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cific facilities. It also should include family and resident satisfaction data.

Although funding to States has resulted in some innovations, it is time to provide reliable, consumer-friendly information on a national basis. None of the existing databases, either at the Federal level or the State level, provide reliable, consumer-friendly information on the broad array of long-term care options.

Unfortunately, definitions and other provisions relating to residential care facilities other than nursing homes vary considerably from State-to-State. The clearinghouse will compile what information is currently available from the States and other sources regarding assisted living, board and care, congregate care, home health care, and other long-term care providers.


Section 2222 would require the Secretary to establish a long-term care consumer clearinghouse which must provide comprehensive detailed information, in a consumer-friendly form, to consumers about choices relating to long-term care providers.

The clearinghouse is to include information about obtaining the services of, and employing, caregivers; options for residential longterm care (e.g., the type of care provided by nursing facilities, and the type of care provided by group homes and other residential facilities); benefits available through the Federal health care programs; and links to Federal and State websites that describe the care available through specific long-term care facilities including information about the satisfaction of those residents and their families with the care provided. The clearinghouse must also provide information (from States and other sources) on long-term care providers including assisted living facilities, board and care facilities, congregate care facilities, home health care providers, and other long-term care providers.

To carry out the activities of this section, the bill would authorize $2 million for FY2006; $3 million for FY2007; and $4 million for each of FYs 2008 and 2009.

Section 2223-Consumer Information about the Continuum of Residential Long-Term Care Facilities

No provision.



The increasing number of older and disabled Americans in recent decades has led to a proliferation of long-term care residential facilities. There are a variety of types of long-term care facilities. While "skilled nursing facilities" are specifically defined in Federal law, other types of residential facilities are not as specifically enumerated and are defined quite differently from State to State. For example, a facility that qualifies as "assisted living" in one State may not fall under that same category under a different State's regulations. Consumers, often during difficult times, are confronted with a maze of decisions and little objective information to provide guidance. A prospective consumer's failure to make appropriate ini

tial decisions about the proper types of long-term care often have dire consequences. A comprehensive study is necessary to be able to provide complete and objective information to consumers and policymakers.


Section 2223 would require the Secretary, in consultation with the Attorney General, to conduct a study on consumer concerns relating to residential long-term care facilities other than nursing facilities. The study may be carried out either directly or through a grant. The organization conducting the study must develop definitions for classes of residential long-term care facilities and collect information on the following features of these facilities: prices, level of services, oversight and enforcement provisions, and admission and discharge criteria.

The Secretary would be required to prepare a report containing the results of the study and submit the report to the Elder Justice Coordinating Council, the Committee on Ways and Means of the House of Representatives, and the Committee on Finance and the Special Committee on Aging of the Senate.

To carry out the study, the bill would authorize $3 million for each of FYs 2006-2009.

Section 2224-Evaluations of Elder Justice Programs

No provision.



Too often, projects in the area of elder abuse, neglect, and exploitation have been funded without regard to whether they have been determined to be effective. Similarly, too few efforts in this area include a validated evaluation component designed to measure efficacy. Given the paucity of data in the field of elder abuse, neglect, and exploitation, it is imperative to leverage resources where they will do the most good. Thus, all grants or other funding mechanisms authorized under this legislation should contain a validated evaluation component, to measure the effectiveness of the efforts. Funding for such evaluations shall be provided either as a stated percentage of the project or as a separate grant for a particular project or group of projects. In addition, grants shall be available to conduct a validated evaluation of ongoing efforts, other than those funded under this legislation.

Individuals selected by the Secretary of HHS with expertise in evaluation methodology, will review the evaluation proposals to determine whether they are adequate to gather meaningful information, and, if not, to advise the applicant why the proposal was not funded, and assist applicants in modifying evaluation proposals.


Section 2224 would require the Secretary of HHS to reserve a portion of the funds appropriated in each program under Title XXII to be used to provide assistance to eligible entities to conduct validated evaluations of the effectiveness of the activities funded under

each program under Title XXII. To be eligible to receive these funds, an eligible entity must submit an application to the Secretary following the timing and requirements prescribed by the Secretary including a proposal for the evaluation.

Entities would be required to submit to the Secretary and appropriate congressional committees a report containing the results of the evaluation together with any recommendations deemed appropriate. The report would be due by the date specified by the Secretary.

Section 101(b) Amendments to the Social Security Act-Long-Term Care Facilities


No Federal provisions for mandatory reporting of crimes in federally funded long-term care facilities. There are some Medicare and Medicaid provisions that apply when a facility that participates in either of those programs closes.

Reporting. Based on a 2000 survey of State Adult Protective Services systems, all States had elder/adult abuse reporting laws. State laws varied in who was a mandated reporter and who was encouraged to report incidents of elder/adult abuse. Many States and territories named health care professionals, such as nurses, physicians and nurse aides, as mandated reporters of elder/adult abuse. Five States did not list anyone as a mandated reporter.

Eleven States reported that there were no statutory consequences for failure of mandated reporters to report abuse; the remaining States and the District of Columbia and Guam had a specified consequence. The most common consequence for failing to report was a misdemeanor with a possible fine and/or jail sentence. State law also varied with regard to specifying a timeframe within which reporters were required to report suspicion of abuse. Nineteen States had no timeframe. Of those that specified a timeframe, the requirements varied from immediately to more than 4 days.

Notification of Facility Closure. If a long-term care facility that receives Federal funds through participation in Medicare or Medicaid closes, current Federal laws and regulations provide some guidance on the parties that need to be notified and the process for relocating residents. If a facility wants to terminate its status as a Medicare provider (for example, due to facility closure), the facility must notify both CMS and the public no later than 15 days in advance of the proposed termination date. If a facility wants to terminate its status as a Medicaid provider, Federal regulations do not specify a timeframe for notifying Federal or State agencies; however, the facility is required to notify Medicaid residents at least 30 days before transferring or discharging him or her. Facility closure is one circumstance in which a resident would need to be transferred.

The State Medicaid agency has the primary responsibility for relocating Medicaid patients and for ensuring their safe and orderly transfer from a facility that no longer participates in Medicaid to a participating facility that meets acceptable standards. CMS has provided guidance to States concerning relocating patients. Each State is expected to have a plan that describes the relocation of pa

tients. Additionally, the notice to residents is to include information as to how to contact the ombudsman established by the Older Americans Act.


Recent reports confirm that there is a growing concern that some recipients of long-term care services are abused by individuals to whom their care has been entrusted. Some problems that occur between a provider of care and a recipient of care are best handled within a given facility and do not require the involvement of law enforcement. But too often, serious crimes are not immediately reported to law enforcement, but instead are handled internally or solely administratively, by reporting to the State survey agency. [See "Nursing Homes: More Can Be Done to Protect Residents from Abuse," GAO Report to the Special Committee on Aging, GAO-02-312, March 2002]. GAO recommended that the Federal Government facilitate the prompt reporting, investigation, and prevention of abuse to help ensure the protection of nursing home residents. In addition, the absence of prompt reporting to law enforcement may result in the compromise of forensic evidence, rendering it more difficult to establish what occurred and whether a crime was committed. Without penalties for failure to report crimes, there is no assurance these crimes will be reported.

The closure of a facility is a significant event in the lives of its residents and, if not handled properly, can result in serious decline and even death of residents. The closure of a nursing facility, and particularly the sudden closure of a nursing home chain, requires a significant government and community response. Thus, advance notice and orderly, well-planned and satisfactory transfer of residents is critical to the residents' health and well-being. Although both long-term care ombudsmen and the States have responsibility for transferring residents in the case of a facility closure, that task is made much more difficult, if they do not have advance notice of such closure. It is thus imperative that facilities factor into their plans, the orderly and adequate transfer of residents in the event of closure and be prohibited from closing suddenly. Finally, this provision will also provide facility staff with assurance that they will have at least 60 days notice prior to a facility closure. The existing provisions or practices at the Federal level do not ensure consistency in closure notice. Moreover, there are no consequences for failure to provide notice of closure in any existing requirements. There is a need, therefore, for a uniform reporting requirement in Federal law for serious crimes committed in nursing homes against nursing home residents.


Reporting of Crimes in Federally-funded Facilities. Section 101(b) of the bill would require reporting to law enforcement of crimes occurring in federally funded long-term care facilities that receive at least $10,000 in Federal funds during the preceding year. The owner or operator of these facilities would be required to annually notify each individual who is an owner, operator, employee, manager, agent, or contractor of a long-term care facility that they are required to report any reasonable suspicion of a crime against any

person who is a resident of or receiving care from the facility. These individuals are referred to in this section as "covered individuals." Suspected crimes must be reported to the Secretary and one or more law enforcement entities for the political subdivision in which the facility is located.

Timing of Reporting. If the events that cause the suspicion of a crime result in serious bodily injury, the covered individual must report the suspicion immediately, but not later than 2 hours after forming the suspicion. If the events that cause the suspicion do not result in serious bodily injury, the individual must report the suspicion not later than 24 hours after forming the suspicion.

Penalties for Non-Reporting. If a covered individual does not report suspicion of a crime within the timeframe described above, the individual will be subject to a civil money penalty of up to $200,000, or the Secretary shall classify the individual as an "excluded individual” (i.e., any employer of the individual is unable to receive Federal funds) for a period of not more than 3 years. If a covered individual does not report suspicion of a crime within the timeframe described above and this violation exacerbates the harm to the victim, or results in harm to another person, the individual will be subject to a civil money penalty of up to $300,000, and the Secretary shall classify the individual as an "excluded individual" (i.e., any employer of the individual is unable to receive Federal funds) for a period of not more than 3 years.

If an individual is classified as an "excluded individual,” any entity that employs that individual will not be eligible to receive Federal funds. The Secretary may take into account the financial burden on providers with underserved populations in determining any penalty to be imposed under this section. Underserved populations are defined as the population of an area designated by the Secretary as an area or population group with a shortage of elder justice programs. These may include those that are geographically isolated, racial and ethnic minority populations, and populations underserved because of special needs (such as language barriers, disabilities, alien status, or age).

Additional Penalties for Retaliation. A long-term care facility may not retaliate against an employee for making a report, causing a report to be made, or for taking steps to make a report. Retaliation includes discharge, demotion, suspension, threats, harassment, denial of a promotion or other employment-related benefit, or any other manner of discrimination against an employee in the terms and conditions of employment because of lawful acts done by the employee. Long-term care facilities may also not retaliate against a nurse by filing a complaint or report with the appropriate State professional disciplinary agency because of lawful acts done by the


If a long-term care facility does retaliate, it shall be subject to a civil money penalty of up to $200,000 or the Secretary may exclude it from participation in any Federal health care program for a period of 2 years.

Notice to Employees. Each long-term care facility must post conspicuously, in an appropriate location, a sign specifying rights of employees under this section. The sign shall include a statement that an employee may file a complaint against a long-term care fa

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