September 22 is not only the first day of fall, but it also marks the tenth annual Falls Prevention Awareness Day. It is a day aimed at raising awareness about fall-related injuries that send older adults to the emergency room every 11 seconds. While these injuries are common and costly for older adults, spreading effective prevention strategies continues to be a challenge. Still, some progress has been made. Policymakers in Washington are beginning to see the promise of falls prevention strategies in helping older adults age independently, remain in their homes and communities, and avoid costly medical treatments. There is a critical need to scale up these prevention efforts, and recently, several key federal policy developments are steps in that direction.
Why It’s So Important
By 2050, there are expected to be nearly 90 million older adults, aged 65 or older, in United States, or roughly twice as many as there are today. This explosive growth in the population of older adults has required a rethinking of how our policies and programs support healthy aging. Though a majority of this large and growing population of older adults have indicated they prefer to age independently in their homes and communities, this desire runs into a harsh reality. Today, most homes lack the structural features and supportive services to make aging in place a safe and viable option. One study estimated that just 3.8 percent of housing units in the United States are physically suitable for individuals with moderate mobility difficulties. Living in unsuitable housing increases the likelihood of costly and debilitating falls.
Falls are the leading cause of injuries and injury-related deaths for those 65 and older and result in annual medical costs of $50 billion. Falls threaten the independence of older adults and can lead to social isolation and further deterioration in their health. Most falls occur in and around the home and are preventable with home modifications: no-step entries; single-floor living, eliminating the need to use stairs; switches and outlets accessible at any height; extra-wide hallways and doors to accommodate walkers and wheelchairs; and lever-style door and faucet handles. Other evidence-based fall prevention strategies include providing vitamin supplements, adjusting medications, and recommending programs like Tai Chi to improve balance.
In the report Healthy Aging Begins at Home, BPC’s Senior Health and Housing Task Force—led by former HUD Secretary Henry Cisneros, former Senator and HUD Secretary Mel Martinez, former Representative Allyson Schwartz, and former Representative Vin Weber—raised the need to better target and coordinate federal resources to support home assessments, modifications, and repairs for older adults. The task force also emphasized the need to more broadly disseminate evidence-based falls prevention strategies. While there is still limited federal support to finance and pay for needed modifications, researchers continue to demonstrate the potential savings and quality-of-life improvements resulting from home modifications and other falls prevention strategies. In fact, one recent study found that a single evidence-based fall prevention intervention could prevent as many as 45,164 medically treated falls and avert up to $442 million in direct medical costs annually. Moreover, it concluded that home modifications delivered by an occupational therapist could help as many as 38.2 million older Americans.
Developments at the Federal Level
With the population of older adults rapidly growing, falls prevention efforts are taking on a greater sense of urgency. There is also clearly a lot of catching up needed to make homes and communities safer as Americans age, and to grow awareness around falls and the options available to prevent them. Importantly, there have been a handful of small victories at the federal level that point to greater recognition of the pressing need to support falls prevention.
1) New Flexibility in Medicare Advantage (MA) Plans: With passage of the Bipartisan Budget Act of 2018 and the release of a guidance letter from the Centers for Medicare and Medicaid Services (CMS), MA plans will be able to offer some new supplemental benefit options to their enrollees beginning in 2019. MA plans will have greater flexibility in targeting services to patients with multiple chronic conditions by offering coverage of nonmedical, health-related services and supports. This expanded coverage could include things like transportation assistance and minor home modifications, such as grab bars and ramps. Given the continued need to build the evidence base for the effectiveness of providing such benefits (particularly regarding their return on investment), BPC has recommended that CMS collect data on this new benefit flexibility.
2) The Senior Home Modification Assistance Initiative Act: This bipartisan legislation, S. 913, reintroduced by Sens. Angus King (I-ME), Susan Collins (R-ME), and Brian Schatz (D-HI), would create a cross-cutting initiative lead by the Department of Health and Human Services (HHS) to coordinate, review, and promote the numerous federal home modification programs and resources that are currently available. Ultimately, this legislation aims to better target and coordinate federal resources to support home assessments, modifications, and repairs for older adults. It would also help older adults better access such resources. The legislation closely aligns with recommendations released in BPC’s Senior Health and Housing Task Force report.
3) HHS Study of Home Modification Best Practices: HHS’s Administration on Community Living announced a funding opportunity designed to assess barriers to adopting home modifications and develop best practices and innovations that can be replicated by local governments and organizations.
4) Aging in Place Home Modification Grants: The Senate’s Fiscal Year 2019 Transportation, Housing and Urban Development, and Related Agencies appropriations bill includes an aging in place home modification grant program. This program would support low-cost home modifications for low-income older adults, while encouraging HUD to track the program’s effectiveness at reducing costly falls, hospitalizations, and emergency response calls.
5) HUD-VA Housing Rehab and Modification Pilot: In April 2018, the Department of Housing and Urban Development and the Department of Veterans Affairs jointly launched a pilot program to provide $13.7 million in competitive grants to nonprofit organizations that provide nationwide or statewide programs that primarily serve veterans and/or low-income individuals. The grants may be used to modify or rehabilitate eligible veterans’ primary residences, recognizing the growing need to fund home adaptations and modifications that can help veterans regain or maintain their independence. Funding for this program is included in the Fiscal Year 2019 Senate appropriations bill.
While the federal government can do more to support falls prevention efforts, these developments demonstrate the growing visibility around this issue and constitute a step in the right direction. Members of both parties in Congress and the Trump administration can find common ground in supporting evidence-based policies that prevent costly, debilitating falls. Falls Prevention Awareness Day remains an important reminder of the progress that has been made and how much more work is yet to be done around this important issue.
See if you’re prepared for healthy aging at home with our interactive checklist: https://bipartisanpolicy.org/health-and-housing-interactive/.