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HR 3701 IHRH

110th CONGRESS Union Calendar No. 351

1st 110th CONGRESS

2d Session

H. R. 3701

[Report No. 110-569]

To amend the Public Health Service Act to direct the Secretary of Health and Human Services to intensify programs with respect to research and related activities concerning falls among older adults.

IN THE HOUSE OF REPRESENTATIVES

September 27, 2007

Mr. PALLONE (for himself and Mr. HALL of Texas) introduced the following bill; which was referred to the Committee on Energy and Commerce

April 8, 2008

Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

[Strike out all after the enacting clause and insert the part printed in italic]

[For text of introduced bill, see copy of bill as introduced on September 27, 2007]

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A BILL

To amend the Public Health Service Act to direct the Secretary of Health and Human Services to intensify programs with respect to research and related activities concerning falls among older adults.

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 `KeepingSafety of Safe From Falls Seniors Act of 20078'.

SEC. FINDINGS.Congress finds the following:(1) One third of older adults over age 65 fall each year. Falls are the leading cause of injury deaths among individuals for this population with risk of falling and injury rates increasingly common with advanced age.(2) Older adults are hospitalized for fall-related injuries five times more often than for injuries from other causes.(3) In 2003, falls among older adults accounted for 12,900 deaths, 1,800,000 emergency department visits, and 421,000 hospitalizations.(4) In 2003, unintentional falls accounted for more than 62.7 percent of nonfatal injuries for people age 65 or older.(5) 87 percent of all fractures among older adults are due to falls.(6) Among older adults who fall, 20 to 30 percent suffer moderate to severe injuries such as hip fractures or head traumas that reduce mobility and independence, increase the risk of premature death, and lead to serious health problems.(7) Hospital admissions for hip fractures among the elderly have increased from 231,000 admissions in 1988 to 338,000 in 1999, with an average hospital stay of one week.(8) From 2000 to 2040, the number of people age 65 or older is projected to increase from 34.8 million to 77.2 million. Given our aging population, by the year 2040, the number of hip fractures is expected to exceed 500,000.(9) 25 percent of older adults who sustain hip fractures remain institutionalized for at least one year and 50 percent of all older people hospitalized for hip fractures cannot return home or live independently after their injury, never returning to their prior level of mobility.(10) 25 percent of adults age 65 or older who sustain a hip fracture die within a year.(11) Annually, more than 64,000 individuals who are over 65 years of age sustain a traumatic brain injury as a result of a fall.(12) 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). By 2020 the cost of fall injuries is expected to reach $43,800,000,000 annually.(13) 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. 2. 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 and transferred redesignated by paragraph (1)) the following:

`SEC. 393D. PREVENTION OF FALLS AMONG OLDER ADULTS.

`Purposes- The purposes of this section are--`(1) to develop effective public education strategies in a national initiative to reduce falls among older adults and 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;`(3) to support demonstration projects designed to reduce the risk of falls and injuries caused by falls; and`(4) 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) (a) Public Education- The Secretary shall--may--

`(1) oversee and support a national education and award grants, contracts, and cooperative agreements campaign to be carried out by qualified organizationsa 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, specializing, or demonstrating expertise, in falls or fall prevention, for the purpose of organizing State-level coalitions of appropriate State and local agencies, safety, health, senior city planning, citizen, and other organizations to design and carry out local education campaigns, focusing on reducing falls among older adults, and preventing repeat falls, and planning and designing safe communities..

`(c) Professional Education- The Secretary shall-- `(b) Research-

`(1) oversee and support a national education campaign and award grants, contracts, and cooperative agreements to be carried out by qualified organizations that focuses on educating physicians, allied health professionals, and related providers of health and safety services about falls risk, assessment, and prevention; andIN GENERAL`(2) award grants, contracts, or cooperative agreements to qualified organizations, institutions, or consortia of qualified organizations and institutions, including nonprofit safety and aging-related organizations that have a demonstrated interest in fall prevention, safety and older adult issues, for the purpose of designing and carrying out State-level professional education campaigns to educate physicians, allied health professionals, and related providers of health and safety services about falls risk, assessment, and prevention.`(d) Research- The Secretary shall award grants, contracts, or cooperative agreements to qualified organizations, institutions, or consortia of qualified organizations and institutions, to--may--

`(1 `(A) conduct and support research to--

`(A `(i) improve the identification of older adults who have a high risk of falling;

`(B `(ii) improve data collection and analysis to identify fall risk and protective factors;

`(C `(iii) design, implement, and evaluate the most effective fall prevention interventions;

`(D) design, implement, and evaluate medication management interventions; `(iv`(E) improve strategies that are proven to be effective in reducing falls by tailoring these strategies to specific populations of older adults;

`(F `(v) conduct research in order to maximize the dissemination of proven, effective fall prevention interventions;

`(G `(vi) intensify proven interventions to prevent falls among older adults;

`(H `(vii) improve the diagnosis, treatment, and rehabilitation of elderly fall victims; and and older adults at high risk for falls; and

`(I `(viii) assess the risk of falls occurring in various settings, including the role of the environment of falls and the effectiveness of environment interventions on preventing falls;;

`(2 `(B) conduct research concerning barriers to the adoption of proven interventions with respect to the prevention of falls among older adults;

`(3 `(C) conduct research to develop, implement, and evaluate the most effective approaches to reducing falls among high-risk older adults living in communities and long-term care facilities;and assisted living facilities; and

`(4 `(D) evaluate the effectiveness of community programs designed to assisted living and nursing home prevent falls among older adults;.

`(5) conduct research to identify effective strategies in home modification `(2) EDUCATIONAL SUPPORT- The Secretary, either directly or through awarding grants, contracts, or cooperative agreements to promote independent livingqualified organizations, institutions, or consortia of qualified organizations and a reductioninstitutions, specializing, or demonstrating expertise, in falls; and`(6) identify an existing Web site, or establish a Web site, to serve as an information clearinghousefall prevention, may provide professional education for physicians and repository of falls researchallied health professionals, and activities being conducted by agencies, organizations, academic institutionsging service providers in fall prevention, evaluation, and related groups.management.

`(e `(c) Demonstration Projects-`(1) COLLABORATIONS BETWEEN HEALTH CARE PROVIDERS AND AGING SERVICES NETWORK-`(A) IN GENERAL- The Secretary shall omay carry out the following:

`(1) Oversee and support projects through grants, contracts, demonstration and cooperative agreements designedresearch projects to reduce the riskbe carried out by qualified organizations, institutions, or consortia of fallsqualified organizations and institutions, specializing, or injuries caused by falls,demonstrating expertise, in falls or bothfall prevention, frail older adults, emphasizing projects that foster collaboration between health care providers and the aging services network, including in the following: areas:

`(i) Demonstrations that target at-risk older adult populations, particularly those with functional limitations, to maximize their independence and quality of life. `(A) A multistate demonstration project assessing`(ii) Demonstrations that assess the effectivenessutility of clinicatargeted fall factor risk screening and management when linked to community-based programs and servicereferral programs.

`(B) Programs designed for community-dwelling older adults that support behavior change,utilize multicomponent fall intervention approaches, including physical activity, medication assessment and other appropriate interventions.reduction when possible, vision enhancement,`(iii) Demonstrations that assess the feasibility and effectiveness of offering evidence-based behavior change and physical activity interventionhome modification strategies.

`(C) Programs that address fallsre targeted to new fall victims who are at a high risk in accessible non-medical settings, with linkagesfor second falls and which are designed to health care providers.maximize independence and quality of life for older adults, particularly those older adults with functional limitations.

`(iv `(D) Private sector and public-private partnerships to develop technologyies to prevent falls among older adults and prevent or reduce injuries if falls occur, including technology designed.

`(2)(A) Award grants, contracts, or cooperative agreements to measure, assess, and rate the tractionqualified organizations, institutions, or consortia of consumer flooring materials, floor polishes,qualified organizations and walkway agents.institutions, specializing, or demonstrating expertise, in falls or fall prevention, to design, implement, and evaluate fall prevention programs using proven intervention strategies in residential and institutional settings.

`(B) EVALUATIONS- The Secretary shall award oneAward 1 or more grants, contracts, or cooperative agreements to a1 or more qualified research organizationorganizations, institutions, or university, as determined by the Secretary, to conduct evaluations of the effectivenessconsortia of the demonstration projects described in subparagraph (A).qualified organizations`(2) COLLABORATIONS BETWEEN HEALTH CARE PROVIDERS AND RESIDENTIAL AND INSTITUTIONAL SETTINGS-`(A) IN GENERAL- The Secretary shall oversee and support demonstration projects designed to reduce the risk of fallsinstitutions, specializing, or injuries caused by falls,demonstrating expertise, in falls or bothfall prevention, in frail older adults, emphasizing projects that foster collaboration between health care providers and residential and institutional settings, including the following:order to carry out a multis`(i) A multi-State demonstration project to implement and evaluate fall prevention programs using proven intervention strategies designed for single and multifamily residential settings with high concentrations appropriate at-risk populations of of older adults, including--

`(i) identifying high-risk populations;

`(ii) evaluating residential facilities;

`(iii) conducting screening to maximize independenceidentify high-risk individuals;

`(iv) providing fall assessment and quality of life, particularly thoserisk reduction interventions and counseling;

`(v) coordinating services with functional limitations. For purposes of carrying out such project, the Secretary shall award onehealth care and social service providers; and

`(vi) coordinating post-fall treatment and rehabilitation.

`(3) Award 1 or more grants, contracts, or cooperative agreements one or more to qualified organizations, institutions, or consortia of qualified organizations and institutions., specializing, or demonstrating expertise, in falls or fall prevention, to conduct evaluations of`(ii) Demonstration projects that assess the effectiveness clinical risk factor screening and management and that is integrated with of the Aging Services Network of residential programs and services capable of providing long-range supportive environments and activity programsdemonstration projects described in this subsection.

`(d) Priority- In awarding grants, contracts, or cooperative agreements under this section, the Secretary may give priority to affect behavior change and falls risk.entitie`(iii) Evidence-based, residential and institutional programs that promotexplore the adoptionuse of healthy behaviors and enhanced physical activity level, and that address other appropriate risk factorscost-sharing with respect to reduceactivities funded under the risk of falls.grant, contract`(iv) Private sector and public-private partnerships to develop technology to prevent falls among older adults and prevent or reduce injuries if falls occur.`(B) EVALUATIONS- The Secretary shall award one or more grants, contracts, or cooperative agreementsagreement to a qualified research organization or university, as determined byensure the Secretary, to conduct evaluationsinstitutional commitment of the effectivenesrecipients of such assistance to demonstration the projects describedfunded under the grant, contract, or agreement. Such non-Federal cost sharing contributions may be provided directly or through donations from public or private entities and may be in subparagraph (A).cash or in-kind, fairly evaluated, including plant, equipment, or services.

`(f `(e) Study of Effects of Falls on Health Care Costs-

`(1) IN GENERAL- The Secretary shallmay 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- NIf the Secretary conducts the review under paragraph (1), the Secretary shall, not later than 36 months after the date the of enactment of the KeepingSafety of Safe From Falls Seniors Act of 2007, the Secretary shall8, submit to Congress a report describing the findings of the Secretary in conducting such review.'.

Union Calendar No. 351

110th CONGRESS

2d Session

H. R. 3701

[Report No. 110-569]

A BILL

To amend the review under paragraph (1).Public Health Service Act to direct`(g) Authorization of Appropriations- For the purposeSecretary of carrying out this section, there is authorizedHealth and Human Services to be appropriated $35,000,000 for eachintensify programs with respect to research and related activities concerning falls among older adults.

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April 8, 2008

Reported with an amendment, committed to the Committee of the fiscal years 2008 through 2011.'.Whole House on the State of the Union, and ordered to be printed