[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).

                                  
