nuses, or other increased compensation or benefits, to employees who obtain certification. To receive grant funds, long-term care facilities would submit applications directly to the Secretary.

Management Improvement. The Secretary of HHS would be required to award grants to long-term care facilities for training and technical assistance. Beneficiaries of this training could include administrators, directors of nursing, staff developers, charge nurses, and others who establish or implement management practices for direct care employees. Training and technical assistance would be intended to promote retention and could include: (1) the establishment of human resource policies rewarding high performance, including policies that provide for improved wages and benefits on the basis of job reviews; (2) the establishment of motivational organizational practices; (3) the creation of a workplace culture that respects and values caregivers and their needs; (4) the promotion of a workplace culture that respects the rights of residents and results in improvements in their care; and (5) the establishment of other programs that promote high quality care, such as continuing education for certified nurse aide employees. Long-term care facilities would submit applications to the Administrator to qualify for grant funds.

Each year, the Secretary would be required to evaluate the above-listed activities and, using the results, determine activities that may be funded in subsequent years. The Secretary would be required to develop accountability measures to ensure that funded activities under this title benefit eligible employees and increase the stability of the long-term care workforce.

Allowing Electronic Submission of Data. Section 2211(b) would require the Secretary of Health and Human Services to develop a plan for adopting open standards for transactions and data elements for such transactions to enable improved electronic submission of clinical data by long-term care facilities and allowing electronic transmission of data using such standards. The optional electronic submission of data shall go into effect not later than 10 years from enactment.

Medication Error Reduction Grant Program. Section 2211(c) would allow grants to be used to improve quality and prevent neglect by improving patient safety and reducing adverse events and health care complications resulting from medication errors in longterm care settings.

The bill would authorize $25 million for each of FYs 2006-2009. Section 2212-Collaborative Efforts to Enhance Communication on Promoting Quality and Preventing Abuse and Neglect in LongTerm Care

No provision.

PRESENT LAW

REASONS FOR CHANGE

Pilot tests are needed to form multidisciplinary community groups to develop collaborative and innovative approaches to improving long-term care. Multidisciplinary community groups are beginning to form in some settings. They are evidencing success in

addressing difficult issues by bringing together various disciplines that have an interest in the subject matter. These successful approaches need to be applied to improving long-term care. Such funds should support community groups consisting of entities, at a minimum, including nursing home providers, advocates, ombudsmen, APS offices, surveyors, State licensing entities, law enforcement, family councils, resident representatives, CNAs, RNs and others.

SENATE BILL

Section 2212 would require the Secretary, after consultation with the Attorney General, to establish pilot projects to improve longterm care. These projects would provide grants to eligible partnerships to develop collaborative and innovative approaches to improve quality and prevent abuse and neglect in long-term care.

Eligible partnerships refer to multidisciplinary community entities, such as a community of nursing facilities, State legal assistance developers, advocates for residents of long-term care facilities, State long-term care ombudsmen, surveyors, the State agencies with responsibility for adult protective services, the State agencies with the responsibility for licensing long-term care facilities, law enforcement agencies, courts, family councils, residents, certified nurse aides, registered nurses, physicians, and other appropriate entities and individuals. Applicants would submit applications to the Secretary to receive funds.

The bill would authorize $2.5 million for each of FYs 2006-2009. Section 2213-Collaborative Efforts to Develop Consensus Around the Management of Certain Quality-Related Factors

No provision.

PRESENT LAW

REASONS FOR CHANGE

Funding should be provided to pilot test multidisciplinary consensus panels at the national level formed to develop collaborative and innovative approaches to improving long-term care. These panels will give various entities that advocate on long-term quality an opportunity to work together toward achieving the common purpose of quality long-term care. In developing approaches to improve long-term care, consensus panels can make significant progress in having the opportunity to work together. Consensus panels have proven successful in addressing difficult issues, such as reduction of restraints.

SENATE BILL

Section 2213 would authorize the Secretary, after consultation with the Attorney General, to provide a limited number of grants to entities that establish multidisciplinary panels to address and develop consensus on quality improvements in long-term care. At least one grant would establish a panel to develop consensus on methods of managing resident-to-resident abuse in long-term care. Entities that receive grant funds would be required to establish a panel to address a specific subject and ensure that the panel uses

the funds to establish a subject-related goal; identify best practices and determine the best way to implement them; and determine an effective way of distributing information. Applicants would submit applications to the Secretary to receive funds.

The bill would authorize $2 million for each of FYS 2006-2009. Section 2214-Adult Protective Services and Demonstration Grant

Programs

Adult Protective Services-Functions

PRESENT LAW

Provisions related to some functions of adult protective services are found in Title XX of the Social Security Act (Social Services Block Grant) (administered by the Administration on Children and Families (ACF)) and the Older Americans Act (administered by AoA), both in DHHS, as follows:

Title XX of the Social Security Act. Title XX provides funds to States to carry out a wide range of social services on behalf of various groups. The statute sets out a number of goals for the use of these funds, including the goal of "preventing or remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests

Funds are generally administered by State social services or human services agencies (for this purpose, sometimes referred to as adult protective services offices), and/or State agencies on aging. Funding history for Title XX is as follows: FY 1998, $2.299 billion; FY 1999, $1.909 billion; FY 2000, $1.775 billion; FY 2001, $1.725; FY 2002, $1.7 billion; FY 2003, $1.7 billion; and FY 2004, $1.7 billion.

No State match is required for Federal Title XX funds, and Federal law does not specify a sub-state allocation formula, so States have complete discretion for the distribution of funds. within their borders. Based on the 2002 Annual Report for the Social Services Block Grant, 34 States used some portion of Title XX funds for adult protective services, and approximately 425,000 adults received adult protective services that were funded in whole or in part with Title XX funds. Of all State expenditures under Title XX for 2002, 5.8 percent were for protective services for adults.1

Older Americans Act. Title II of the Older Americans Act requires the Assistant Secretary on Aging in DHHS to establish a National Center on Elder Abuse. The Center is required to, among other things, compile, publish and disseminate research and training materials on prevention of elder abuse, neglect, and exploitation; maintain a clearinghouse on programs showing promise in preventing elder abuse, neglect, and exploitation; conduct research and demonstration projects that identify causes and prevention, and treatment; and provide technical assistance to State agencies and other organizations in planning and improving prevention programs. AoA awards

1A percentage of expenditures differs from a percentage of the Title XX appropriation. Title XX expenditures include spending from funds transferred from the Temporary Assistance for Needy Families (TANF) program to Title XX.

funds to six organizations that share the funds: the National Association of State Units on Aging, which administers the Center, in cooperation with the National Protective Services Association, the National Committee for the Prevention of Elder Abuse, the American Bar Association, and the Clearinghouse on Abuse, Neglect and Exploitation.

Funding history for the Center is as follows: FY1998, $250,000; FY1999, $200,000; FY2000, $815,250; FY2001, $815,000; FY2002, $815,000, and FY2003, $815,000. The 2000 amendments to the Act required that the Center receive at least the same amount of funds as it received in FY2000.

Title III of the Older Americans Act authorizes, but does not require, State agencies on aging to conduct various activities related to prevention of elder abuse, neglect and exploitation. No Federal funds are separately allotted for this purpose under Title III, and States decide how much of their Title III allotments are to be used for prevention activities. In many States, State agencies on aging administer funds for adult protective services funded under Title XX of the Social Security Act (described above).

Title VII of the Older Americans Act authorizes a program of grants to States to carry out activities related to prevention of elder abuse, neglect, and exploitation. Funds are administered by State agencies on aging. In FY2004, the appropriation level for this program is $5.2 million.

REASONS FOR CHANGE

Although APS exists in all 50 States, it has no Federal office to provide leadership and guidance to the field or to collect and disseminate data. APS exists to protect vulnerable adults and the elderly who are unable to protect themselves from abuse, exploitation or neglect by others, or who are unable to provide for their own basic needs. As APS laws evolved, each State developed its own definition of APS. In many States, these programs are chronically underfunded and their purpose and scope vary broadly from Stateto-State. This fragmented system leaves giant cracks for America's seniors to fall through and offers no minimal guarantee of protection for the elderly. In fact, less than one percent (0.08 percent) of Social Security Block Grant (SSBG) funding allotted for victims of abuse actually reaches the elderly, while 93 percent goes to child abuse and 6 percent to domestic violence victims.

Development of meaningful measurements of protective services outcomes also has been hampered by the variation of State services, lack of uniform definitions of abuse, and lack of up-to-date case management systems. Improved coordination between protective services and law enforcement professionals, as also provided for by this proposal, will enable an enhanced level of protection against abuses of vulnerable adult and older Americans.

It is estimated that approximately 80 percent of elder abuse cases occur in home settings by relatives and approximately 20 percent occurs in facilities. APS is the first responder in all States to elder abuse in home settings and in 50 percent of the States with respect to elder abuse in facilities. This bill, therefore, requires the

Secretary to establish certain support functions with respect to APS to be administered by the Secretary.

SENATE BILL

Section 2214 would establish certain functions with respect to Adult Protective Services (APS) to be administered by the Secretary.

Adult Protective Services-Functions. Functions include providing funding and support to State and local adult protective services offices that investigate reports of abuse, neglect and exploitation of elders and vulnerable adults; collecting and disseminating information on abuse in coordination with the Department of Justice; developing and disseminating information on best practices; and conducting research and providing technical assistance to States that provide or fund protective services.

To carry out these functions, the bill authorizes $3 million for FY 2006 and $4 million for each of FYS 2007-2009.

Adult Protective Service Grant Program (State Formula
Grants)

PRESENT LAW

No provision in current law for State formula grants that are solely and specifically targeted at providing adult protective services and carrying out projects to employ workers having caseloads. of elders alone.

Some other legislation is related to adult protective services, as follows:

Title XX of the Social Security Act. Title XX provides funds to States to carry out a wide range of social services on behalf of various groups. The statute sets out a number of goals for the use of these funds, including the goal of "preventing or remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests . . ." Funds are generally administered by State social services or human services agencies (for this purpose, sometimes referred to as adult protective services offices), and/or State agencies on aging.

Title III of the Older Americans Act authorizes, but does not require, State agencies on aging to conduct various activities related to prevention of elder abuse, neglect, and exploitation, which may include adult protective services. No Federal funds are separately appropriated for this purpose under Title III, and States decide how much of their Title III allotments are to be used for these activities. In many States, State agencies on aging administer funds for adult protective services funded under Title XX of the Social Security Act (described above).

Title VII of the Older Americans Act authorizes a program of grants to States to carry out activities related to prevention of elder abuse, neglect, and exploitation. Funds are administered by State agencies on aging. In FY2004, the appropriation level for this program is $5.2 million.