[House Report 116-535]
[From the U.S. Government Publishing Office]
116th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 116-535
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PROMOTING ALZHEIMER'S AWARENESS TO PREVENT ELDER ABUSE ACT
_______
September 24, 2020.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Nadler, from the Committee on the Judiciary, submitted the
following
R E P O R T
[To accompany H.R. 6813]
The Committee on the Judiciary, to whom was referred the
bill (H.R. 6813) to amend the Elder Abuse Prevention and
Prosecution Act to improve the prevention of elder abuse and
exploitation of individuals with Alzheimer's disease and
related dementias, having considered the same, reports
favorably thereon without amendment and recommends that the
bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 1
Background and Need for the Legislation.......................... 2
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
New Budget Authority and Tax Expenditures and Congressional
Budget Office Cost Estimate.................................... 4
Duplication of Federal Programs.................................. 4
Performance Goals and Objectives................................. 5
Advisory on Earmarks............................................. 5
Section-by-Section Analysis...................................... 5
Changes in Existing Law Made by the Bill, as Reported............ 6
Purpose and Summary
H.R. 6813, the ``Promoting Alzheimer's Awareness to Prevent
Elder Abuse Act,'' would require the Department of Justice's
Elder Justice Coordinator to develop best practices and
training materials for professionals treating, protecting and
caring for people living with Alzheimer's and related
dementias. This legislation will build upon existing
requirements for training materials by requiring the Elder
Justice Coordinator to engage in greater consultation with
relevant entities and stakeholders. Specifically, H.R. 6813
requires that, in the preparation of training materials, the
Elder Justice Coordinator consult with the Secretary of Health
and Human Services, State, local, and Tribal adult protective
services, aging, social, and human services agencies, as well
as Federal, State, local, and Tribal law enforcement agencies.
In addition, the bill adds a new requirement that the Elder
Justice Coordinator consult, as appropriate, with nationally
recognized nonprofit associations with relevant expertise when
creating or updating guides and training materials. H.R. 6813
also requires the Elder Justice Coordinator to develop specific
training materials in the evaluation of evidence in cases where
the victims and witnesses have Alzheimer's disease or related
dementias.
Background and Need for the Legislation
More than 5.8 million Americans are currently living with
Alzheimer's or dementia--more than 1 in 10 people 65 or
older.\1\ By 2050, the number of people age 65 and older with
Alzheimer's dementia is projected to reach 13.8 million.\2\
Approximately one in 10 seniors aged 60 and older have
experienced some form of elder abuse, and among those with
Alzheimer's and related dementias, some estimates are over 50
percent.\3\ Research suggests that the 2.5 million vulnerable
individuals in residential care settings are at much higher
risk for abuse and neglect than older persons who live at
home.\4\ However, one study estimated that only 1 in 14 cases
of abuse are reported to authorities.\5\ The toll of abuse
brings serious consequences. According to the National Council
on Aging, seniors who have been abused have a 300% higher risk
of death when compared to those who have not been
mistreated.\6\
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\1\Hebert LE, Weuve J, Scherr PA, Evans DA., Alzheimer disease in
the United States (2010-2050) estimated using the 2010 Census,
Neurology (2013), https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3719424/.
\2\Id.
\3\National Center on Elder Abuse, Statistics & Data (Sept. 2020),
https://ncea.acl.gov/What-We-Do/Research/Statistics-and-Data.aspx#16.
\4\Richard J. Bonnie & Robert B. Wallace, National Research
Council, Panel to Review Risk and Prevalence of Elder Abuse and
Neglect, (2003), https://www.ncbi.nlm.nih.gov/books/NBK98802/.
\5\Id.
\6\XinQi Dong, MD, Melissa Simon, MD, MPH, et al., Elder Self-
neglect and Abuse and Mortality Risk in a Community-Dwelling
Population, JAMA (Oct. 2010), https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC2965589/.
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During the pandemic resulting from Covid-19 in 2020, people
living with Alzheimer's and other forms of dementia face even
greater risk to their health and safety. Approximately seven
out of ten residents in long-term care facilities have some
form of cognitive impairment, with 29 percent having mild
impairment, 23 percent moderate impairment, and 19 percent
severe impairment.\7\ According to one study, over 50% of
nursing home staff admitted to mistreating (e.g. physical
violence, mental abuse, neglect) older patients within the
prior year.\8\ With social isolation measures limiting contact
with family members and other visitors, these individuals are
at even greater risk of abuse and exploitation.
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\7\Sheryl Zimmerman, Philip D. Sloane, and David Reed, Dementia
Prevalence And Care In Assisted Living, HEALTH AFFAIRS, VOL. 33, NO. 4:
THE LONG REACH OF ALZHEIMER'S DISEASE (April 2014) https://
www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1255.
\8\National Center on Elder Abuse, Research Brief: Long-Term Care
Facilities, (2012), https://ncea.acl.gov/NCEA/media/docs/Abuse-of-
Residents-of-Long-Term-Care-Facilities-(2012)_1.pdf.
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On October 18, 2017, Congress enacted the Elder Abuse
Prevention and Prosecution Act of 2017 to address the need for
better data collection on elder abuse.\9\ Several federal
agencies currently collect elder abuse data on an ongoing
basis. Two distinct data sets include the National Adult
Mistreatment Report System (NAMRS) (which collects state-level
adult protective services data) and the Financial Crimes
Enforcement Network (FinCEN) (which collects data on suspected
elder financial exploitation submitted by financial
institutions).\10\
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\9\Pub.L. 115-70, 131 Stat. 1208 (2017).
\10\Department of Justice Elder Justice Initiative, https://
www.justice.gov/elderjustice/eappa.
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Although many cases may go unreported, NAMRS reflects data
on elder abuse cases reported to state and local authorities.
Based on the most current reported data, neglect comprised the
highest percentage across types of elder abuse, followed by
financial exploitation.\11\
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\11\Id.
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Financial exploitation causes large economic losses for
elders, families, businesses, and government programs.\12\ Even
though a vast number of cases go unreported, financial
exploitation of seniors is becoming the most prevalent form of
elder abuse.\13\ A key factor that makes the elderly more
susceptible to financial exploitation is cognitive decline.\14\
According to FinCen data analyzed by the Consumer Financial
Protection Bureau, financial exploitation lasts longer than
average in cases where the targeted person has a diminished
cognitive capacity.\15\ This population is particularly
vulnerable to scams as their condition makes it more difficult
for them to communicate the crimes to law enforcement or to
seek critical assistance from first responders or other social
services personnel.
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\12\Connolly, M.T., Brandl, B., & Breckman, R., The Elder Justice
Roadmap: A Stakeholder Initiative to Respond to an Emerging Health,
Justice, Financial and Social Crisis (2014), https://www.justice.gov/
file/852856/download.
\13\Stephen Deane, Securities & Exchange Commission, Elder
Financial Exploitation: Why is it a concern, what regulators are doing
about it, and looking ahead (June 2018), https://www.sec.gov/files/
elder-financial-exploitation.pdf.
\14\Id.
\15\Consumer Financial Protection Bureau, Suspicious Activity
Reports on Elder Financial Exploitation: Issues and Trends, at 22 (Feb.
2019), https://s3.amazonaws.com/files.consumerfinance.gov/f/documents/
cfpb_suspicious-activity-reports-elder-financial-
exploitation_report.pdf.
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People living with Alzheimer's or dementia may also have
difficulty understanding or explaining situations; and their
behaviors may be misunderstood as uncooperative, disruptive or
combative. The Elder Abuse Prevention and Prosecution Act
required the Justice Department to create training materials to
help criminal justice, health care, and social services
personnel assess and respond to elder abuse cases. Under the
Act, the Elder Justice Coordinator is responsible for
evaluating training models to determine best practices and
creating or compiling and making publicly available replication
guides and training materials for law enforcement officers,
first responders, social workers, prosecutors, judges,
individuals working in victim services, adult protective
services, medical personnel, mental health personnel, financial
services personnel, and any other individuals that encounter
and support people living with Alzheimer's and other types of
dementia.
This legislation will build upon existing requirements for
training materials by requiring the Elder Justice Coordinator
to engage in greater consultation with relevant entities and
stakeholders. H.R. 6813 would also require further training
materials relating to victims and witnesses who have
Alzheimer's disease and related dementias. One study determined
that a significant subset of individuals with dementia
illnesses could reliably report on emotional events and were
even able to report details of the event accurately and to
recall the same event with the same accuracy after a short time
delay.\16\ Crime victims with dementia should be evaluated for
their ability to remember emotional events in order to
determine whether they can provide testimony about the criminal
events. This legislation would require the Elder Justice
Coordinator to develop specific training materials to support
individuals evaluating witness and working with crime victims
in these types of cases.
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\16\Aileen Wiglesworth, Ph.D., Laura Mosqueda, M.D., People with
Dementia as Witnesses to Emotional Events, NCJRS (April 2011), https://
www.ncjrs.gov/pdffiles1/nij/grants/234132.pdf.
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Committee Consideration
On September 15, 2020, the Committee met in open session
and ordered the bill, H.R. 6813, favorably reported, by a voice
vote, a quorum being present.
Committee Votes
No recorded votes occurred during the Committee's
consideration of H.R. 6813.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the Committee advises that the
findings and recommendations of the Committee, based on
oversight activities under clause 2(b)(1) of rule X of the
Rules of the House of Representatives, are incorporated in the
descriptive portions of this report.
New Budget Authority and Tax Expenditures and Congressional Budget
Office Cost Estimate
With respect to the requirements of clause 3(c)(2) of rule
XIII of the Rules of the House of Representatives and section
308(a) of the Congressional Budget Act of 1974 and with respect
to requirements of clause (3)(c)(3) of rule XIII of the Rules
of the House of Representatives and section 402 of the
Congressional Budget Act of 1974, the Committee has requested
but not received a cost estimate for this bill from the
Director of Congressional Budget Office (CBO). The Committee
has requested but not received from the Director of the CBO a
statement as to whether this bill contains any new budget
authority, spending authority, credit authority, or an increase
or decrease in revenues or tax expenditures.
Duplication of Federal Programs
No provision of H.R. 6813 establishes or reauthorizes a
program of the Federal government known to be duplicative of
another federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Performance Goals and Objectives
The Committee states that pursuant to clause 3(c)(4) of
rule XIII of the Rules of the House of Representatives, H.R.
6813 would facilitate the Federal government's ability to
develop best practices and training materials for professionals
treating, protecting and caring for people living with
Alzheimer's and related dementias.
Advisory on Earmarks
In accordance with clause 9 of rule XXI of the Rules of the
House of Representatives, H.R. 6813 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.
Section-by-Section Analysis
The following discussion describes the bill as reported by
the Committee.
Sec. 1. Short title. This section establishes the short
title of the bill as the ``Promoting Alzheimer's Awareness to
Prevent Elder Abuse Act.''
Sec. 2 Addressing Alzheimer's Disease in best practices.
Section 2 addresses best practices to assist individuals with
Alzheimer's disease. This section would expand the current
provisions of the Elder Abuse Prevention and Prosecution Act to
include any special considerations for witnesses who have
Alzheimer's disease and related dementias.
Under current law, the Elder Justice Coordinator is
responsible for evaluating training models to determine best
practices and creating or compiling and making publicly
available replication guides and training materials for the
wide range of individuals whose work may bring them in contact
with this specific population. This section would require these
materials to address evidentiary issues and other legal issues
relating to witnesses who have Alzheimer's disease and related
dementias.
Section 2 would further address the need to include victims
and witnesses who have Alzheimer's disease and related
dementias when assessing, responding to, and interacting with
victims and witnesses in elder abuse cases, including in
administrative, civil, and criminal judicial proceedings.
Section 2 also requires that, in the preparation of training
materials, the Elder Justice Coordinator consults with the
Secretary of Health and Human Services, State, local, and
Tribal adult protective services, aging, social, and human
services agencies, as well as Federal, State, local, and Tribal
law enforcement agencies. In addition, the bill adds a new
requirement that the Elder Justice Coordinator consult, as
appropriate, with nationally recognized nonprofit associations
with relevant expertise when creating or updating guides and
training materials.
Sec. 3 Report on outreach. This section would amend the
current reporting requirements of the Elder Abuse Prevention
and Prosecution Act by requiring the Attorney General to
include a link to the publicly available best practices and the
replication guides and training materials created or compiled
under the Act's requirements. The additional reporting
requirements take effect two years after the enactment date of
the Act. Following the initial report, the Justice Department's
would be required to report to Congress on an annual basis.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
ELDER ABUSE PREVENTION AND PROSECUTION ACT
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TITLE I--SUPPORTING FEDERAL CASES INVOLVING ELDER JUSTICE
SEC. 101. SUPPORTING FEDERAL CASES INVOLVING ELDER JUSTICE.
(a) Support and Assistance.--
(1) Elder justice coordinators.--The Attorney General
shall designate in each Federal judicial district not
less than one Assistant United States Attorney to serve
as the Elder Justice Coordinator for the district, who,
in addition to any other responsibilities, shall be
responsible for--
(A) serving as the legal counsel for the
Federal judicial district on matters relating
to elder abuse;
(B) prosecuting, or assisting in the
prosecution of, elder abuse cases;
(C) conducting public outreach and awareness
activities relating to elder abuse; and
(D) ensuring the collection of data required
to be collected under section 202.
(2) Investigative support.--The Attorney General, in
consultation with the Director of the Federal Bureau of
Investigation, shall, with respect to crimes relating
to elder abuse, ensure the implementation of a regular
and comprehensive training program to train agents of
the Federal Bureau of Investigation in the
investigation and prosecution of such crimes and the
enforcement of laws related to elder abuse, which shall
include--
(A) specialized strategies for communicating
with and assisting elder abuse victims; and
(B) relevant forensic training relating to
elder abuse.
(3) Resource group.--The Attorney General, through
the Executive Office for United States Attorneys, shall
ensure the operation of a resource group to facilitate
the sharing of knowledge, experience, sample pleadings
and other case documents, training materials, and any
other resources to assist prosecutors throughout the
United States in pursuing cases relating to elder
abuse.
(4) Designated elder justice working group or
subcommittee to the attorney general's advisory
committee of united states attorneys.--Not later than
60 days after the date of enactment of this Act, the
Attorney General, in consultation with the Director of
the Executive Office for United States Attorneys, shall
establish a subcommittee or working group to the
Attorney General's Advisory Committee of United States
Attorneys, as established under section 0.10 of title
28, Code of Federal Regulations, or any successor
thereto, for the purposes of advising the Attorney
General on policies of the Department of Justice
relating to elder abuse.
(b) Department of Justice Elder Justice Coordinator.--[Not
later than]
(1) In general._Not later than 60 days after the
date of enactment of this Act, the Attorney General
shall designate an Elder Justice Coordinator within the
Department of Justice who, in addition to any other
responsibilities, shall be responsible for--
[(1)] (A) coordinating and supporting the law
enforcement efforts and policy activities for
the Department of Justice on elder justice
issues;
[(2)] (B) evaluating training models to
determine best practices and creating or
compiling and making publicly available
replication guides and training materials for
law enforcement officers, prosecutors, judges,
emergency responders, individuals working in
victim services, adult protective services,
social services, and public safety, medical
personnel, mental health personnel, financial
services personnel, and any other individuals
whose work may bring them in contact with elder
abuse regarding how to--
[(A)] (i) conduct investigations in
elder abuse cases;
[(B)] (ii) address evidentiary issues
and other legal issues, including
witnesses who have Alzheimer's disease
and related dementias; and
[(C)] (iii) appropriately assess,
respond to, and interact with victims
and witnesses in [elder abuse cases,]
elder abuse cases (including victims
and witnesses who have Alzheimer's
disease and related dementias),
including in administrative, civil, and
criminal judicial proceedings; and
[(3)] (C) carrying out such other duties as
the Attorney General determines necessary in
connection with enhancing the understanding,
prevention, and detection of, and response to,
elder abuse.
(2) Training materials.--
(A) In general.--In creating or compiling
replication guides and training materials under
paragraph (1)(B), the Elder Justice Coordinator
shall consult with the Secretary of Health and
Human Services, State, local, and Tribal adult
protective services, aging, social, and human
services agencies, Federal, State, local, and
Tribal law enforcement agencies, and nationally
recognized nonprofit associations with relevant
expertise, as appropriate.
(B) Updating.--The Elder Justice Coordinator
shall--
(i) review the best practices
identified and replication guides and
training materials created or compiled
under paragraph (1)(B) to determine if
the replication guides or training
materials require updating; and
(ii) perform any necessary updating
of the replication guides or training
materials.
(c) Federal Trade Commission.--
(1) Federal trade commission elder justice
coordinator.--Not later than 60 days after the date of
enactment of this Act, the Chairman of the Federal
Trade Commission shall designate within the Bureau of
Consumer Protection of the Federal Trade Commission an
Elder Justice Coordinator who, in addition to any other
responsibilities, shall be responsible for--
(A) coordinating and supporting the
enforcement and consumer education efforts and
policy activities of the Federal Trade
Commission on elder justice issues; and
(B) serving as, or ensuring the availability
of, a central point of contact for individuals,
units of local government, States, and other
Federal agencies on matters relating to the
enforcement and consumer education efforts and
policy activities of the Federal Trade
Commission on elder justice issues.
(2) Reports to congress.--Not later than 1 year after
the date of enactment of this Act, and once every year
thereafter, the Chairman of the Federal Trade
Commission and the Attorney General shall each submit
to the Committee on the Judiciary of the Senate and the
Committee on the Judiciary of the House of
Representatives [a report detailing] a report--
(A) detailing the enforcement actions taken
by the Federal Trade Commission and the
Department of Justice, respectively, over the
preceding year in each case in which not less
than one victim was an elder or that involved a
financial scheme or scam that was either
targeted directly toward or largely affected
elders, including--
[(A)] (i) the name of the district
where the case originated;
[(B)] (ii) the style of the case,
including the case name and number;
[(C)] (iii) a description of the
scheme or scam; and
[(D)] (iv) the outcome of the case.
(B) with respect to the report by the
Attorney General, including a link to the
publicly available best practices identified
under subsection (b)(1)(B) and the replication
guides and training materials created or
compiled under such subsection.
(d) Use of Appropriated Funds.--No additional funds are
authorized to be appropriated to carry out this section.
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[all]