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What home and/or community strategies or modifications are most important to reduce the risk of falling and how can policymakers encourage their widespread adoption? View the full forum.

By Bill Kelly

It is commonly understood that falls are the leading cause of injury among older adults. Falls cost $34 billion a year in medical costs, placing a heavy burden on Medicare, Medicaid, and seniors themselves. Medicaid covers nursing home costs for low-income seniors during the long recovery periods after hip fractures, when patients have recovered but have lost their housing, and when patients can no longer live independently.

Most falls are caused by a combination of risk factors, and it is the interaction between health-related factors (muscle weakness, poor balance and vision, medication and side effects) and physical hazards (loose scatter rugs, dim lighting) that creates the greatest risk.

SAHF members operate more than 800 senior apartment communities and serve about 60,000 seniors. Through HUD and other funding sources, they provide resident service coordination at nearly two-thirds of these properties. With adequate funding, senior communities are ideally positioned to coordinate multidimensional programming to help residents and seniors in the community maintain the independence necessary to age in place, because the residents and service coordinators know and trust one another.

As it is, SAHF members are stretching limited resources to serve as many residents as possible, using evidence-based falls prevention programming. Their continuing contact with residents makes it more possible for staff to develop a holistic sense of a resident’s risk factors—both health-related risks and physical factors—and to work with experts to mitigate them.

For example, Volunteers of America has implemented the nationally recognized Matter of Balance (MOB) falls prevention program at 10% of its senior properties, though funding constraints limit program expansion. MOB uses a variety of activities to reduce the fear of falling and increase the activity levels of older adults, and participation is associated with a $938 annual decrease in medical costs per participant.

As funding permits, Mercy Housing is implementing a Matter of Balance at their senior properties. For example, grant funding supported MOB in Arizona to serve 157 seniors at seven properties. Eighty percent of participants reported positive outcomes, including reduced fear of falling and plans to continue exercising.

Likewise, in 2015 Mercy Housing has trained and certified 31 multilingual resident service coordinators in San Francisco and Sacramento. To date, 10 properties have implemented MOB workshops in English, Cantonese, Mandarin and Russian and achieved high satisfaction and completion rates. The presence of onsite exercise classes improves participation in MOB and helps keep residents engaged. Mercy Housing also supports Tai Chi sessions to help residents better maintain and recover their balance.

Policies that could help expand the reach and impact of falls prevention programming in underserved communities include housing financing that supports community space for evidence-based interventions, design features promoting aging in place, appropriately trained resident service coordinators to expand the reach and impact of programming, reliable funding for evidence-based falls prevention programming in affordable housing settings, and Medicaid and Medicare reimbursement mechanisms that allow reimbursement for falls assessment and prevention.

Bill Kelly is a Strategic Advisor at the Stewards of Affordable Housing for the Future.


Welcome to the BPC Health and Housing Expert Forum. Each month contributors from different parts of the health and housing sectors will be invited to respond to a discussion topic. Have a question you’d like us to consider? Please leave it in the comments.

Any views expressed on this forum do not necessarily represent the views of the Senior Health and Housing Task Force, its co-chairs, or the Bipartisan Policy Center.