Elderly Falls Prevention Legislation and Statutes

2/26/2021

elderly man

Each year, millions of older adults—those 65 and older—fall. According to the Centers for Disease Control and Prevention (CDC), each year 3 million older people are treated in emergency departments for fall injuries, and over 800,000 patients a year are hospitalized because of a fall injury.

Falls represent a substantial financial cost and with the aging of the U.S. population, the resulting expenditures are expected to increase substantially if more is not done to prevent falls. 

  • In 2015, total medical costs to treat older adult falls exceeded $50 billion, of this total amount, medical costs for fatal falls accounted for $750 million.
  • For nonfatal falls, Medicare and Medicaid shouldered 75% of the financial burden of medical costs, which totaled $38 billion for the two programs. 
  • Medicare spent approximately $29 billion on falls (constituting 6 percent of all Medicare spending for older adults). Medicaid spent $9 billion on falls (8 percent of all Medicaid spending for older adults). 
  • Fall-related expenses for private and other payers totaled $12 billion (5 percent of their total older adult spending). 

Injuries associated with falls also typically diminish older adults’ mobility, which can, in turn, reduce their ability to live independently and require care in a nursing home or help with daily activities (e.g., bathing, dressing or other household tasks). Preventing falls can help reduce Medicaid costs for institutional and home and community-based long-term services and supports. Furthermore, older adults who suffer a fall are twice as likely to experience a subsequent fall, further increasing the likelihood they will require long-term services and supports such as nursing facility services.

Multiple evidence-based programs exist to prevent falls among older adults. The programs vary by focus (e.g., physical mobility, medication management, home modifications), target population (e.g., the older adult, their caregivers, health care providers) and setting (e.g., home, hospital, nursing home). It is unclear where most falls occur and how much home and environment play a role, but some studies estimate that 30% to 50% of falls for older adults in community settings are due to environmental factors like poor lighting or uneven surfaces.

elderly falls 50-state map ncsl

deaths from falling 50-state map ncsl

Preventing Falls

Falls are not an inevitable part of aging and are largely preventable. The Centers for Disease Control and Prevention has developed a fall prevention tool kit for health care providers called STEADI (Stopping Elderly Accidents, Deaths and Injuries) to help them reduce falls by implementing the American Geriatrics Society’s clinical guideline for fall prevention.

Some strategies to reduce falls include:

  • Providing incentives to primary care providers to integrate falls risk assessment and fall prevention activities into their practice.
  • Supporting continuing medical education courses or trainings that teach health care providers how to assess and reduce the risk of falls through treatment and/or referral to evidence-based fall prevention programs.
  • Encouraging the concept of “aging in place” by providing support home modifications intended to keep seniors safely in their homes and reduce the risk of falling.
  • Facilitating better medication management to prevent falls

Preventing Falls Through Home Safety

With falls being the number one leading cause of fatal and nonfatal injury for people over the age of 65, addressing potential hazards in the home that increase the risk of falls is one strategy state policymakers can pursue to help reduce falls, improve health outcomes and decrease health costs. The National Council on Aging (NCOA), in collaboration with stakeholders and experts, developed the 2015 Falls Free National Action Plan for strategies to reduce the growing number of falls and fall-related injuries among older adults. The plan includes 12 broad goals, including a specific goal related to home safety. Strategies for improving home safety including raising awareness, identifying funding sources for home assessments and modifications, as well as supporting consumer adoption of those home modifications.

As people age, many find their homes do not have the necessary features to help them live independently and safely. Hazards within the home posing a fall risk include loose rugs, inadequate lighting, unstable furniture, and obstructed walkways. Interventions can range from simple to complex modifications, including the installation of better lighting, grab bars in the shower, or modifications to allow for a wheelchair.

Many older adults do not have the financial means to modify their homes, particularly as other costs for health care rise as people age. The Bipartisan Policy Center projects that over the next 20 years, nearly 40% of older adults over age 62 will have financial assets of $25,000 or less, and 20% will have assets of less than $5,000. When home assessments and modifications may be unaffordable for older adults, Medicare and Medicaid provide potential funding options. Home assessments and modifications, when paired with other supports, can help individuals remain in their homes and active in their communities, potentially avoiding the need for costlier institutional home settings like nursing facilities. Medicare now covers payment for home modifications for people who are chronically ill when there is a reasonable expectation of improving health or overall individual functioning.

Medicaid also provides options to cover the cost of home assessments and modifications. Home and Community-Based Services (HCBS) waivers provide states with the opportunity to assess homes for safety hazards and make necessary modifications. Most states cover home modifications using HCBS waivers, including installing ramps and grab-bars, home control units such as adaptive switches for lighting, bathroom modifications and widening of doorways. Some states have a dollar limit on home modifications, such as Colorado, which allows for up to $14,000 over the course of a person’s lifetime.

Another Medicaid waiver option states may use to support fall prevention strategies includes Section 1115 waivers. Section 1115 waivers allow states to waive certain Medicaid requirements in order to design experimental or demonstration programs to meet their state’s needs. For example, Maine uses an 1115 waiver to cover home modifications as well as an exercise program called Matter of Balance, a nationally recognized fall prevention program that helps to reduce fear of falling and increase activity levels in older adults.

State Action

In an effort to prevent and reduce falls, states have adopted legislation that includes supporting older adults in their homes, communities and clinical settings. For example, California enacted SB 280 in 2019 requiring the state’s Department of Housing and Community Development to investigate possible changes to building standards to promote aging in place design, including installation of grab bars.  The California legislation allows the department to incorporate changes to the residential code if the requirements do not significantly increase the cost of construction.

States have taken various other legislative actions to prevent falls. ConnecticutNew MexicoNew York and Washington established statewide fall prevention programs dedicated to raising awareness and providing resources to older adults. Similarly, some states, such as Utah, established fall prevention commissions or workgroups to develop recommendations for preventing falls. Minnesota requires unlicensed personnel in assisted living facilities to complete fall prevention training, and  Washington requires long-term care workers to complete core competency training, which includes fall prevention training.

According to a 2019 report from the US Senate Select Committee on Aging, cross-cutting interventions that include multiple facets such as education and awareness, physical mobility and addressing home safety increase the effectiveness of the interventions. State policymakers can consider these cross-cutting interventions and use them to create or modify statewide initiatives to reduce falls, improve health outcomes and reduce health costs.

Check out NCSL’s Injury Prevention Database to search state legislation related to older adults falls from 2015 to present. Visit the injury and violence prevention overview page to learn about other topics and additional resources.

Legislation

Below is a list of enacted legislation through 2014 that addresses falls among older adults. To view current state actions related to falls, and other injury and violence prevention topics, please visit NCSL's Injury and Violence Prevention Legislation Database.

Legislation Through 2014

State

Session Law and Statute Information

California

Cal. Health and Safety Code §125704 (California Osteoporosis Prevention and Education Act) requires the department of health services to develop effective protocols for the prevention of falls and fractures and establish these protocols in community practice to improve the prevention and management of osteoporosis.

Cal. Welfare and Institutions Code §9450 Requires the development of the "aging in place" concept be recognized and supported by the state as a means to retaining elders in their home with less injury. Requires that funding for education and making home improvements be facilitated through public and private sources. Requires that recommendations for changes in home modification policies and information for home modification projects and products be developed.

Connecticut

Conn. Gen. Stat. §17b-33 Establishes a fall prevention program within the department of social services that: supports research, development and evaluation of risk identification and intervention strategies; establishes a professional education program in fall prevention; and oversees and supports demonstration and research projects.

Florida

Fl. Stat. § 944.804 Requires the department of corrections to establish and operate a geriatric facility where generally healthy elderly offenders can perform general work appropriate for their physical and mental condition in order to decrease the likelihood of falls, accidental injury and other conditions known to be particularly hazardous to the elderly.

Hawaii

Hawaii Rev. Stat. § 321-225.5 Establishes a fall prevention and early detection coordinator within the Department of Health's Emergency Medical Services and Injury Prevention System Branch responsible for coordinating provision of public and private services that focus on fall prevention and early detection for older adults.

Maine 2005 House Bill 1214 Promotes research designed to develop, implement and evaluate the most effective approaches to reducing and treating falls among high-risk older adults. Educates health care professionals and providers about fall prevention, evaluation and management and oversees and supports demonstration projects designed to prevent falls among older adults.

Massachusetts

Mass. Gen. Laws Ann. ch. 111, §224 Establishes a commission on falls prevention within the department of public health.
Minnesota 2013 Minn. Laws, Chap. 108 Establishes requirements for instructors, training content, and competency evaluations for unlicensed personnel. This training includes the prevention of falls for providers working with the elderly or individuals at risk of falls. (2013 House Bill 1233/Senate Bill 1034)
New Mexico

New Mexico Stat., Ch. 37, § 1, 24-1-36 (2014 HB 99) Establishes a statewide and community-based older adult fall risk awareness and prevention program.

New Jersey Assembly Joint Resolution 52 Designates the third full week of September in each year as Fall Prevention Awareness Week.
Oregon Or. Rev. Stat. §410.420 Requires funds appropriated through Oregon Project Independence to be used for services to support community care givers and strengthen the natural support systems for seniors including fall prevention activities.

Texas

Tex. Human Resources Code Ann.  §161.351-3 Establishes "Fall Prevention Awareness Week." Allows the state's department of aging and disability services to develop recommendations to: raise public awareness about fall prevention; educate older adults and individuals who provide care to older adults about best practices to reduce the incidence and risk of falls among older adults; encourage state and local governments and the private sector to promote policies and programs that help reduce the incidence and risk of falls among older adults; encourage area agencies on aging to include fall prevention education in their services; develop a system for reporting falls to improve available information on falls; and incorporate fall prevention guidelines into state and local planning documents that affect housing, transportation, parks, recreational facilities and other public facilities.

Washington

Wash. Rev. Code §43.70.705 Requires the department of social and health services to establish a statewide fall prevention program, including: networking with community services; identifying service gaps, making affordable senior-based, evaluated exercise programs more available; providing consumer education to older adults, their adult children, and the community at large; and conducting professional education on fall risk identification and reduction.

Wash. Rev. Code §74.39A.074 Requires long-term care workers to complete 70 hours of long-term care basic training on "core competencies," including fall prevention.

Additional Resources

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