The Elder Justice Act: Background and Issues
for Congress
Kirsten J. Colello
Specialist in Health and Aging Policy
September 3, 2014
Congressional Research Service
7-5700
www.crs.gov
R43707

---

The Elder Justice Act: Background and Issues for Congress

Summary
Elder abuse is a complex issue that often requires a multifaceted policy response that combines
public health interventions, social services programs, and criminal law enforcement for abusive
behavior. To address this complexity, the Elder Justice Act was enacted as part of the Patient
Protection and Affordable Care Act (ACA, P.L. 111-148, as amended). The act attempts to
provide a coordinated federal response by emphasizing various public health and social service
approaches to the prevention, detection, and treatment of elder abuse. The Elder Justice Act also
represents Congress’s first attempt at comprehensive legislation to address abuse, neglect, and
exploitation of the elderly at the federal level.
To date, most activities and programs authorized under the Elder Justice Act have not received
federal funding through the annual appropriations process. Moreover, the authorizations of
appropriations for most provisions under the act expire on September 30, 2014. As a result of this
limited federal funding, the federal government has not substantially developed and expanded its
role in addressing the prevention, detection, and treatment of elder abuse. Despite the lack of
discretionary appropriations, some elder justice activities have received funding from mandatory
funding appropriated through the ACA Prevention and Public Health Fund (PPHF).
For FY2012, the Secretary of the Department of Health and Human Services (HHS) transferred
$6.0 million to the Administration for Community Living (ACL) from the PPHF for new grants
to states and tribes to test elder abuse prevention strategies. Funded projects included using
forensic accountants to prevent elder financial exploitation, increasing medication adherence to
prevent elder self-neglect, and developing screening tools to identify elder abuse. For FY2013,
$2.0 million was transferred to ACL from the PPHF for elder justice activities, which funded
development of the National Adult Protective Services Data Reporting System Project. No PPHF
funds were transferred to ACL for elder justice activities for FY2014.
For FY2015, the President’s budget request includes $25.0 million in discretionary funding for
the Elder Justice Initiative that would be used to fund Adult Protective Services, research, and
evaluation activities. The 2015 budget request does not specify an intended transfer of funding
from the PPHF for elder justice activities. On June 10, 2014, the Senate Appropriations
Subcommittee on the Departments of Labor, Health and Human Services, and Education (DOL-
HHS-ED) approved its FY2015 bill by voice vote. The subcommittee recommends $10.0 million
for the Elder Justice Initiative. The House has yet to see legislative action in the subcommittee or
full committee for its FY2015 DOL-HHS-ED appropriations bill.
This report provides a brief legislative history of the Elder Justice Act, summarizes elder justice
provisions enacted as part of ACA, and administrative efforts related to implementation and
funding. The report then describes several issues for Congress with respect to the act’s
reauthorization.

Congressional Research Service

---

The Elder Justice Act: Background and Issues for Congress

Contents
Legislative History ........................................................................................................................... 3
Elder Justice Act .............................................................................................................................. 4
Elder Justice Provisions ............................................................................................................. 4
National Coordination of Elder Justice Activities and Research ......................................... 4
Programs to Promote Elder Justice ..................................................................................... 7
Protecting Residents of Long-Term Care Facilities ................................................................... 9
National Training Institute for Surveyors ............................................................................ 9
Reporting to Law Enforcement of Crimes Occurring in Federally Funded
Long-Term Care Facilities ............................................................................................. 10
National Nurse Aide Registry .................................................................................................. 10
Funding for Elder Justice Activities ............................................................................................... 11
Issues for Congress ........................................................................................................................ 14
Federal Leadership .................................................................................................................. 14
Elder Abuse Data Collection ................................................................................................... 15
Elder Abuse Prevention ........................................................................................................... 15
Concluding Observations ............................................................................................................... 15

Tables
Table 1. Funding for Elder Justice Activities for FY2012, FY2013, FY2014, and FY2015
Budget Request ........................................................................................................................... 12
Table 2. Elder Abuse Prevention Interventions Program ............................................................... 12
Table A-1. Elder Justice Act: Authorizations of Appropriations .................................................... 17

Appendixes
Appendix A. Elder Justice Act: Authorizations of Appropriations ................................................ 17
Appendix B. Elder Justice Resources ............................................................................................ 19

Contacts
Author Contact Information........................................................................................................... 20

Congressional Research Service

---

The Elder Justice Act: Background and Issues for Congress

here is growing attention to elder abuse as a public policy issue in the United States. While
the extent of such abuse is largely unknown, there is some indication that the problem is
Tserious and that many incidents of abuse are never reported. A 2011 study of the extent of
elder abuse in the United States found that 11% of individuals ages 60 and older who reside in the
community reported some type of abuse in the past year.1 Another 2008 study found that 9% of
community-residing older adults ages 57 to 85 reported verbal mistreatment; 3.5% reported
financial mistreatment; and 0.2% reported physical mistreatment by a family member in the past
year.2
Yet, studies such as these are likely to underestimate the full extent of elder abuse as they do not
include all categories of abuse, exclude individuals who reside in institutional settings such as
nursing facilities, and generally exclude individuals with significant cognitive impairment (for
more information see text box “What is Elder Abuse?”). In addition, incidents of elder abuse may
go unreported as older individuals can be reluctant to report abuse by an individual they also rely
upon for their personal care and well-being.3 Moreover, a number of studies have associated
physical and mental health problems among victims of elder abuse as well as inadequate social
supports that, if present, may assist individuals in prevention, detection, and treatment.4

What Is Elder Abuse?
Behaviors that constitute elder abuse and neglect, also referred to as elder mistreatment, are considered to
be “intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to
a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder or failure by a
caregiver to satisfy the elder’s basic needs or to protect the elder from harm.”
Elder abuse and neglect may occur in domestic or institutional settings, and are further described.
•
Domestic elder abuse general y refers to any of the fol owing types of mistreatment that are committed
by someone with whom the elder has a special relationship (for example, a spouse, sibling, child, friend,
or caregiver).
•
Institutional elder abuse general y refers to any of the fol owing types of mistreatment occurring in
residential facilities (such as a nursing facility, assisted living facility, group home, board and care facility,
foster home, etc.) and is usually perpetrated by someone with a legal or contractual obligation to provide
some element of care or protection.
The fol owing are generally considered the major categories of elder abuse and neglect:
•
Physical abuse is the use of force that may result in bodily injury, physical pain, injury or impairment.
•
Psychological abuse is the infliction of mental anguish, pain or distress through verbal or non-verbal acts.

1 Acierno, Ron, M. A. Hernandez, A. B. Amstadter, et al., “Prevalence and Correlates of Emotional, Physical, Sexual,
and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study,” American
Journal of Public Health, vol. 100 (2011).
2 Laumann, Edward O., S. A. Leitsch, and L. J. Waite, “Elder Mistreatment in the United States: Prevalence Estimates
From a Nationally Representative Study,” The Journals of Gerontology Series B: Psychological and Social Sciences,
vol. 63 (2008).
3 Centers for Disease Control and Prevention, Understanding Elder Abuse: Fact Sheet, Division of Violence and
Prevention, National Center for Injury Prevention and Control, 2013, http://www.cdc.gov/violenceprevention/pdf/em-
factsheet-a.pdf.
4 U.S. Government Accountability Office, Stronger Federal Leadership Could Enhance National Response to Elder
Abuse, GAO-11-208, Mar 2, 2011, http://www.gao.gov/assets/320/316224.pdf. Reissued on March 22, 2011.
Congressional Research Service
1

---

The Elder Justice Act: Background and Issues for Congress

•
Sexual abuse is non-consensual sexual contact of any kind with an older adult.
•
Financial abuse is the illegal or improper exploitation or use of funds or resources (e.g., property, assets)
of an older adult.
•
Neglect is the refusal or failure to fulfill any part of a person’s obligations or duties to care for an older
adult.
Source: Richard J. Bonnie and Robert B. Wallace, eds., Elder Mistreatment: Abuse, Neglect and Exploitation in an
Aging America, National Research Council (Washington, DC: National Academy Press, 2003); National Center
on Elder Abuse (NCEA), Frequently Asked Questions, Administration on Aging, http://www.ncea.aoa.gov/faq/
index.aspx; and Krug, Etienne G., et al., eds. World Report on Violence and Health: Chapter 5, Abuse of the Elderly,
2002.

Elder abuse is a complex issue that often requires a multifaceted policy response which combines
public health initiatives, social services programs, and criminal law enforcement for abusive
behavior. To address this complexity, the Elder Justice Act was enacted as part of the Patient
Protection and Affordable Care Act (ACA, P.L. 111-148, as amended).5 It provides a coordinated
federal response by emphasizing various public health and social service approaches to the
prevention, detection, and treatment of elder abuse. It also represents Congress’s first attempt at
comprehensive legislation to address abuse, neglect, and exploitation of the elderly at the federal
level. Enactment of the Elder Justice Act places the issue of elder abuse on par with similar
legislation Congress has enacted with respect to child abuse and neglect, under the Child Abuse
Prevention and Treatment Act,6 and domestic violence, under the Violence Against Women Act.7
Similar to other newly authorized grant programs
Elder Justice Defined
under the ACA, implementation of new grants
Elder justice is defined in statute, from a societal
under the Elder Justice Act has been hampered by
perspective, as efforts to (1) prevent, detect, treat,
the lack of federal discretionary spending for
intervene in, and prosecute elder abuse, neglect, and
authorized activities, which is subject to the
exploitation; and (2) protect elders with diminished
capacity while maximizing their autonomy.
annual appropriations process. Agency
implementation of some elder justice programs
From an individual perspective, elder justice is defined
and activities has moved forward without such
as the recognition of an elder’s rights, including the
right to be free of abuse, neglect, and exploitation.
dedicated spending. However, a coordinated
federal response to the issue has thus far been
Source: SSA § 2011 as amended by § 6703(a) of
ACA [42 U.S.C. § 1397j]
limited; in part due to actions Congress has taken
since FY2010 to curb federal discretionary
spending.8
The extent of elder abuse has the potential to grow in scope as the older population continues to
increase in size, and individuals live longer post-retirement. In 2012, an estimated 13.7% of the

5 § 6703(a) through (c) of ACA.
6 For more information on the Child Abuse Prevention and Treatment Act, see CRS Report RL30923, Child Abuse
Prevention and Treatment Act: Reauthorization Proposals in the 107th Congress, by Emilie Stoltzfus.
7 For more information on the Violence Against Women Act, see CRS Report R42499, The Violence Against Women
Act: Overview, Legislation, and Federal Funding, by Lisa N. Sacco.
8 For more information see CRS Report R41390, Discretionary Spending Under the Affordable Care Act (ACA),
coordinated by C. Stephen Redhead.
Congressional Research Service
2

---

The Elder Justice Act: Background and Issues for Congress

total U.S. population was age 65 and older. That percentage is projected to increase to 20.3% by
2030.9 Thus, Congress will likely have a continued interest in shaping the federal role and
response to elder abuse going forward. This report provides a brief legislative history of the Elder
Justice Act, summarizes elder justice provisions enacted as part of ACA and any administrative
efforts related to implementation and funding. The report then describes several issues for
Congress with respect to the act’s reauthorization.
Legislative History
Congressional interest in the issue of elder abuse spans more than a quarter of a century with
numerous hearings and reports concerning the need for a federal response to abuse, neglect, and
exploitation of the elderly. Prior to enactment of the Elder Justice Act as part of the ACA,
Congress took a number of steps towards addressing elder abuse, including authorizing federal
assistance to state Adult Protective Services (APS) programs through the Social Services Block
Grant (SSBG) program and amendments to the Older Americans Act (OAA) to provide separate
funding for elder abuse prevention and vulnerable elder rights protection activities, including
establishment of the Long-Term Care Ombudsman Program (LTCOP). Provisions regarding elder
justice were also incorporated in the OAA reauthorization of 2006 (P.L. 109-365).10
In 2002, the 107th Congress first introduced the Elder Justice Act (S. 2933) by then Senator John
Breaux. Since then, Elder Justice Act legislation was re-introduced in subsequent Congresses with
Senate Finance Committee action on bills in the 108th, 109th, and 110th Congresses.11 In the 111th
Congress, Senator Orrin Hatch introduced the Elder Justice Act of 2009 (S. 795) which addressed
public health and social services approaches to the issue. A separate bill (H.R. 2006) was
introduced in the House by Representative Peter T. King, which, in addition to the public health
and social services provisions also included criminal justice provisions. The Senate bill (S. 795)
was incorporated into the Senate Finance Committee’s health reform bill (S. 1796) and
subsequently adopted in the Senate health reform bill (H.R. 3590) which became the ACA (P.L.
111-148).
It is important to note that the elder justice provisions enacted under the ACA did not achieve the
multidisciplinary approach (public health, social services, and criminal justice) fully envisioned
in earlier versions of introduced legislation. Enactment of the Elder Justice Act under the ACA
contains provisions that address certain public health and social services approaches to
prevention, detection, and treatment of elder abuse primarily under the Department of Health and

9 U.S. Census Bureau, Profile America: Facts for Features, May 2014 Older Americans Month, Department of
Commerce, U.S. Census Bureau News, CB14-FF.07 March 24, 2014, http://www.census.gov/newsroom/releases/pdf/
cb14ff-07_older_americans.pdf and U.S. Census Bureau, “2012 National Population Projections: Summary Tables,”
Table 3, Middle Series, http://www.census.gov/population/projections/data/national/2012/summarytables.html.





10 Congress included several provisions related to elder justice activities in the OAA Amendments of 2006 (P.L. 109-
365). For example, the law added various elder justice activities to be carried out by the Assistant Secretary for Aging.
These provisions include responsibility for Administration on Aging (AoA) to develop and implement systems for
elder justice and to conduct an elder abuse national incidence study. It also added a requirement that the Assistant
Secretary award funds for competitive grants to states for development and implementation of elder justice activities
under Title VII of OAA.
11 The Elder Justice Act has been introduced in the 108th Congress (S. 333; H.R. 2490), 109th Congress (S. 2010; H.R.
4993), and 110th Congress (S. 1070; H.R. 1783).
Congressional Research Service
3

---

The Elder Justice Act: Background and Issues for Congress

Human Services (HHS) authorities and administration. It does not include a criminal justice
response which would address the prevention, detection, and prosecution of elder abuse crimes
under various Department of Justice (DOJ) authorities and administration. Earlier versions of the
Elder Justice Act included such a multidisciplinary approach that incorporated criminal justice
provisions. With enactment of the Elder Justice Act under the ACA, criminal justice provisions
have been incorporated into a separate stand-alone bill, most recently introduced by
Representative Peter T. King as the Elder Abuse Victims Act in the 113th Congress (H.R. 861) on
February 27, 2013. This bill was referred to the House Committee on Judiciary with no further
action taken to date.
Elder Justice Act
The Elder Justice Act provisions enacted under the ACA authorize entities and programs that
address federal coordination of elder abuse and administration of new grant activities, as well as
certain protections for residents of long-term care facilities, and other specified studies. 12 The
following describes these provisions in greater detail.
Elder Justice Provisions
Several of the Elder Justice provisions enacted under the ACA amended the Social Security Act
(SSA) which incorporated Elder Justice into a renamed Title XX entitled Block Grants to States
for Social Services and Elder Justice. The ACA subsequently reorganized the structure of SSA
Title XX, by placing previously existing sections (i.e., Sections 2001-2007) under a new Subtitle
A, Block Grants to States for Social Services, and adding a new Subtitle B, Elder Justice.
National Coordination of Elder Justice Activities and Research
Several SSA Elder Justice provisions address federal coordination and research activities.
Specifically, SSA Title XX, Subtitle B establishes an Elder Justice Coordinating Council and an
Advisory Board on Elder Abuse, Neglect, and Exploitation. It also addresses research protections
and awards grants to establish and operate stationary and mobile forensic centers. These
provisions and any administrative or other actions to implement authorized programs or activities
are further described below.13
Elder Justice Coordinating Council
The Elder Justice Act established the Elder Justice Coordinating Council at HHS. The Council
includes the HHS Secretary as chair and the U.S. Attorney General, as well as the head of each
federal department or agency, identified by the chair, as having administrative responsibility or
administering programs related to elder abuse, neglect, and exploitation.14 The Council is required

12 § 6703(a) through (c) of the ACA.
13 Prior to Part I, new Subtitle B begins with Sections 2011 (Definitions) and 2012 (General Provisions), which are not
discussed here.
14 The Elder Justice Coordinating Council members include heads of the following departments and agencies: U.S.
Department of Health and Human Services (Chair), Consumer Financial Protection Bureau, Corporation for National
and Community Service, U.S. Department of Housing and Urban Development, U.S. Department of Justice, U.S.
(continued...)
Congressional Research Service
4

---

The Elder Justice Act: Background and Issues for Congress

to submit a report to the appropriate committees of Congress within two years of enactment and
every two years thereafter that describes its activities and challenges; and make recommendations
for legislation, model laws, and other actions deemed appropriate. There are authorized to be
appropriated such sums as necessary to carry out the Council’s functions. (See report section
entitled “Authorizations of Appropriations” for further appropriations information.)
On Oct. 11, 2012, the HHS Secretary convened the inaugural meeting of the Elder Justice
Coordinating Council. The Council is a permanent group, anticipated to meet twice a year. The
HHS Secretary has assigned responsibility for implementing the Council to the Administration for
Community Living (ACL). The work of the Council is supported by a staff-level Elder Justice
Interagency Working Group also led by ACL which was established prior to ACA. Since the
inaugural meeting, the Council has convened several times. During these meetings Elder Justice
Interagency Working Group members presented proposals for federal action and a summary of
steps for federal involvement in the prevention, detection, and prosecution of elder abuse. The
working group also coordinated a report of federal activities in elder justice since 2010.15 At the
May 2014 meeting the Council agreed to a set of eight recommendations for increased federal
involvement in addressing elder abuse (see text box “Elder Justice Coordinating Council:
Recommendations for Increased Federal Involvement in Elder Abuse”).
Advisory Board on Elder Abuse, Neglect, and Exploitation
The Advisory Board on Elder Abuse, Neglect, and Exploitation is established to create a short-
and long-term multidisciplinary plan for development of the field of elder justice and make
recommendations to the Elder Justice Coordinating Council. The Advisory Board must be
composed of 27 members from the general public appointed by the Secretary and must have
experience and expertise in prevention of elder abuse, neglect, and exploitation. The Advisory
Board is required to submit a report to the Elder Justice Coordinating Council and the appropriate
committees of Congress within 18 months of enactment and annually thereafter that contains
information on the status of federal, state, and local elder justice activities; and makes specified
recommendations. There are authorized to be appropriated such sums as necessary to carry out
the functions of the Advisory Board. On July 14, 2010, HHS published a notice establishing the
Advisory Board;16 however, no subsequent public announcement by HHS has been made about
Board appointments or activities. (See report section entitled “Authorizations of Appropriations”
for further appropriations information.)
Research Protections
The HHS Secretary is required to promulgate guidelines to assist researchers working in the areas
of elder abuse, neglect, and exploitation with issues relating to human research subject
protections. For the purposes of the application of certain specified federal regulations to research

(...continued)
Department of Labor, U.S. Department of the Treasury, U.S. Department of Veterans Affairs, U.S. Postal Inspection
Service, Federal Trade Commission, and the Social Security Administration.
15 For a copy of the report, a list of EJCC members, and more information on EJCC meetings and proposals, see
http://www.aoa.gov/AoA_programs/Elder_Rights/EJCC/Index.aspx.
16 U.S. Department of Health and Human Services, “Establishment of the Advisory Board on Elder Abuse, Neglect,
and Exploitation,” 75 Federal Register 40838, July 14, 2010.
Congressional Research Service
5

---

The Elder Justice Act: Background and Issues for Congress

conducted under this subpart it defines “legally authorized representative” 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. No public
information on the status of guidance promulgated by HHS Secretary was found. (See report
section “Authorizations of Appropriations” for further appropriations information.)

Elder Justice Coordinating Council: Recommendations for Increased Federal
Involvement in Elder Abuse
1. Support the Investigation and Prosecution of Elder Abuse Cases—Support the investigation and
prosecution of elder abuse, neglect, and financial exploitation cases by providing training and resources to
federal, state, and local investigators and prosecutors.
2. Enhance Services to Elder Abuse Victims—Support and protect elder abuse victims by improving
identification of elder abuse and enhancing response and outreach to victims.
3. Develop a National Adult Protective Services (APS) System—Develop a national APS system based upon
standardized data col ection and a core set of service provision standards and best practices.
4. Develop a Federal Elder Justice Research Agenda—Establish a coordinated research agenda across federal
agencies to identify best practices for prevention of and intervention in elder abuse and elder financial
exploitation.
5. Develop a Broad-Based Public Awareness Campaign—Develop a comprehensive, strategic, and broad-
based national public awareness campaign, with clear and consistent messaging to raise awareness and
understanding of elder abuse, neglect, and exploitation.
6. Cross-disciplinary Training on Elder Abuse—Develop training to educate stakeholders across multiple
sectors and disciplines on preventing, detecting, intervening in, and responding to elder abuse, neglect, and
exploitation.
7. Combat Elder Financial Exploitation, including Abuse by Fiduciaries—Prevent, detect, and respond to elder
financial exploitation through federal enforcement activities, policy initiatives, coordination, oversight and
education, and by col aborating with industry to enhance fraud detection and provide resources for victims.
8. Improve Screening for Dementia and Cognitive Capacity, Financial Capacity, and Financial Exploitation—
Improve the ability of APS and first responders to screen for diminished capacity, diminished financial
capacity, and vulnerability to or victimization of financial exploitation.
Source: Administration for Community Living, Eight (8) Recommendation from the Elder Justice Coordinating
Council for Increased Federal Involvement in Addressing Elder Abuse, May 2014, http://aoa.gov/AoARoot/
AoA_Programs/Elder_Rights/EJCC/docs/Eight_Recommendations_for_Increased_Federal_Involvement.pdf.
Authorizations of Appropriations
To carry out the above functions of the Elder Justice Coordinating Council, (SSA Section 2021),
Advisory Board on Elder Abuse, Neglect, and Exploitation (SSA Section 2022), and research
protection guidelines for human subjects (SSA Section 2023) a new SSA Section 2024,
Authorization of Appropriations, authorizes to be appropriated $6.5 million for FY2011, and $7.0
million for each of FY2012 through FY2014. To date, Congress has not provided discretionary
funding for these activities through the annual appropriations process. However, the Elder Justice
Coordinating Council has convened several times, as previously mentioned.
Elder Abuse, Neglect, Exploitation Forensic Centers
SSA Elder Justice provisions also added a section regarding establishment and support of elder
abuse, neglect, and exploitation forensic centers. This provision requires the HHS Secretary, in
Congressional Research Service
6

---

The Elder Justice Act: Background and Issues for Congress

consultation with the U.S. 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. It authorizes to be appropriated $4 million for FY2011, $6
million for FY2012, and $8 million for each of FY2013 and FY2014 to carry out these activities.
To date, Congress has not provided discretionary funding for these activities through the annual
appropriations process.

Elder Abuse Forensic Centers
Elder abuse forensic centers bring together multidisciplinary teams of professionals in health care, social
services, and criminal justice (e.g., law enforcement, attorneys, and victim advocates). In this context,
forensic science involves utilizing elder abuse experts from different disciplines to investigate and resolve
cases of abuse or neglect. Developed out of a need to integrate services that have been historically
fragmented and difficult to navigate, the forensic center model is an entity that can bridge these different
disciplines by employing a full-time staff, conducting regular face-to-face meetings to review cases of abuse
and neglect, engaging in problem-solving, and facilitating recommended actions. Multidisciplinary team
members, who may either work for the center or a participating organization, may conduct joint visits,
trainings, and engage in frequent and ongoing collaboration and consultation.
Source: Cafaro Shneider, Diana, Laura Mosqueda, Erika Falk, et al. “Elder Abuse Forensic Centers,” Journal
of Elder Abuse & Neglect, vol. 22 (2010); Navarro, Adria E., K. H. Wilber, J. Yonashiro, et al., “Do We Really
Need Another Meeting? Lessons From the Los Angeles County Elder Abuse Forensic Center,” The
Gerontologist, vol. 50 (2010).
Programs to Promote Elder Justice
SSA Elder Justice provisions establish several grant programs and other activities to promote
elder justice through various enhancements to the workforce and electronic health record
technology, grants to adult protective services programs and training for long-term care
ombudsman, among other activities. These provisions are described below.
Enhancement of Long-Term Care
The Elder Justice Act required the HHS Secretary, in coordination with the Secretary of Labor, to
carry out activities that provide incentives for individuals to train for, seek, and maintain
employment providing direct care in long-term care (LTC). In doing so, the HHS Secretary is
required to award grants to eligible entities to conduct programs that offer direct care employees
continuing training and varying levels of certification.
The act further authorized the HHS Secretary to make grants to LTC facilities for specified
activities that would assist such entities in offsetting costs related to purchasing, leasing,
developing, and implementing certified electronic health records (EHR) technology designed to
improve patient safety and reduce adverse events and health care complications resulting from
medication errors. This section also requires the Secretary to adopt electronic standards for the
exchange of clinical data by LTC facilities and, within 10 years of enactment, to have in place
procedures to accept the optional electronic submission of clinical data by LTC facilities pursuant
to such standards. The standards adopted must be compatible with standards established under
current law, as specified, and with general health information technology standards.
The section authorizes to be appropriated $20.0 million for FY2011, $17.5 million for FY2012,
and $15.0 million for each of FY2013 and FY2014 to carry out the activities under this section.
Congressional Research Service
7

---

The Elder Justice Act: Background and Issues for Congress

To date, Congress has not provided discretionary funding for these activities through the annual
appropriations process.
Adult Protective Service Functions and Grant Program
Adult Protective Services (APS) programs are social services programs established through
legislation enacted in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S.
Virgin Islands. APS programs serve seniors and adults with disabilities by offering a system for
reporting and investigating abuse as well as providing social services to assist victims. State APS
laws vary in the age of eligibility for APS assistance, definition of abuse, types of abuse covered,
classification of the abuse as criminal or civil, mandatory reporting requirements, investigative
procedures, and remedies for abuse. Prior to enactment of the Elder Justice Act, there was no
dedicated federal funding authority for state APS programs. However, some states have used
federal funding provided under the OAA and the Social Services Block Grant program to
supplement state and local funding for APS programs.
Several SSA Elder Justice provisions addressed federal funding and additional resources for state
APS programs. Specifically, SSA Title XX requires the HHS Secretary to ensure that the
Department (1) provides authorized funding to state and local APS offices that investigate reports
of elder abuse, neglect, and exploitation; (2) collects and disseminates data in coordination with
DOJ; (3) develops and disseminates information on best practices regarding, and provides
training on, carrying out APS; (4) conducts research related to the provision of APS; and (5)
provides technical assistance to states and other entities that provide or fund APS. To carry out
these functions, the section authorizes to be appropriated $3 million for FY2011 and $4 million
for each of FY2012 through FY2014. To date, Congress has not provided discretionary funding
for these activities through the annual appropriations process.
The HHS Secretary is also required to establish two grant programs. The first are grants to
enhance APS programs provided by states and local governments. The second are grants to states
for APS demonstration programs. Annual grants awarded to states to enhance APS programs are
to be distributed to states based on a formula. For each of FY2011 through FY2014, the section
authorizes to be appropriated $100.0 million for annual grants to enhance APS programs and
$25.0 million for the APS demonstration grants. To date, Congress has not provided discretionary
funding for these activities through the annual appropriations process.
Long-Term Care Ombudsman Program Grants and Training
The Long-Term Care (LTC) Ombudsman Program is a consumer advocacy program that aims to
improve the quality of care, as well as the quality of life, for residents in long-term care settings
by investigating and resolving complaints made by, or on behalf of, such residents. Established
under Title VII of the Older Americans Act (OAA), the Administration on Aging (AoA) within
the Administration for Community Living (ACL) under HHS administers the nationwide
program. As of 2010, there were 53 state LTC Ombudsman Programs operating in all 50 states,
the District of Columbia, Guam, and Puerto Rico, and 578 local programs. States and territories
receive an annual allotment for ombudsman activities based on a statutory funding formula.17 For
FY2014, the total appropriated funding for the LTC Ombudsman Program was $15.9 million.

17 For more information on OAA funding formulas see, CRS Report RS22549, Older Americans Act: Funding
(continued...)
Congressional Research Service
8

---

The Elder Justice Act: Background and Issues for Congress

SSA Elder Justice provisions require the HHS Secretary to award grants to eligible entities with
relevant expertise and experience in abuse and neglect in LTC facilities or state LTC ombudsman
programs to (1) improve the capacity of state LTC ombudsman programs to respond to and
resolve abuse and neglect complaints; (2) conduct pilot programs with state or local LTC
ombudsman offices; and (3) provide support for such state LTC ombudsman programs and such
pilot programs. It authorizes to be appropriated $5 million for FY2011, $7.5 million for FY2012,
and $10 million for each of FY2013 and FY2014. The section also requires the Secretary to
establish programs to provide and improve ombudsman training with respect to elder abuse,
neglect, and exploitation for national organizations and state LTC ombudsman programs. It
authorizes to be appropriated $10 million for each of FY2011 through FY2014. To date, Congress
has not provided discretionary funding for these activities through the annual appropriations
process.
Protecting Residents of Long-Term Care Facilities
Provisions enacted under the Elder Justice Act establish (1) a National Training Institute for
Surveyors and grants to state survey agencies; and (2) requirements for reporting crimes in
federally funded LTC facilities.18
National Training Institute for Surveyors
As specified under SSA Titles XVIII (Medicare) and XIX (Medicaid), each state has a licensing
and certification agency that inspects long-term care facilities that participate in Medicare and/or
Medicaid. These state agencies conduct standard surveys, extended surveys and, under certain
circumstances, impose remedies for noncompliance. The surveys they conduct examine both the
facility's processes for delivering care and the outcomes of residents' care to ensure the minimum
standards are met. CMS’ Survey & Certification Group provides some instruction and training to
state and federal surveyors through classroom and web-based training applications.19
The Elder Justice Act requires the HHS Secretary to enter into a contract to establish and operate
the National Training Institute for federal and state surveyors to carry out specified activities that
provide and improve training of surveyors investigating allegations of abuse, neglect, and
misappropriation of property in programs and LTC facilities that receive payments under
Medicare or Medicaid. It authorizes to be appropriated $12 million for the period of FY2011
through FY2014 to carry out these activities. The HHS Secretary is also required to award grants
to state survey agencies that perform surveys of Medicare or Medicaid participating facilities to
design and implement complaint investigation systems. It authorizes $5 million for each of
FY2011 through FY2014 to carry out these activities. To date, Congress has not provided
discretionary funding for these activities through the annual appropriations process.

(...continued)
Formulas, by Kirsten J. Colello.
18 ACA Section 6703(b).
19 Centers for Medicare and Medicaid Services, Survey & Certification – Surveyor Training, http://cms.hhs.gov/
Medicare/Provider-Enrollment-and-Certification/SurveyorTraining/index.html.
Congressional Research Service
9

---

The Elder Justice Act: Background and Issues for Congress

Reporting to Law Enforcement of Crimes Occurring in Federally Funded
Long-Term Care Facilities
The Elder Justice Act amended SSA Title XI, Part A by adding a new Section 1150B, requiring
the reporting of crimes occurring in LTC facilities that receive at least $10,000 in federal funds
during the preceding year. It requires owners, operators, employees, managers, agents, or
contractors of nursing facilities (covered individuals) to report any reasonable suspicion of a
crime (as defined by the law of the applicable political subdivision) against a resident or
individual receiving care from the facility to the appropriate entities. Failure to report suspicion of
a crime would result in a civil monetary penalty and the Secretary may make a determination to
exclude the covered individual from participation in any federal health care program. If an
individual is classified as an “excluded individual,” a LTC facility that employs that person is not
eligible to receive federal funds under the SSA.
Section 1150B also requires applicable nursing facilities to annually notify covered individuals
that they are required to report any reasonable suspicion of a crime to the appropriate entities. It
prohibits a LTC facility from retaliating against an employee for making a report. If retaliation
occurs, the LTC facility may be subject to a civil money penalty or the HHS Secretary may
exclude them from participation in any federal health care program for a period of two years, or
both. In addition, each LTC facility is required to post conspicuously, in an appropriate location, a
sign specifying the rights of employees under this section.
In June 2011, CMS issued guidance to state survey agency directors describing the regulations
related to the reporting of reasonable suspicion of a crime in applicable nursing facilities and
provided responses to frequently asked questions.20 A 2014 report by the HHS Office of Inspector
General found that 61% of nursing facilities (9,487 facilities) had documentation to support
meeting both reporting requirements: (1) to annually notify covered individuals of their obligation
to report reasonable suspicion of crime, and (2) to clearly post a sign specifying the rights of
employees to make such reports.21
National Nurse Aide Registry
Nurse aides generally work in nursing facilities under the direction of a nurse and provide the
majority of direct care to residents, helping with activities of daily living (ADLs) (i.e., eating,
bathing, dressing, toileting, transferring, and mobility). They may also provide health-related and
other housekeeping tasks such as administering medications, checking vital signs, assisting with
medical equipment such as oxygen or a ventilator, making a resident’s bed, or cleaning a
resident’s room. However, the scope of work performed by nurse aides can vary according to
state licensing requirements and the provider.
Federal regulations require each state and DC to establish and maintain a nurse aide registry of
individuals who have completed training and are registered to work as nurse aides in that state.22

20 CMS, Reporting Reasonable Suspicion of a Crime in a Long-Term Care Facility (LTC): Section 1150B of the Social
Security Act, S&C: 11-30-NH, June 17, 2011 (revised January 201, 2012), see http://www.cms.gov/Medicare/Provider-
Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/SCLetter11_30.pdf
21 HHS, Office of Inspector General, Nursing Facilities’ Compliance with Federal Regulations for Reporting
Allegations of Abuse of Neglect, OEI-07-00010, August 2014.
22 42 CFR § 483.156.
Congressional Research Service
10

---

The Elder Justice Act: Background and Issues for Congress

State-based nurse aide registries also must include individuals who have been prohibited from
employment as nurse aides in LTC facilities due to substantiated findings of abuse, neglect, or
misappropriation of property. Nurse aide registries are utilized by LTC providers to conduct
background checks on potential employees as LTC facilities are required to check their state
nurse aide registry and other state-based registries that are believed to include information on the
potential employee. Such databases can be an effective resource in identifying individuals with a
history of abuse.
The HHS Secretary is required, in consultation with appropriate government agencies and private
sector organizations, to conduct a study on establishing a national nurse aide registry.23 No later
than 18 months after the date of enactment, the Secretary is required to submit a report to the
Elder Justice Coordinating Council and appropriate congressional committees containing the
findings and recommendations of the study. It authorizes to be appropriated such sums as
necessary to carry these activities, with funding for the study not to exceed $500,000. To date,
Congress has not provided discretionary funding for this activity through the annual
appropriations process and no study has been completed or report submitted to these entities.
Funding for Elder Justice Activities
To date, most programs and activities authorized under the Elder Justice Act have not received
funding.24 The President’s budget request in each of fiscal years 2012 through 2014 requested
funding for adult protective services grants. However, Congress has not provided discretionary
funding for this activity nor any other Elder Justice Act authorized program or activity through
the annual appropriations process.
Despite the lack of discretionary appropriations, some elder justice activities have received funds
transferred from mandatory appropriations to the Prevention and Public Health Fund (PPHF). In
ACA, Congress provided the PPHF with a permanent annual appropriation.25 PPHF funds are to
be transferred by the HHS Secretary for prevention, wellness, and public health activities and are
available on October 1, the beginning of each new fiscal year.26

23 ACA Section 6703(c).
24 The ACA reauthorized funding for numerous existing discretionary programs administered by HHS. The ACA also
created many new discretionary programs, including those authorized under the Elder Justice Act, and provided for
each an authorization of appropriations. While most of those existing discretionary programs continue to receive an
annual discretionary appropriation, albeit at levels below the amounts authorized by the law, few of the new grant
programs authorized under the ACA have received any discretionary funding. For more information see CRS Report
R41390, Discretionary Spending Under the Affordable Care Act (ACA), coordinated by C. Stephen Redhead.
25 ACA Section 4002; 42 U.S.C. §300u-11.
26 For more information about the Prevention and Public Health Fund (PPHF) see Appendix C of CRS Report R43304,
Public Health Service Agencies: Overview and Funding, coordinated by Amalia K. Corby-Edwards and C. Stephen
Redhead.
Congressional Research Service
11

---

The Elder Justice Act: Background and Issues for Congress

Table 1. Funding for Elder Justice Activities for
FY2012, FY2013, FY2014, and FY2015 Budget Request
($ in millions)
FY2015
President’s
FY2012a
FY2013b
FY2014
Budget

(appropriated)
(appropriated)
(appropriated)
(requested)
Elder Justice/Adult
$6.0 $2.0
—
$25.0
Protective Services
Source: HHS, ACL, Fiscal Year 2014 Justification of Estimates for Appropriations Committees, April 10, 2013,
http://www.acl.gov/About_ACL/Budget/docs/FY2014_ACL_CJ.pdf; HHS, ACL, Fiscal Year 2015 Justification of Estimates
for Appropriations Committees, http://acl.gov/About_ACL/Budget/docs/FY_2015_ACL_CJ.pdf.
a. FY2012 amounts reflect the 0.189% rescission required by P.L. 112-74, Division F, Sec. 527.
b. FY2013 amounts are the final year funding amounts after rescissions, sequestration, and transfers.
For FY2012, the HHS Secretary transferred $6.0 million to ACL from the PPHF for new grants to
states and tribes to test elder abuse prevention strategies (authorized under SSA Section 2042 and
Section 751 of the OAA). ACL awarded a total of eight grants, including grants to states, tribal
organizations, and for an evaluation of the state grantees (see Table 2 for state grant activities).
Projects included using forensic accountants to prevent elder financial exploitation, increasing
medication adherence to prevent elder self-neglect, and developing screening tools to identify
elder abuse. In addition to grants to states, three tribal organizations received grant funding
totaling $700,000 for the development of a multi-disciplinary team to address elder abuse in
Indian Country; development and testing of culturally appropriate evidence based screening tools;
and culturally appropriate train-the-trainer modules to improve skills on addressing and
intervening with elder abuse issues.27
Table 2. Elder Abuse Prevention Interventions Program
State Grant Summaries and FY2012 Award Amounts
Award
Grantee
Intervention
Amount
University of Texas Health
Pilot an intervention to increase medication adherence in older
$1,018,000
Science Center at Houston (on
adults who have chronic health conditions and also experience
behalf of the State of Texas)
self-neglect
Texas Department of Family &
Demonstrate the effectiveness of an approach to embed APS
$907,000
Protective Services
specialists within a primary care physician group to provide
technical assistance and support for increased elder abuse
prevention using the Elder Abuse Suspicion Index (EASI), a
validated screening tool for physicians.
University of California, Irvine
Pilot and asses the effectiveness of a new approach to elder
$1,020,000
(on behalf of the state of
abuse prevention based on a multi-dimensional intervention that
California)
mitigates key factors associated with risk for elder abuse and
neglect in adults with dementia.

27 Administration for Community Living, Protecting American’s Seniors: The Elder Abuse Prevention Interventions
Program, at http://acl.gov/NewsRoom/Publications/docs/Protecting_Americas_Seniors-
%20The_%20Elder_%20Abuse_%20Prevention_%20Interventions_%20Program.pdf.
Congressional Research Service
12

---

The Elder Justice Act: Background and Issues for Congress

Award
Grantee
Intervention
Amount
New York State Office for the
Pilot an intervention that addresses the prevention of elder
$1,020,000
Aging
financial exploitation and abuse through a coordinated enhanced
multi-disciplinary team (E-MDT) with forensic accountants to
investigate and intervene in complex cases.
Alaska Department of Health
Implement, test, and measure the performance of the Critical
$1,005,000
and Social Services
Time Intervention (CTI) case management model in preventing
elder abuse, neglect, and exploitation through identification of
high risk elders, reducing reports of abuse to APS, and
increasing support systems through community col aborations.
Source: Personal communication from the Administration for Community Living, July 10, 2013; award amounts
rounded to the nearest thousand.
For FY2013, $2.0 million was transferred to ACL from the PPHF for elder justice activities which
funded development of the National Adult Protective Services Data Reporting System Project
(see text box below). No PPHF or other funds were transferred to ACL for elder justice activities
for FY2014.
National Adult Protective Services (APS) Data Reporting System
For FY2013, $2.0 million was transferred to ACL from the PPHF for elder justice activities. Through an interagency
agreement between ACL and HHS’ Office of the Assistant Secretary for Planning and Evaluation (ASPE), these funds
were used for the National APS Data Reporting System Project. Together with ASPE, ACL is overseeing a two-year
project to design, develop, and pilot a National APS Data Reporting System. The key function of the system will be to
collect case-level client data from state or local APS agency investigations, both systematically and efficiently. Data wil
be used to report national statistics on the characteristics of clients and perpetrators of maltreatment; types of
maltreatment allegations and related findings; risk and protective factors associated with clients; services received or
identified; and client outcomes, based upon the knowledge available to APS agencies.
The multiphase project includes a first phase to define system content and scope system functionality. The second
phase includes system design and development of functionality to pilot state participation in a national data collection
system. Piloting the system will include gathering information on the administrative burden associated with voluntary
state participation and future recommendations to ACL. Subsequent phases of the project will include expanding the
national data col ection system to additional states. However, the timing and scope of such expansion is subject to
completion of the first two phases and evaluation of the pilot, as well as the availability of resources to support states’
continued participation.
The project has a multiagency steering committee with representatives from ACL, ASPE, DOJ, and the Centers for
Disease Control and Prevention (CDC). In addition, the National Center on Elder Abuse and the National Adult
Protective Services Association are providing consulting expertise. To date, approximately 15 states have participated
in discussions of the national data report system. Approximately 50 stakeholders from other organizations have also
provided input into project planning. The project’s technical support contract ends in September 2015. Subject to
OMB approval, ACL anticipates the first phase of national data col ection to occur at the end of 2016, with a report
available for release in mid-2017.
Source: CRS communication with ACL, July 10, 2014.

For FY2015, the President’s budget requested $25 million in discretionary funding for the Elder
Justice Initiative which would be used to fund Adult Protective Services, research, and evaluation
activities (authorized under SSA Section 2042, and OAA Sections 411 and 751). The 2015 budget
request did not specify an intended transfer of funding from the PPHF to ACL for elder justice
activities. On June 10, 2014, the Senate Appropriations Subcommittee on the Departments of
Labor, Health and Human Services, and Education (DOL-HHS-ED) approved their FY2015 bill
Congressional Research Service
13

---

The Elder Justice Act: Background and Issues for Congress

by voice vote. The Subcommittee recommends $10 million for the Elder Justice Initiative “to
develop partnerships across disciplines for the prevention, investigations and prosecution of
abuse, including financial abuse against the elder.”28 The House has yet to take legislative action
in the subcommittee or full committee for their FY2015 DOL-HHS-ED appropriations bill.
Issues for Congress
The ACA created many new discretionary programs, including those authorized under the Elder
Justice Act, and provided for each an authorization of appropriations. Among these new grant
programs, few have received any discretionary funding.29 The authorizations of appropriations for
most Elder Justice Act provisions expire on September 30, 2014 (see Table A-1 of Appendix A
for information on specific Elder Justice Act authorizations of appropriations). Most elder justice
programs and activities have yet to receive funding through the annual congressional
appropriations process limiting the administration’s response to implementation. Furthermore, no
legislation has been introduced in the 113th Congress to reauthorize the Elder Justice Act.
In considering reauthorization of the Elder Justice Act, Congress faces a decision whether or not
to extend the authorizations of appropriations associated with existing programs and activities.
Some policy makers may consider new language to modify or delete existing authorities as well
as authorize new programs or activities. Congress may also want to consider the relationship
between Elder Justice Act authorities and other similar or related authorities in other statutes. For
example, the OAA establishes the LTC Ombudsman Program, administered by AoA within ACL.
The Elder Justice Act authorizes grants under SSA to improve capacity and provide assistance to
state LTC Ombudsman Programs as well as provide training to ombudsman. As authorized these
programs have different committees of jurisdiction responsible for program authorization and
oversight.
In the context of these legislative actions, policy makers may look to existing administrative
activities for areas of continued legislative emphasis. A discussion of selected issues follows.
Federal Leadership
The lack of federal funding has hampered the ability of the federal government to further develop
and expand its role in addressing the prevention, detection, and treatment of elder abuse. The
OAA first called attention to the importance of federal leadership in the area of elder justice.
Under the OAA, the AOA has primary responsibility for federal leadership in carrying out elderly
justice activities.30 However, funding under the OAA for such activities has also been limited.
According to GAO, the Elder Justice Act “reaffirmed the importance of federal leadership of
elder justice activities and provides a vehicle for establishing and implementing national priorities
in this area.” While the Elder Justice Coordinating Committee has appointed members and
convened several times, an Advisory Board on Elder Abuse, Neglect, and Exploitation tasked to

28 U.S. Senate, Committee on Appropriations, FY15 LHHS Subcommittee Markup Bill Summary, June 10, 2014,
http://www.appropriations.senate.gov/news/fy15-lhhs-subcommittee-markup-bill-summary.
29 For more information see CRS Report R41390, Discretionary Spending Under the Affordable Care Act (ACA),
coordinated by C. Stephen Redhead.
30 42 U.S.C. 3011
Congressional Research Service
14

---

The Elder Justice Act: Background and Issues for Congress

put forth a plan to develop the field of elder abuse has yet to be established. Further federal
efforts to develop objectives, priorities, policy, and a long-term planning on these issues may be
limited by available funding.
Elder Abuse Data Collection
Federal efforts to collect data on elder abuse at the national level are compounded by variation in
state statutory definitions of elder abuse that make it difficult to identify actions that constitute
elder abuse, and by the absence of a uniform reporting system across states. A 2011 GAO report
recommended the HHS Secretary conduct a pilot study to collect, compile, and disseminate APS
administrative data.31 To this end, ACL has utilized funding from the PPHF to begin the process
of designing, developing, and eventually pilot testing the National APS Data Reporting System.
Policymakers may have a continued interest in this initiative and further funding efforts to expand
these activities based on findings and recommendations from the administration.
Elder Abuse Prevention
According to ACL, “most communities do not have comprehensive elder abuse prevention efforts
that engage a broad set of individuals and institutions that can play a role in combating abuse,
such as health professionals, law enforcement and legal services agencies, social workers, clergy,
and community organizations.”32 To implement the Elder Justice Act, the ACL is currently
funding several grants to states and tribal organizations that test interventions designed to prevent
elder abuse, neglect, and exploitation. These multidisciplinary models draw on prevention
strategies from other family violence prevention programs and can assist in developing the
evidence base for more widespread dissemination. ACL has invested in an evaluation of such
grants. Based on findings from the evaluation, such initiatives could be disseminated more
broadly to other states and entities through federally funded web-sites such as the National Center
for Elder Abuse, federal technical assistance, and further funding opportunities.
Concluding Observations
The Elder Justice Act represents one set of policies that exist in the broader context of domestic
social policy to address the complex issue that is elder abuse. That is, as a federal legislative
response, the Elder Justice Act may best serve as a catalyst for further federal coordination and
action that can bring about greater public awareness and attention to the needs of a growing, and
potentially vulnerable, aging population. According to GAO, the Elder Justice Act “provides a
vehicle for setting national priorities and establishing a comprehensive, multidisciplinary elder
justice system in this country.”33 Such a response touches on a range of domestic policy programs

31 Ibid.
32 Administration for Community Living, Protecting American’s Seniors: The Elder Abuse Prevention Interventions
Program, at http://acl.gov/NewsRoom/Publications/docs/Protecting_Americas_Seniors-
%20The_%20Elder_%20Abuse_%20Prevention_%20Interventions_%20Program.pdf.
33 U.S. Government Accountability Office, Stronger Federal Leadership Could Enhance National Response to Elder
Abuse, GAO-11-208, Mar 2, 2011, http://www.gao.gov/assets/320/316224.pdf; U.S. Government Accountability
Office, Survey of Adult Protective Services Program Administrators (GAO-11-129SP, March 2011), an E-supplement
to GAO-11-208, GAO-11-129SP, Mar 2, 2011, http://www.gao.gov/products/GAO-11-129SP.
Congressional Research Service
15

---

The Elder Justice Act: Background and Issues for Congress

and issues that are not specific to one congressional committee’s jurisdiction or area of expertise.
Furthermore, congressional oversight into federal administration, implementation, and related
activities must rely on different committees of jurisdiction as well as the experience of select
committees such as the Senate Special Committee on Aging. According to subject matter experts,
elder abuse is not an easy problem to address as it is
a complex cluster of distinct but related phenomena involving health, legal, social service,
financial, public safety, aging, disability, protective services, and victim services, aging
services, policy, research, education, and human rights issues. It therefore requires a
coordinated multidisciplinary, multi-agency, and multi-system response.34
Achieving such a response will likely require congressional interest in overseeing the range of
elder justice programs and activities that currently exist across agencies. In addition, further
research may assist policy makers to address areas where service delivery is either fragmented or
lacks sufficient resources, or both. According to stakeholders, there are numerous challenges in
responding to elder abuse, including lack of coordination, data, and resources.35 Addressing these
challenges could assist in developing an informed strategic and coordinated federal response.

34 Connolly, Marie-Therese, B. Brandl, R. Breckman, The Elder Justice Roadmap: A Stakeholders Initiative to Respond
to an Emerging Health, Justice, Financial and Social Crisis, 2014, at http://ncea.acl.gov/Library/Gov_Report/
index.aspx.
35 Ibid.
Congressional Research Service
16

---

The Elder Justice Act: Background and Issues for Congress

Appendix A. Elder Justice Act: Authorizations of
Appropriations
Table A-1 provides a section-by-section list of those Elder Justice Act provisions with an
authorization of appropriations.
Table A-1. Elder Justice Act: Authorizations of Appropriations
ACA
Statutory
Section
Authority
Provision
Authorization of Appropriations
6703(a) SSA
Sec. Elder Justice Coordinating Council
Such sums as necessary (no years specified),
2021
see also new SSA Sec. 2024 below

6703(a) SSA
Sec. Advisory Board on Elder Abuse,
Such sums as necessary (no years specified),
2022
Neglect, and Exploitation
see also new SSA Sec. 2024 below

6703(a) SSA
Sec. Authorization of appropriations
$6.5 million for FY2011, and $7.0 million
2024
for each of FY2012 through FY2014

6703(a) SSA
Sec. Forensic centers and expertise
$4 million for FY2011, $6 million for
2031
FY2012, and $8 million for each of FY2013
and FY2014

6703(a) SSA
Sec. Incentives for LTC staffing
For new SSA Sec. 2041: $20 million for
2041(a)
FY2011, $17.5 million for FY2012, and $15
mil ion for each of FY2013 and FY2014
6703(a) SSA
Sec. Certified EHR technology grant
See above authorization of appropriations
2041(b)
program
for SSA Sec. 2041

6703(a) SSA
Sec. Standards for transactions involving
See above authorization of appropriations
2041(c)
clinical data by LTC facilities
for SSA Sec. 2041

6703(a) SSA
Sec. Adult protective service functions
$3 million for FY2011, and $4 million for
2042(a)
each of FY2012 through FY2014

6703(a) SSA
Sec. Grants to enhance provision of
$100 million for each of FY2011 through
2042(b)
adult protective services
FY2014

6703(a) SSA
Sec. Adult protective services
$25 million for each of FY2011 through
2042(c)
demonstration grants
FY2014

6703(a) SSA
Sec. Long-term care ombudsman
$5 million for FY2011, $7.5 million for
2043(a)
program grants
FY2012, and $10 million for each of FY2013
and FY2014
6703(a) SSA
Sec. Ombudsman training programs
$10 million for each of FY2011 through
2043(b)
FY2014

6703(b) New National Training Institute for
$12 million for the period of FY2011
authority
Surveyors
through FY2014

Congressional Research Service
17

---

The Elder Justice Act: Background and Issues for Congress

ACA
Statutory
Section
Authority
Provision
Authorization of Appropriations
6703(b) New Grants to state survey agencies
$5 million for each of FY2011 through
authority
FY2014

6703(c) New National nurse aide registry study
Such sums as necessary (no years specified)
authority
and report
to carry out these activities, with funding
not to exceed $500,000
Source: Table prepared by the Congressional Research Service based on the text of the Patient Protection and
Affordable Care Act (ACA; P.L. 111-148, as amended).
Notes: EHR = Electronic Health Records; LTC = Long-Term Care; SSA = Social Security Act.
Congressional Research Service
18

---

The Elder Justice Act: Background and Issues for Congress

Appendix B. Elder Justice Resources
The resources below provide further information on elder justice issues.
• State Resources (National Center on Elder Abuse)
http://www.ncea.aoa.gov/Stop_Abuse/Get_Help/State/index.aspx
A directory of state hotlines and agencies for reporting suspected elder abuse, neglect, or
exploitation. If the situation is serious, threatening, or dangerous, constituents should call
911 or the local police for immediate help. This directory also lists state laws, agencies,
and statistics related to elder abuse and neglect.
• National Center on Elder Abuse (U.S. Administration on Aging)
http://www.ncea.aoa.gov/
The National Center on Elder Abuse (NCEA) compiles and publishes resources for policy
makers, consumers, researchers, and social service, justice, and health care workers on
elder abuse and neglect. The website includes frequently asked questions, research briefs
on topics such as the mistreatment of LGBT elders and the abuse of people with
dementia, and annotated bibliographies of recent published research on elder abuse and
neglect.
• Elder Abuse (Centers for Disease Control and Prevention)
http://www.cdc.gov/violenceprevention/elderabuse/
Includes statistics, prevention strategies for practitioners, and the consumer fact sheet
“Understanding Elder Abuse.”
• Key Issues: Elder Abuse (U.S. Government Accountability Office)
http://www.gao.gov/key_issues/elder_abuse/issue_summary
A summary of types of elder abuse, and diagrams of federal agency missions and
responsibilities to combat elder financial exploitation. Click the “Key Reports” tab for
GAO reports on elder justice issues.
• Participating Federal Departments and Agencies Activities Relevant to Elder Justice
(Elder Justice Interagency Working Group, June 2014)
http://www.aoa.gov/AoA_programs/Elder_Rights/EJCC/docs/
AgencyDescriptions.pdf
Describes federal elder justice programs, initiatives, web pages, and other activities
within the U.S. Department of Health and Human Services, the U.S. Department of
Justice, the Consumer Financial Protection Bureau, the Federal Trade Commission, the
Social Security Administration, the U.S. Department of Housing and Urban
Development, the U.S. Department of the Treasury, the U.S. Postal Inspection Service,
and the U.S. Securities and Exchange Commission.
• Statute Compilations (U.S. House of Representatives, Office of the Legislative
Counsel)
legcounsel.house.gov/HOLC/Resources/comps_alpha.html
Congressional Research Service
19

---

The Elder Justice Act: Background and Issues for Congress

The statutory text of the Elder Justice Act appears at Title VI, Subtitle H, sections 6701
through 6703 of the Patient Protection and Affordable Care Act, which is listed under “P” on
this web page.

Author Contact Information
Kirsten J. Colello
Specialist in Health and Aging Policy
kcolello@crs.loc.gov, 7-7839

Congressional Research Service
20

---