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                                                        Calendar No. 99
110th Congress                                                   Report
                                 SENATE
 1st Session                                                    110-110

======================================================================



 
                     SAFETY OF SENIORS ACT OF 2007

                                _______
                                

                 June 28, 2007.--Ordered to be printed

                                _______
                                

   Mr. Kennedy, from the Committee on Health, Education, Labor, and 
                   Pensions, submitted the following

                              R E P O R T

                         [To accompany S. 845]

    The Committee on Health, Education, Labor, and Pensions, to 
which was referred the bill (S. 845) to direct the Secretary of 
Health and Human Services (HHS) 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 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..........................3
  V. Cost estimate....................................................4
 VI. Regulatory impact statement......................................5
VII. Application of law to the legislative branch.....................5
VIII.Section-by-section analysis......................................5

 IX. Changes in existing law..........................................6

                  I. Purpose and Need for Legislation

    The purpose of ``Safety of Seniors Act of 2007'' is to 
direct the Secretary of Health and Human Services (HHS) to 
enhance programs with respect to research and related 
activities concerning elder falls. In older Americans, falling 
is the leading cause of injury and death. According to the 
Centers for Disease Control and Prevention (CDC), falls among 
older adults and traumatic brain injuries cost the United 
States an estimated 80 billion dollars in 2000.
    More than \1/3\ of adults aged 65 and older fall each year. 
According to the CDC, in 2002, more than 12,800 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. Hospital admissions for hip 
fractures among the elderly have increased from 321,000 
admissions in 1988 to 327,000 in 2001. Annually, more than 
80,000 individuals who are over 65 years of age sustain a TBI 
as a result of a fall.
    In addition to their effect on the quality of life of 
seniors and their families, falls also have an impact on 
healthcare costs due to increased physician visits, emergency 
room use and hospitalization. According to the CDC, the direct 
medical cost totaled $179 million dollars for fatal and $19 
billion dollars for nonfatal fall injuries in 2000.
    To address the impact of falls on seniors, their families, 
and healthcare costs, the Safety of Seniors Act of 2007 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) Enhancing 
services and conducting research to determine the most 
effective approaches to preventing and treating falls among 
older adults; and (3) Urging the Secretary of Health and Human 
Services (HHS) to evaluate the effect of falls on healthcare 
costs, the potential for reducing falls, and the most effective 
strategies for reducing healthcare costs associated with falls.

                              II. Summary

    The purpose of this legislation is to enhance and improve 
programs that authorize activities to reduce falls among the 
elderly.
    Specifically, the legislation directs the Department of 
Health and Human Services (HHS) to:
    (1) Develop public education programs on fall prevention 
for the elderly, family members, caregivers, and others 
involved with the elderly.
    (2) Enhance services and conduct research to determine the 
most effective approaches to preventing and treating falls 
among older adults; and
    (3) Evaluate the effect of falls on health care costs, the 
potential for reducing falls, and the most effective strategies 
for reducing healthcare costs associated with falls.

           III. History of Legislation and Votes in Committee

    On March 29, 2007 the Committee considered and approved a 
manager's amendment to S. 845. Senators Mikulski and Enzi 
cosponsored the manager's amendment. Senators Kennedy, Hatch 
and Kohl also sponsored S. 845.
    During the 110th Congress, S. 845, The Safety of Seniors 
Act of 2007 was introduced by Senator Enzi for himself and 
Senator Mikulski on March 12, 2007. Senators Kennedy and Hatch 
cosponsored the bill.
    The legislation was first introduced during the 107th 
Congress, on February 7, 2002, by Senator Hutchinson, for 
himself and Senators Mikulski and Enzi, as S. 1922. 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.
    The bill was reintroduced as S. 1217 during the 108th 
Congress on June 9, 2003, by Senator Enzi, for himself and 
Senator Mikulski. 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.
    During the 109th Congress, the bill was introduced as S. 
1531, The Keeping Seniors Safe from Falls Act by Senator Enzi 
for himself and Senator Mikulski on July 28, 2005. Senators 
Baucus, Dole, Grassley, Cochran, Durbin, Isakson and Murray 
cosponsored the bill. On September 20, 2006, the Committee 
considered and unanimously approved a manager's amendment to S. 
1531. S. 1531, the Keeping Seniors Safe from Falls Act and 
Reauthorization of Traumatic Brain Injury Act was a combination 
of two bills--The Keeping Seniors Safe from Falls Act and the 
Traumatic Brain Injury Reauthorization. Senators Mikulski, 
Hatch, Kennedy, DeWine, Murray, and Isakson cosponsored the 
manager's amendment.

              IV. Explanation of Bill and Committee Views

    The Keeping Seniors Safe from Falls Act of 2007 encourages 
the Secretary of HHS to enhance the Department's efforts to 
prevent and treat injuries. The legislation focuses on reducing 
and preventing falls among older adults. The committee-reported 
bill would increase funding for elder falls programs 
administered by the Centers for Disease Control and Prevention 
(CDC).
    The legislation 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 directs the 
Secretary to carry out his authority through agencies, such as 
the CDC and its National Center for Injury Prevention and 
Control (NCIPC), 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. 
HHS 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 with 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.
    The committee reported bill raises the authorization of 
appropriations level for Part J--Prevention and Control of 
Activities, which is the authorization of appropriations line 
for injury prevention activities, including Elder Falls 
Activities, from $50 million to $58,361,000 for fiscal year 
2008 and such sums from 2009-2010. The increase is to meet the 
level appropriated by appropriators in fiscal year 2007, not to 
authorize new money.
    CDC is the lead Federal agency for injury prevention and 
control, and its programs are designed to prevent premature 
death and disability and reduce human suffering and medical 
costs caused by elder falls. Funds are utilized for both 
intramural and extramural research as well as assisting State 
and local health agencies in implementing injury prevention 
programs. The committee recognizes the vital role CDC serves as 
a focal point for all Federal injury control activities.
    The committee also recognizes that falls are not only the 
leading cause of injury deaths among Americans over the age of 
65, but also cost an estimated $19 billion annually in direct 
medical costs. The committee further recognizes that falls 
among the elderly are preventable through proven public health 
community interventions. As more of our citizens grow older, 
the committee continues to be concerned that falls among the 
elderly are becoming a major public health issue and that falls 
prevention efforts are limited due to lack of resources. The 
committee recognizes the need for Federal resources that would 
be allocated to support falls prevention activities to prevent 
premature death and disability and reduce human suffering and 
medical costs caused by falls.

                            V. Cost Estimate


S. 845--Safety of Seniors Act of 2007

    S. 845 would modify the Public Health Service Act to 
authorize funding for programs to detect, prevent, and treat 
injuries. The bill would also direct the Secretary of Health 
and Human Services (HHS) to undertake research, education, and 
other activities aimed at reducing the extent and effect of 
falls among older adults.
    S. 845 would authorize the appropriation of $58.4 million 
for 2008 and such sums as may be necessary for fiscal years 
2009 and 2010 for the specified activities. Assuming that the 
costs in 2009 and 2010 would be equal to the 2008 authorization 
adjusted for inflation, CBO estimates that HHS would require 
$178 million in budget authority to carry out those activities 
over the 2008-2010 period. Based on historical spending 
patterns for similar activities, and assuming appropriation of 
the authorized amounts, CBO estimates that implementing S. 845 
would cost $22 million in 2008 and $172 million over the 2008-
2012 period. Enacting S. 845 would not affect direct spending 
or receipts.
    S. 845 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act. State, 
local, and tribal governments could benefit from grants and 
other assistance programs authorized by the bill.
    The estimated budgetary impact of S. 845 is shown in the 
following table. The costs of this legislation fall within 
budget function 550 (health).

----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2007    2008    2009    2010    2011    2012
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATIONS

Estimated Authorization Level...................................       0      58      59      61       0       0
Estimated Outlays...............................................       0      22      48      56      36      10
----------------------------------------------------------------------------------------------------------------

    The costs of this bill to the federal government were 
estimated by Tim Gronniger. The intergovernmental and private-
sector impacts were analyzed by Leo Lex and Paige Shevlin, 
respectively. This estimate was approved by Robert A. Sunshine, 
Assistant Director for Budget Analysis.

                    VI. Regulatory Impact Statement

    Pursuant to the requirements of paragraph 11(b) of rule 
XXVI of the Standing Rules of the Senate, the committee has 
determined that the bill will not have a significant regulatory 
impact.

           VII. Application of Law to the Legislative Branch

    The committee has determined there is no impact of this law 
on the legislative branch.

                   VIII. Section-by-Section Analysis


Section 1. Short Title

    Section 1 provides the short title of the bill, the 
``Safety of Seniors Act of 2007''.

Section 2. Amendments to the Public Health Service Act

    Section 2 amends part J of Title III of the Public Health 
Service Act to add a new section 393 D, Prevention of Falls 
Among Older Adults.
    Subsection (a) authorizes the Secretary of the Department 
of Health and Human Services (HHS) to establish a national 
public education campaign to reduce falls among older adults 
and prevent repeat falls. It also establishes authority for the 
Secretary of HHS to make grants or enter into contracts or 
cooperative agreements to assist State-level coalitions in 
conducting local education campaigns to reduce falls and 
prevent repeat falls among older adults.
    Subsection (b) authorizes the Secretary of 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 among older 
adults; tailoring proven fall reduction strategies to specific 
populations of older adults; improving diagnosis, treatment, 
and rehabilitation of older adults who have fallen and those at 
high risk for falls; and assessing the risk of falls occurring 
in various settings.
    This subsection authorizes the HHS Secretary to conduct 
research concerning barriers to adopting proven fall prevention 
methods; developing, implementing, and evaluating the most 
effective approaches to reducing falls among high-risk older 
adults living in community settings, including long-term care 
and assisted living facilities; and evaluating the 
effectiveness of community programs designed to prevent falls 
among older adults. It also authorizes the HHS Secretary to 
make grants or enter into contracts or cooperative agreements 
to provide professional education for physicians, allied health 
professionals, and aging service providers in fall prevention, 
evaluation, and management.
    Subsection (c) authorizes the Secretary of HHS to oversee 
and support demonstration programs carried out by qualified 
organizations, institutions, or a consortium of qualified 
organizations to conduct the following--
          a multistate demonstration project assessing 
        the utility of targeted fall risk screening and 
        referral programs;
          programs that use multiple approaches to 
        prevent falls;
          programs targeting newly discharged fall 
        victims at high risk for second falls; and
          private sector and public-private 
        partnerships to develop technology to prevent falls and 
        prevent or reduce fall-related injuries.
    The Secretary of HHS is authorized to award grants, 
contracts, or cooperative agreements to design, implement, and 
evaluate fall prevention programs using proven intervention 
strategies in residential and institutional settings; and, to 
carry out a multistate demonstration project to implement and 
evaluate fall prevention programs using these strategies for 
single and multifamily residences with high concentrations of 
older adults.
    This subsection also authorizes the HHS Secretary to award 
grants, contracts, or cooperative agreements to conduct 
evaluations of the effectiveness of the demonstration projects 
in this subsection.
    Subsection (d) authorizes the HHS Secretary to review the 
effects of falls on health care costs, the potential for 
reducing falls, and the most effective strategies for reducing 
fall-related health care costs. If such review is conducted, 
the Secretary is required to submit to Congress describing the 
findings. The report must be submitted no later than 36 months 
after the date of the bill's enactment.

Section 3. Authorization of Appropriations

    Section 3 authorizes the appropriation of $58,361,000 for 
fiscal year 2008 and such sums as may be necessary for fiscal 
years 2009 and 2010.

                      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. (a) The Secretary, through the Director of the 
Centers for Disease Control and Prevention, shall--
          (1) * * *

           *       *       *       *       *       *       *

    (d) * * *

         NATIONAL PROGRAM FOR TRAUMATIC BRAIN INJURY REGISTRIES

    Sec. 393B. (a) 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--
          (1) demographic information about each traumatic 
        brain injury;
          (2) information about the circumstances surrounding 
        the injury event associated with each traumatic brain 
        injury;
          (3) administrative information about the source of 
        the collected information, dates of hospitalization and 
        treatment, and the date of injury; and
          (4) information characterizing the clinical aspects 
        of the traumatic brain injury, including the severity 
        of the injury, outcomes of the injury, the types of 
        treatments received, and the types of services 
        utilized.

[SEC. 393B.] SEC. 393C. USE OF ALLOTMENTS FOR RAPE PREVENTION 
                    EDUCATION.

    (a) Permitted Use.--The Secretary, acting through the 
National Center for Injury Prevention and Control at the 
Centers for Disease Control and Prevention, shall award 
targeted grants to States to be used for rape prevention and 
education programs conducted by rape crisis centers, State 
sexual assault coalitions, and or public and private nonprofit 
entities for--
          (1) educational seminars;

           *       *       *       *       *       *       *


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

    (a) Public Education.--The Secretary may--
          (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.
    (b) Research.--
          (1) In general.--The Secretary may--
                  (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 older adults 
                        at high risk for falls; 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 communities and long-term care and 
                assisted living facilities; and
                  (D) evaluate the effectiveness of community 
                programs designed to prevent 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, may provide professional education 
        for physicians and allied health professionals, and 
        aging service providers in fall prevention, evaluation, 
        and management.
    (c) Demonstration Projects.--The Secretary may 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 new 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 technologies 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 
        and institutions, in order to carry out a multistate 
        demonstration project to implement and evaluate fall 
        prevention programs using proven intervention 
        strategies designed for single and 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 fall assessment and risk 
                reduction interventions and counseling;
                  (v) coordinating services with health care 
                and social ser-
                vice 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.
    (d) Study of Effects of Falls on Health Care Costs.--
          (1) In general.--The Secretary may 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.--If the Secretary conducts the review 
        under paragraph (1), the Secretary shall, not later 
        than 36 months after the date of enactment of the 
        Safety of Seniors Act of 2007, submit to Congress a 
        report describing the findings of the Secretary in 
        conducting such review.

           *       *       *       *       *       *       *


                           GENERAL PROVISIONS

    Sec. 394. (a) The Secretary, acting through the Director of 
the Centers for Disease Control and Prevention, shall establish 
an advisory committee to advise the Secretary and such Director 
with respect to the prevention and control of injuries.

           *       *       *       *       *       *       *


                    AUTHORIZATIONS OF APPROPRIATIONS

    Sec. 394A. For the purpose of carrying out this part, there 
are authorized to be appropriated [$50,000,000 for fiscal year 
1994, and \1\ such sums as may be necessary for each of the 
fiscal years 1995 through 1998, and such sums as may be 
necessary for each of the fiscal years 2001 through 2005.] 
$58,361,000 for fiscal year 2008, and such sums as may be 
necessary for each of fiscal years 2009 and 2010.

           *       *       *       *       *       *       *