39–010 

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 

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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 

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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. 

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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 Level ................................................................... 4,656 4,730 4,825 4,926 5,039 

Estimated Outlays ...................................................................................... 4,462 4,553 4,688 4,830 4,931 

Proposed Changes: 

Estimated Authorization Level ................................................................... 3 3 3 3 3 

Estimated Outlays ...................................................................................... 1 2 3 3 3 

CDC Spending Under S. 1217: 

Estimated Authorization Level ................................................................... 4,659 4,733 4,828 4,929 5,042 

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. 

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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 statelevel 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 

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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 ø280b¿ (a) * * * 

* * * * * * * 

NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY REGISTRIES

SEC. ø393B.¿ 393C. ø280b–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— 

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(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 highrisk 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. 

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(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). 

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