Sec. 208. Evaluations. 
TITLE III—TAX PROVISIONS 
Sec. 301. Long-Term care facility worker employment tax credit. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) The proportion of the United States popu-
lation age 60 years or older will drastically increase 
in the next 30 years as more than 76,000,000 baby 
boomers approach retirement and old age. 
(2) Each year, anywhere between 500,000 and 
5,000,000 elders in the United States are abused, 
neglected, or exploited. 
(3) Elder abuse, neglect, and exploitation have 
no boundaries, and cross all racial, social class, gen-
der, and geographic lines. 
(4) Victims of elder abuse, neglect, and exploi-
tation are not only subject to injury from mistreat-
ment and neglect, they are also 3.1 times more likely 
than elders who were not victims of elder abuse, ne-
glect, and exploitation to die at an earlier age than 
expected. 
(5) There is a general dearth of data as to the 
nature and scope of elder abuse, neglect, and exploi-
tation. In recognition of the need to improve data 
collection efforts with respect to elder abuse, neglect, 
and exploitation, Congress required the Secretary of 
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Health and Human Services to conduct a study by 
the end of 2008 on establishing a uniform national 
database on elder abuse under section 405 of title 
IV of Division C of the Tax Relief and Health Care 
Act of 2006 (Public Law 109–432). 
(6) Despite the dearth of data in the field, ex-
perts agree that most cases of elder abuse, neglect, 
and exploitation are never reported and that abuse, 
neglect, and exploitation shorten a victim’s life, often 
triggering a downward spiral of an otherwise pro-
ductive, self-sufficient elder’s life. Programs address-
ing other difficult issues such as domestic violence 
and child abuse and neglect have demonstrated the 
need for a multifaceted law, combining public health, 
social service, and law enforcement approaches. 
(7) For over 20 years, Congress has been pre-
sented with facts and testimony calling for a coordi-
nated Federal effort to combat elder abuse, neglect, 
and exploitation. 
(8) The Federal Government has been slow to 
respond to the needs of victims of elder abuse, ne-
glect, and exploitation or to undertake prevention ef-
forts. 
(9) No Federal law has been enacted that ade-
quately and comprehensively addresses the issues of 
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elder abuse, neglect, and exploitation and there are 
very limited resources available to those in the field 
that directly deal with the issues. 
(10) Differences in State laws and practices in 
the areas of elder abuse, neglect, and exploitation 
lead to significant disparities in prevention, protec-
tive and social services, treatment systems, and law 
enforcement, and lead to other inequities. 
(11) The Federal Government has played an 
important role in promoting research, training, pub-
lic safety, and data collection, and the identification, 
development, and dissemination of promising health 
care, social, and protective services, and law enforce-
ment practices, relating to child abuse and neglect, 
domestic violence, and violence against women. The 
Federal Government should promote similar efforts 
and protections relating to elder abuse, neglect, and 
exploitation. 
(12) The Federal Government should provide 
leadership and assist States and communities in 
their efforts to protect elders in the United States 
by— 
(A) promoting coordinated planning among 
all levels of government; 
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(B) generating and sharing knowledge rel-
evant to protecting elders; 
(C) providing leadership to combat the 
abuse, neglect, and exploitation of the Nation’s 
elders; and 
(D) providing resources to States and com-
munities to promote elder justice. 
(13) The problem of elder abuse, neglect, and 
exploitation requires a comprehensive approach 
that— 
(A) integrates the work of health, legal, 
and social service agencies and organizations; 
(B) emphasizes the need for prevention, re-
porting, investigation, assessment, treatment, 
and prosecution of elder abuse, neglect, and ex-
ploitation at all levels of government; 
(C) ensures that sufficient numbers of 
properly trained personnel with specialized 
knowledge are in place to— 
(i) treat, assess, and provide services 
relating to elder abuse, neglect, and exploi-
tation; and 
(ii) carry out elder protection duties; 
(D) is sensitive to ethnic and cultural di-
versity; 
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(E) recognizes the role of mental health, 
disability, dementia, substance abuse, medica-
tion mismanagement, and family dysfunction 
problems in increasing and exacerbating elder 
abuse, neglect, and exploitation; and 
(F) balances elders’ right to self-deter-
mination with society’s responsibility to protect 
elders. 
(14) The human, social, and economic cost of 
elder abuse, neglect, and exploitation is high and in-
cludes unnecessary expenditures of funds from many 
public programs. 
(15) The failure to coordinate activities relating 
to, and comprehensively prevent and treat, elder 
abuse, neglect, and exploitation threatens the future 
and well-being of millions of elders in the United 
States. 
(16) All elements of society in the United 
States have a shared responsibility in responding to 
a national problem of elder abuse, neglect, and ex-
ploitation. 
SEC. 3. PURPOSES. 
The purposes of this Act are as follows: 
(1) To enhance the social security of the Nation 
by ensuring adequate public-private infrastructure 
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and resolving to prevent, detect, treat, understand, 
and intervene in, and where appropriate, aid in the 
prosecution of, elder abuse, neglect, and exploitation. 
(2) To bring a comprehensive approach to pre-
venting and combating elder abuse, neglect, and ex-
ploitation, a long invisible problem that afflicts the 
most vulnerable among the aging population of the 
United States. 
(3) To raise the issue of elder abuse, neglect, 
and exploitation to national attention, and to create 
the infrastructure at the Federal, State, and local 
levels, to ensure that individuals and organizations 
on the front lines, who are fighting elder abuse, ne-
glect, and exploitation with scarce resources and 
fragmented systems, have the resources and infor-
mation needed to carry out their fight. 
(4) To bring a comprehensive multidisciplinary 
approach to elder justice. 
(5) To set in motion research and data collec-
tion to fill gaps in knowledge about elder abuse, ne-
glect, and exploitation. 
(6) To supplement the activities of service pro-
viders and programs, to enhance training, and to le-
verage scarce resources efficiently, in order to ensure 
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that elder justice receives the attention it deserves as 
the Nation’s population ages. 
(7) To recognize and address the role of mental 
health, disability, dementia, substance abuse, medi-
cation mismanagement, and family dysfunction prob-
lems in increasing and exacerbating elder abuse, ne-
glect, and exploitation. 
(8) To create short- and long-term strategic 
plans for the development and coordination of elder 
justice research, programs, studies, training, and 
other efforts nationwide. 
(9) To promote collaborative efforts and dimin-
ish overlap and gaps in efforts in developing the im-
portant field of elder justice. 
(10) To honor and respect the right of all indi-
viduals with diminished capacity to decisionmaking 
autonomy, self-determination, and dignity of choice. 
(11) To respect the wishes of individuals with 
diminished capacity and their family members in 
providing supportive services and care plans in-
tended to protect elders from abuse, neglect (includ-
ing self-neglect), and exploitation. 
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TITLE I—DEPARTMENT OF 
HEALTH AND HUMAN SERVICES 
SEC. 101. DEFINITIONS. 
Except as otherwise specifically provided, any term 
that is defined in section 2011 of the Social Security Act 
(as added by section 102(a)) and is used in this title has 
the meaning given such term by such section. 
SEC. 102. ELDER JUSTICE. 
(a) ELDER JUSTICE.— 
(1) IN GENERAL.—Title XX of the Social Secu-
rity Act (42 U.S.C. 1397 et seq.) is amended— 
(A) in the title heading, by inserting 
‘‘AND ELDER JUSTICE’’ after ‘‘SO-
CIAL SERVICES’’; 
(B) by inserting before section 2001 the 
following: 
‘‘PART A—BLOCK GRANTS TO STATES FOR SOCIAL 
SERVICES’’; 
and 
(C) by adding at the end the following: 
‘‘PART B—ELDER JUSTICE 
‘‘SEC. 2011. DEFINITIONS. 
‘‘In this part: 
‘‘(1) ABUSE.—The term ‘abuse’ means the 
knowing infliction of physical or psychological harm 
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or the knowing deprivation of goods or services that 
are necessary to meet essential needs or to avoid 
physical or psychological harm. 
‘‘(2) ADULT PROTECTIVE SERVICES.—The term 
‘adult protective services’ means such services pro-
vided to adults as the Secretary may specify and in-
cludes services such as— 
‘‘(A) disseminating reports of adult abuse, 
neglect, or exploitation; 
‘‘(B) investigating the reports described in 
subparagraph (A); 
‘‘(C) case planning, monitoring, evaluation, 
and other case work and services; and 
‘‘(D) providing, arranging for, or facili-
tating the provision of medical, social service, 
economic, legal, housing, law enforcement, or 
other protective, emergency, or support services. 
‘‘(3) CAREGIVER.—The term ‘caregiver’ means 
an individual who has the responsibility for the care 
of an elder, either voluntarily, by contract, by receipt 
of payment for care, or as a result of the operation 
of law, and means a family member or other indi-
vidual who provides (on behalf of such individual or 
of a public or private agency, organization, or insti-
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tution) compensated or uncompensated care to an 
elder who needs supportive services in any setting. 
‘‘(4) DIRECT
CARE.—The term ‘direct care’ 
means care by an employee or contractor who pro-
vides assistance or long-term care services to a re-
cipient. 
‘‘(5) ELDER.—The term ‘elder’ means an indi-
vidual age 60 or older. 
‘‘(6) ELDER JUSTICE.—The term ‘elder justice’ 
means— 
‘‘(A) from a societal perspective, efforts 
to— 
‘‘(i) prevent, detect, treat, intervene 
in, and prosecute elder abuse, neglect, and 
exploitation; and 
‘‘(ii) protect elders with diminished 
capacity while maximizing their autonomy; 
and 
‘‘(B) from an individual perspective, the 
recognition of an elder’s rights, including the 
right to be free of abuse, neglect, and exploi-
tation. 
‘‘(7) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means a State or local government agency, In-
dian tribe or tribal organization, or any other public 
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or private entity that is engaged in and has expertise 
in issues relating to elder justice or in a field nec-
essary to promote elder justice efforts. 
‘‘(8) EXPLOITATION.—The term ‘exploitation’ 
means the fraudulent or otherwise illegal, unauthor-
ized, or improper act or process of an individual, in-
cluding a caregiver or fiduciary, that uses the re-
sources of an elder for monetary or personal benefit, 
profit, or gain, or that results in depriving an elder 
of rightful access to, or use of, benefits, resources, 
belongings, or assets. 
‘‘(9) FIDUCIARY.—The term ‘fiduciary’— 
‘‘(A) means a person or entity with the 
legal responsibility— 
‘‘(i) to make decisions on behalf of 
and for the benefit of another person; and 
‘‘(ii) to act in good faith and with 
fairness; and 
‘‘(B) includes a trustee, a guardian, a con-
servator, an executor, an agent under a finan-
cial power of attorney or health care power of 
attorney, or a representative payee. 
‘‘(10) GRANT.—The term ‘grant’ includes a 
contract, cooperative agreement, or other mechanism 
for providing financial assistance. 
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‘‘(11) GUARDIANSHIP.—The term ‘guardian-
ship’ means— 
‘‘(A) the process by which a State court 
determines that an adult individual lacks capac-
ity to make decisions about self-care and prop-
erty, and appoints another individual or entity 
known as a guardian, as a conservator, or by a 
similar term, as a surrogate decisionmaker; 
‘‘(B) the manner in which the court-ap-
pointed surrogate decisionmaker carries out du-
ties to the individual and the court; or 
‘‘(C) the manner in which the court exer-
cises oversight of the surrogate decisionmaker. 
‘‘(12) INDIAN TRIBE.— 
‘‘(A) IN
GENERAL.—The term ‘Indian 
tribe’ has the meaning given such term in sec-
tion 4 of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450b). 
‘‘(B) 
INCLUSION
OF
PUEBLO
AND 
RANCHERIA.—The term ‘Indian tribe’ includes 
any Pueblo or Rancheria. 
‘‘(13) LAW ENFORCEMENT.—The term ‘law en-
forcement’ means the full range of potential re-
sponders to elder abuse, neglect, and exploitation in-
cluding— 
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‘‘(A) police, sheriffs, detectives, public safe-
ty officers, and corrections personnel; 
‘‘(B) prosecutors; 
‘‘(C) medical examiners; 
‘‘(D) investigators; and 
‘‘(E) coroners. 
‘‘(14) LONG-TERM CARE.— 
‘‘(A) IN GENERAL.—The term ‘long-term 
care’ means supportive and health services spec-
ified by the Secretary for individuals who need 
assistance because the individuals have a loss of 
capacity for self-care due to illness, disability, 
or vulnerability. 
‘‘(B) LOSS
OF
CAPACITY
FOR
SELF- 
CARE.—For purposes of subparagraph (A), the 
term ‘loss of capacity for self-care’ means an in-
ability to engage in 1 or more activities of daily 
living, including eating, dressing, bathing, and 
management of one’s financial affairs. 
‘‘(15) LONG-TERM CARE FACILITY.—The term 
‘long-term care facility’ means a residential care pro-
vider that arranges for, or directly provides, long- 
term care. 
‘‘(16) NEGLECT.—The term ‘neglect’ means— 
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‘‘(A) the failure of a caregiver or fiduciary 
to provide the goods or services that are nec-
essary to maintain the health or safety of an 
elder; or 
‘‘(B) self-neglect. 
‘‘(17) NURSING FACILITY.— 
‘‘(A) IN GENERAL.—The term ‘nursing fa-
cility’ has the meaning given such term under 
section 1919(a). 
‘‘(B) INCLUSION OF SKILLED NURSING FA-
CILITY.—The term ‘nursing facility’ includes a 
skilled nursing facility (as defined in section 
1819(a)) 
‘‘(18) SELF-NEGLECT.—The term ‘self-neglect’ 
means an adult’s inability, due to physical or mental 
impairment or diminished capacity, to perform es-
sential self-care tasks including— 
‘‘(A) obtaining essential food, clothing, 
shelter, and medical care; 
‘‘(B) obtaining goods and services nec-
essary to maintain physical health, mental 
health, or general safety; or 
‘‘(C) managing one’s own financial affairs. 
‘‘(19) SERIOUS BODILY INJURY.— 
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‘‘(A) IN
GENERAL.—The term ‘serious 
bodily injury’ means an injury— 
‘‘(i) involving extreme physical pain; 
‘‘(ii) involving substantial risk of 
death; 
‘‘(iii) involving protracted loss or im-
pairment of the function of a bodily mem-
ber, organ, or mental faculty; or 
‘‘(iv) requiring medical intervention 
such as surgery, hospitalization, or phys-
ical rehabilitation. 
‘‘(B) CRIMINAL SEXUAL ABUSE.—Serious 
bodily injury shall be considered to have oc-
curred if the conduct causing the injury is con-
duct described in section 2241 (relating to ag-
gravated sexual abuse) or 2242 (relating to sex-
ual abuse) of title 18, United States Code, or 
any similar offense under State law. 
‘‘(20) SOCIAL.—The term ‘social’, when used 
with respect to a service, includes adult protective 
services. 
‘‘(21) 
STATE
LEGAL
ASSISTANCE
DEVEL-
OPER.—The term ‘State legal assistance developer’ 
means an individual described in section 731 of the 
Older Americans Act of 1965. 
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‘‘(22) STATE LONG-TERM CARE OMBUDSMAN.— 
The term ‘State Long-Term Care Ombudsman’ 
means the State Long-Term Care Ombudsman de-
scribed in section 712(a)(2) of the Older Americans 
Act of 1965. 
‘‘SEC. 2012. GENERAL PROVISIONS. 
‘‘(a) PROTECTION OF PRIVACY.—In pursuing activi-
ties under this part, the Secretary shall ensure the protec-
tion of individual health privacy consistent with the regu-
lations promulgated under section 264(c) of the Health 
Insurance Portability and Accountability Act of 1996 and 
applicable State and local privacy regulations. 
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this part 
shall be construed to interfere with or abridge an elder’s 
right to practice his or her religion through reliance on 
prayer alone for healing when this choice— 
‘‘(1) is contemporaneously expressed, either 
orally or in writing, with respect to a specific illness 
or injury which the elder has at the time of the deci-
sion by an elder who is competent at the time of the 
decision; 
‘‘(2) is previously set forth in a living will, 
health care proxy, or other advance directive docu-
ment that is validly executed and applied under 
State law; or 
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