[Senate Hearing 119-482]
[From the U.S. Government Publishing Office]
S. Hrg. 119-482
PREVENTING FALLS, PRESERVING
INDEPENDENCE: TECHNOLOGY,
COMMUNITY PROGRAMS, AND
INNOVATION IN SENIOR SAFETY
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
SECOND SESSION
__________
WASHINGTON, DC
__________
MAY 20, 2026
__________
Serial No. 119-30
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
64-194 PDF WASHINGTON : 2026
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SPECIAL COMMITTEE ON AGING
RICK SCOTT, Florida, Chairman
DAVE McCORMICK, Pennsylvania KIRSTEN E. GILLIBRAND, New York
JIM JUSTICE, West Virginia ELIZABETH WARREN, Massachusetts
TOMMY TUBERVILLE, Alabama MARK KELLY, Arizona
RON JOHNSON, Wisconsin RAPHAEL WARNOCK, Georgia
ASHLEY MOODY, Florida ANDY KIM, New Jersey
JON HUSTED, Ohio ANGELA ALSOBROOKS, Maryland
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McKinley Lewis, Majority Staff Director
Claire Descamps, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Rick Scott, Chairman................ 1
Opening Statement of Senator Kirsten E. Gillibrand, Ranking
Member......................................................... 2
PANEL OF WITNESSES
Christine Didion, MSW, Director of Programs, Area Agency on Aging
Pasco-Pinellas, St. Petersburg, Florida........................ 3
Laura Mitchell, Co-Founder and CEO, GrandCare Systems, San
Marcos, California............................................. 5
Martha Petteys, Director of Grant Management and Health
Strategies, Alliance of New York State YMCAs, Saratoga Springs,
New York....................................................... 7
APPENDIX
Prepared Witness Statements
Christine Didion, MSW, Director of Programs, Area Agency on Aging
Pasco-Pinellas, St. Petersburg, Florida........................ 26
Laura Mitchell, Co-Founder and CEO, GrandCare Systems, San
Marcos, California............................................. 35
Martha Petteys, Director of Grant Management and Health
Strategies, Alliance of New York State YMCAs, Saratoga Springs,
New York....................................................... 39
Questions for the Record
Christine Didion, MSW, Director of Programs, Area Agency on Aging
Pasco-Pinellas, St. Petersburg, Florida........................ 45
Martha Petteys, Director of Grant Management and Health
Strategies, Alliance of New York State YMCAs, Saratoga Springs,
New York....................................................... 48
Statements for the Record
Advancing Foot and Ankle Medicine and Surgery Statement.......... 52
American Physical Therapy Association Statement.................. 55
Alliance for Physical Therapy Quality and Innovation Statement... 59
Argentum Statement............................................... 62
North East Medical Services Statement............................ 68
PREVENTING FALLS, PRESERVING
INDEPENDENCE: TECHNOLOGY,
COMMUNITY PROGRAMS, AND
INNOVATION IN SENIOR SAFETY
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Wednesday, May 20, 2026
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:32 p.m., Room
216, Hart Senate Office Building, Hon. Rick Scott, Chairman of
the Committee, presiding.
Present: Senator Scott, Gillibrand, Kim.
Also present: Senator King.
OPENING STATEMENT OF SENATOR
RICK SCOTT, CHAIRMAN
The Chairman. The U.S. Senate Special Committee on Aging
will now come to order. Every year, more than 14 million older
Americans experience a fall. Many of them end up in emergency
rooms across our great country.
Many seniors never recover and lose the independence they
spent a lifetime building. Falls are the leading cause of
injury, injury related hospitalization, and injury related
death for Americans over the age of 65. This isn't something we
should ever accept as an inevitable statistic.
It is a crisis we need to resolve. The numbers behind this
crisis are staggering. Non-fatal medical spending related to
falls among older adults reached approximately $80 billion in
2020. With Medicare bearing the majority of that cost, and as
our population continues to age, that number will only rise
unless our country wakes up and addresses this issue head on.
We are talking about tens of billions of dollars spent
treating injuries that in many cases were preventable. As bad
as those numbers are, it is about as much--it is much more than
the budget. Every single one of those cases is an individual.
This is a grandfather in Florida who breaks his hip and
never returns to his home. It is about someone's grandmother
who falls alone and waits hours before anyone finds her. It is
about families who worry if they are getting the call every
time the phone rings.
Falls don't just injure people physically, they take an
emotional toll, create fear, increase isolation, and cause a
loss of confidence that accelerates decline. Once a senior
stops moving, stops going out, and stops engaging with their
community, the consequences begin to compound.
That is because none of us were put on this earth to sit
alone and stare out the window. We need family, we need
friends, hobbies, purpose. Those things are what make life
worth living. The good news is that nobody has to just accept
this fate. There are solutions on the rise across the country.
Our incredible Area Agencies on Aging are on the front
lines, delivering programs at work, strength and balance
training, home safety assessments, and medication reviews that
identify high risk drug combinations before they cause a fall,
are just a glimpse of what these organizations can do.
These are all proven interventions that save lives and help
keep overall costs down. I am thankful for the work of the
Administration for Community Living and the role the whole
agency plays in supporting and scaling these efforts through a
nationwide network of state and local partners.
The work the ACL and the AAAs do together is exactly the
kind of federal investment that pays for itself many times
over. That is why I am proud to be leading the reauthorization
the Older Americans Act with Ranking Member Gillibrand,
Chairman Cassidy, and Ranking Member Sanders.
Alongside these OAA programs, technology is opening new
doors we have never had before. Remote monitoring systems, fall
detection sensors, predictive analytics, and smart home
platforms are changing what is possible in fall prevention and
emergency response. When a senior falls and no one is home,
every minute matters.
Technology is cutting response times, reducing long-term
complications, and giving families everywhere peace of mind.
Let me be direct, the Older American Act is a foundational law
governing community-based services for older Americans, and it
is far past time Congress actually reauthorizes it.
This hearing is an opportunity to continue building the
record, documenting what is working, and identifying where gaps
exist given the lapse in OAA reauthorization. I want to thank
our witnesses for taking the time to be here and for the work
they do every day on behalf of older Americans and now I would
like to recognize Ranking Member Gillibrand for her opening
statement.
OPENING STATEMENT OF SENATOR
KIRSTEN E. GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Thank you, Mr. Chairman. I Appreciate
all our witnesses. Every year an estimated one in four adults
will fall, which can result in injury, hospitalization, and
even death.
Today's hearing explores the role technology and innovation
can play in senior safety. For example, smartphone apps can
assess an older adult's fall risk. In-home sensors can alert
caregivers when a loved one falls. Wearable devices can even
cushion the blow of a fall.
Before today's hearing, I worked with Senators King and Kim
to ask the Government Accountability Office, the GAO, to report
on new technologies that provide promise in helping our older
adults and people with disabilities live safely and
independently. We also asked GAO to examine the challenges
older adults face with adopting such new technologies.
We know these challenges are real. For example, technology
is expensive. AI can be biased. Communities can lack high speed
internet access. There is promise in technology, but its
promise does have limits. This means we cannot stop investing
in programs that have a proven track record of working.
This includes federal fall prevention programs authorized
by the Older Americans Act, delivered through the
Administration of Community Living, as well as the programs
afforded by CDC and HUD. Finally, we need to remember how much
technology and innovation is built upon federally funded
research.
I look forward to hearing more about the opportunity that
this emerging technology plays in keeping our seniors safe, as
well as the role of our current successful falls prevention
program. I would just personally say, I have watched how falls
affected my own family members when my grandmother, my great-
grandmother fell and broke her hip, which is the story every
time, it took a lot of work, effort, using the walker.
Using the walker, sometimes you don't graduate from the
walker because you never have that confidence again. Another
one of my friends in her 90's, she recently fell and kept her
indoors for two months until she was fully recovered and could
be back on the sidewalks where they are uneven and where her
eyesight is just not strong enough to catch those uneven
surfaces.
When my mother-in-law fell, she had such a serious shoulder
injury, it took three surgeries to fix it. I personally know
the tragedies and complexities that arise because of falls, and
they are life changing. Sometimes your loved one does not
regain their capability that they had before the fall.
Sometimes the psychological impact of the fall restricts
their movement, restricts their ambition, restricts their
willingness to travel or explore. It reduces the size of their
world. It changes their confidence level. It can affect them
emotionally, physically, and psychologically.
Personally, I know how urgent and important this is, so I
am very eager to hear your solutions.
The Chairman. Thank you, Ranking Member. Now, for our first
witness, I would like to introduce Christine Didion from my
home State of Florida. She is the Director of Programs at the
Area Agency on Aging, Pasco Pinellas in St. Petersburg,
Florida.
She has dedicated her career to connecting older adults in
our communities with the services and support they need to stay
safe, healthy, and independent at home. Thank you for being
here today, and please begin your testimony.
STATEMENT OF CHRISTINE DIDION, MSW, DIRECTOR
OF PROGRAMS, AREA AGENCY ON AGING
PASCO-PINELLAS, ST. PETERSBURG, FLORIDA
Ms. Didion. Thank you. Chairman Scott, Ranking Member
Gillibrand, and distinguished members of this Committee, thank
you for the opportunity to speak before you today.
I am honored to represent my colleagues, our partners, and
the work we do at the Area Agency on Aging of Pasco Pinellas in
St. Petersburg, Florida. It is a distinct privilege to advocate
on behalf of the thousands of seniors and caregivers we serve
and to speak on this vital topic that impacts one in four
Americans aged 65 and older each year.
If I were to ask you what your plans are for your golden
years, most of us are not making plans to limit our activities
because we will have a fear of falling, or worse, making plans
on how we are going to care for ourselves after experiencing a
fall that results in a serious injury.
Unfortunately, the stark reality of falls and the
reverberating impacts suggest that maybe we should be making
these plans. More than 14 million older adults report
experiencing a fault each year, and falls remain the leading
cause of fatal and non-fatal injuries among older adults.
Eighty billion in healthcare costs were estimated to be
spent in 2020 on the treatment of non-fatal injuries from a
fall among older adults, with an estimated 71 percent of those
costs paid for by Medicare or Medicaid. That cost is expected
to rise to $101 billion by 2030. Even if an older adult never
experiences a fall, the fear of falling still exists for a
majority of those over the age of 65.
A fear of falling can lead to an avoidance of physical
activities, functional limitations, and increases in social
isolation. This can all compound to reduce an older adult's
quality of life and impact their ability to live well and
independently.
Through the Older Americans Act, or OAA, older adults and
communities are not powerless against the growing impacts of
falls and the fear of falling. For more than 50 years, the OAA
has represented the national commitment to assisting older
adults to age at home and is the cornerstone of the Nation's
non-Medicaid home and community-based services system.
Each year, through the OAA, more than 14 million older
Americans receive supportive services from the nationwide Aging
Network, which consists of State Units on Aging, Area Agencies
on Aging, Title VI Native American Aging Programs, and
thousands of local service providers.
The OAA provides a wide array of home and community-based
services that address the social determinants of health and
supports evidence based falls prevention programs and safety
technology.
The Area Agency on Aging of Pasco-Pinellas, with OAA funds
that are contracted through the Florida Department of Elder
Affairs, has forged over 61 public-private partnerships to
provide the evidence-based falls prevention programs of A
Matter of Balance, bingocize, and Enhance Fitness to over 753
older adults over the last year.
Because of our partnerships with residential communities,
our local hospital systems, local YMCA branch, senior centers,
and libraries, we are meeting older adults where they are in
the community and equipping them with more than just a few tips
on how to reduce falls.
These programs are proven to empower older adults to reduce
their fear of falling, increase their coordination and balance,
engage in strength training or other physical activity, and
build environmental awareness.
These outcomes prevent falls from happening, and these
prevented falls yield an estimated savings of over $1 billion
in health care costs. While the work to prevent falls will
continue, we must also work to reduce the long lie, or the time
an older adult remains on the floor after a fall.
OAA funding can provide wearable emergency alert response
and fall detection technology that allows for 24/7 monitoring
and emergency assistance at the detection of a fall or the
press of a button. In West Central Florida, over a quarter of
older adults live alone and are often far away from family.
Beyond dispatching emergency services, this technology
keeps remote families informed in real time. A recent
activation in our area allowed a daughter to coordinate
directly with paramedics and provide vital medical history
after her mother, who lives alone, had fallen.
This technology has been able to transform potentially
fatal isolation into a connected, responsive network that
supports the independence of older adults. Falls do not have to
be an inevitable part of aging. They can be a preventable
health event using existing and proven interventions.
The reauthorization and adequate funding of the Older
Americans Act gives Congress the opportunity to ensure that the
more than 600 Area Agencies on Aging that serve every area of
the United States can continue to provide evidence-based falls
prevention programs and safety technology that is cost-
effective and community focused.
Not only will this reduce the risk of falls, but it will
increase the overall wellness of older adults to live well
where they choose to and alleviate fall related injury costs on
an already strained health care system.
I thank Chairman Scott, Ranking Member Gillibrand, and the
members of this Committee for their leadership and support of a
reauthorized Older Americans Act to continue to help older
adults live well. Thank you.
The Chairman. Thank you for your testimony. Next, I would
like to introduce Laura Mitchell, Co-Founder and CEO of
GrandCare Systems based in San Marcos, California.
She is a nationally recognized leader in aging technology
and remote monitoring, and GrandCare has been at the forefront
of aging technology platforms that help older adults and their
caregivers manage health, safety, and communication from home.
Thank you for being here. It is a long way. Please begin
your testimony.
STATEMENT OF LAURA MITCHELL, CO-FOUNDER
AND CEO, GRANDCARE SYSTEMS,
SAN MARCOS, CALIFORNIA
Ms. Mitchell. Thanks. Hi, my name is Laura Mitchell. I am
the CEO of GrandCare Systems, an assistive technology that
empowers independence using touch screens for communication and
integrated activity and telehealth sensors. It is truly an
honor to be with you here today.
I would like to start my testimony with a true story about
Jean, one of our GrandCare clients from Florida. At the age of
75, Jean experienced her first petit-mal seizure. Her daughter
didn't know until four critical hours later when she found her
mom confused and disoriented.
Doctors advised assisted living as her only option, but
Jean wanted to stay home, and instead, she began to use
GrandCare. Using simple motion sensors, the system tracked her
daily patterns and could alert her daughter if something seemed
off, like wandering or inactivity. It also tracked her blood
pressure and reminded her when to take her medications.
Jean stayed in her home for another four years until
something shifted. She became agitated. She wasn't sleeping,
and she showed signs of sundowners. Now, typically, that might
lead to additional medications and maybe even a diagnosis that
could alter Jean's life but Jean's daughter, Carol, had data.
Using GrandCare's motion reports, she was able to pinpoint
exactly when Jean's behavior changed.
She brought that information to the doctor, and together
they saw that this change aligned perfectly when Jean's blood
pressure medication changed. They switched the medication, the
symptoms disappeared.
Think about that for just a minute. Without this
technology, Jean could have been treated for the wrong
condition, medicated unnecessarily, or even prematurely forced
into a higher level of care. Instead, she remained home for an
additional two years.
Due to the power of proactive, data driven care, Jean
stayed in her own home beyond the initial diagnosis for over
six years, saving her family over $180,000. When people think
about falls, we picture, help, I have fallen and I can't get
up, a commercial that actually aired almost 40 years ago.
While falls are absolutely serious, they are not the root
problem, they are merely a symptom. Studies have shown that
falls can be caused by things like medication noncompliance,
dehydration, or other underlying health issues. By the time a
fall occurs, we are already in crisis mode, and the outcomes,
like we said, can be devastating.
We have to ask ourselves, why are we still waiting for the
fall? Why should technology activate only after something goes
wrong? The good news is today we have technology tools to shift
from reactive to proactive, predictive, and preventative care.
Imagine a simple tablet in the home, something accessible and
empowering.
It reminds mom to take her medications, to drink more
water, to take her blood pressure reading. Meanwhile,
unobtrusive smart home sensors are working quietly. They can
recognize when something seems amiss, like the kitchen hasn't
been accessed at mealtime, medications weren't taken, or if
mom's vitals are out of threshold.
Only then, only when true support is actually needed, will
it notify a designated caregiver. This isn't about
surveillance, it is about independence. It is connection to
family and giving older adults the confidence and security to
live where they want, while ensuring someone is there whenever
needed.
Access to this type of technology isn't a luxury. It is a
moral obligation deserved, regardless of age or cognitive
function. Through simple video chat, messaging, and even brain
games, individuals can stay engaged and mentally acute.
Technology doesn't isolate, it connects. Beyond the improved
happiness, health, and safety outcomes that technology
provides, it also saves a lot of money.
The cost of this technology compares to a mere 15 days in
the average assisted living community, 15 days. Now, not every
person has the option to stay home, but if technology can
support one person to delay additional care, they can save
roughly $50,000 a year but it is not only saving money. It is
about preserving dad's dignity, securing independence for mom.
It is about adult children having peace of mind.
It is about taking care of our parents and our loved ones
when they need us the most. Now we are at a turning point. Our
nation is in an aging crisis exacerbated by staffing shortages
and high health care. We cannot solve tomorrow's challenges
with yesterday's tools.
Let's move beyond crisis management and turn to proactive
and person-centered technology. It is time to reimagine aging
in America, not as a loss of independence, but as an
opportunity for personal growth, purpose, and the ability for
our greatest generation to live life on their own terms. Thank
you.
The Chairman. Thank you, Ms. Mitchell. Next, I would like
to introduce Martha Petteys. She is the Director of Grant
Management and Health Strategies for the Alliance of New York
State YMCAs.
She oversees statewide implementation and scaling of
evidence-based chronic disease prevention programs to reduce
fall risk and lower long term health care costs for seniors.
Thank you for being here. Please begin your testimony.
STATEMENT OF MARTHA PETTEYS, DIRECTOR OF
GRANT MANAGEMENT AND HEALTH STRATEGIES,
ALLIANCE OF NEW YORK STATE YMCAS,
SARATOGA SPRINGS, NEW YORK
Ms. Petteys. Chairman Scott, Ranking Member Gillibrand, and
distinguished members of the Committee, thank you for inviting
me to testify on this important topic. I am here on behalf of
the 35 YMCA associations and over 140 branches and program
sites across the State of New York.
In my role as Director of Grant Management and Health
Strategies at the Alliance of Newark State YMCAs, I support Ys
with healthy aging initiatives, community partnerships, and
evidence-based programs that strengthen health and well-being
across the lifespan. For 175 years, YMCAs have been dedicated
to strengthening communities through youth development, healthy
living, and social responsibility.
As the largest provider of after school programming in New
York State, YMCA's also support communities through early
childhood education, food access, housing, and lifesaving swim
instruction. This broad community presence allows Ys to support
older adults through programs that promote healthy aging,
independence, and well-being.
As this Committee examines the role of technology,
community programs, and innovation in senior safety, the Ys'
experience delivering both in-person and statewide virtual
falls prevention programs demonstrates that technology can be a
powerful tool to expand access for older adults facing
barriers, such as transportation, mobility, or isolation.
At the same time, we have learned technology is most
effective when paired with trusted, community-based
relationships and local support. Falls remain the leading cause
of injury and accident related deaths for adults over the age
of 65. According to the CDC, one in four adults reports falling
every year.
Falls are devastating for individuals and families and are
a major driver of long-term health costs but now for the good
news. Falls are not a normal part of aging. They are
preventable and proven, evidence-based falls prevention
programs like those offered every day at YMCAs are changing
stories for people like Marianne.
Fear of falling kept Marianne isolated in her New York City
department, afraid to venture outside onto busy city streets
with her walker but Marianne took a virtual, a matter of
balance, class. She learned strategies to reduce falls risk in
her home and exercises to improve her strength and balance.
Through the virtual class, she also found encouragement,
connection, and confidence. The Alliance of New York State
YMCAs is currently managing an Administration for Community
Living Grant awarded to the New York State YMCA Foundation to
support a statewide falls prevention initiative. The initiative
both complements and expands the YMCA's broader healthy aging
work.
Through technology and ACL funding support, Ys have reached
more older adults than would have been possible through
traditional in-person programming alone, particularly in rural,
underserved, and home bound communities. In just two years,
more than 1,000 people have participated in falls prevention
programs through this initiative.
In addition to falls prevention programming, YMCAs have
long partnered with federal, state, and local health
organizations to deliver evidence-based programs that support
chronic disease prevention, arthritis management, cancer
survivorship, diabetes prevention, and healthy aging.
We urge Congress to support the highest level of funding
possible for the CDC so Ys can continue to deliver these
supportive programs and to preserve funding for the ACL so
community-based healthy aging and falls prevention programs
like the New York State Initiative can continue. Every dollar
invested in community-based organizations like the YMCA create
lasting impact and strengthens the health of communities.
Federal investment in prevention helps older adults remain
independent, connected, and healthier longer. They are
investments in dignity, healthier communities, and changing
stories for people like Marianne. New York State YMCAs look
forward to continuing this critical work in communities across
the state.
Thank you again for the opportunity to testify, and for the
work of this Committee on behalf of older adults.
The Chairman. I thank each of you for your testimony. I
think we are going to turn it over to Senator King. Welcome to
the Aging Committee.
Senator King. Mr. Chairman, thank you very much. I
appreciate your accommodating me. I am sort of halfway between
a witness and a Senator today. I am not a normal member of this
Committee, but this is an issue I have taken a deep interest
in.
As the Chairman and all of us know, one of the principal
problems facing our society today is the high cost of health
care, and prevention is the low-hanging fruit to combat the
high cost of health care. The cheapest health intervention is
the one that doesn't have to happen.
That is why I think this hearing is so important, because
as you have testified, falls are a tremendously important and
significant and dangerous part of the aging process, but they
can be prevented. I have done my own falls prevention work by
selling my Harley a couple of years ago, which was a very hard
decision, but I had an attack of prudence.
My second thought is, an old friend of mine once said, the
secret to a long life is to always use the banister and that is
something that I follow all the time and that sounds funny, but
it is really true and how many times have we gone down the
steps with our hand on the banister and one foot sort of slips,
and if you don't have that banister, you are in trouble.
The steps behind the U.S. Senate where they always take the
pictures are a death trap. They are granite and there is no
banisters, so I have a couple of suggestions along this line.
One is this, this is an $11 bathmat. I am the Johnny Appleseed
of bathmats.
Whenever I go to see somebody, and they don't have one of
these in their shower, I buy one and send it to them. Now, here
is the proposal, though. Why doesn't CMS send one of this to
every Medicare recipient in the country?
I did the back of the envelope calculation. It would pay
for itself in about nine months. This is $11. I suspect if CMS
bought them by the millions, they could get a deal, and it
would have a noticeable effect on the number of falls. A very
simple idea.
Along with that is, and I have some legislation along this
line, allow CMS to spend money on prevention, things like grab
bars and bathmats. Right now, Medicare will pay for a broken
hip, but they won't pay for a grab bar in your shower. That is
just insane.
I think, Mr. Chairman, that is one of the things we need to
do, is authorize Medicare to get much more active in the
prevention area and to provide things like this. I mean, I am
not kidding. Send out 20 or 30 million of these and you will
see the $100 million cost of falls fall significantly.
I am proposing that we should have an office in HHS
dedicated to falls prevention, and one in the Veterans
Administration. The initial Medicare home visit should include
an analysis of the house in terms of fall risks. Medicaid, as I
mentioned, should cover--or Medicare, rather--should cover
equipment like grab bars, bathmats, and others. There should be
a tax credit, I believe, for home improvements that prevent
these kinds of injuries.
Again, this would be a tax credit that paid for itself
because of the savings to Medicare and Medicaid that are
occasioned by treatment of falls and finally, Mr. Chair, I
suggest right now that the Congressional Budget Office--when we
legislate things, the Congressional Budget Office estimates
costs, but they are not allowed under their rules to estimate
projected savings.
I believe we should instruct the Congressional Budget
Office to look at the savings as well as the cost of these
kinds of preventive measures, so you all have nodded. Could you
all say, yes, Senator King, you have some good ideas here, just
for the record but this is--I am very passionate about this
because all of us have experienced falls.
My sister had a bad fall just about a year ago and they--if
she would have had a bathmat, she wouldn't have had that fall
in the shower and a disproportionate number of these falls
occur in the bathroom.
That is why something like this - I think makes sense. Mr.
Chairman, I deeply appreciate you allowing me to come and
testify today, and hope that I look forward to working with the
Committee on some of these legislative proposals that I think
can really make a significant difference. I appreciate it.
Thank you.
The Chairman. That is a good idea. You know, if you were in
business, you would clearly do it, right? Because you could
save money, and everybody is better off. Like, why we don't do
this in Government doesn't make any sense.
Senator King. The return on investment is infinite.
The Chairman. Right.
Senator King. Thank you.
The Chairman. Yes. It makes people's lives better, too, on
top of that. Senator Kim.
Senator Kim. Thank you, Chairman and thank you Senator King
for those thoughts there. I mean, I think it is absolutely
critical and important for us to be thinking so much more about
the preventative space.
You know, I have shared a lot in this Committee, as well as
more broadly in the Senate, about how my, you know, my father
was diagnosed with Alzheimer's last year, but what I don't talk
as much about is what initially caused this crisis that we are
with him is that he fell.
He is somebody that broke his femur and was originally sent
to the hospital that way and it was that kind of change in
location, and the surgery, and the medication involved that
very much spurred his cognitive decline as well and we are kind
of in this doom loop right now as a family because he cannot
walk but he cannot remember that he cannot work, and constantly
stands up and falls, and constantly stands up, falls, goes back
to the hospital.
We have now, you know, have sensors within his room to let
us know when he is trying to stand up. We have sensors that let
us know if he is on the ground, so this technology is something
that I am using in my father's room right now while I am here
to try to help make sure that we are understanding of his fall
risk, as well as be able to quickly remedy.
I have an app that lets me know, you know, whether or not
any of these sensors have been triggered, so you know, I just
share that with you because like I feel it and see it in my own
way and, you know, I am interested in trying to figure this out
more deeply, so you know, Ms. Didion, if you don't mind, I
would like to just start with you.
You know, can you share how access to fall prevention
technology could have an impact on a family's considerations,
whether that they are weighing, you know, long-term care
facility or care at home, and what is the better option? You
know, how is this technology now being utilized to help people
make those types of decisions?
Ms. Didion. Absolutely and thank you, Senator Kim, for
sharing that story about your father. Because you are right,
technology can really make a difference for a senior or an
older adult being able to remain in their own home.
We know that a vast majority of older adults want to remain
in their own home, or want to remain with family, living with
family, or are living with a memory condition or other chronic
condition that otherwise they wouldn't be able to live alone
without that support of a caregiver or family and technology
can only leverage the time, effort, and care that a caregiver
or family can provide to a senior or leverage that additional
independence for a senior to live on their own.
Like I mentioned, in West Central Florida, a quarter of
older adults live alone, and we often see in Florida that they
are not living anywhere near their family. Their family lives
up North, in my colleague's State of New York, or all over.
That is the great thing about emergency alert response
technology is a family, or caregiver, or whoever does not have
to live in the same home.
They don't have to live on the same street. They could live
in a different state. Like I mentioned in my testimony, the
daughter who got the call about her mom who had fallen, she
actually lived in a completely different state. She lived on a
different coast, in California actually, but she was able to be
connected right away.
Not only are emergency services able to be contacted, but
caregivers or other loved ones can be contacted too and can
really set up that step process so that maybe emergency
services don't need to be called, maybe just a caregiver who
does happen to live by just needs to come over and check on
that person, so you may be eliminating a trip to the emergency
room after all, even with that emergency technology.
Senator Kim. Yes. I find that it just allows me to operate
without this constant anxiety of wondering whether he is okay
at any given moment, having to check in and that kind of vein.
It just gives that reassurance that I think, you know,
allows for caregivers when they are away to have that respite
that they absolutely need in addition to just, you know,
hopefully, you know, proceeding in other ways.
Ms. Mitchell, I wanted to turn to you because I think what
I find interesting here is that there is a lot of potential
here, the potential dual applications that this technology can
be used for with both older adults as well as with people with
disabilities.
I just feel like, as we are thinking through how to be able
to harness this, you know, that is something that we can
potentially buildupon but I wanted to kind of get your thoughts
about that potential there.
Ms. Mitchell. Well, thank you so much. Yes, I think that
individuals living with intellectual and developmental
disabilities have a pretty high fall risk as well. I think it
is in the 25 to 33 percent for adults 65 plus. It is about 35
to 40 percent in adults living with intellectual and
developmental disabilities but then when we are talking about
adults with intellectual and developmental disability that are
65 plus, it goes up to the highest risk of 45 to 70 percent.
The good news is people with intellectual and developmental
disabilities are living longer than ever and that is great, but
we do have some added fall risks because of balance issues and
gait issues.
I think that technology can play a pivotal role in not only
supporting that individual to proactively sort of prevent the
fall with, you know, reminders, drink more water, take your
blood pressure medication, you know, whatever medications they
are taking, but also take your vitals reading, so there is lots
of different ways that we can determine before a fall occurs.
Of course, there is accessibility things. We have got the
bathmat, we have got banisters, and I definitely agree with
that but then, you know, how do we prevent the fall? Then if a
fall does occur, it is critical that we know right away, so
maybe we are detecting excessive motion in the bathroom.
Maybe we are detecting that, hey, this person didn't get up
and get out of bed, or we are detecting that that person didn't
access the fridge at mealtime. All of these different
checkpoints that are just sort of notifying us that something
may be wrong.
Senator Kim. I am going to go right away and get a bathmat
for my own--oh yes, yes, okay. Well, I am making progress here
on this----
[Laughter.]
Ms. Mitchell. Should bring one for everyone.
Senator Kim. My wife can no longer say that I don't get any
benefit out of this job but the last thing I will just say here
is, the question now is - how do we scale this? You know, how
do we try to actually proliferate this in a meaningful way?
Because, you know, like I will be honest, it was hard for me to
explain and convince my dad that these sensors are okay, or
even for me.
I didn't even know about this. I needed someone to tell me
about this. I am busy with my life, and I don't always have the
latest understanding of where the technology is and as Senator
King was mentioning, you know, I think Government can play a
big role in trying to scale this, so it is not just sort of a
case by case type of situation.
I guess I just wanted to ask you, Ms. Mitchell, as I close
out here, just what is the role of the Federal Government? What
should we be considering about not only in terms of knowing
about this technology, but how we might be able to play a role
to be able to proliferate this and get this in the hands of
many more people that could very well benefit from it?
Ms. Mitchell. Yes, so I think reimbursements and waivers
play a pivotal role. There seem to be a little bit more
reimbursements going on, on the Medicaid side of things for
individuals with intellectual and developmental disabilities,
more so than Medicare. I think that is really too bad because I
think the Government should actually proactively support this
type of technology.
It is clearly less expensive than the cost of hands on
caregiving, and we are at such a need for hands on caregiving
that individuals that actually don't need it 24/7, we are
wasting an individual that may be, you know, staying overnight
and watching Netflix or sleeping while this person is also
sleeping and instead, that individual could be delegated to
somewhere where that person--where somebody actually really
needs that 24/7 hands on support.
I think that if Government put some money toward this type
of proactive technology, it would not only save, you know,
everybody money, the cost of health care. If someone is
healthier, it is going to save money. If someone is happier, it
is going to save more money. If someone has less isolated, they
are at a much less risk for falls and all sorts of other bad
outcomes.
When you mentioned your father maybe not being willing to
try out this type of technology, I think there are some ways
that we can get around that, so that is why we have the
technology that helps connect individuals.
For the story I told you about with Jean, she was the one
who contacted us in 2005 and asked for us to do the technology
in her home and asked if we would please call her daughter
Carol and convince her that she could do it.
The reason was, as she said, I need Carol to live her own
life. She is calling me constantly and I want her to live her
own life. She also wanted to stay independent at home. She was
a swimmer. She grew orchids in her kitchen. She was not ready
for assisted living.
It was that need for independence and the desire for her
daughter to be notified if something was wrong, but having that
independence where she wasn't going to have her daughter be
contacting her every minute of the day just to check in.
There was some technology that was playing that role, and
it allowed her daughter to actually spend that time with her
mom and being her daughter. Not being her caregiver but being
her daughter because she knew what was happening in the home
and she didn't have to spend time talking about it.
Senator Kim. Yes. Thank you for sharing that. Chairman, I
yield back.
The Chairman. Thank you, Senator. Senator King, Senator
Kim, thank you both. Senator Justice.
Senator Justice. Thank you, Mr. Chairman and thank all of
you all for being here. You know, it was a big time honor for
me to introduce this bill and be a part of that and everything
in every way. I have got a confession to make.
You know, there is three ways in the world you can make a
friend. You can ask a favor, make a confession, or tell a
secret. Now, think about that and carry that with you in your
life. Make a confession, ask a favor, tell a secret. Well, I am
going to make a confession and tell a secret right now.
First of all, you know, folks that some way grow older, we
don't really believe that we are older for a long time, you
know and all of a sudden, I still think I am 25 years old and I
have climbed every mountain, I have followed every bird dog in
the world all over kingdom come. I have loved to hunt and fish
and play golf and do everything in the world.
I am kind of broke up now because I was too slow to get out
of the way and I got hit a lot. You know, but with all that
being said, let me just tell you just this. This past
basketball season, I am the girls' high school basketball coach
at Greenbrier High School. A public school, big school, and
everything, and my team just happened to be really rolling
along.
All of a sudden, we are in the quarterfinals of the state
tournament, and we win and now we are going to the final four,
and if I could fast forward, we finished, we won it, we won the
whole state championship and we ended up 27-0 on the season, so
they are a pretty good team.
In fact, they are an incredible team, to tell you the
truth, and great, great kids but after the quarterfinal game,
you know, you go into this room where all the media is there,
all the cameras and everything, and they tell us, then you go
up on a platform and you are sitting there with probably three
of your players and everything that they want to interview, and
they want talk to you too.
I am sitting there and everything, and they tell us that
when we go in the room, watch all these wires now right here
and everything because just maybe you could fall or trip over
that and everything and so, I get through all the wires. I am
on the stage. Everything is all good--all good in the world.
You remember, I don't think I am 75 years old and at that time,
really, I was still 74 years old.
The next thing I come off that stage, and the next I know I
am flying through the air, and I am going just like this, and I
have face planted right on the floor. I dislocated my shoulder,
and I hit right on a knee that has had so many surgeries it is
unbelievable and it was a really, really bad day, you know.
I can tell you just this, that since that time now, I am
three times more disabled than I was right before that
happened. Now, I need two knee replacements, and I need a hip
replacement and all that and I have got to get all that done,
and I hope to goodness after that happens that things will be
better.
Let me tell you, not long ago there was a group of physical
therapists that I met with, and they told me about this
incredible, incredible idea. You know, SAFE Act. I thought,
well, what in the world is SAFE Act? You know, we went through
all the different stuff, and then, lo and behold, all of a
sudden, they said something that at the time maybe didn't mean
near as much to me as it means today.
That is a way to improve potential balance and a way to
avoid falls. Because we all know that as we age, $80 billion a
year--are you kidding me? You know, I just came out of the Ag
Committee meeting, and really and truly we are scrambling
around trying to figure out how we could have x number of
dollars because our foreign community is upside down and we are
hurting like you can't imagine.
With all that being said, $80 billion attributed to falls
in this country? This is our opportunity, and this is our
moment--our moment is right now--to do something that really
and truly a lot of us as we grew a little bit older, we never
really would have believed that it would be us but as I was
flying through the air, believe me be, I knew it was us and I
was the us.
I commend you in every way. I really only have one
question, and basically it is just this, that--you know, and
maybe this is to Ms. Didion and that would be just, in your
work, how many people show up after they have had a fall,
versus how many show up trying to prevent a fall?
Ms. Didion. That is a great question, Senator. It actually
is a mix that we see, just anecdotally. Under our evidence-
based falls prevention programs that we offer anywhere, we
actually get a lot of people who come because they said their
friend took the class, one of our classes, whether it is A
Matter of Balance, bingocize, or Enhance Fitness, their friend
took the class, said they had a great time.
They can't believe they actually had fun talking about
falls for eight weeks and their friends suggested it, they have
never had a fall, but they just thought it might be a fun thing
to do and then of course on the flip side, we do have those
people that do come to us after they have experienced the fall,
they have broken a limb or experienced a serious injury, and
they don't want it to happen again.
Either, or we don't care how you came to the Area Agency on
Aging to take an evidence-based falls prevention class or
access any of the support services that the Older Americans Act
can provide to keep a senior in their home. We just want to
keep a senior in their home as safe as possible.
Senator Justice. I commend you. Keep doing the great work,
and we have got to get this across the finish line because this
is really, really, really important. Maybe it took, you know,
hard-headedness for me to believe, but I believe, I will
promise you that. Thank you so much. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator.
[Technical problems]--sorry. Polypharmacy is one of the
most overlooked fall risk factors we have. How often have you
seen older adults come into your programs who are on drug
combinations that nobody has flagged as dangerous, and do the
AAAs have the resources and clinical support to address that
systematically?
Ms. Didion. Yes, absolutely. That is a great question. We
do see that a lot and as you said, one of the biggest fall
risks, or risk for causing a fall, is living with a chronic
condition and being on multiple different medications that can
have side effects like dizziness or confusion that can increase
the chance for a fall. We do you see that lot with older adults
that we serve.
That is the great thing about, especially, A Matter of
Balance class that can be offered with funding from the Older
Americans Act, because we can address or empower an older adult
to advocate for themselves or learn how to advocate with their
family to talk to their doctor about their different
medications or different treatment options for their chronic
conditions.
Because the other great thing about the Older Americans Act
is we don't just offer evidence-based classes for falls
prevention. We are able to offer evidence-based classes that
address chronic conditions like living with diabetes, chronic
pain, or just general chronic conditions and teaching older
adults how to self-manage those and that includes looking at
their medications and asking the right questions with their
doctor about what kind of medications they are on.
Then on the other side, again on the Older Americans Act,
it is really looking at that holistically of how we can prevent
falls, and the Old Americans Act really allows Area Agencies on
Aging, and State Units on Aging, and those local service
providers to do that because we can address other factors and
chronic conditions that can help prevent falls like meals, and
again, those emergency alert response technology systems.
The Chairman. Thank you. Ms. Mitchell, you have been
building aging technology for quite a while, which means you
have watched a lot of promising products fail to scale or fail
to reach the people who need them most.
What is the single biggest structural barrier preventing
fall prevention technology from achieving widespread adoption
among older adults, and is it a funding problem, a
reimbursement problem, or something else entirely?
Ms. Mitchell. Yes, thank you. I think there is a couple
things. First, I think funding is definitely a problem. I would
say the biggest problem, though, might be internet connectivity
and that sounds crazy, because internet has been around since
the 90's but it is especially access to this type of
telehealth, or telemedicine, or activity of daily living
monitoring technologies.
You need internet for it to function and particularly in
remote areas, it is great for them to have internet
connectivity, which is where it is the hardest to get internet,
so I think it is a twofold funding for this type of technology,
also funding for internet connectivity, and, you know, sort of
turning that into more of a utility versus a nice to have,
because it is really a need to have.
And then also really about awareness, letting individuals
know that this is a--this is a technology that works. There is
a return on investment. It is proven. It is not new, so I mean,
the 40 year ago, help, I have fallen, and I can't get up, a lot
of changes have been made since then and that is a great piece
to have, that complementary piece of crisis management but for
the proactive, preventative technology is really where we are
going to save the money.
The Chairman. You know, what is frustrating is the Federal
Government has spent a fortune to do broadband, but it doesn't
pay to connect the home, it just pays to lay the fiber and so,
fortunately now with satellite technology, we don't have to
rely on that but don't worry, we are still spending the money.
Ms. Petteys, the YMCA's evidence-based fall prevention
programs have strong outcome data behind them. What does the
research actually show in terms of fall rate reduction, and why
hasn't evidence been sufficient to drive the kind of federal
investment and reimbursement these programs have earned?
You know what doesn't make sense to me is Medicare
Advantage, because you don't have to worry about a federal law.
It is like, are the Medicare Advantage players doing this?
Because they have an economic interest in doing it. It is
just----
Ms. Petteys. Unfortunately, no. Yes, I would love to talk
to you about the return on investment and exactly this point.
We talked already about one in four older adults will
experience a fall every year. Of those falls, more than half
will result in a trip to the hospital, so if we could talk
about what that means in money terms, the average ER visit for
a fall is over $1,000.
The average inpatient trip for a fall is over $18,000. The
cost for an individual to take a virtual, a matter of balance
program, $250, so according to a recent study by the National
Council on Aging, individuals who took evidence-based falls
prevention programs saw a 52 percent reduction in the number of
falls, so that is a $250 investment in prevention that can help
an older adult stay independent, connected, and out of the
hospital.
The Chairman. Let me ask you a question, if you--would you
take the financial risk? If I went to Mehmet Oz, who is running
CMS, and said, you know, Medicare, you pay for this program, or
Medicaid, whatever, and then if it doesn't save that amount of
money, you have to give the money back. Would you guys all do
that?
Ms. Petteys. Yes, the Y----
The Chairman. You take that financial risk, right? It
doesn't make sense. As a business guy, I would do that in a
heartbeat, right, to save the money. I mean, it is not just to
save the money. You change people's lives, right. Okay. If you
have a--if any of you want to do that, and you give me
something, I will take it to CMS.
I mean, just try for whatever you are responsible for.
Because they have all--you know, they have all the data, right.
They know exactly--they know what they have been spending, so
you could do a program. They know exactly what they are
spending on this. We have to file for Medicare, it is pretty
specific, so you know exactly that is. You know, what this
costs, so, you know, just take a portion of the savings, so
Okay.
All right, Ms. Didion, Area Agencies on Aging receive a mix
of federal, state, and local funding, and they operate within a
significant amount of federal regulatory and reporting
overhead_I bet, I bet you love all that.
How much of your staff's time and your organization's
resources go toward compliance and paperwork rather than
actually serving seniors, and what federal requirements could
be eliminated or streamlined without reducing outcomes? Just so
you know, when I was Governor of Florida, first I was a
business guy. You know what you got--as a business person, you
would get frustrated with? Government and crazy, stupid
Government regulations. I am sure that never happens to you,
right?
Ms. Didion. Oh, no, not at all. No, and I do have to brag
about our Area Agency on Aging. The great thing about the Older
Americans Act and setting up that aging infrastructure or
network is that there is a constant feedback loop of
monitoring, and fiscal responsibility, and programmatic
responsibility.
To an extent, having that regulation and having that follow
through is very important because that is how we know that
things are doing what they are supposed to be doing and that it
is working for seniors.
We have gone 17 years, my particular Area Agency on Aging
has gone 17 years with the--from the Florida Department of
Elder Affairs not having a finding, so we are all too familiar
with being in compliance, following those regulations, and when
we are monitored by our State Unit on Aging.
All that to say, you know, especially on the evidence-based
side, it is actually very important that we do follow that
regulation, again, for those specific evidence-based programs,
because that is how we know that those programs are working.
Like my colleague said, those evidence-based falls prevention
programs result in a 52 percent reduction in falls.
In addition to that, there is a 58 percent reduction in
falls that result in serious injury and we don't necessarily
have to keep tracking that after every Matter of Balance class
because that evidence-based programming tells us that that is
what that programming does for us.
The Chairman. Have you ever gone to a Medicare Advantage
program and just ask them? Because they should pay you. I mean,
if you can prove this, they should pay you and you should take
a cut of the savings. Because you--it sounds like you got--each
of every one of you can defend it, right?
You should go to the Medicare Advantages because they don't
have to worry about what CMS does, just ask them and go with
the proposal of whatever--you know, a cut of the savings. They
pay for your programs, and then you get a cut of the saving. If
they don't--if they--it doesn't make any sense if they wouldn't
do it.
Ms. Didion. If I can add, you know, it is certainly
important that there should be private investment in falls
prevention, Medicare Advantage plans, private insurance
companies. There definitely should be that private-public
partnership.
We do want to make sure that we are reaching all of those
seniors and older adults, including the ones that just have
straight Medicare, they don't have access or are able to afford
those Medicare Advantage plans or other private insurance
options. That is why those public-private partnerships are so
important, and like you said, there should be that investment
on the private side.
The Chairman. You know, you should be able to make a
profit. If you can save them that much money, you should make a
profit off the Medicare Advantage that you can do the others.
On top of that, if you give me the information, I will see if I
can get CMS to do a pilot with you that would help, you know,
make it happen across the country.
Florida has been a leader in state level innovation on
elder services. To what extent do Federal OAA requirements and
funding conditions constrain Florida's ability to design
programs that fit its population, and would you support giving
states more flexibility in how they use OAA dollars, even if it
meant less federal prescription over how programs are run? I
will just ask you--same----what do you think?
Ms. Didion. Thank you. Yes, we would enjoy any kind of
flexibility to be able to use funding to support seniors. The
main issue is that the funding is just inadequate across the
board. It doesn't matter if we are shifting funding between
Title III-B supportive services to Title III-D preventive
services, or from both buckets to Title III-C nutrition
services.
In our area--excuse me, in our planning and service area,
we have over 7,000 seniors waiting for at least one kind or one
type of Older Americans Act service because we just don't have
the funding to serve the need in our communities.
Yes, while flexibility is always welcome, we really have to
pivot and know what seniors need and where they need it the
most to be able to help them and again, that Older Americans
Act really helps that holistic approach to preventing falls. It
is not just that Title III-D evidence-based programming.
The Chairman. What I found when I became Governor of
Florida, is a lot of the regulation, is all put in because
somebody did the wrong thing and took advantage of the program,
and everybody else pays for it. Then the consumer, whoever, the
senior in this case, gets less, right.
Ms. Mitchell, predictive analytics are increasingly being
discussed as a way to identify fall risks before fall happens.
How mature is that capability today in real-world deployment,
and what would it take for that kind of tool to move from a
premium product to something an Area Agency on Aging could
integrate into its program?
Ms. Mitchell. Right. I think that is, you know, what we are
always going toward is being able to predict versus being able
to just, you know, assess based on what has already happened.
At GrandCare we like to call our data that we receive,
let's call it little data, right, so we are taking a GrandCare
System, and we are monitoring, or we are managing somebody's
chronic conditions. We are saying, okay, so if Jim has
congestive heart failure, I want to know if Jim gains five
pounds in two days because that is indicative of a problem, and
I am going to set up a clinical visit before that turns into a
hospital admission.
Obviously that kind of--that is sort of predictive, that
type of thing, or I want to know if somebody is having a
seizure, so I want to detect if there is wandering motion that
occurs. I want to be notified so that I can go in and intervene
before something else occurs, so you know, that type of stuff
exists already today.
Some of the AI and predictive analytics, I think in my mind
it is, hey, so I want to know if Jean gets out of bed every day
at this time, for weeks and weeks and week, what happens if a
month later, now she is getting out of the bed at this, or what
happens if she used to get out of bed every night--you know, we
are pretty habitual creatures--so what happens if she gets out
of bed every night, you know, at 2:00 a.m. in the morning to
use the restroom, well, now she is using the restroom three or
four times.
That could be a UTI, that could be sundowners, that could a
lot of things, so being able to assess that information and
comparing information from something that this person used to
do or something that they are doing later is super helpful.
What if my mom used to win at Solitaire all the time and
suddenly now on the system she is losing? You know, like all of
those types of things--or it used to take her this long to play
the memory game and now it is taking her this long, so being
able to assess that kind of information--all of that
information exists right now.
We can take a look and see how many times they are playing
games, which videos they are watching, how much they are video
chatting with family and friends. Like all of that is just
untapped and ready to be either put into, you know, delegated
into a greater analytics system so that somebody can create
algorithms and determine, hey, we have determined that this
person who is about to have a stroke, here is their motion
patterns.
Here was their blood pressure. Here are the amount of times
that they use the restroom. All of that kind of information
would be very, very exciting for us to know in order to predict
events, but also prevent them.
The Chairman. It makes sense. Ms. Mitchell, a lot of
seniors and their families are enthusiastic about technology in
the abstract, but are resistant to it in practice, often
because of privacy concerns or the perception that monitoring
feels intrusive. How does GrandCare approach that tension, and
what have you learned about designing systems that actually--
that people actually use and keep using?
Ms. Mitchell. Yes, I think that that is a great question,
you know. I often feel like older adults aren't scared of
technology. I mean, this is a population that went from
walking--to potentially walking to flying in their lifetime and
so it is not technology. They use technology every day. They
watch TV. I mean all sorts of different technologies.
They have got fancy cars, and fly, and do all the things
that we are all utilizing technology. It all comes down to the
interface, so are we providing them with something that they
feel is accessible, usable, and friendly to what their needs
are and what they want to do or are we forcing them to use a
technology like, here is my tablet, go ahead and use this, and
it may have been not designed specifically with them in mind.
At GrandCare, we designed it initially in 2005 with the older
adult in mind.
Now we also have individuals with intellectual and
developmental disabilities that we also work together with, so
we have designed for both populations and it really is designed
so that an individual who can read or look at pictures or touch
buttons can participate with. We have had folks that are in
hospice that can't touch the touch screen at all.
And family members that live far away, like in hospices,
you can't--you may not know necessarily how much time you have.
If you are flying in from another state, you may say, okay,
well, for the next, you know, six weeks, I am going to sort of
be on edge and sort of wonder, but with a technology like this,
I can video chat in with mom and dad.
She doesn't even need to be able to touch the touch screen.
If I am designated, I can drop in on that touch screen and then
talk, and communicate, and connect at end of life, so it is
really giving those advantages over the disadvantages. It is
really about somebody feeling more secure and of course, you
know, we don't have any sort of access to remotely monitoring
or assessing that ourselves.
We provide it for the family members to be able to assess
the tools and set up rules. They are not sitting there pouring
over the motion graphs. That would be very boring to look at
motion graphs, but instead we are just saying, if this happens,
you know, if there is excessive motion in the bathroom in the
middle of the night for more than 45 minutes, I want to be
notified and in that case, I might be able to sort of support
somebody. If somebody is sick, did a fall occur? It is just an
outlier that occurred.
The idea is not monitoring. The idea is about providing
independence and letting individuals be connected to family and
friends wherever they want to live.
The Chairman. Ms. Petteys, YMCAs sit in communities across
the country, including in rural and underserved areas where
Area Agencies on Aging may have limited reach. How are you
thinking about the YMCA network as a delivery infrastructure
for fall prevention, and where does that partnership with the
AAAs work well and where are the gaps?
Ms. Petteys. Thank you. Yes, we are--across New York State,
we have over 140 different locations across the state, and we
do work with our Area Offices of Aging in many of those
locations and we see the use of technology really to expand
that reach that we have to fill in those gaps, as you say, to
meet those individuals wherever they are at.
For our evidence-based falls prevention programs, we are
not only offering them at YMCA facilities across the state, but
we are also bringing those programs into other community
settings, like senior centers, like libraries, or my favorite,
we have a program happening at an Old Joanne's Fabric in a mall
in upstate New York, so we are bringing those program where the
people are at.
Then technology, like I said, is allowing us to fill in
those gaps to reach those individuals who have various
barriers, say mobility, transportation, or maybe they are
caregivers themselves, so they are at home.
We are always about connecting with partners throughout the
region because we know that we cannot do this work alone, so we
are absolutely open to partnerships with the AOAs and others.
The Chairman. Well, first of all, I want to thank each of
you for what you do every day. If there is any way I can help
you in working with CMS, or any of the Medicare Advantage, or
anything else, if you just let me know.
Thanks everybody for being here today and participating.
What we have heard today reinforces something I came into this
hearing already believing: falls are not an inevitable part of
aging. They are a preventable crisis, and we have the tools,
the programs, and knowledge to do something about it. I look
forward to continuing to work with members across the aisle and
down the dais.
If any Senators have additional questions for the witnesses
or statements to be added, the hearing record will be open
until next Wednesday at 5:00 p.m. Thank each of you for being
here.
[Whereupon, at 4:37 p.m., the hearing was adjourned.]
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APPENDIX
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Prepared Witness Statements
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Questions for the Record
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U.S. Senate Special Committee on Aging
"Caught in the Middle: Supporting Families in the Sandwich Generation"
May 13, 2026
Questions for the Record
Christine Didion
Ranking Member Kirsten E. Gillibrand
Question:
You stated that 80 percent of falls-related injuries are
paid for by Medicare and Medicaid in your testimony. You also
stated that a notable amount of falls treatment is paid for by
families - families who are already coping with inflation and
increased prices on everything from gas to groceries.
Considering the huge impact that Medicare and Medicaid
funding has on falls treatment and prevention, can you talk
about the impact on individuals and their families if federal
funding for these programs were jeopardized?
Response:
The Centers for Disease Control and Prevention estimates
that $80 billion in healthcare costs were spent in 2020 on the
treatment of non-fatal injuries from a fall among Older Adults
and that cost is expected to rise to $101 billion by 2030. 71%
of those costs were estimated to be paid by Medicare or
Medicaid.
The impact of falls reverberates far beyond just the
physical effects; falls touch every aspect of an Older Adult's
life including their wallets. Even with healthcare costs
covered by Medicare and Medicaid historically, there remains
out-of-pocket expenses that an Older Adult and, potentially
their family or Caregiver, are responsible for. For an Older
Adult or Caregiver that is already stretching every dollar to
buy groceries, pay their utility bill, or purchase fuel for
their car, a single fall can instantly plunge a family into a
financial crisis situation. Any reductions in Medicare or
Medicaid coverage will only escalate these existing issues.
We also must remember that Medicare does not pay for any
type of long-term care assistance for Older Adults, whether
that is in-home long-term support or in an institutional
setting. If a senior experiences an injury from a fall that
necessitates the need for long-term supportive and healthcare
services, and they cannot afford it on their own or access
long-term supports through Medicaid, it increases the chances
that a loved one will now need to step into an unpaid caregiver
role, often having to leave the workforce to care for the Older
Adult.
Ultimately, any jeopardization of Medicare and Medicaid
funding puts more pressure on the nationwide Aging Network and
Area Agencies on Aging (AAA). AAAs, with level-funding, will
have to stretch Older Americans Act funding even further to
provide home-and-community-based services to Older Adults with
high levels of needs that may have otherwise been able to
receive supportive services through Medicaid Waiver programs.
Restricting access to long-term care and supportive services
drives up out-of-pocket costs, forces Older Adults to rely on
unpaid family caregivers, or gives Older Adults no choice but
to enter institutionalized care settings, ultimately increasing
Medicaid spending and driving more families into economic
crisis situations.
Senator Elizabeth Warren
Question:
Untreated hearing loss and balance issues are associated
with a significantly higher risk of falls for older adults. How
do Area Agencies on Aging integrate treatment for hearing loss
and balance issues into their falls prevention efforts?
Response:
There are many factors that can contribute to or increase
the risk of an Older Adult experiencing a fall. Untreated
hearing loss not only triples the risk of a fall but can
isolate a senior, reduce their environmental awareness, and can
cause or increase balance instability. Area Agencies on Aging
(AAA) must address falls prevention holistically and through
the Older Americans Act (OAA), AAAs are able to provide a wide
array of home-and-community-based services that address the
social determinants of health that keep Older Adults living in
their own homes and communities.
Evidence-based falls prevention programs, like A Matter of
Balance, help participants understand the many factors that can
contribute to a fall and include comprehensive health
checklists into its curriculum. Participants learn and become
empowered to take steps to act on their health, including
understanding what hearing loss is and what balance issues may
look like. Other Evidence-based falls prevention programs, like
Bingocize and Enhance Fitness, focus on and implement balance
exercise, functional movements, and strength training.
Evidence-based falls prevention programs, funded by the
OAA, simply work. In a study by the National Council on Aging,
evidence-based falls prevention programs contributed to a 52%
reduction in the number of falls, a 56% reduction in falls that
caused an injury, and programs that incorporated balance and
strength training components reduced fall rates by 42%.
AAAs don't stop at just evidence-based programs to connect
Older Adults with solutions to falls prevention; the wide array
of programs and services, funded by the OAA, can contribute to
a decrease in falls. Congregate and home-delivered meals help
seniors access socialization and important nutrition that can
lessen the impact of chronic conditions; adult day care
services can provide supervision for an Older Adult and respite
for a family caregiver; home modification can address
environmental concerns and provide falls prevention tools like
ramps and grab bars; emergency alert and falls detection
technology decrease the chance of an Older Adult remaining on
the floor after a fall occurs; and, information and referral
services can link Older Adults to important community
resources, like free hearing screenings. The reauthorization
and adequate funding of the Older Americans Act gives Congress
the opportunity to ensure that the national aging network can
continue to provide holistic services that help to prevent
falls in a cost-effective and community-focused way.
Question:
A recent study found that hearing loss intervention slowed
the loss of thinking and memory abilities for older adults at
increased risk of cognitive decline by 48% over three years.
Since individuals experiencing cognitive impairment are also at
greater risk of falls, how should Congress better leverage
resources in the Older Americans Act to connect older adults
with evidence-based hearing loss interventions?
Response:
The reauthorization, modernization, and adequate funding of
the Older Americans Act gives Congress the opportunity to
ensure that the national aging network, and the 600 Area
Agencies on Aging (AAAs), can continue to providelistic
services that help to prevent falls in a cost-effective and
community-focused way.
Expanding and modernizing the available services that the
Older Americans Act (OAA) allows for AAAs to deploy in
communities can leverage greater returns on investment.
Expanding definitions of Title IIID Health and Wellness
Programs should include evidence-based sensory health
interventions, like hearing health education and auditory
screenings and interventions. Expansion of Title IIIB
supportive services should modernize services and provide
flexibility for AAAs to identify and address unmet needs in
their communities, such as providing assistive devices that
enhance mobility options and aid when balance concerns exist,
and assistive sensory devices like talk-to-text telephones and
over-the-counter hearing aids.
Most importantly, federal funding for the OAA must keep up
with demand for the vast array of home-and-community-based
services that are proven measures to prevent falls. Each year,
through the OAA, more than 14 million Older Americans receive
critical support from the nationwide Aging Network; however,
the current funding level has not kept up with the growing
number of adults turning 60 in the United States. In fact, per
capita OAA funding over the last ten years has decreased by 3%.
This has resulted in waitlists for services and Older Adults
having to seek costly institutional care because they cannot
access adequate community-based support services that will keep
them in their own home. Increased funding of all Titles of the
Older Americans Act will provide more Older Adults with
evidence-based falls prevention programs, safety technology,
home modifications, nutrition, and expanded, modern services to
support Older Adults in living where they choose to.
Question:
Under Medicare Part B, seniors cannot seek preventive
hearing and balance care from an audiologist without first
obtaining a physician order and cannot receive treatment
services provided by audiologists. In your view, would updating
the Medicare statute to eliminate these barriers to preventive
hearing and balance care support overall falls prevention
efforts?
Response:
Any removed barriers for Older Adults to access preventive
health measures is a critical step forward in falls prevention.
The current path requires an Older Adult to schedule and travel
to a primary care physician just to get a referral to an
audiologist. For Older Adults with limited incomes or
transportation access concerns, this lengthy process may make
them skip this type of care entirely. The untreated hearing or
balance issues then go unnoticed until it causes a fall
resulting in an injury or death.
Allowing audiologists to provide both preventive care and
direct treatment services under Medicare Part B would support
the critical work the national Aging Network engages in. First,
it will help to catch the risk earlier. If an Older Adult is
able to walk directly into an audiologist's office at the first
sign of dizziness or hearing concerns, they will be able to
receive treatment immediately, thus decreasing the risk of an
injurious fall. Second, it strengthens the community safety
net. Area Agencies on Aging (AAA) rely on public-private
partnerships, especially in the healthcare system, to reach
Older Adults. If barriers are removed for Older Adults to
easily access audiologists who can refer Older Adults directly
into evidence-based programs, like a Matter of Balance, and
vice versa, it will further strengthen the falls prevention
safety net.
Question:
Research shows that consistent hearing aid use is
associated with lower prevalence of falls. How can Congress
better incorporate hearing and balance care into national falls
prevention strategies?
Response:
The reauthorization, modernization, and adequate funding of
the Older Americans Act gives Congress the opportunity to
ensure that the national aging network, and the 600 Area
Agencies on Aging (AAAs), can continue to provide holistic
services that help to prevent falls in a cost-effective and
community-focused way.
Expanding and modernizing the available services that the
Older Americans Act (OAA) allows for AAAs to deploy in
communities can leverage greater returns on investment.
Expanding definitions of Title IIID Health and Wellness
Programs should include evidence-based sensory health
interventions, like hearing health education and auditory
screenings and interventions. Expansion of Title IIIB
supportive services should modernize services and provide
flexibility for AAAs to identify and address unmet needs in
their communities, such as providing assistive devices that
enhance mobility options, like walkers, canes, and lift chairs,
and assistive sensory devices like talk-to-text telephones and
over-the-counter hearing aids.
Most importantly, federal funding for the OAA must keep up
with demand for the vast array of home-and-community-based
services that are proven measures to prevent falls. Each year,
through the OAA, more than 14 million Older Americans receive
critical support from the nationwide Aging Network; however,
the current funding level has not kept up with the growing
number of adults turning 60 in the United States. In fact, per
capita OAA funding over the last ten years has decreased by 3%.
This has resulted in waitlists for services and Older Adults
having to seek costly institutional care because they cannot
access adequate community-based support services that will keep
them in their own home. Increased funding of all Titles of the
Older Americans Act will provide more Older Adults with
evidence-based falls prevention programs, safety technology,
home modifications, nutrition, and expanded, modern services to
support Older Adults in living where they choose to.
U.S. Senate Special Committee on Aging
"Caught in the Middle: Supporting Families in the Sandwich Generation"
May 13, 2026
Questions for the Record
Martha Petteys
Ranking Member Kirsten E. Gillibrand
Question:
Your organization received funding from the Administration
for Community Living to carry out programs related to three
different evidence-based methods of falls prevention. They
include A Matter of Balance, offered both in person and
virtually; EnhanceFitness; and Moving for Better Balance.
Can you discuss the benefits of utilizing different types
of falls prevention services and what the drawbacks would be if
you were limited to only providing one?
Response:
With thousands of locations nationwide, YMCAs provide an
established infrastructure to deliver evidence-based programs
at scale, particularly in communities where other providers may
be limited. YMCAs are also uniquely positioned as trusted
community-based providers to meet older adults where they are.
Effective falls prevention is not a one-size-fits-all approach
but considers the unique needs of an individual, including
level of mobility, health, and confidence.
Programs such as A Matter of Balance, EnhanceFitness, and
Moving for Better Balance each serve a purpose. Offering
multiple evidence-based interventions allows YMCAs to match
participants to the appropriate level and type of program.
Internally, different types of programs allow providers to
scale reach across the community.
If providers were limited to only one program model, many
older adults could be excluded due to fit or access, limiting
the overall public health impact of falls prevention efforts.
Delivering multiple programs maximizes capacity and
effectiveness, ensuring access to the right intervention at the
proper time.
Question:
Funding for research equips older Americans with the
knowledge and confidence to avoid falls. For example, the
National Institute on Aging helped to develop and test a
program called "A Matter of Balance" to empower older Americans
with techniques to reduce the incidence of falling. Remarkably,
participants reported significant improvements after just 6
weeks of engaging with the program.
New York State YMCAs utilize "A Matter of Balance." Can you
speak to the direct connection between support for federally
funded research and incidence of falls? What happens to these
vital community networks when federal funding is disrupted
through inadequate funding or staffing?
Response:
Federal funding has been essential to develop and validate
evidence-based falls prevention programs that community-based
organizations like YMCAs rely on. These programs are cost-
effective and produce strong outcomes - including reduced risk,
improved mobility, and increased confidence among participants
after short periods.
When federal funding is disrupted, program implementation
is affected. Reduced technical assistance and training can slow
expansion, particularly in underserved areas.
During the pandemic, for example, program delivery and
accessibility were disrupted. Simultaneously rates of isolation
and need for programming to reduce falls when individuals were
homebound rose. This period served as a case study,
underscoring how fragile systems can be when implementation
support is reduced.
Ultimately, programs rely on federal investments. When the
pipeline from the federal to the community level is disrupted,
fewer older adults would be able to access programs that keep
them healthy and independent.
Question:
How have ACL grants enabled the YMCA's falls prevention
work to reach more members of the community?
Response:
The ACL grant has been integral in expanding the reach and
sustainability of YMCA falls prevention programming across the
state. In particular, ACL grant funding has enabled the
development and expansion of a statewide virtual program,
significantly increasing access for older adults in rural and
underserved communities. This virtual delivery model has acted
as a "doorway" into other YMCA programs and has connected
individuals to additional in-person services and social
supports.
Without federal investment, YMCAs face limitations in their
ability to scale programs and maintain staff.
Question:
How could more seniors benefit if Congress were to scale
investments into these types of preventative public health
initiatives?
Response:
Scaling federal investment in evidence-based falls
prevention programs would significantly expand access for older
adults while also generating long-term savings and return on
investment in public health systems.
As we have mentioned, falls are the leading cause of fatal
and non-fatal injuries among older adults, according to the
CDC. Among older adults who fall, over half receive care in a
hospital; the estimated annual average cost per inpatient visit
for falls injuries is $18,658 and $1,112 per emergency
department visit. (https://www.sciencedirect.com/science/
article/abs/pii/S0020138323009166).
According to a July 2025 study by the National Council on
Aging, participants in evidence-based falls prevention programs
experienced a 52% reduction in the number of times they fell, a
56% reduction in the number of falls that caused injury and an
18% reduction in emergency room visits due to falls. (https://
www.ncoa.org/article/return-on-investment-of-evidence-based-
falls-prevention-programs/).
The cost of sending an individual through one of our eight-
session virtual A Matter of Balance programs is approximately
$250. While falls cannot be eliminated entirely, evidence
suggests that investments in proven falls prevention programs
can reduce fall risk, improve confidence and independence, and
help avoid costly injuries and health care utilization. Even
small investments in prevention have the potential to generate
meaningful benefits for older adults, caregivers, and the
broader health care system. Falls prevention represents a
proactive investment that reduces reliance on costly
emergencies and acute care services. Furthermore, scaled
investments continue to keep programs stable and sustained.
Community-based organizations like YMCAs are consistently
operating at or near capacity and are unable to meet demand
without support. Scaled investment would allow providers to
expand programming, reach new areas, and serve more
participants overall. Together, these outcomes demonstrate that
falls prevention is not only a health intervention, but a
system-level strategy to reduce strain on the health care
system.
Question:
We have heard that older adults can be reluctant to
participate in some falls prevention programs that involve
exercise. This can be especially true if the older adult has
been physically inactive for years. We also hear about how
loneliness and social isolation can be significant problems for
America's older adults.
Can you discuss the role of social connection in convincing
people to participate in falls prevention programs and regular
exercise? Do many falls prevention programs essentially tackle
two significant problems for America's seniors at the same
time?
Response:
Social connection is a critical, and often under-
recognized, component of effective falls prevention
programming. Many older adults are initially hesitant to
participate in exercise-based programming due to fear, lack of
confidence, and previous periods of inactivity. However, group-
based community programs like those offered by YMCAs address
both physical and social needs simultaneously.
Research shows that social isolation is associated with
higher risks of depression, reduced physical activity, and
increased fall risk. Positive social connections improve
motivation, reduce stress, and increase engagement in healthy
behaviors, all of which contribute to lower fall risk and
improved overall well-being.
According to a recent report from the US Surgeon General,
loneliness, isolation, and lack of connection in our country is
an alarming public health crisis. Lacking connection increases
the risk for premature death by up to 60%, comparable to
smoking daily (https://aging.ny.gov/combating-social-
isolation).
The CDC estimates that loneliness costs the US economy an
estimated $406 billion a year, in addition to $6.7 billion a
year in Medicare costs for socially isolated adults.
In this way, falls prevention programs effectively address
two major health challenges at once - physical risk of injury
and social isolation. The combination of movement and
connection is what makes these programs especially powerful and
effective in supporting healthy aging.
Senator Raphael Warnock
Question:
Since 2014, the Administration for Community Living (ACL)
at the Department of Health and Human Services has provided
federal grants to community-based organizations and government
agencies that implement evidence-based falls prevention
programs, including the Atlanta Regional Commission in Georgia.
However, the Trump administration cut the workforce at the
Administration for Community Living by nearly half on April 1,
2025, and has proposed to dissolve the agency.
How will cuts to ACL's workforce affect their efforts to
reduce the risk of falls among older Americans in states like
Georgia?
Response:
The Administration for Community Living plays a central
role in supporting the development, implementation, and scaling
of evidence-based falls prevention programs nationwide. Any
significant reduction in staffing or capacity within ACL could
slow technical assistance and limit coordination with states.
This would have downstream impacts on local organizations
that rely on guidance and funding to implement programs
effectively, particularly in states with emerging or under-
resourced infrastructure. These programs rely on trained
instructors and community-based staff to deliver them
effectively; disruptions in funding directly affect workforce
capacity and program quality. In practical terms, reduced
federal support could slow the expansion of falls prevention
services at a time when demand continues to grow.
Question:
In 2024, nearly 74,000 Georgians aged 65 and older visited
the emergency room for a fall-related injury, and 844 died as a
result of their fall. The Centers for Disease Control and
Prevention's (CDC) National Center for Injury Prevention and
Control (NCIPC) has played a vital role in leading public
health research on falls among older adults and in developing
clinical toolkits to help health professionals treat
individuals with fall-related injuries. However, the Trump
administration eliminated nearly one-third of its workforce on
April 1, 2025, including the entire workforce that focused on
older adult falls.
How can Congress continue investments in medical research
and clinical practices to improve treatments for older
Americans with fall-related injuries, given massive layoffs at
NCIPC?
Response:
The Centers for Disease Control and Prevention's National
Center for Injury Prevention and Control has played a critical
role in advancing research, surveillance, and clinical guidance
related to older adult falls. This work has helped translate
evidence into practical tools for healthcare providers and
community organizations.
Reductions in workforce capacity within this area could
slow the development and dissemination of updated clinical
guidance, limiting data collection and analysis, and weakening
national coordination on falls prevention strategies.
Congress can continue to strengthen outcomes for older
adults by maintaining and expanding investments in both medical
research and community-based prevention. Sustained federal
support ensures that evidence-based interventions continue to
be developed, rigorously evaluated, and implemented
effectively, and that health care providers have the knowledge
and tools to reduce falls-related injuries. Continued and
sustained federal investment will be critical to maintaining
momentum and meeting growing demand as the population ages.
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Statements for the Record
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