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REASONS FOR CHANGE

Currently, there exists no Federal advisory body to periodically bring together national experts on elder abuse, neglect and exploitation with the purpose of making systematic and coordinated recommendations from a national perspective on ways to prevent elder abuse, neglect and exploitation. The bill meets this need by creating an Advisory Board on Elder Abuse, Neglect and Exploitation. There is little national coordination of any type on elder abuse, neglect, and exploitation matters. An Advisory Board on Elder Abuse, Neglect, and Exploitation would advise the Elder Justice Coordinating Council by not only providing guidance from a variety of perspectives, but would also be responsible for creating short and long term strategic plans for the development of the field of elder justice.

The Advisory Board is intended to be comprised of individuals with experience and expertise in prevention of elder abuse, neglect and exploitation. It is within the discretion of the Secretary and the Attorney General to include representatives from the following as members of the Advisory Board:

Social service providers (including State and local agencies with the statutory responsibility for adult protective services); health care providers (including geriatrics, emergency medicine, and nursing and mental health professionals); legal professionals (including law enforcement and the judiciary); gerontologists; psychologists; State and local government (including State units on aging); organizations providing services to elders and disabled persons; volunteer groups; elder rights advocates; family groups; experts in adult fiduciary relationships, and those serving as or monitoring fiduciaries, including guardians; and individuals in forensics-related positions (including coroners, medical examiners and forensic pathologists).

SENATE BILL

Section 2202 would establish the Advisory Board on Elder Abuse, Neglect and Exploitation.

Solicitation of Nominations, Membership, and Terms. The Secretary of HHS would be required to publish a notice in the Federal Register soliciting nominations for Advisory Board membership. The Board would be composed of 27 members appointed by the Secretary, and must have experience and expertise in prevention of elder abuse, neglect and exploitation. Each member would be appointed for a 3-year term, except for the first members of the Board whose terms would be staggered.

Duties and Reports. The Board would be required to create a short and long-term multidisciplinary plan for development of the field of elder justice.

Within 18 months of the bill's enactment and annually thereafter, the Advisory Board would be required to prepare and submit to the Elder Justice Coordinating Council and the appropriate committees of Congress, a report containing information on Federal, State, and local public and private elder justice activities. The report is also to contain recommendations on programs, research, services, practice, enforcement and coordination among entities

that carry out elder justice and other related activities; modifications needed in Federal and State laws, research, training; and national data collection; and on a multidisciplinary strategic plan to guide the field of elder justice.

Other Requirements. The bill sets forth requirements relating to powers of the Board, vacancies, expired terms, election of officers, travel expenses, and detail of government employees to the Board. Section 2203-Human Subject Research

PRESENT LAW

Definition of Legally Authorized Representative. Subpart A of Part 46 of Title 45, Code of Federal Regulations, known as the Common Rule, that governs most Federally-funded human subjects research, currently defines the term "legally authorized representative" as "an individual or judicial or other body authorized under applicable law to consent on behalf of a prospective subject to the subject's participation in the procedure(s) involved in the research." Researcher Guidelines. No guidelines are currently in place to assist researchers who work in the areas of elder abuse, neglect, and exploitation, with issues relating to human subject research.

REASONS FOR CHANGE

Due to the difficulty in conducting research and collecting data with respect to human subjects, it is necessary to develop guidance for researchers to ensure standards of research and privacy of clinical data.

SENATE BILL

Section 2203 would define "legally authorized representative," for purposes of research under the proposed Title XXII, to mean, “unless otherwise provided by law, the individual, or judicial or other body authorized under the applicable law to consent to medical treatment on behalf of another person."

It would also require the Secretary, acting through the Director of the National Institute on Aging (NIA), to promulgate guidelines to assist researchers working in the areas of elder abuse, neglect, and exploitation, with issues relating to human subject research. Section 2204-Regulations

No provision.

PRESENT LAW

SENATE BILL

Section 2204 would authorize the Secretary of HHS to issue regulations that may be necessary to carry out new Title XXII.

Section 2205-Authorization of Appropriations

No provision.

PRESENT LAW

SENATE BILL

To carry out the functions under Subtitle A (the Federal Elder Justice System), the bill authorizes $3 million for FY2006, and $3.5 million for each of FYs 2007–2009.

Subtitle B-Elder Justice Programs

Section 2211-Enhancements for Long-Term Care

PRESENT LAW

Grants and Incentives to Enhance Long-Term Care Staffing. No provision concerning Federal agency coordination to encourage the employment of welfare recipients or recipients of Temporary Assistance to Needy Families (TÁNF) in long-term care facilities.

Nursing homes that receive Federal funds are required to meet certain Federal laws and standards to receive funding. These laws require nursing aides, who work on a full-time basis for more than 4 months, to complete a training and/or competency evaluation program and be competent to provide care. Nursing homes must also provide regular performance reviews and in-service education (including training for individuals providing nursing and nursing-related services to residents with cognitive impairments) to assure that nurse aides are competent to perform services. Regulations also require nurse aides to complete a training program lasting no less than 75 clock hours of training, at least 16 of which must be supervised practical training, in order to be certified.

A number of States have also used enhanced Medicaid funding to improve recruitment and retention of nurse aides working in nursing homes. For these States, some portion of an increase in State Medicaid payments (and other public funding sources) to long-term care providers must be (or intended to be) used to increase wages and/or benefits for nursing aides. Typically, this "wage pass-though" legislation has either designated some specified dollar amount (e.g., $0.50 or $1.00) or a certain percentage of increased State payments to be used for wages and/or benefits.

Allowing Electronic Submission of Data. Section 101 of the Medicare Modernization Act requires the Secretary to develop, adopt, recognize or modify initial uniform standards relating to requirements for electronic prescription drug programs taking into consideration any recommendations from the National Committee on Vital and Health Statistics.

There is no provision for adopting uniform standards for data not related to prescription drug programs. There is no provision requiring the Secretary to allow long-term care facilities to submit data electronically to HHS using uniform open standards.

Medication Error Reduction Grant Program. Section 108 of the Medicare Modernization Act authorizes the Secretary to make grants to physicians for the purpose of assisting such physicians to implement electronic prescription drug programs. Those grant funds may be used for software and hardware to enable e-prescribing and for providing education and training to eligible physician staff on the use of technology to implement the electronic transmission of prescription and patient information. There is no

such authority for the Secretary to make grants to long-term care facilities for the same purposes.

REASONS FOR CHANGE

Grants and Incentives to Enhance Long-Term Care Staffing. Currently, there is a dearth of individuals available to care for our Nation's elderly. This shortage is apparent not only in skilled nursing facilities, but in all long-term care residential settings and home health care programs as well. What is viewed today as a mere workforce shortage will be described in terms of crisis proportions in the not-so-distant future. In the year 2000, for every individual over the age of 85, there were 38 people aged 20-64. By 2050 that ratio will change dramatically-instead of 38 to 1 that ratio will be 11 to 1. The workforce shortage is not the only challenge. By encouraging long-term care providers to offer innovative programs the pool of eligible employees might increase exponentially.

Over a decade ago, Congress called on HHS to study the relationship between nursing home staff and quality of care for nursing home residents. HHS' two-phase study, Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, indicated that factors such as staff-resident ratios, management practices, and retention rates have a direct link to quality of resident care. Though these studies were limited to nursing homes, the general findings can be extrapolated to include many residential care facilities for the elderly and disabled.

Additionally, the Institute of Medicine's (IOM) 2001 report, Improving the Quality of Long-Term Care, States that in 1997 the turnover rate in nursing homes was 93 percent for nursing assistants. And, as the IOM goes on to point out, this statistic carries increased significance in a setting where individuals are being cared for—with a 93 percent staff turnover rate it is difficult to foster meaningful relationships between staff and residents. The IOM recommended that the Federal Government "undertake measures to improve work environments including competitive wages, career development opportunities, work rules, job design and supervision that will attract and retain a capable, committed work force."

The bill will improve quality of care for individuals living in longterm care facilities by accomplishing three goals: improve recruitment of direct care staff; decrease turnover rates of direct care staff; and improve management practices.

Allowing Electronic Submission of Data. The provision builds on the Administration's support for and initiatives to adopt "open standards" by allowing long-term care facilities to submit data using those standards. Although the Federal Government is currently expending funds to drive the development and adoption of open standards, HHS does not accept data sent in open standards. The use of open standards is critical to ensuring that systems are able to communicate with each other and without human manipulation, thus allowing information to be processed automatically and quickly. Automatic, expedited processing of information will reduce neglect in the form of medical errors and save lives. Currently, data may only be transmitted electronically using spreadsheets, pdfs, or SAS transport files. This form of submission does not allow

systems to communicate with each other, and slows the processing of information.

The President's Information Technology Advisory Committee describes open standards as follows:

"Standardized clinical vocabulary is essential to computerized decision-support tools using sharable protocols that lower error rates and improve the quality of health care. Medical language must be recorded in standard ways so its meaning can be shared with other EHR (electronic health record) systems in a manner that is interoperable and computable (i.e., able to be manipulated and combined with other data by a computer). This language must be coded in a standard manner, even if the concepts are referred to by different local names, displayed in different local languages, or depicted in different local alphabets."

Medication Error Reduction Grant Program. According to the Institute of Medicine, medical errors cause up to 98,000 deaths in this country each year, in addition to otherwise avoidable injuries, hospitalizations, and expenses. Although technologies are available to reduce errors and save lives, start-up costs and a lack of awareness have slowed the diffusion of these technologies, and prevented our long-term care facilities and elderly patients from reaping the benefits of these technologies.

The grant program would improve patient safety among the elderly by reducing medication errors in long-term care facilities. Grant money could be used by long- term care facilities to purchase proven technologies; the adoption of computer physician order entry systems, for example, is an essential component of any effective strategy to reduce medication errors.

Purchase and deployment of such systems is a substantial investment. Costs can delay the rapid introduction of new information technologies into long-term care facilities that already are grappling with other major financial challenges. The grant program will reduce this barrier by providing financial incentives for long-term care facilities to adopt the resource intensive information technologies essential to system-wide strategies for reducing and eventually ending most medication errors.

SENATE BILL

Grants and Incentives to Enhance Long-Term Care Staffing. Section 2211(a) would require the Secretary of HHS to carry out activities that provide incentives for individuals to train for, seek, and maintain employment providing direct care in long-term care facilities.

Coordination of Federal Agencies to Train Long-Term Care Staff. The Secretary of HHS would be required to coordinate activities with the Secretary of Labor and the Assistant Secretary of ACF to provide incentives to welfare-to-work and TANF recipients to train for and seek employment as direct care providers in long-term care facilities.

Career Ladders, Wage and Benefit Grants. The Secretary of HHS would be required to award grants to long-term care facilities to conduct programs that offer direct care employees continuing training and varying levels of certification. Grants would also be used to provide for or make arrangements with employers to pay bo

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