To direct the Secretary of Health and Human Services to expand and intensify programs with respect to research and related activities concerning elder falls.

June 9, 2003

Mr. ENZI (for himself and Ms. MIKULSKI) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

To direct the Secretary of Health and Human Services to expand and intensify programs with respect to research and related activities concerning elder falls.

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

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.

`(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.'.

END