Keep It On the Tip of Your Tongue: S. 333
Elder Justice Act Reintroduced

Want to improve federal efforts on behalf of abused and at-risk elders? Then keep talking and writing about S. 333, the Elder Justice Act (EJA).

The EJA -- first introduced last September -- was re-introduced into the Senate on February 10, 2003 by Senator John Breaux (D-LA), ranking member of the Senate Special Committee on Aging, and Senator Orrin Hatch (R-Utah), chairman of the Senate Judiciary Committee. Assigned the bill number S. 333, EJA originally had 14 co-sponsors. Six more have signed up in the two months since the introduction (see accompanying "Co-sponsors" box).

Summary of Bill

Senator Breaux's staff prepared the following plain-English summary of the main components of the bill:

"The Elder Justice Act would provide federal resources to support State and community efforts on the front lines dedicated to fighting elder abuse with scarce resources and fragmented systems. From a social perspective, elder justice means assuring adequate public-private infrastructure and resources to prevent, detect, treat, understand, intervene in and, where appropriate, prosecute elder abuse, neglect and exploitation. From an individual perspective, elder justice is the right of every older person to be free of abuse, neglect and exploitation. The Elder Justice Act would promote both aspects of elder justice with the following provisions:

• Elevate elder justice issues to national attention. Creation of (1) Offices of Elder Justice at the Departments of Health and Human Services and Justice to serve programmatic, grant-making, policy and technical assistance functions relating to elder justice, (2) a public-private and a Coordinating Council to coordinate activities of all relevant federal agencies, States, communities and private and not-for-profit entities, and (3) a consistent funding stream and national coordination for Adult Protective Services (APS).
• Improving the quality, quantity and accessibility of information. An Elder Justice Resource Center and Library will provide information for consumers, advocates, researchers, policy makers, providers, clinicians, regulators and law enforcement and prevent "re-inventing" the wheel. A national data repository also will be developed to increase the knowledge base and collect data about elder abuse, neglect and exploitation.
• Increasing knowledge and supporting promising projects. Given the paucity of research, Centers of Excellence will enhance research, clinical practice, training and dissemination of information relating to elder justice. Priorities include a national incidence and prevalence study, jump-starting intervention research, developing community strategies to make elders safer, and enhancing multi-disciplinary efforts.
• Developing forensic capacity. There is scant data to assist in the detection of elder abuse, neglect and exploitation. Creating new forensic expertise (similar to that in child abuse) will promote detection and increase expertise. New programs will train health professionals in both forensic pathology and geriatrics.
• Victim assistance, "safe havens," and support for at-risk elders. Elder victims' needs, which are rarely addressed, will be better met by supporting creation of "safe havens" for seniors who are not safe where they live and development of programs focusing on the special needs of at-risk elders and older victims.
• Increasing prosecution. Technical, investigative, coordination, and victim assistance resources will be provided to law enforcement to support elder justice cases. Preventive efforts will be enhanced by supporting community policing efforts to protect at-risk elders.
• Training. Training to combat elder abuse, neglect and exploitation is supported both within individual disciplines and in multi-disciplinary (such as public health-social service-law enforcement) settings.
• Special programs to support underserved populations including rural, minority and Indian seniors.
• Model State Laws and Practices. A study will review state practices and laws relating to elder justice.
• Increasing Security, Collaboration, and Consumer Information in Long-Term Care.
  -- Improving prompt reporting of crimes in long-term care settings
  -- Criminal background checks for long-term care workers
  -- Enhancing long-term care staffing
  -- Information about long-term care for consumers through a Long-Term Care Consumer Clearinghouse
  -- Promoting accountability through a new federal law to prosecute abuse and neglect in nursing homes
• Evaluations and accountability. Provisions to determine 'what works' and assure funds are properly spent."

Revisions to Bill

According to Breaux, "Although some minor and technical edits, revisions, and clarifications were made [to the Elder Justice Act bill], the spirit and substance of the Act remain unchanged:

• Fostering the knowledge, resources, awareness and leadership necessary to promote elder justice
• Providing the resources to the State and local entities that need them."

The primary changes, according to a document summarizing them supplied by Senate staff, include:

• "The applicable age covered by the bill was changed from 65 to 60 to conform to other federal legislation.
• The terms 'fiduciary' or 'guardianship' were added in certain places throughout the bill to ensure inclusion of these issues in the legislation.
• Terms of advisory board and coordinating council members changed from life to 3-year terms.
• The HHS Secretary was authorized to issue regulations with regard to facility closures.
• A civil enforcement provision was added to the new federal cause of action, providing DOJ a full range of remedies, but conveys no private or implied cause of actions.
• Most appropriations paragraphs were consolidated into one appropriations paragraph for Title I and one appropriations paragraph for Title II."

Some of these changes, Lauren Fuller, Senator Breaux's staffer on the Senate Special Committee on Aging, told AAR, were made in response to concerns expressed about the original EJA. She was quick to note, however, that no opposition to the bill has emerged. Although the nursing home industry was reportedly upset about the new civil Federal cause of action, a meeting Committee staff held with nursing home industry representatives resulted in their discovering they had misunderstood the provision, and withdrawing their concern. Some unions are unhappy that there is no whistleblower protection in the bill, although Fuller says adding it in is not out of the question, if unions can do the necessary footwork to ensure such a provision does not lose the bill co-sponsors or votes.

Appropriations Amount Not Available

Fuller noted that staff is still seeking a Congressional Budget Office (CBO) estimate of what the provisions of the bill will cost, although she expected the figure to come in at around $650 million for seven years. This figure is lower than some earlier estimates, Fuller said, but is far more likely to result in passage of the bill.

What's Next

Two Representatives -- Rahm Emanuel, a Democrat representing the 5th District of Illinois, and Pete King, a Republican from the 3rd District of New York -- are expected to introduce a House version of the bill. Currently staff is working to beef up the list of 30 potential House co-sponsors, focusing particularly on senior members of House committees with jurisdiction over the bill.

On the Senate side, the bill has been referred to the Finance Committee, where "almost everyone" is a co-sponsor of the bill. Staff, however, is still working on gaining the co-sponsorship of Finance Committee Chair Chuck Grassley. Special Committee on Aging Chair Larry Craig has also not yet signed on, citing concerns about cost and bureaucracy. It is for perhaps this reason that the Senate Aging Committee's lauded elder justice website is no longer available there (although Senator Breaux expects to have it linked to his own website "soon"), and why S. 333 is not included on the Committee's list of "Pertinent Legislation."

Although on average it takes seven years for a bill to be signed into law, Senator Breaux believes there is a "lot of momentum" behind the bill and hopes to make the EJA an election year issue, with passage by May 2004. To do this, constituents and professionals are urged to join the Elder Justice Coalition (see sidebar) and, even more importantly, contact their Representatives and Senators. "It's so incredibly helpful" when constituents contact their Members about a bill, Fuller notes; constituent letters or visits and "events" at which co-sponsors are highlighted are three of the most effective means of gaining co-sponsors and support, she said. The White House should also be contacted, as Senator Breaux would love to get the President "on board," as well.

On the Senate side, questions about EJA should be directed to Lauren Fuller at 202-224-1467. On the House side, contact Pete Spiro of Rep. Emanuel's office, at 202-226-7635.