[Congressional Record Volume 150, Number 133 (Thursday, November 18, 2004)]
[Senate]
[Pages S11508-S11510]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   ELDER FALLS PREVENTION ACT OF 2003

  Mr. McCONNELL. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 785, S. 1217.
  The PRESIDING OFFICER. The clerk will state the bill by title.
  The legislative clerk read as follows:

       A bill (S. 1217) to direct the Secretary of Health and 
     Human Services to expand and intensify programs with respect 
     to research and related activities concerning elder falls.

  There being no objection, the Senate proceeded to consider the bill, 
which was reported from the Committee on Health, Education, Labor, and 
Pensions, with an amendment and an amendment to the title, as follows:
  (Strike the part printed in black brackets and insert the part 
printed in italic.)

                                S. 1217

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

     [SECTION 1. SHORT TITLE.

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

     [SEC. 2. FINDINGS.

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

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

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

                  [``PART R--PREVENTION OF ELDER FALLS

     [``SEC. 399AA. PURPOSES

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

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

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

     [``SEC. 399AA-2. RESEARCH.

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

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

       [``Subject to the availability of appropriations, the 
     Secretary, acting through the Director of the Centers for 
     Disease Control and Prevention and in consultation with the 
     Director of the Agency for Healthcare Research and Quality, 
     shall carry out the following:
       [``(1) Oversee and support demonstration and research 
     projects to be carried out by the National Safety Council and 
     other qualified organizations in the following areas:
       [``(A) A multi-State demonstration project assessing the 
     utility of targeted fall risk screening and referral 
     programs.
       [``(B) Programs designed for community-dwelling elderly 
     individuals that shall utilize multi-component fall 
     intervention approaches, including physical activity, 
     medication assessment and reduction when possible, vision 
     enhancement, and home modification strategies.

[[Page S11509]]

       [``(C) Programs targeting newly-discharged fall victims who 
     are at a high risk for second falls, which shall include 
     modification projects available to various living settings 
     (in accordance with accepted building codes and standards) 
     and which are designed to maximize independence and quality 
     of life for elders, particularly those elders with functional 
     limitations.
       [``(D) Private sector and public-private partnerships to 
     develop technology to prevent falls and prevent or reduce 
     injuries if falls occur.
       [``(2)(A) Provide grants to qualified organizations and 
     institutions to design, implement, and evaluate fall 
     prevention programs using proven intervention strategies in 
     residential and institutional settings.
       [``(B) Provide one or more grants to one or more qualified 
     applicants in order to carry out a multi-State demonstration 
     project to implement and evaluate fall prevention programs 
     using proven intervention strategies designed for multi-
     family residential settings with high concentrations of 
     elders, including identifying high risk populations, 
     evaluating residential facilities, conducting screening to 
     identify high risk individuals, providing pre-fall 
     counseling, coordinating services with health care and social 
     service providers and coordinating post-fall treatment and 
     rehabilitation.
       [``(C) Provide one or more grants to qualified applicants 
     to conduct evaluations of the effectiveness of the 
     demonstration projects in this section.

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

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

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

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

     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

[[Page S11510]]

     Services to intensify programs with respect to research and 
     related activities concerning falls among older adults.''.

  Ms. MIKULSKI. Mr. President, I am pleased that today the Senate will 
pass the Keeping Seniors Safe from Falls Act of 2004 (S. 1217) that 
Senator Enzi and I introduced. Falls are a serious public health 
problem that affects millions of seniors each year. This bill focuses 
on public education, research, and demonstration projects to help 
reduce falls by older adults.
  The facts are staggering. One out of every three Americans over age 
65 falls every year. In 2000, over 10,200 seniors died and 
approximately 1.6 million seniors visited an emergency department as a 
result of a fall. Falls are the leading cause of injury deaths among 
seniors, accounting for 64,000 traumatic brain injuries and 340,000 hip 
fractures each year. Falls can be financially disastrous for families, 
and falls place a serious financial strain on our health care system. 
By 2020, falls by older adults are estimated to cost the health care 
system more than $32 billion.
  These facts do not begin to tell the story of what falls can mean for 
older adults and their loved ones. Falls don't discriminate. Kay Graham 
was the victim of a fall. Many of us have friends or relatives who have 
fallen. A fall can have a devastating impact on a person's physical, 
emotional, and mental health. If an older woman loses her footing on 
her front porch steps, falls, and suffers a hip fracture, she would 
likely spend about two weeks in the hospital, and there is a 50 percent 
chance that she would not return home or live independently as a result 
of her injuries.
  Two years ago, I chaired a hearing of the Subcommittee on Aging on 
the problem of falls among older adults. The subcommittee heard 
testimony from Lillie Marie Struchen, a 91-year-old woman who had 
recently fallen in her bathroom when she slipped on the tile. Lillie 
Marie could not reach the panic button in her apartment, and it took 
her some time before she could get to her feet and call for help. 
Lillie Marie was lucky. She recovered from her fall and returned to her 
normal routines. She shared with the subcommittee some steps that she 
and her family have taken to prevent future falls, knowing that she may 
not be so lucky next time.
  These falls, like the ones that Lillie Marie and thousands of others 
suffer from each year, can be prevented. With some help, there are 
simple ways that seniors can improve the safety of their homes and make 
a fall far less likely. Home modifications like hand rails in the 
bathroom, rubber mats on slippery tile floors, and cordless telephones 
that seniors can keep nearby can make a big difference. Well-trained 
pharmacists can review medications to make sure that two drugs do not 
interact to cause dizziness and throw a senior off balance.
  That's what this legislation is about--getting behind our Nation's 
seniors and giving help to those who practice self-help. This bill 
creates public education campaigns for older adults, their families, 
and health care providers about how to prevent falls. It expands 
research on falls by older adults to develop better ways to prevent 
falls and to improve the treatment and rehabilitation of elder victims. 
This legislation also requires an evaluation of the effect of falls on 
health care costs, the potential for reducing falls, and the potential 
for reducing health care costs associated with falls.
  Reducing the number of falls will help seniors live longer, 
healthier, more independent lives. I want to acknowledge the leadership 
of the National Safety Council on this issue. I also thank Senator Enzi 
for working with me in such a bipartisan manner to move this bill 
forward. The support of Senator Gregg and Senator Kennedy was also 
vital in getting this bill through the Senate. I hope that our 
colleagues in the House will take swift action to pass this important 
bill this year.
  Mr. McCONNELL. Mr. President, I ask unanimous consent the committee 
amendment be agreed to, the bill, as amended, be read a third time and 
passed, the amendment to the title be agreed to, the motion to 
reconsider be laid upon the table, and that any statements relating to 
the bill be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendment in the nature of a substitute was agreed to.
  The bill (S. 1217), as amended, was read the third time and passed.
  The title was amended 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.

                          ____________________