[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1217 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1217

  To direct the Secretary of Health and Human Services to expand and 
  intensify programs with respect to research and related activities 
                        concerning elder falls.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 9, 2003

Mr. Enzi (for himself and Ms. Mikulski) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To direct the Secretary of Health and Human Services to expand and 
  intensify programs with respect to research and related activities 
                        concerning elder falls.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Elder Fall Prevention Act of 2003''.

SEC. 2. FINDINGS.

    The Congress finds as follows:
            (1) Falls are the leading cause of injury deaths among 
        individuals who are over 65 years of age.
            (2) By 2030, the population of individuals who are 65 years 
        of age or older will double. By 2050, the population of 
        individuals who are 85 years of age or older will quadruple.
            (3) In 2000, falls among elderly individuals accounted for 
        10,200 deaths and 1,600,000 emergency department visits.
            (4) Sixty percent of fall-related deaths occur among 
        individuals who are 75 years of age or older.
            (5) Twenty-five percent of elderly persons who sustain a 
        hip fracture die within 1 year.
            (6) Hospital admissions for hip fractures among the elderly 
        have increased from 231,000 admissions in 1988 to 332,000 in 
        1999. The number of hip fractures is expected to exceed 500,000 
        by 2040.
            (7) Annually, more than 64,000 individuals who are over 65 
        years of age sustain a traumatic brain injury as a result of a 
        fall.
            (8) Annually, 40,000 individuals who are over 65 years of 
        age visit emergency departments with traumatic brain injuries 
        suffered as a result of a fall, of which 16,000 of these 
        individual are hospitalized and 4,000 of these individuals die.
            (9) The rate of fall-induced traumatic brain injuries for 
        individual who are 80 years of age or older increased by 60 
        percent from 1989 to 1998.
            (10) The estimated total cost for non-fatal traumatic brain 
        injury-related hospitalizations for falls in individuals who 
        are 65 years of age or older is more than $3,250,000,000. Two-
        thirds of these costs occurred among individual who were 75 
        years of age or older.
            (11) The costs to the Medicare and Medicaid programs and 
        society as a whole from falls by elderly persons continue to 
        climb much faster than inflation and population growth. Direct 
        costs alone will exceed $32,000,000,000 in 2020.
            (12) The Federal Government should devote additional 
        resources to research regarding the prevention and treatment of 
        falls in residential as well as institutional settings.
            (13) A national approach to reducing elder falls, which 
        focuses on the daily life of senior citizens in residential, 
        institutional, and community settings is needed. The approach 
        should include a wide range of organizations and individuals 
        including family members, health care providers, social 
        workers, architects, employers and others.
            (14) Reducing preventable adverse events, such as elder 
        falls, is an important aspect to the agenda to improve patient 
        safety.

SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

                  ``PART R--PREVENTION OF ELDER FALLS

``SEC. 399AA. PURPOSES

    ``The purposes of this title are--
            ``(1) to develop effective public education strategies in a 
        national initiative to reduce elder falls in order to educate 
        the elders themselves, family members, employers, caregivers, 
        and others who touch the lives of senior citizens;
            ``(2) to expand needed services and conduct research to 
        determine the most effective approaches to preventing and 
        treating elder falls; and
            ``(3) to require the Secretary to evaluate the effect of 
        falls on the costs of medicare and medicaid and the potential 
        for reducing costs by expanding education, prevention, and 
        elderly intervention services covered under these two programs.

``SEC. 399AA-1. PUBLIC EDUCATION.

    ``Subject to the availability of appropriations, the Administration 
on Aging within the Department of Health and Human Services shall--
            ``(1) oversee and support a three-year national education 
        campaign to be carried out by the National Safety Council to be 
        directed principally to elders, their families, and health care 
        providers and focusing on ways of reducing the risk of elder 
        falls and preventing repeat falls; and
            ``(2) provide grants to qualified organizations and 
        institutions for the purpose of organizing State-level 
        coalitions of appropriate State and local agencies, safety, 
        health, senior citizen and other organizations to design and 
        carry out local education campaigns, focusing on ways of 
        reducing the risk of elder falls and preventing repeat falls.

``SEC. 399AA-2. RESEARCH.

    ``(a) In General.--Subject to the availability of appropriations, 
the Secretary shall--
            ``(1) conduct and support research to--
                    ``(A) improve the identification of elders who have 
                a high risk of falling;
                    ``(B) improve data collection and analysis to 
                identify fall risk and protective factors;
                    ``(C) design, implement, and evaluate fall 
                prevention interventions to identify the most effective 
                of the numerous potential strategies available;
                    ``(D) improve strategies that are proven to be 
                effective in reducing falls by tailoring these 
                strategies to specific elderly populations;
                    ``(E) conduct research in order to maximize the 
                dissemination of proven, effective fall prevention 
                interventions;
                    ``(F) expand proven interventions to prevent elder 
                falls;
                    ``(G) improve the diagnosis, treatment, and 
                rehabilitation of elderly fall victims; and
                    ``(H) assess the risk of falls occurring in various 
                settings;
            ``(2) conduct research concerning barriers to the adoption 
        of proven interventions with respect to the prevention of elder 
        falls (such as medication review and vision enhancement);
            ``(3) conduct research to develop, implement, and evaluate 
        the most effective approaches to reducing falls among very high 
        risk elders living in nursing homes, assisted living, and other 
        types of long-term care facilities; and
            ``(4) evaluate the effectiveness of community programs to 
        prevent assisted living and nursing home falls by elders.
    ``(b) Administration.--In carrying out subsection (a), the 
Secretary shall--
            ``(1) conduct research and surveillance activities among 
        community-dwelling and institutionalized elders through the 
        Director of the Centers for Disease Control and Prevention;
            ``(2) conduct research related to elder fall prevention in 
        health care delivery settings and clinical treatment and 
        rehabilitation of elderly fall victims through the Director of 
        the Agency for Healthcare Research and Quality; and
            ``(3) ensure the coordination of the activities described 
        in paragraphs (1) and (2).
    ``(c) Grants.--The Secretary shall award grants to qualified 
organizations and institutions to enable such organizations and 
institutions to provide professional education for physicians and 
allied health professionals in elder fall prevention.

``SEC. 399AA-3. DEMONSTRATION PROJECTS.

    ``Subject to the availability of appropriations, the Secretary, 
acting through the Director of the Centers for Disease Control and 
Prevention and in consultation with the Director of the Agency for 
Healthcare Research and Quality, shall carry out the following:
            ``(1) Oversee and support demonstration and research 
        projects to be carried out by the National Safety Council and 
        other qualified organizations in the following areas:
                    ``(A) A multi-State demonstration project assessing 
                the utility of targeted fall risk screening and 
                referral programs.
                    ``(B) Programs designed for community-dwelling 
                elderly individuals that shall utilize multi-component 
                fall intervention approaches, including physical 
                activity, medication assessment and reduction when 
                possible, vision enhancement, and home modification 
                strategies.
                    ``(C) Programs targeting newly-discharged fall 
                victims who are at a high risk for second falls, which 
                shall include modification projects available to 
                various living settings (in accordance with accepted 
                building codes and standards) and which are designed to 
                maximize independence and quality of life for elders, 
                particularly those elders with functional limitations.
                    ``(D) Private sector and public-private 
                partnerships to develop technology to prevent falls and 
                prevent or reduce injuries if falls occur.
            ``(2)(A) Provide grants to qualified organizations and 
        institutions to design, implement, and evaluate fall prevention 
        programs using proven intervention strategies in residential 
        and institutional settings.
            ``(B) Provide one or more grants to one or more qualified 
        applicants in order to carry out a multi-State demonstration 
        project to implement and evaluate fall prevention programs 
        using proven intervention strategies designed for multi-family 
        residential settings with high concentrations of elders, 
        including identifying high risk populations, evaluating 
        residential facilities, conducting screening to identify high 
        risk individuals, providing pre-fall counseling, coordinating 
        services with health care and social service providers and 
        coordinating post-fall treatment and rehabilitation.
            ``(C) Provide one or more grants to qualified applicants to 
        conduct evaluations of the effectiveness of the demonstration 
        projects in this section.

``SEC. 399AA-4. REVIEW OF REIMBURSEMENT POLICIES.

    ``(a) In General.--The Secretary shall undertake a review of the 
effects of falls on the costs of the medicare and medicaid programs and 
the potential for reducing costs by expanding services covered by these 
two programs. This review shall include a review of the reimbursement 
policies of the medicare and medicaid programs in order to determine if 
additional fall-related education, prevention, and early prevention 
services should be covered or reimbursement guidelines should be 
modified.
    ``(b) Report.--Not later than 18 months after the date of the 
enactment of this title, the Secretary shall submit to the Congress a 
report describing the findings of the Secretary in conducting the 
review under subsection (a).

``SEC. 399AA-5. AUTHORIZATION OF APPROPRIATION.

    ``In order to carry out this title, there are authorized to be 
appropriated--
            ``(1) to carry out the national public education provisions 
        described in section 399AA-1(1), $5,000,000 for each of fiscal 
        years 2004 through 2006;
            ``(2) to carry out the State public education campaign 
        provisions of section 399AA-1(2), $8,000,000 for each of fiscal 
        years 2004 through 2006;
            ``(3) to carry out research projects described in section 
        399AA-2, $10,000,000 for each of fiscal years 2004 through 
        2006;
            ``(4) to carry out the demonstration projects described in 
        section 399AA-3(1), $7,000,000 for each of fiscal years 2004 
        through 2006; and
            ``(5) to carry out the demonstration and research projects 
        described in section 399AA-3(2), $8,000,000 for each of fiscal 
        years 2004 through 2006.''.
                                 <all>