For this estimate, CBO assumes that the bill will be enacted near the start of fiscal year 2005 and that the authorized amounts will be appropriated for each year. CBO estimates the resulting outlays based on the spending patterns of activities similar in nature to those authorized under this bill.

Spending Subject to Appropriation

Title I: Department of Health and Human Services. Title I of the bill would authorize the appropriation of funding for various programs and activities that would be conducted through the Department of Health and Human Services (HHS). The authorizations total $176 million in 2006 and $837 million over the 2006-2009 period, and if fully funded, would result in additional outlays of $682 million over the four-year period (see Table 2).

Subtitle A: Federal Elder Justice System. The bill would establish a federal Office of Adult Protective Services within the Department of Health and Human Services. The office would administer a number of grant programs authorized by the bill, collect data relating to the abuse, exploitation, and neglect of elderly people, and conduct research, develop best practices, and provide technical assistance to states and other entities. S. 333 also would create an Elder Justice Coordinating Council that would make recommendations to the Secretary of HHS and the Attorney General for the coordination of the activities of federal, state, local, and private agencies relating to elder justice issues. In addition, the bill authorizes an Advisory Board on Elder Abuse that would be responsible for creating a shortterm and long-term multidisciplinary strategy, for development of the field of elder justice and to make recommendations to the Elder Justice Coordinating Council.

For the activities under subtitle A, S. 333 would authorize the appropriation of $3 million in 2006 and $3.5 million each year from 2007 to 2009. Assuming the appropriation of the authorized amounts, the resulting outlays would be $2 million in 2006, and $13 million over the 2006-2009 period.

Subtitle B: Elder Justice Programs. S. 333 would authorize appropriations for a variety of grant programs directed toward elder justice issues to be administered by HHS. Assuming the appropriation of the authorized amounts, CBO estimates those provisions would result in outlays of $108 million in 2006 and $503 million over the 2006-2009 period.

Section 2211: Enhancement of Long-Term Care. The bill would authorize funding for certain programs to train workers for employment in long-term care facilitics and to improve compensation for employees who achieve certification under these programs. These grant also would be used to promote the training of management employees who direct workers in long-term care facilities. This section would authorize the appropriation of $25 million annually for the 2006-2009 period.

Section 2212: Collaborative Efforts to Enhance Communication on Quality of and Preventing Abuse and Neglect in Long-Term Care. The bill would authorize funding for pilot projects to develop approaches to improve the quality of long-term care, including the prevention of abuse and neglect in this care. The bill specifies that these projects use multidisciplinary community partnerships comprised of a broad range of organizations representing stakeholders in the delivery of quality long-term care. This section would authorize the appropriation of $2.5 million annually for the 2006-2009 period.

Section 2213: Collaborative Efforts to Develop Consensus Around the Management of Certain Quality-Related Factors. The bill would authorize funding for the Secretary of HHS to make grants to eligible entities to establish a multidisciplinary panel to address and develop consensus on approaches to improving the quality of long-term care. The panel would review the relevant data and research, identify the best practices, assess the best ways to carry out these practices, and determine how information on these findings should be distributed. This section would authorize the appropriation of $2 million annually for the 2006-2009 period.

Section 2214: Adult Protective Services Functions and Demonstration Grant Programs. The bill would authorize grants to states to employ caseworkers whose focus would be entirely on providing protective services for elderly clients. Section 2214 also would authorize grants to states to establish demonstration projects to test the effectiveness of training programs designed to help detect elder abuse or financial exploitation. These grants also could be used to test the feasibility of establishing safe havens for victims of elder abuse. This section would authorize the appropriation of $100 million for the 2006-2009 period for the elder justice caseworkers. In addition, the bill would authorize $25 million for the 2006-2009 period for the state demonstration programs. Moreover, S. 333 would authorize $3 million in 2006 and $4 million for each year from 2007 to 2009 to support investigations, undertake data collection and dissemination, conduct research, and provide technical assistance on elder justice issues.

Subtitle C: Collection and Data, Dissemination of Information, and Studies. S. 333 would authorize appropriations for collection of data and the distribution of information about elder abuse and about residential long-term care facilities. Assuming the appropriation of the authorized amounts, CBO estimates those provisions would result in outlays of $5 million in 2006 and $167 million over the 2006-2009 period.

Section 2221: Collection of Uniform National Data on Elder Abuse, Neglect, and
Exploitation. The bill would require the Secretary of HHS, in consultation with the

Attorney General, to develop a national system of reporting and data collection on elder abuse, neglect, and exploitation. The Secretary would develop a method for collecting national data and a uniform national data reporting form. The new reporting system first would be pilot-tested in six states before being implemented nationally. Section 2221 would authorize funding for the proposed federal activities as well as state grants to improve data collection efforts. This section would authorize the appropriation of $10 million in 2006, $30 million in 2007, and $100 million in both 2008 and 2009.

Section 2222: Long-term Care Consumer Clearinghouse. The bill would direct the Secretary of HHS to establish an information clearinghouse for consumers with information about long-term care alternatives, federal benefits, and links to federal and state websites that profile various types of care and consumer feedback for specific facilities. The clearinghouse would provide information on assisted living facilities, board and care facilities, congregate care facilitics, home health care providers, and other long-term care providers. This section would authorize the appropriation of $2 million in 2006, $3 million in 2007, and $4 million in both 2008 and 2009.

Section 2223: Consumer Information About the Continuum of Residential Long-Term Care Facilities. The bill would direct the Secretary of HHS and the Attorney General to conduct (either directly or through grants) a study on consumer concerns relating to residential long-term care facilities. This section would authorize the appropriation of $3 million annually over the 2006-2009 period.

Title II: Department of Justice. S. 333 would authorize a number of grants through the Department of Justice for training programs, interagency coordination, forensic activities, model law development, and evaluation programs relating to elder abuse. The bill would authorize the appropriation of $24 million in 2006 and $127 million for the 2006-2009 period. Assuming the authorized amounts are appropriated, outlays would total $9 million in 2006 and $81 million over the 2006-2009 period (see Table 3). The components of that spending are as follows:

Section 201: Victim Advocacy Grants. The bill would authorize the Attorney General, in consultation with the Secretary of HHS, to award grants to eligible entities to study the special needs of victims of elder abuse, neglect, and exploitation. The funding would be for pilot programs that would, among other activities, provide training to personnel who deal with the needs of victims of elder abuse, neglect, and exploitation. Section 201 would authorize the appropriation of $3 million annually for the 2006-2009 period.