Report on Falls, Injuries Released

PUblished in Woonsocket Call on October 20, 2019

Last Wednesday morning in Dirksen Senate Office Building 562, the U.S. Special Committee on Aging held a hearing to put a spotlight on the economic consequences on falls and to explore ways to prevent and reduce falls and related injuries. At the one hour and 55-minute hearing, titled “Falls Prevention: National, State, and Local Level Solutions to Better Support Seniors,” its annual report, Falls Prevention: Solutions to Better Support Seniors, was released.

According to the Senate Aging Committee, falls are the leading cause of both fatal and nonfatal injuries among older adults that incur $50 billion annually in total medical costs. That number is expected to double to $100 billion by 2030, and the majority of these costs are borne by Medicare and Medicaid.

“Falls are the leading cause of fatal and non-fatal injuries for older Americans, often leading to a downward spiral with serious consequences. In addition to the physical and emotional trauma of falls, the financial toll is staggering,” said Sen. Susan Collins (R-Maine), who chairs the Senate Aging Committee. “Now is the time, and now is our opportunity, to take action to prevent falls. Our bipartisan report includes key recommendations to take steps to reduce the risk of falls,” the Maine Senator noted in an Oct. 16 statement.

Pushing for Positive Change in Releasing Fall Report

“We must dispel our loved ones of the stigma associated with falling so that they can get the help they need to age in place – where they want to be – in their homes and communities,” said Sen. Robert P. Casey, Jr. (D-Pa.). “I am hopeful that our work over the past year will propel the research community to do more, get more dollars invested into supporting home modifications and encourage more older adults to be active,” said the Special Committee’s Ranking Member.

At the hearing, the Committee unveiled a comprehensive report that provides evidence-based recommendations on ways to reduce the risk of falling. The Committee received input from multiple federal agencies, including the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, and the Food and Drug Administration. In addition, approximately 200 respondents representing falls prevention advocates, hospitals, community organizations, home health agencies, and others shared their expertise on this issue.

The 34-page Aging Committee’s report made recommendations as how to raise awareness about falls-related risks, prevention and recovery at the national, state and local levels. It suggested ways of improving screening and referrals for those at risk of falling so that individuals receive the preventive care necessary to avoid a fall or recover after one. It noted ways of targeting modifiable risk factors, including increasing the availability of resources for home safety evaluations and modifications, so that older adults can remain in their homes and communities. Finally, it called for reducing polypharmacy so that health care providers and patients are aware of any potential side effects that could contribute to a fall.

Increasing Medicare Funding for Bone Density Testing

In an opening statement, Collins noted that falls are often times attributed to uneven sidewalks or icy stairs, medications, medical reasons or muscle strength. But one key cause of falling is osteoporosis, which can be especially dangerous for people who are completely unaware that they suffer from low bone density, she says.

According to Collins, although Medicare covers bone density testing, reimbursement rates have been slashed by 70 percent since 2006, resulting in 2.3 million fewer women being tested. “As a result, it is estimated that more than 40,000 additional hip fractures occur each year, which results in nearly 10,000 additional deaths,” she said, noting legislation, Increasing Access to Osteoporosis Testing Beneficiaries Act that she has introduced with Sen. Ben Cardin,” to reverse these harmful reimbursement cuts.

Casey stated, “I am particularly interested in sharing this report with the relevant agencies and learning how the recommendations will be implemented. Not just put in a report. Implemented,” adds Casey.

Peggy Haynes, MPA, Senior Director, of Portland-based Healthy Aging, MaineHealth that offers A Matter of Balance, an evidence-based falls prevention program, came to the Senate hearing to share details about its impact. “The health care community has a critical role to play in fall prevention – beginning with screening for falls, assessing fall risk factors, reviewing medications and referring to both medical and community-based fall prevention interventions. Our health system is focused on preventing falls in every care setting,” says Haynes.

“The need for a range of community-based options led MaineHealth to be a founding member of the Evidence Based Leadership Collaborative, promoting the increased delivery of multiple evidence-based programs that improve the health and well-being of diverse populations,” adds Haynes.

Haynes noted that older participants attend eight two-hour sessions to help them reduce their fear of falling, assisting them to set realistic goals for increasing their activity and changing their home environment to reduce fall risk factors. A Matter of Balance is offered in 46 states reaching nearly 100,000 seniors.

Virginia Demby, an 84-year-old visually-impaired retired nurse who is an advocate for Community and Older Adults, in Chester, Pennsylvania, came to the Senate hearing to support the importance of fall prevention programs. Despite living with low vision, Demby remains physically active by participating in exercises classes for older adults at the Center for the Blind and Visually Impaired in Chester. She is an advocate for older adults and now helps the local senior center wellness manager recruit more seniors to take falls prevention classes and find new places to offer the classes.

Kathleen A. Cameron, MPH, Senior Director, Center for Healthy Aging, of the Arlington, Virginia-based National Council on Aging, discussed the work of the National Falls Prevention Resource Center, which helps to support evidence-based falls prevention programs across the nation and highlighted policy solutions to reduce falls risk.

Finally, Elizabeth Thompson, chief executive officer, Arlington, Virginia-based National Osteoporosis Foundation, testified that bone loss and osteoporosis are fundamental underlying contributors to the worst consequences of falls among older Americans: broken and fractured bones. Osteoporotic fractures are responsible for more hospitalizations than heart attacks, strokes and breast cancer combined, she noted.

For details of the Senate Aging Committee report, go to http://www.aging.senate.gov/imo/media/doc/SCA_Falls_Report_2019.pdf.

Lawmakers Consider Proposals to Reduce Costs of Prescription Drugs

Published in the Pawtucket Times on April 15, 2002

Amid the political bickering over the separation of powers bill and the controversy over allowing Rhode Islanders to vote next November on bringing gambling to the Ocean State, the Rhode Island General Assembly is getting around to considering three legislative proposals with broad public and bipartisan political support.

In the shadow of a huge state budget deficit, bills strongly endorsed by both senior and disabled advocates, would make pharmaceutical costs affordable while not costing the state one penny.

It was standing room only last Wednesday in Room 35 at a House Finance Committee hearing, chaired by Chairman Steven Costantino (D-Providence), of the subcommittee on human services. The legislative hearing, lasting almost four hours, drew the attention of the Rhode Island Commission on Aging, the Forum on Aging, the Gray Panthers, and Choices, to name a few.

Dozens of aging and disability advocacy groups, staffers of the Department of Elderly Affairs and the Department of Human Services, and lobbyists for the powerful pharmaceutical industry came to listen to testimony that would officially kick of the state’s debate on lowering pharmaceutical costs for seniors and persons with disabilities.

Under on legislative proposals (H 7291/S 2729), the state Department of Human Services would seek a waiver from the federal government allowing Rhode Island to use Medicaid funding to pay for prescription drugs for low-income seniors with incomes of up to $ 17,720 and couples with incomes up to  $ 23,880.

This bill, authored by Lt. Gov. Charles Fogarty and sponsored by Rep. Constantino and House Finance Chairman Gordon Fox, would enroll approximately 90 percent of the 37,500 seniors now enrolled in the Pharmaceutical Assistance for the Elderly Program (RIPAE) – the state’s pharmaceutical program. Because these seniors would now quality for prescription drug coverage under Medicaid, all Food and Drug Administration (FDA) drugs would be covered, not just those currently covered under RIPAE. Seniors would likely pay small co-payments, probably less than $ 10, rather than the 40 percent co-payments currently charged.

At this hearing, testimony was gathered on two other Fogarty legislative proposals that would make prescription drugs  more affordable to seniors and persons with disabilities who are not covered by the waiver. One bill (H 7290) would allow seniors enrolled in the RIPAE – approximately 5,000 seniors – to buy prescription drugs not currently covered by RIPAE at the discounted state price.

The second (H 7524) would allow 4,300 low-income persons on Social Security Disability Income (SSDI) who are between ages 55 and 65 to become members of RIPAE and purchase prescription medications at the state discounted rate.

Under both of these legislative proposals, the state would be able to obtain the manufacturer’s rebate available through RIPAE. Rebate funds gained from drug purchases by persons in the new SSDI part of RIPAE would accrue in a special fund to be used to subsidized the cost of these drugs in the future. This legislative initiative, like the other two, would be of no cost to the state.

There’s a very good reason why these proposals should be enacted, says Fogarty, who chairs the state’s Long-Term Care Coordinating Council. “Far too many of our seniors still face great burdens in paying for their medications. If your income is less than $ 10,000 per year – which is the median income for a person on RIPAE – having to pay $ 1,000 or more out of pocket for one’s prescription is a big problem.

“This year, in spite of our budget woes, we have a tremendous opportunity to greatly expand our prescription assistance program for seniors and persons with disabilities. By taking advantage of federal Medicaid dollars, we can save seniors millions and we can do these expansions with no added costs to the state,” Fogarty adds.

Susan Sweet, who represents CHOICES, a home and community advocacy agency and the Rhode Island Minority Elderly Task Force, says the expansion of RIPAE is critical, especially in light of the federal government’s failure to create a federal Medicare pharmaceutical benefit.

“Being able to pay for prescriptions avoids sickness, unnecessary hospitalizations and admissions to nursing homes, saving millions of dollars and many years of productive lives for seniors,” says Sweet. “Pharmaceutical products are the current and future medical miracles, and health insurance is inadequate without adequate drug cover, she says.

Shirley Kaiser, president of the Rhode Island Gray Panthers, whose group has battled years for putting the brakes on rising pharmaceutical costs, says seniors are giddy with the news that Rhode Island may finally move to addressing the problem.

The Gray Panthers strongly endorse the legislative proposals, and she believes this is the year for enactment of a legislative remedy.

At the Rhode Island General Assembly, some bills are enacted while many die during the legislative process, even those with great merit.

In light of the state’s fiscal uncertainties, lawmakers now have a rare opportunity to assist older Rhode Islanders and persons with disabilities in obtaining affordable prescription drugs at no cost to the state coffers.

With the widespread support and endorsement of these legislative proposals from state officials, aging and disability advocacy groups, and the pharmaceutical industry, for me it’s a no brainer – pass these bills and quickly sign them into law, says Kaiser.

It is now time to put this longtime aging issue behind us and move forward to other pressing matters like creating and paying for a seamless long-term care system.

Ensure passage of the three bills by telling your representatives and senators how important these three proposals are for you, and request their passage.