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REASONS FOR CHANGE

It is essential that greater understanding be achieved about how best to provide adult protective services to older Americans. This provision, therefore, establishes a demonstration grant program designed to compare and contrast the outcomes of workers. Conducting a demonstration grant designed to compare and contrast the outcomes of workers who carry reasonable caseloads consisting of elder abuse cases, i.e., 25 cases, with the typical caseload of workers carrying caseloads consisting of mixed caseloads (children, vulnerable adults and elderly) will provide significant data upon which to base future policy decisions.

SENATE BILL

Grants to Improve Worker Caseloads for Adult Protective Services. The Secretary would be required to award annual grants to enhance adult protective service programs provided to elders by States and local governments. These grants are to support projects that employ workers who have caseloads consisting only of elders and to identify the number of cases that should comprise a reasonable elder caseload.

Formula for Distribution of Funds. Distribution of funds to States would be based on a formula that takes into account the number of elders (people age 60 or older) residing in a State relative to the total U.S. population of elders. States would receive no less than 0.75 percent of the grant program's annual appropriation. The District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa would receive no less than 0.1 percent of the annual appropriation. In order to comply with these minimum amount requirements, the Secretary is required to make pro rata reductions in amounts to be allotted.

Use of Funds. Funds may be used only by States and local governments to provide adult protective services for elders. State receiving funds would be required to provide these funds to the agency or unit of State government having legal responsibility for providing adult protective services in the State. Each State would be required to use these funds to supplement and not supplant other Federal, State, and local public funds expended to provide adult protective services.

Reports. Each State would be required to submit a report to the Secretary comparing outcomes of workers who carry caseloads consisting only of elders with workers whose caseloads include other individuals. The report would also be required to identify a reasonable worker/elder client caseload. The Secretary would be required to submit to the appropriate congressional committees a report compiling, summarizing, and analyzing the State reports, as well making recommendations for appropriate legislative or administrative action. This report is to be submitted no later than October 1, 2010.

The bill would authorize $100 million for each of FYs 2006-2009.

State Adult Protective Service Grants (Demonstration Program)

PRESENT LAW

No provision in current law specifically authorizes a dedicated amount of funds for State adult protective service demonstration programs. However, the Older American Act authorizes a related demonstration program (as follows), but no specific authorization is specified by law.

Section 413 of the Older Americans Act, Older Individuals' Protection from Violence Projects, requires the Assistant Secretary to award funds to States, area agencies on aging, and nonprofit organizations, or tribal organizations to carry out a wide range of projects related to protection of older persons from violence. Funds are to be used to: support local communities to coordinate activities regarding intervention in and prevention of abuse, neglect, and exploitation; develop outreach to assist victims; expand access to family violence and sexual assault programs (including shelters, rape crisis centers, and support groups) as well as mental health services, safety planning and other services; and promote research on legal organization and training impediments to providing services through shelters and other programs.

REASONS FOR CHANGE

Targeted demonstration grants to develop training modules and develop improved methods of detecting elder abuse will assist in developing an enhanced base of knowledge on the provision of adult protective services throughout the country.

SENATE BILL

Section 2214 would require the Secretary to establish grants to States for adult protective service demonstration programs. Funds may be used by State and local units of government to conduct demonstration programs that test: training modules developed for the purpose of detecting or preventing elder abuse; methods to detect or prevent financial exploitation and elder abuse; the feasibility of establishing safe havens for victims; whether training on elder abuse forensics enhances the detection of abuse by employees of State or local government; and other related matters. States would submit applications to the Secretary.

Each State receiving funds would be required to submit a report on the demonstration to the Secretary. The Secretary would be required to submit to the appropriate congressional committees a report compiling, summarizing, and analyzing the State reports, as well making recommendations for appropriate legislative or administrative action. This report is to be submitted no later than October 1, 2010.

The bill would authorize $25 million for the period FY2006–2009.

Subtitle C-Collection of Data, Dissemination of Information and Studies

Section 2221-Collection of Uniform National Data on Elder Abuse, Neglect, and Exploitation

PRESENT LAW

No provision that establishes an ongoing, uniform national data collection process or provides grants to States to assist with data collection.

A related law, the Family Violence Prevention and Services Act of 1992 (P.L. 102–295), required HHS to conduct a study of the national incidence of abuse, neglect, and exploitation of elderly persons. This study, referred to as "the National Elder Abuse Incidence Study," used a nationally-representative sample of 20 counties in 15 States and combined local Adult Protective Services (APS) reports with reports from other community service agencies to estimate the number of new elder abuse and neglect cases over a given period. The final report for this study was released by HHS in 1998.

In addition to the study described above, the Federal Government has periodically surveyed State APS units over the last 20 years on the prevalence of elder abuse, neglect and exploitation. In these surveys, there was significant variation among the States in the definitions used and the comprehensiveness of data collected. This variation has created challenges in establishing a national data set and identifying trends in abuse, neglect and exploitation.

REASONS FOR CHANGE

To correctly assess the scope and nature of elder abuse, neglect, and exploitation, it is imperative to improve overall data collection nationwide. Although diverse reporting requirements in different States and complexities accompanying various confidentiality and privacy requirements exist, it is nonetheless critical to begin the process of compiling a centralized data base on elder abuse, neglect, and exploitation. This data repository will be an invaluable resource for research, training, raising public awareness, guiding public policy and other purposes.

The only incidence and prevalence study on elder abuse, published in 1998, was narrow in scope. Not only is the information from that study outdated as the demographics of older Americans have changed, it is not widely accepted as definitive on the subject. Compilation of new data will advance knowledge and research in the area of elder abuse, neglect and exploitation. Further, it will make it easier for the National Institutes of Health and the National Academies to develop a blueprint for further study in this area that, thus far, these entities have been unable to achieve.

SENATE BILL

Section 2221 would establish as the purpose of the section the improvement, streamlining, and promotion of uniform collection, maintenance and dissemination of national data regarding elder abuse, neglect and exploitation. The activities of the Secretary would be carried out in three phases.

The Secretary would be required to develop, under Phase I, a method for collecting national data regarding elder abuse, neglect and exploitation and uniform national data reporting forms adapted to each relevant entity or discipline (e.g., health, public safety, social and protective services and law enforcement). The Secretary would be required to consult with the Attorney General and work with experts in the Bureau of Justice Statistics and the Office of Justice Programs to develop this method for national data collection. The national data reporting forms must include the definitions of Title XXII for determining whether an event will be reportable. Finally, the activities that would be carried out under this section must ensure the protection of individual health privacy consistent with the regulations under Section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and any State and local privacy regulations. Phase I must occur no later than one year after the date of enactment.

Phase II would require the Secretary to ensure that the national data reporting forms and data collection methods (developed under Phase I) would be pilot tested in six States selected by the Secretary. After pilot testing the data collection efforts, the Secretary must review the findings, consult with the Attorney General and other relevant experts, and adjust the national data reporting forms and data collection methods as necessary. Phase II must occur no later than one year following the completion of activities under Phase I.

Phase III would require the Secretary to submit the national data reporting forms and instructions to (1) the heads of the relevant components of DHHS, the Department of Justice, the Department of the Treasury, and other appropriate Federal entities; and (2) the Governor's office of each State for collection from all relevant State entities of data including health care, social services, and law enforcement data.

In Phase III, the Secretary would be authorized to award grants to States to improve data collection activities relating to elder abuse, neglect and exploitation. Each State that wants to apply for a grant, must submit an application to the Administrator following the prescribed requirements. Each State receiving a grant in a fiscal year would be required to submit data for the calendar year that begins during that year using the national data forms.

The amount of each grant to a State must be distributed using the following method: For the first fiscal year in which a State receives grant funds, the Secretary would be required to initially distribute 50 percent of those funds. The remaining funds are to be distributed at the end of the calendar year that begins during that fiscal year if the Secretary determines that the State has properly reported data required under this section for the calendar year. For subsequent years, the Secretary would be required to distribute grant funds to a State for a fiscal year if the State properly reported required data for the calendar year that ends during that fiscal year. The reports submitted by States must indicate the State and year in which the event occurred and identify the total number of events that occurred in each State during the year and the type of event.

The Secretary would be required to submit a report regarding the activities required by this section to Congress including the Committee on Finance and the Special Committee on Aging of the Senate. The first report must be submitted no later than one year after the date of enactment of the bill and annually thereafter.

To carry out the activities of this section, the bill would authorize $10 million for FY2006; $30 million for FY2007; and $100 million for each of FYs 2008 and 2009.

Section 2222-Long-Term Care Consumer Clearinghouse

PRESENT LAW

No provision requiring establishment of a long-term care consumer clearinghouse.

In related activities, DHHS has funded some States to establish State-based consumer-friendly access to information about longterm care services. In FY2003 and FY2004, the Centers for Medicare and Medicaid Services (CMS) and AoA awarded approximately $18 million in grants to States for the purpose of assisting States in their efforts to create a single, coordinated system of information and access for all persons seeking long term care to minimize confusion, enhance individual choice, and support informed decisionmaking. A total of 24 States have received grants for this purpose. Some of the common activities under this grant program include information and referral, outreach, counseling about public benefits and long-term care options, and case management. States' methods for implementing the grant may vary; some States have established an actual physical location, and other States have established a Statewide clearinghouse through a toll-free number or a web-based information site.

In addition, CMS has made available to the public, via its website, a comparison of Medicare and Medicaid-certified nursing homes and home health agencies. The information provides detailed facility and agency information and characteristics, and contains several measures of quality (e.g., improvement in mobility). This website does not cover assisted living facilities, group homes and other residential facilities that are not nursing facilities; nor does it cover non-medical, non-certified, home and communitybased long-term care services.

REASONS FOR CHANGE

Currently there is no centralized repository of information to assist those trying to make choices about long-term care. This longterm care clearinghouse would house comprehensive information in a consumer-friendly form for those attempting to make choices about long-term care. For example, families trying to make decisions about whether they can continue to care for a loved one at home, might be interested in how to get assistance at home and for caregiver tips. They also may wish to learn about the different options in residential care, ranging from group homes to nursing homes. The clearinghouse website would provide hyperlinks to CMS sites providing information about nursing homes generally, the Medicare and Medicaid programs, and information about spe

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