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






                                                       Calendar No. 785
108th CONGRESS
  2d Session
                                S. 1217

                          [Report No. 108-395]

  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, Ms. Mikulski, Mrs. Murray, Mr. Baucus, Mr. 
 Grassley, Mr. Cochran, Mr. Lautenberg, Mr. Bingaman, and Mr. Bunning) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

                            October 8, 2004

 Reported by Mr. Gregg, with an amendment and an amendment to the title
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Elder Fall Prevention Act 
of 2003''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    The Congress finds as follows:</DELETED>
        <DELETED>    (1) Falls are the leading cause of injury deaths 
        among individuals who are over 65 years of age.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (3) In 2000, falls among elderly individuals 
        accounted for 10,200 deaths and 1,600,000 emergency department 
        visits.</DELETED>
        <DELETED>    (4) Sixty percent of fall-related deaths occur 
        among individuals who are 75 years of age or older.</DELETED>
        <DELETED>    (5) Twenty-five percent of elderly persons who 
        sustain a hip fracture die within 1 year.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (12) The Federal Government should devote 
        additional resources to research regarding the prevention and 
        treatment of falls in residential as well as institutional 
        settings.</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (14) Reducing preventable adverse events, such as 
        elder falls, is an important aspect to the agenda to improve 
        patient safety.</DELETED>

<DELETED>SEC. 3. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.</DELETED>

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

         <DELETED>``PART R--PREVENTION OF ELDER FALLS</DELETED>

<DELETED>``SEC. 399AA. PURPOSES</DELETED>

<DELETED>    ``The purposes of this title are--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) to expand needed services and conduct 
        research to determine the most effective approaches to 
        preventing and treating elder falls; and</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 399AA-1. PUBLIC EDUCATION.</DELETED>

<DELETED>    ``Subject to the availability of appropriations, the 
Administration on Aging within the Department of Health and Human 
Services shall--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 399AA-2. RESEARCH.</DELETED>

<DELETED>    ``(a) In General.--Subject to the availability of 
appropriations, the Secretary shall--</DELETED>
        <DELETED>    ``(1) conduct and support research to--</DELETED>
                <DELETED>    ``(A) improve the identification of elders 
                who have a high risk of falling;</DELETED>
                <DELETED>    ``(B) improve data collection and analysis 
                to identify fall risk and protective factors;</DELETED>
                <DELETED>    ``(C) design, implement, and evaluate fall 
                prevention interventions to identify the most effective 
                of the numerous potential strategies 
                available;</DELETED>
                <DELETED>    ``(D) improve strategies that are proven 
                to be effective in reducing falls by tailoring these 
                strategies to specific elderly populations;</DELETED>
                <DELETED>    ``(E) conduct research in order to 
                maximize the dissemination of proven, effective fall 
                prevention interventions;</DELETED>
                <DELETED>    ``(F) expand proven interventions to 
                prevent elder falls;</DELETED>
                <DELETED>    ``(G) improve the diagnosis, treatment, 
                and rehabilitation of elderly fall victims; 
                and</DELETED>
                <DELETED>    ``(H) assess the risk of falls occurring 
                in various settings;</DELETED>
        <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(4) evaluate the effectiveness of community 
        programs to prevent assisted living and nursing home falls by 
        elders.</DELETED>
<DELETED>    ``(b) Administration.--In carrying out subsection (a), the 
Secretary shall--</DELETED>
        <DELETED>    ``(1) conduct research and surveillance activities 
        among community-dwelling and institutionalized elders through 
        the Director of the Centers for Disease Control and 
        Prevention;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(3) ensure the coordination of the activities 
        described in paragraphs (1) and (2).</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 399AA-3. DEMONSTRATION PROJECTS.</DELETED>

<DELETED>    ``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:</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) A multi-State demonstration project 
                assessing the utility of targeted fall risk screening 
                and referral programs.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(D) Private sector and public-private 
                partnerships to develop technology to prevent falls and 
                prevent or reduce injuries if falls occur.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(C) Provide one or more grants to qualified 
        applicants to conduct evaluations of the effectiveness of the 
        demonstration projects in this section.</DELETED>

<DELETED>``SEC. 399AA-4. REVIEW OF REIMBURSEMENT POLICIES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 399AA-5. AUTHORIZATION OF APPROPRIATION.</DELETED>

<DELETED>    ``In order to carry out this title, there are authorized 
to be appropriated--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) to carry out research projects described in 
        section 399AA-2, $10,000,000 for each of fiscal years 2004 
        through 2006;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Keeping Seniors Safe From Falls Act 
of 2004''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Falls are the leading cause of injury deaths among 
        individuals who are over 65 years of age.
            (2) In 2000, falls among older adults accounted for 10,200 
        deaths and 1,600,000 emergency department visits.
            (3) Hospital admissions for hip fractures among the elderly 
        have increased from 231,000 admissions in 1988 to 332,000 in 
        1999.
            (4) Annually, more than 64,000 individuals who are over 65 
        years of age sustain a traumatic brain injury as a result of a 
        fall.
            (5) The total cost of all fall injuries for people age 65 
        and older was calculated in 1994 to be $27,300,000,000 (in 2004 
        dollars).
            (6) A national approach to reducing falls among older 
        adults, which focuses on the daily life of senior citizens in 
        residential, institutional, and community settings, is needed.

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

    Part J of title III of the Public Health Service Act (42 U.S.C. 
280b et seq.) is amended--
            (1) by redesignating section 393B (as added by section 1401 
        of Public Law 106-386) as section 393C and transferring such 
        section so that it appears after section 393B (as added by 
        section 1301 of Public Law 106-310); and
            (2) by inserting after section 393C (as redesignated by 
        paragraph (1)) the following:

``SEC. 393D. PREVENTION OF FALLS AMONG OLDER ADULTS.

    ``(a) Purposes.--The purposes of this section are--
            ``(1) to develop effective public education strategies in a 
        national initiative to reduce falls among older adults in order 
        to educate older adults, family members, employers, caregivers, 
        and others;
            ``(2) to intensify services and conduct research to 
        determine the most effective approaches to preventing and 
        treating falls among older adults; and
            ``(3) to require the Secretary to evaluate the effect of 
        falls on health care costs, the potential for reducing falls, 
        and the most effective strategies for reducing health care 
        costs associated with falls.
    ``(b) Public Education.--The Secretary shall--
            ``(1) oversee and support a national education campaign to 
        be carried out by a nonprofit organization with experience in 
        designing and implementing national injury prevention programs, 
        that is directed principally to older adults, their families, 
        and health care providers, and that focuses on reducing falls 
        among older adults and preventing repeat falls; and
            ``(2) award grants, contracts, or cooperative agreements to 
        qualified organizations, institutions, or consortia of 
        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 reducing falls among older adults and 
        preventing repeat falls.
    ``(c) Research.--
            ``(1) In general.--The Secretary shall--
                    ``(A) conduct and support research to--
                            ``(i) improve the identification of older 
                        adults who have a high risk of falling;
                            ``(ii) improve data collection and analysis 
                        to identify fall risk and protective factors;
                            ``(iii) design, implement, and evaluate the 
                        most effective fall prevention interventions;
                            ``(iv) improve strategies that are proven 
                        to be effective in reducing falls by tailoring 
                        these strategies to specific populations of 
                        older adults;
                            ``(v) conduct research in order to maximize 
                        the dissemination of proven, effective fall 
                        prevention interventions;
                            ``(vi) intensify proven interventions to 
                        prevent falls among older adults;
                            ``(vii) improve the diagnosis, treatment, 
                        and rehabilitation of elderly fall victims; and
                            ``(viii) assess the risk of falls occurring 
                        in various settings;
                    ``(B) conduct research concerning barriers to the 
                adoption of proven interventions with respect to the 
                prevention of falls among older adults;
                    ``(C) conduct research to develop, implement, and 
                evaluate the most effective approaches to reducing 
                falls among high-risk older adults living in long-term 
                care facilities; and
                    ``(D) evaluate the effectiveness of community 
                programs to prevent assisted living and nursing home 
                falls among older adults.
            ``(2) Educational support.--The Secretary, either directly 
        or through awarding grants, contracts, or cooperative 
        agreements to qualified organizations, institutions, or 
        consortia of qualified organizations and institutions, shall 
        provide professional education for physicians and allied health 
        professionals in fall prevention.
    ``(d) Demonstration Projects.--The Secretary shall carry out the 
following:
            ``(1) Oversee and support demonstration and research 
        projects to be carried out by qualified organizations, 
        institutions, or consortia of qualified organizations and 
        institutions, in the following areas:
                    ``(A) A multistate demonstration project assessing 
                the utility of targeted fall risk screening and 
                referral programs.
                    ``(B) Programs designed for community-dwelling 
                older adults that utilize multicomponent fall 
                intervention approaches, including physical activity, 
                medication assessment and reduction when possible, 
                vision enhancement, and home modification strategies.
                    ``(C) Programs that are targeted to newly 
                discharged fall victims who are at a high risk for 
                second falls and which are designed to maximize 
                independence and quality of life for older adults, 
                particularly those older adults with functional 
                limitations.
                    ``(D) Private sector and public-private 
                partnerships to develop technology to prevent falls 
                among older adults and prevent or reduce injuries if 
                falls occur.
            ``(2)(A) Award grants, contracts, or cooperative agreements 
        to qualified organizations, institutions, or consortia of 
        qualified organizations and institutions, to design, implement, 
        and evaluate fall prevention programs using proven intervention 
        strategies in residential and institutional settings.
            ``(B) Award 1 or more grants, contracts, or cooperative 
        agreements to 1 or more qualified organizations, institutions, 
        or consortia of qualified organizations and institutions, in 
        order to carry out a multistate demonstration project to 
        implement and evaluate fall prevention programs using proven 
        intervention strategies designed for multifamily residential 
        settings with high concentrations of older adults, including--
                    ``(i) identifying high-risk populations;
                    ``(ii) evaluating residential facilities;
                    ``(iii) conducting screening to identify high-risk 
                individuals;
                    ``(iv) providing pre-fall counseling;
                    ``(v) coordinating services with health care and 
                social service providers; and
                    ``(vi) coordinating post-fall treatment and 
                rehabilitation.
            ``(3) Award 1 or more grants, contracts, or cooperative 
        agreements to qualified organizations, institutions, or 
        consortia of qualified organizations and institutions, to 
        conduct evaluations of the effectiveness of the demonstration 
        projects described in this subsection.
    ``(e) Study of Effects of Falls on Health Care Costs.--
            ``(1) In general.--The Secretary shall conduct a review of 
        the effects of falls on health care costs, the potential for 
        reducing falls, and the most effective strategies for reducing 
        health care costs associated with falls.
            ``(2) Report.--Not later than 36 months after the date of 
        enactment of the Keeping Seniors Safe From Falls Act of 2004, 
        the Secretary shall submit to Congress a report describing the 
        findings of the Secretary in conducting the review under 
        paragraph (1).''.
            Amend the title so as to read: ``A bill to direct the 
        Secretary of Health and Human Services to intensify programs 
        with respect to research and related activities concerning 
        falls among older adults.''.




                                                       Calendar No. 785

108th CONGRESS

  2d Session

                                S. 1217

                          [Report No. 108-395]

_______________________________________________________________________

                                 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.

_______________________________________________________________________

                            October 8, 2004

        Reported with an amendment and an amendment to the title