONG-TERM CARE FACILITIES CLOSE

8 ‘‘SEC. 1150B. (a) IN GENERAL.— 

9 ‘‘(1) NOTIFICATION OF FACILITY CLOSURE.— 

10 Subject to paragraph (2), if the owner or operator de11 termines under section 1150A(a)(1) that a long-term 

12 care facility received at least $10,000 in Federal 

13 funds under this Act during the preceding year, the 

14 owner or operator of the facility shall— 

15 ‘‘(A) submit to the Secretary and the appro16 priate State regulatory agency written notifica17 tion of an impending closure not later than the 

18 date that is 60 days prior to the date of such clo19 sure; 

20 ‘‘(B) include in the notice a plan for the 

21 transfer and adequate relocation of the residents 

22 of the facility prior to closure, including assur23 ances that the residents will be transferred to the 

24 most appropriate facility in terms of quality, 

25 services, and location; and 


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1 ‘‘(C) not later than 10 days after the facil2 ity closure, submit to the Secretary and the ap3 propriate State agency information identifying 

4 where residents of the closed facility were trans5 ferred and on what date. 

6 ‘‘(2) EXCEPTION WHERE THE SECRETARY HAS

7 ISSUED A TERMINATION NOTICE.—In the case of a 

8 long-term care facility described in paragraph (1) for 

9 which the Secretary has issued a termination notice 

10 for the facility to close by not later than 15 days after 

11 the issuance of such notice, the Secretary shall estab12 lish requirements for the notification, transfer, and 

13 adequate relocation of residents within an appro14 priate timeframe. 

15 ‘‘(b) SANCTIONS.—Any person owning or operating a 

16 long-term care facility that fails to comply with the require17 ments of subsection (a) shall be subject to— 

18 ‘‘(1) a civil monetary penalty of up to 

19 $1,000,000; 

20 ‘‘(2) exclusion from participation in the pro21 grams under this Act (in accordance with the proce22 dures of section 1128); and 

23 ‘‘(3) any other applicable civil monetary pen24 alties and assessments. 


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1 ‘‘(c) PROCEDURE.—The provisions of section 1128A 

2 (other than subsections (a) and (b) and the second sentence 

3 of subsection (f)) shall apply to a civil money penalty or 

4 assessment under this section in the same manner as such 

5 provisions apply to a penalty or proceeding under section 

6 1128A(a). 

7 ‘‘(d) DEFINITION.—In this section, the term ‘long-term 

8 care facility’ has the meaning given that term in section 

9 2011.’’. 

10 (c) NATIONAL NURSE AIDE REGISTRY.— 

11 (1) DEFINITION OF NURSE AIDE.—In this sub12 section, the term ‘‘nurse aide’’ has the meaning given 

13 that term in sections 1819(b)(5)(F) and 1919(b)(5)(F) 

14 of the Social Security Act (42 U.S.C. 1395i– 

15 3(b)(5)(F); 1396r(b)(5)(F)). 

16 (2) STUDY AND REPORT.— 

17 (A) IN GENERAL.—The Secretary, in con18 sultation with appropriate government agencies 

19 and private sector organizations, shall conduct a 

20 study on establishing a national nurse aide reg21 istry. 

22 (B) AREAS EVALUATED.—The study con23 ducted under this subsection shall include an 

24 evaluation of— 


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1 (i) who should be included in the reg2 istry; 

3 (ii) how such a registry would comply 

4 with Federal and State privacy laws and 

5 regulations; 

6 (iii) how data would be collected for 

7 the registry; 

8 (iv) what entities and individuals 

9 would have access to the data collected; 

10 (v) how the registry would provide ap11 propriate information regarding violations 

12 of Federal and State law by individuals in13 cluded in the registry; 

14 (vi) how the functions of a national 

15 nurse aide registry would be coordinated 

16 with the pilot program for national and 

17 State background checks on direct patient 

18 access employees of long-term care facilities 

19 or providers established under section 307 of 

20 the Medicare Prescription Drug, Improve21 ment, and Modernization Act of 2003 (Pub22 lic Law 108–173); and 

23 (vii) how the information included in 

24 State nurse aide registries developed and 

25 maintained under sections 1819(e)(2) and 


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1 1919(e)(2) of the Social Security Act (42 

2 U.S.C. 1395i–3(e)(2); 1396r(e)(2)(2)) would 

3 be provided as part of a national nurse aide 

4 registry. 

5 (C) CONSIDERATIONS.—In conducting the 

6 study and preparing the report required under 

7 this subsection, the Secretary shall take into con8 sideration the findings and conclusions of rel9 evant reports and other relevant resources, in10 cluding the following: 

11 (i) The Department of Health and 

12 Human Services Office of Inspector General 

13 Report, Nurse Aide Registries: State Com14 pliance and Practices (February 2005). 

15 (ii) The General Accounting Office 

16 (now known as the Government Account17 ability Office) Report, Nursing Homes: 

18 More Can Be Done to Protect Residents 

19 from Abuse (March 2002). 

20 (iii) The Department of Health and 

21 Human Services Office of the Inspector 

22 General Report, Nurse Aide Registries: 

23 Long-Term Care Facility Compliance and 

24 Practices (July 2005). 


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1 (iv) The Department of Health and 

2 Human Services Health Resources and 

3 Services Administration Report, Nursing 

4 Aides, Home Health Aides, and Related 

5 Health Care Occupations—National and 

6 Local Workforce Shortages and Associated 

7 Data Needs (2004)(in particular with re8 spect to chapter 7 and appendix F). 

9 (v) The 2001 Report to CMS from the 

10 School of Rural Public Health, Texas A&M 

11 University, Preventing Abuse and Neglect 

12 in Nursing Homes: The Role of Nurse Aide 

13 Registries. 

14 (vi) Information included in State 

15 nurse aide registries developed and main16 tained under sections 1819(e)(2) and 

17 1919(e)(2) of the Social Security Act (42 

18 U.S.C. 1395i–3(e)(2); 1396r(e)(2)(2)). 

19 (D) REPORT.—Not later than 18 months 

20 after the date of enactment of this Act, the Sec21 retary shall submit a report to the Elder Justice 

22 Coordinating Council, the Committee on Finance 

23 of the Senate, and the Committee on Ways and 

24 Means and the Committee on Energy and Com25 merce of the House of Representatives containing 


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1 the findings and recommendations of the study 

2 conducted under this paragraph. 

3 (E) FUNDING LIMITATION.—Funding for the 

4 study conducted under this subsection shall not 

5 exceed $500,000. 

6 (3) CONGRESSIONAL ACTION.—After receiving the 

7 report submitted by the Secretary under paragraph 

8 (2)(D), the Committee on Finance of the Senate and 

9 the Committee on Ways and Means and the Com10 mittee on Energy and Commerce of the House of Rep11 resentatives shall, as they deem appropriate, take ac12 tion based on the recommendations contained in the 

13 report. 

14 (4) AUTHORIZATION OF APPROPRIATIONS.— 

15 There are authorized to be appropriated such sums as 

16 are necessary for the purpose of carrying out this sub17 section. 

18 (d) CONFORMING AMENDMENTS.— 

19 (1) TITLE XX.—Title XX of the Social Security 

20 Act (42 U.S.C. 1397 et seq.), as amended by section 

21 5(a), is amended— 

22 (A) in the heading of section 2001, by strik23 ing ‘‘TITLE’’ and inserting ‘‘SUBTITLE’’; and 


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1 (B) in subtitle 1, by striking ‘‘this title’’ 

2 each place it appears and inserting ‘‘this sub3 title’’. 

4 (2) TITLE IV.—Title IV of the Social Security 

5 Act (42 U.S.C. 601 et seq.) is amended— 

6 (A) in section 404(d)— 

7 (i) in paragraphs (1)(A), (2)(A), and 

8 (3)(B), by inserting ‘‘subtitle 1 of’’ before 

9 ‘‘title XX’’ each place it appears; 

10 (ii) in the heading of paragraph (2), 

11 by inserting ‘‘SUBTITLE OF’’ before ‘‘TITLE

12 XX’’; and 

13 (iii) in the heading of paragraph 

14 (3)(B), by inserting ‘‘SUBTITLE OF’’ before 

15 ‘‘TITLE XX’’; and 

16 (B) in sections 422(b), 471(a)(4), 472(h)(1), 

17 and 473(b)(2), by inserting ‘‘subtitle 1 of’’ before 

18 ‘‘title XX’’ each place it appears. 

19 (3) TITLE XI.—Title XI of the Social Security 

20 Act (42 U.S.C. 1301 et seq.) is amended— 

21 (A) in section 1128(h)(3)— 

22 (i) by inserting ‘‘subtitle 1 of’’ before 

23 ‘‘title XX’’; and 

24 (ii) by striking ‘‘such title’’ and insert25 ing ‘‘such subtitle’’; and 


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1 (B) in section 1128A(i)(1), by inserting 

2 ‘‘subtitle 1 of’’ before ‘‘title XX’’. 


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Calendar No. 1029 

110TH CONGRESS 

2D SESSION S. 1070 

[Report No. 110–470] 

A BILL 

To amend the Social Security Act to enhance the 

for other purposes. ecute elder abuse, neglect, and exploitation, and to prevent, detect, treat, intervene in, and prosquate public-private infrastructure and to resolve social security of the Nation by ensuring adeSEPTEMBER 18 (legislative day, SEPTEMBER 17), 2008 

Reported with an amendment 


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