[House Report 110-569]
[From the U.S. Government Publishing Office]
110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-569
======================================================================
SAFETY OF SENIORS ACT OF 2008
_______
April 8, 2008.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Dingell, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 3701]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 3701) 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, having considered the
same, report favorably thereon with an amendment and recommend
that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 1
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 8
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Safety of Seniors Act of 2008''.
SEC. 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 redesignated by
paragraph (1)) the following:
``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, 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 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, specializing, or
demonstrating expertise, in falls or fall prevention, 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,
specializing, or demonstrating expertise, in falls or fall
prevention, 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, 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) Award 1 or more grants, contracts, or cooperative
agreements to 1 or more qualified organizations, institutions,
or consortia of qualified organizations and institutions,
specializing, or demonstrating expertise, in falls or fall
prevention, 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 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,
specializing, or demonstrating expertise, in falls or fall
prevention, to conduct evaluations of the effectiveness of the
demonstration projects described in this subsection.
``(d) Priority.--In awarding grants, contracts, or cooperative
agreements under this section, the Secretary may give priority to
entities that explore the use of cost-sharing with respect to
activities funded under the grant, contract, or agreement to ensure the
institutional commitment of the recipients of such assistance to the
projects funded 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 cash or in-
kind, fairly evaluated, including plant, equipment, or services.
``(e) 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
2008, submit to Congress a report describing the findings of
the Secretary in conducting such review.''.
Purpose and Summary
The purpose of H.R. 3701, the ``Safety of Seniors Act of
2008'', is to amend the Public Health Service Act to direct the
Secretary of Health and Human Services (HHS) to expand programs
with respect to research and related activities concerning
falls among older adults.
Background and Need for Legislation
Falls represent a serious health risk for millions of older
Americans. In the United States, one of every three persons age
65 or older falls each year. Falls are the leading cause of
injury deaths and the most common cause of injuries and
hospital admissions for trauma in older adults. According to
the Centers for Disease Control and Prevention (CDC), in 2002,
more than 12,800 people aged 65 and older died from fall-
related injuries and more than 1.6 million seniors were treated
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 traumatic brain injury as a result of a fall.
In addition to their effect on the quality of life of
seniors and their families, falls also contribute to rising
healthcare costs due to increased physician visits, emergency
room use, and hospitalization. According to the CDC, the direct
medical cost totaled $179 million for fatal and $19 billion for
nonfatal fall injuries in 2000.
To address the effect of falls on seniors, their families,
and healthcare costs, H.R. 3701 would focus ongoing Federal
efforts to prevent falls among older adults by developing a
national education campaign to reduce falls among older adults,
by enhancing services and conducting research to determine the
most effective approaches to preventing and treating falls
among older adults, and by urging the Secretary of 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.
Hearings
There were no hearings held in connection to the bill
reported by the Committee.
Committee Consideration
Tuesday, March 11, 2008, the Subcommittee on Health met in
open markup session and favorably forwarded H.R. 3701, amended,
to the full Committee for consideration, by a voice vote. On
Thursday, March 13, 2008, the full Committee met in open markup
session and ordered H.R. 3701 favorably reported to the House,
as amended by the Subcommittee on Health, by a voice vote. No
amendments were offered during full Committee consideration.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 3701 reported to the House. A motion by Mr.
Dingell to order H.R. 3701 favorably reported to the House, as
amended, was agreed to by a voice vote.
Committee Oversight Findings
Regarding clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the oversight findings of the
Committee regarding H.R. 3701 are reflected in this report.
Statement of General Performance Goals and Objectives
The objective of H.R. 3701 is to amend the Public Health
Service Act to authorize the Secretary of HHS to oversee and
support a national education campaign focusing on reducing
falls among older adults and preventing repeat falls and to
award grants, contracts, or cooperative agreements to design
and carry out local education campaigns. Specifically, the
legislation directs 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 healthcare costs, the
potential for reducing falls, and the most effective strategies
for reducing healthcare costs associated with falls.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Regarding compliance with clause 3(c)(2) of rule XIII of
the Rules of the House of Representatives, the Committee finds
that H.R. 3701 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Earmarks and Tax and Tariff Benefits
Regarding compliance with clause 9 of rule XXI of the Rules
of the House of Representatives, H.R. 3701 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
3701 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate on
H.R. 3701 provided by the Congressional Budget Office pursuant
to section 402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, April 4, 2008.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 3701, the Safety
of Seniors Act of 2008.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Mindy Cohen.
Sincerely,
Robert A. Sunshine
(For Peter R. Orszag, Director).
Enclosure.
H.R. 3701--Safety of Seniors Act of 2008
H.R. 3701 would modify the Public Health Service Act to
authorize funding for programs to detect, prevent, and treat
injuries due to falls among older adults. The bill would also
direct the Secretary of Health and Human Services and the
Centers for Disease Control and Prevention to undertake
research, education, and other activities aimed at reducing the
extent and effect of falls among older adults.
Based on historical spending patterns for similar
activities, CBO estimates that implementing H.R. 3701 would
cost $1 million in 2009 and $13 million over the 2009-2013
period, assuming the availability of appropriated funds.
Enacting H.R. 3701 would not affect direct spending or
receipts.
H.R. 3701 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act.
The estimated budgetary impact of H.R. 3701 is shown in the
following table. The costs of this legislation fall within
budget function 550 (health).
------------------------------------------------------------------------
By fiscal year, in millions of
dollars--
---------------------------------------
2009 2010 2011 2012 2013
------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level... 3 3 3 3 3
Estimated Outlays............... 1 3 3 3 3
------------------------------------------------------------------------
The CBO staff contacts for this estimate are Tim Gronniger
and Mindy Cohen. This estimate was approved by Keith J.
Fontenot, Deputy Assistant Director for Health and Human
Resources, Budget Analysis Division.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 3701 prepared by the Director of the
Congressional Budget Office pursuant to section 423 of the
Unfunded Mandates Reform Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
3701.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 3701 is provided in the
provisions of Article I, section 8, clause 1, that relate to
expending funds to provide for the general welfare of the
United States.
Applicability to Legislative Branch
The Committee finds that H.R. 3701 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act of 1995.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 establishes the short title of the Act as the
``Safety of Seniors Act of 2008''.
Section 2. Amendments to the Public Health Service Act
Section 2 of this legislation amends Part J of title III of
the Public Health Service Act (42 U.S.C. 280b et seq.) to add a
new section 393D, Prevention of Falls Among Older Adults.
Section 2 authorizes the Secretary of 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.
Section 2 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.
Section 2 authorizes the Secretary of HHS 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 Secretary of HHS 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.
Section 2 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 (1) a multistate
demonstration project assessing the utility of targeted fall-
risk screening and referral programs; (2) programs that use
multiple approaches to prevent falls; (3) programs targeting
newly discharged fall victims at high risk for second falls;
and (4) private sector and public-private partnerships to
develop technology to prevent falls and prevent or reduce fall-
related injuries.
Section 2 authorizes the Secretary of HHS 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 section also authorizes the Secretary of HHS
to award grants, contracts, or cooperative agreements to
conduct evaluations of the effectiveness of the demonstration
projects in this section.
Section 2 authorizes the Secretary of HHS to review the
effects of falls on healthcare costs, the potential for
reducing falls, and the most effective strategies for reducing
fall-related healthcare costs. If such review is conducted, the
Secretary is required to submit a report to Congress describing
the findings. The report must be submitted no later than 36
months after the date of the bill's enactment.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (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
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part J--Prevention and Control of Injuries
* * * * * * *
SEC. [393B.] 393C. USE OF ALLOTMENTS FOR RAPE PREVENTION EDUCATION.
(a) * * *
* * * * * * *
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,
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 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, specializing, or demonstrating
expertise, in falls or fall prevention, 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, specializing, or demonstrating
expertise, in falls or fall prevention, 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,
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) Award 1 or more grants, contracts, or cooperative
agreements to 1 or more qualified organizations,
institutions, or consortia of qualified organizations
and institutions, specializing, or demonstrating
expertise, in falls or fall prevention, 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 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,
specializing, or demonstrating expertise, in falls or
fall prevention, to conduct evaluations of the
effectiveness of the demonstration projects described
in this subsection.
(d) Priority.--In awarding grants, contracts, or cooperative
agreements under this section, the Secretary may give priority
to entities that explore the use of cost-sharing with respect
to activities funded under the grant, contract, or agreement to
ensure the institutional commitment of the recipients of such
assistance to the projects funded 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 cash or in-kind, fairly evaluated,
including plant, equipment, or services.
(e) 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 2008, submit to Congress a
report describing the findings of the Secretary in
conducting such review.
* * * * * * *