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cility that violates the provisions of this section with the Secretary. The notice must also contain information as to how to file a complaint.

Notification of Public Agencies and Safety of Residents in the Event of Facility Closure. In addition, if a long-term care facility (that receives at least $10,000 in Federal funds during the previous year) is going to close, the owner or operator of the facility must submit to the Secretary and the appropriate State regulatory agency written notification of an impending closure within 60 days prior to the closure date. In the notice, the owner or operator must include a plan for transfer and adequate relocation of residents, including assurances that residents will not be moved to a facility which provides substandard care or for which an administrative or law enforcement action is pending. Within 10 days after the facility closes, the owner or operator of the facility must submit to the Secretary, and the appropriate State agency, information on where the residents were transferred to and when.

Anyone who owns a skilled nursing facility that fails to comply with the notification of closure and reporting requirements shall be subject to a civil monetary penalty of up to $1,000,000, exclusion from participation in the programs under the Social Security Act, and any other civil monetary penalties and assessments.

A civil monetary penalty or assessment will be imposed in the same manner as a civil monetary penalty, assessment or exclusion under Section 1128A of the Social Security Act.

TITLE II-DEPARTMENT OF JUSTICE

Section 201-Victim Advocacy Grants

PRESENT LAW

Title II-Section 1209. Enhancing Protections for Older and Disabled Women from Domestic Violence and Sexual Assault. Section 1209(c) of the Victims of Trafficking and Violence Protection Act of 2000 (P.L. 106-386) (Protections for Older and Disabled Individuals from Domestic Violence and Sexual Assault) authorizes the Attorney General to award grants to States, the District of Columbia, tribal governments, and territories through the Services, Training, Officers, Prosecutors (STOP) formula grant program. Grant funding is to be used for developing, enlarging, or strengthening programs that assist law enforcement, prosecutors, courts, and others in helping older and disabled women who are victims of domestic violence or sexual assault. This assistance can include recognizing, investigating, and prosecuting instances of such violence or assault and targeting outreach and support, counseling, and other services to these older and disabled victims. The Act authorizes $5 million for each FYS 2001-2005 for this purpose. Current law does not include the older victims. Moreover, current law does not necessarily address the victimization of older men.

REASONS FOR CHANGE

It is useful to periodically conduct an independent evaluation of the overall impact of different types of investigations and prosecutions. This aids in determining which ones are most effective in ad

dressing a crime and influencing future behaviors, and which ones have unintended consequences. In this regard, the study must sample and quantify the cutcomes of a reasonable number of investigations and prosecutions and draw a correlation to the desired impact of curbing elder abuse, neglect, and exploitation. Many prosecutors and investigators working in child abuse prevention have found it vital to include victim assistance professionals as part of the team. These professionals play a significant role in supporting victims and ensuring their ability to participate in court proceedings. Thus, the study and pilots envisioned would evaluate how outcomes are impacted by the use of victims advocates, and what types of victim assistance is most needed. In addition, training for victim advocacy will further enhance the ability of various professionals to ensure the ability of older victims to participate in court proceedings.

SENATE BILL

The bill would permit the Attorney General, after consultation with the Secretary of HHS, to award grants to eligible entities to study the needs of victims of elder abuse, neglect, and exploitation.

It would authorize $2.5 million for FY2006 and $3 million for each of FYs 2007-2009 for pilot programs that would: (1) develop programs for victims of elder abuse, neglect, and exploitation; (2) provide training to relevant personnel; and (3) examine special approaches aimed at meeting the needs of victims of elder abuse, neglect, and exploitation.

Section 202-Supporting State and Local Prosecutors in Elder Justice Matters

PRESENT LAW

Title II, Section 1209 of the Violence of Trafficking and Violence Protection Act of 2000 (P.L. 106-386) permits the Attorney General to make grants for training programs to assist front line law enforcement personnel to enhance their ability to address, investigate, and prosecute instances of elder abuse, neglect, and exploitation. The Administration obligated $4.9 million in FY2003 and has estimated an obligation of $666,000 for FY2004 for the Training Grants to Stop Abuse and Sexual Assault of Older Individuals or Individuals with Disabilities program.

REASONS FOR CHANGE

State Attorneys General and District Attorneys pursue numerous types of cases relating to elder justice, including financial fraud cases. These are cases where elders are victims of financial scams, domestic violence, institutional abuse and neglect. Present law restricts the ability to train State and local law enforcement in the full array of issues relating to elder abuse. In addition, prosecutors are without legal research support on cases of elder abuse. The American Prosecutors Research Institute for Prosecution of Child Abuse, which has been in existence for 16 years, has been the "goto" clearinghouse for information and support to prosecutors and allied professionals for all needs associated with prosecuting physical and sexual abuse and neglect cases. Elder abuse, neglect, and exploitation cases often arise at the local level, and can be complex

cases to prosecute. There, however, is no national resource for local prosecutors to utilize. This provision would allow a legal research center to develop such a capacity.

SENATE BILL

The bill would require the Attorney General, after consultation with the Secretary of HHS to award grants to eligible entities to provide support to State and local prosecutors who handle elder justice-related cases. The grants would also be used to fund the creation of a Center for the Prosecution of Elder Abuse, Neglect, and Exploitation that would advise and support prosecutors with respect to elder abuse, neglect, and exploitation. Among other things, the Center would be required to collaborate with experts in the field and the Advisory Board on Elder Abuse, Neglect, and Exploitation; and provide local prosecutors and their staff with relevant training and technical support with respect to handling, preventing, and prosecuting elder abuse, neglect, and exploitation.

The bill would authorize $6 million for FY2006, and $8 million for each of FYS 2006-2009 to carry out these grants.

Section 203-Supporting Federal Cases Involving Elder Justice

No provision.

PRESENT LAW

REASONS FOR CHANGE

Nurse investigators and others with similar expertise are critical to pursuing Federal failure of care cases, usually involving an individual or entity that knowingly bills the United States for inadequate care. This section provides resources for such assistance.

SENATE BILL

The bill would require the Attorney General to hire additional Federal prosecutors and make funding available to them to enter into contracts with experts such as nurse investigators and other experts to identify, assist with, or pursue cases related to elder justice. The bill would also permit the Attorney General to fund a resource group to assist prosecutors nationwide with respect to elder justice matters.

The bill would also require that the Office of Inspector General in DHHS enter into contracts with nurse investigators and other experts to investigate and pursue failure of care allegations.

The bill would authorize $3.25 million for FY2006, and $4.5 million for each of FYs 2007-2009.

Section 204 Supporting Law Enforcement in Elder Justice Matters

PRESENT LAW

Title II, Section 1209 of the Violence of Trafficking and Violence Protection Act of 2000 (P.L. 106-386) permits the Attorney General to make grants for training programs to assist front line law enforcement personnel to enhance their ability to address, investigate, and prosecute instances of elder abuse, neglect, and exploitation. The Administration obligated $4.9 million in FY2003 and

has estimated an obligation of $666,000 for FY2004 for the Training Grants to Stop Abuse and Sexual Assault of Older Individuals or Individuals with Disabilities program.

REASONS FOR CHANGE

State and local law enforcement pursues numerous types of cases relating to elder justice, including financial fraud cases. These are cases where elders are victims of financial scams, domestic violence, institutional abuse and neglect. Present law restricts the ability to train State and local law enforcement in the full array of issues relating to elder abuse. Federal leadership and support in developing training and policies to guide law enforcement in these complex cases is essential.

SENATE BILL

The bill would require the Attorney General, after consultation with the Secretary of HHS, to award grants to eligible entities to provide training and technical support to front line law enforcement personnel with respect to elder justice matters. The bill would authorize $6 million for FY2006, and $8 million for each year of FYs 2007-2009.

Section 205-Establishment and Support of Elder Abuse, Neglect, and Exploitation Forensic Centers

No provision.

PRESENT LAW

REASONS FOR CHANGE

As with child abuse in the 1960's, little is known about identifying the signs of elder abuse, neglect, or exploitation in elders. Absent forensic evidence, it is difficult to prosecute a criminal case. Forty years ago, child abuse was still considered to be a social services problem and not a law enforcement problem. If there is no detection or reporting, there can be no prosecution. Just as it was said that children bruise and fall often when considering child abuse, it is often said that frail elderly bruise and are injured easily. We simply do not yet know what patterns in bruising or what types of fractures indicate that someone has been abused or what patterns of decubitus ulcers or malnutrition indicate that someone has been neglected. There are 282 established Child Advocacy Centers around the country, and over 300 centers in development. These centers provide comprehensive culturally competent, multidisciplinary team responses to allegations of child abuse in a dedicated, child-friendly setting. The team responses include medical and forensic evaluation, therapeutic intervention, victim support and advocacy, case review and case tracking. There is no such center for elders who are the subject of an abuse, neglect, or exploitation claim.

The analysis of whether an older person has been abused or neglected is often a complex issue. It is complicated by the fact that the conditions and illnesses of aging may mask or mimic the signs of elder abuse or neglect. In addition, many of the frailest elders suffer from dementia, making explicit reporting by the victim un

likely, and rendering it important to recognize the sometimes subtle signs or changes that may follow from abuse, such as sudden withdrawal. Because these issues are not yet part of the national consciousness, many people consider it inconceivable, for example, that an older person would be the victim of a sexual assault or that adult children would abuse their parents. Such assumptions compound problems in detection, and lead to delayed, if any, assessment.

Many health and social services professionals report that much more is learned about potentially abusive, neglectful, or exploitative aspects of an elder's living arrangement with a house call-a visit to where the individual lives: Thus, the utility of mobile forensic units should be a pilot-tested to ascertain if it is a better mechanism than other models for gathering forensic information.

One of the most significant impediments to accurate measurement of elder mistreatment is a dearth of knowledge in how to detect it among health, emergency, social services, and legal providers. Development and dissemination of evidence-based forensic markers of abuse, neglect, and exploitation will assist those on the front lines, including coroners and medical examiners, family practitioners and emergency room physicians, APS, long-term care ombudsmen, medical directors and others to detect potential problems. Development and dissemination of forensic methodologies will also assist those on the front lines to know when and how to intervene and when to defer to law enforcement.

SENATE BILL

The bill would require the Attorney General to award grants to eligible entities to establish and operate both stationary and mobile forensic centers and to develop forensic expertise pertaining to elder abuse, neglect, and exploitation. With respect to the stationary forensic centers, the bill would require the Attorney General to make four grants to higher education institutions with demonstrated expertise in forensics or commitment to preventing or treating elder abuse, neglect, or exploitation; and with respect to mobile forensic centers, the bill would require the Attorney General to make six grants to appropriate entities.

Funding would be authorized for the centers to: (1) develop forensic markers that would determine whether abuse or neglect occurred and whether a crime was committed; (2) conduct research to describe and disseminate information on the forensic markers; (3) determine methodologies for how and when intervention should occur; and (4) develop forensic expertise with respect to elder abuse, neglect, and exploitation in order to provide relevant evaluation, intervention, support and advocacy, case review and tracking. The bill would also require the Attorney General, in coordination with the Secretary, to use data to develop the capacity to collect forensic evidence.

The bill would authorize $4 million in funding for FY2006, $6 million for FY2007 and $8 million for each of FYs 2008-2009.

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