[Senate Report 108-395]
[From the U.S. Government Publishing Office]
Calendar No. 785
108th Congress Report
SENATE
2d Session 108-395
======================================================================
KEEPING SENIORS SAFE FROM FALLS ACT OF 2004
_______
October 8, 2004.--Ordered to be printed
_______
Mr. Gregg, from the Committee on Health, Education, Labor, and
Pensions, submitted the following
R E P O R T
[To accompany S. 1217]
The Committee on Health, Education, Labor, and Pensions, to
which was referred the 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, having considered the same, reports favorably
thereon with an amendment in the nature of a substitute and an
amendment to the title, recommends that the bill (as amended)
do pass.
CONTENTS
I. Purpose and need for legislation.................................1
II. Summary..........................................................2
III. History of legislation and votes in committee....................2
IV. Explanation of bill and committee views..........................2
V. Cost estimate....................................................3
VI. Regulatory impact statement......................................4
VII. Application of law to the legislative branch.....................5
VIII.Section-by-section analysis......................................5
IX. Changes in existing law..........................................5
I. Purpose and Need for Legislation
More than a third of adults aged 65 years or older fall
each year, and falls are the leading cause of unintentional
injury deaths as well as nonfatal unintentional injuries among
older Americans.
According to the Centers for Disease Control and
Prevention, in 2001, more than 11,600 people aged 65 and older
died from fall-related injuries. More than 1.6 million seniors
were treated that year in emergency departments for fall-
related injuries, and nearly 400,000 seniors were hospitalized
as a result of a fall. Falls account for approximately 62
percent of all nonfatal unintentional injuries in the United
States. Of those who fall, 20 to 30 percent suffer moderate to
severe injuries such as hip fractures or traumatic brain
injuries that reduce mobility and independence and increase the
risk of premature death.
In addition to their effect on the quality of life of
seniors and their families, fall also have an impact on
healthcare costs due to increased physician visits, emergency
room use and hospitalization. the total cost of all fall
injuries for people age 65 and older was estimated in 1994 to
be $27.3 billion (in 2004 dollars).
To address the impact of falls on seniors, their families,
and healthcare costs, the Keeping Seniors Safe from Falls Act
of 2004 would focus ongoing Federal efforts to prevent falls
among older adults on three priorities: (1) developing a
national education campaign to reduce falls among older adults;
(2) intensifying services and conducting research to determine
the most effective approaches to preventing and treating falls
among older adults; and (3) directing the Secretary of Health
and Human Services (HHS) 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.
II. Summary
The Keeping Seniors Safe from Falls Act of 2004 authorizes
the Department of Health and Human Services (HHS) to develop
public education programs on fall prevention for the elderly,
family members, caregivers, and others involved with the
elderly. It authorizes an intensification of research on
effective approaches to fall prevention and treatment. The
legislation also directs the Secretary of HHS to evaluate the
effect of falls on healthcare costs and the potential for
reducing such costs through various strategies.
III. History of Legislation and Votes in Committee
During the 107th Congress, on February 7, 2002, Senator
Hutchinson, for himself and Senators Milulski and Enzi,
introduced S. 1922, a bill to direct the Secretary of Health
and Human Services to expand and intensify programs with
respect to research and related activities concerning falls of
older Americans. Senators Baucus, Miller and Murray also
cosponsored S. 1922. The Health, Education, Labor, and Pensions
(HELP) Subcommittee on Aging held a hearing on S. 1922 on June
11, 2002.
During the 108th Congress, on June 9, 2003, Senator Enzi,
for himself and Senator Mikulsi, introduced S. 1217. Senators
Murray, Baucus, Grassley, Cochran, Lautenberg, Bingaman, and
Bunning also cosponsored S. 1217. On September 22, 2004, the
HELP Committee considered a substitute amendment to S. 1217
offered by Senators Enzi and Mikulski which was approved by
unanimous consent.
IV. Explanation of Bill and Committee Views
The Keeping Seniors Safe from Falls Act of 2004 directs the
Secretary of HHS to refocus the Department's efforts to prevent
falls among older adults through public education and research,
and to assess the impact that falls have on healthcare costs.
The committee expects the Secretary to carry out his authority
through agencies, such as the Centers for Disease Control and
Prevention and its National Center for Injury Prevention and
Control, which have the necessary experience and expertise to
conduct and support such work.
The committee expects the public education campaign to be
directed principally to older adults, their families, and
healthcare providers, and to be focused on the twin goals of
reducing falls among older adults and preventing repeat falls.
The Department of Health and Human Services or its designated
agency should consider organizations with expertise in
designing and implementing large-scale programs to prevent
injuries; experience in working in cooperation with government
agencies, businesses and corporate organizations; and other
non-profit organizations and institutions and the capability to
carry out major public education campaigns on a national basis.
The committee believes that HHS should utilize the injury
prevention and community health education expertise available
at colleges and universities in carrying out provisions of this
Act. The committee urges HHS to involve these and other
qualified organizations and institutions in the implementation
of this legislation.
V. Cost Estimate
U.S. Congress,
Congressional Budget Office,
Washington, DC, October 8, 2004.
Hon. Judd Gregg,
Chairman, Committee on Health, Education, Labor, and Pensions,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 1217, the Keeping
Seniors Safe from Falls Act of 2004.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Tim
Gronniger.
Sincerely,
Elizabeth M. Robinson
(For Douglas Holtz-Eakin, Director).
Enclosure.
S. 1217--Keeping Seniors Safe from Falls Act of 2004
Summary: S. 1217 would direct the Secretary of Health and
Human Services to intensify public education and research
efforts to prevent falls among older adults. Many of the
activities specified by the bill are conducted by the Centers
for Disease Control and Prevention (CDC) under its general
injury-prevention authority, but implementing the bill would
increase the number and scope of such fall-reduction programs.
Accordingly, assuming appropriation of necessary amounts, CBO
estimates that implementing S. 1217 would cost $1 million in
2005 and $12 million over the 2005-2009 period. Enacting S.
1217 would not affect direct spending or revenues.
S. 1217 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary impact of is shown in the following table. The costs
of this legislation fall within budget function 550 (health).
Basis of estimate: For this estimate, CBO assumes that S.
1217 will be enacted near the start of fiscal year 2005, that
the necessary amounts will be appropriated for each fiscal
year, and that outlays will follow the historical spending
rates of similar CDC programs.
------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------
2005 2006 2007 2008 2009
------------------------------------------------------------------------
CDC Spending Under Current Law
\1\:
Estimated Authorization 4,656 4,730 4,825 4,926 5,039
Level....................
Estimated Outlays......... 4,462 4,553 4,688 4,830 4,931
Proposed Changes:
Estimated Authorization 3 3 3 3 3
Level....................
Estimated Outlays......... 1 2 3 3 3
CDC Spending Under S. 1217:
Estimated Authorization 4,659 4,733 4,828 4,929 5,042
Level....................
Estimated Outlays......... 4,463 4,555 4,691 4,833 4,934
------------------------------------------------------------------------
\1\ Current-law estimates are CBO baseline projections that reflect the
2004 appropriation ($4,589 million) adjusted for anticipated
inflation.
S. 1217 would amend the Public Health Service Act (PHSA) to
direct the Secretary of Health and Human Services to pursue
programs to study and prevent falls among older adults. In
general, the PHSA authorizes appropriations for the injury-
prevention and control activities it defines. S. 1217 would
authorize public education campaigns, demonstration projects,
and research activities.
The CDC currently pursues many of the activities specified
in S. 1217 under its general authority to research and prevent
injuries. Its initiative, ``Preventing Injuries Among Older
Adults,'' focuses primarily on injuries from falls and motor
vehicle crashes. This program operates demonstration programs
with the states, funds research and education through non-
profit organizations, and funds prevention research on falls
among older adults, just as S. 1217 would require. In fiscal
2004, the CDC spent almost $2 million on fall-prevention and
other injury-reduction efforts directed at older adults. Based
on information from CDC, CBO expects that implementing S. 1217
would lead to an expansion of those efforts, and that the
expanded program would be comparable in scope to existing
programs to prevent unintentional injuries. CBO estimates the
new fall-prevention activities would cost $1 million in 2005
and $12 million over the 2005-2009 period, assuming
appropriation of necessary amounts.
Intergovernmental and private-sector impact: S. 1217
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal Costs: Tim Gronniger. Impact
on State, Local, and Tribal Governments: Leo Lex. Impact on the
Private Sector: Peter Richmond.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
VI. Regulatory Impact Statement
The committee has determined that there will be de minimis
changes in the regulatory burden imposed by this bill.
VII. Application of Law to the Legislative Branch
Section 102(b)(3) of Public Law 104-1, the Congressional
Accountability Act (CAA) requires a description of the
application of this bill to the legislative branch. This bill
does not amend any act that applies to the legislative branch.
VIII. Section-by-Section Analysis
Section 1. Short Title
Section 1 provides the short title of the bill, the Keeping
Seniors Safe from Falls Act of 2004.
Section 2. Findings
Section 2 enumerates various findings that underscore the
need for the legislation.
Section 3. Amendments to the Public Health Service Act
Section 3 amends part J of Title III of the Public Health
Service Act to add a new section 393D, Prevention of Falls
Among Older Adults.
Subsection (a) of section 393D outlines the purposes of
this section.
Subsection (b) directs HHS to establish a national public
education campaign to prevent falls among older adults and
prevent repeat falls. It also establishes authority for HHS to
make grants or enter into contracts or cooperative agreements
to assist state-level coalitions in conducting local education
campaigns to reduce falls among older adults.
Subsection (c) directs HHS to conduct and support research
in areas such as identifying older adults who have a high risk
of falling; designing, implementing, and evaluating the most
effective ways to prevent falls; improving diagnosis,
treatment, and rehabilitation of older adults who have fallen;
tailoring proven fall reduction strategies to specific
populations of older adults; and eliminating barriers to
adopting proven fall prevention methods. It also directs the
HHS Secretary to make grants or enter into contracts or
cooperative agreements to provide professional education for
physicians and allied health professionals in fall prevention.
Subsection (d) gives HHS the authority to conduct and
support demonstration programs to assess the utility of
targeted fall risk screening and referral programs; programs
that use multiple approaches to prevent falls; and programs
targeting newly discharged fall victims at high risk for second
falls. HHS may also conduct and support demonstration programs
to develop technology to prevent falls among older adults and
prevent or reduce fall-related injuries, and to implement and
evaluate fall prevention programs using proven intervention
strategies in different settings.
Subsection (e) directs the Secretary to evaluate the effect
of falls on health care costs, the potential for reducing
falls, and the most effective strategies for reducing fall-
related health care costs.
IX. Changes in Existing Law
In compliance with rule XXVI paragraph 12 of the Standing
Rules of the Senate, the following provides a print of the
statute or the part or section thereof to be amended or
replaced (existing law proposed to be omitted is enclosed in
black brackets, new matter is printed in italic, existing law
in which no change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
Part J--Prevention and Control of Injuries
RESEARCH
Sec. 391 [280b] (a) * * *
* * * * * * *
NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY REGISTRIES
Sec. [393B.] 393C. [280b-1c] In General.--The Secretary,
acting through the Director of the Centers for Disease Control
and Prevention, may make grants to States or their designees to
operate the State's traumatic brain injury registry, and to
academic institutions to conduct applied research that will
support the development of such registries, to collect data
concerning--
* * * * * * *
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
or 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).