Trying to Reduce ‘Costly Public Health Crisis’ of Senior Falls

Lilo H. Stainton | September 13, 2019 | Health Care
In 2017, over 77,500 people in New Jersey were hospitalized from falls; Senate committee calls for $11.7 million pilot program to reduce fall risk among elderly Medicaid members

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Elderly falling
Every seven minutes, another New Jersey resident over 60 falls, according to state figures, resulting in more than 200 emergency room visits each day and at least 400 deaths a year in the Garden State. The falls “constitute a costly public health crisis for New Jersey,” note two state lawmakers who are involved in an effort to reduce them.

The problem is the leading cause of death and hospitalization among senior citizens here, and the issue will only grow in scope as more people enter this age group.

According to the state Department of Human Services, which oversees Medicaid and runs the Division on Aging Services, in 2017 more than 77,500 people ended up in the hospital as a result of falls, the vast majority of which were elderly; 441 of these older residents died as a result. Nationwide data shows one-third of all seniors will fall at some point, and one in five of these individuals will suffer a serious hip injury.

To help cut this toll, New Jersey lawmakers want to establish a pilot program — modeled on successful efforts in other states — to reduce fall risk among elderly Medicaid members in nursing homes and other long-term care facilities. The plan calls for the state to educate elderly residents, family members, caregivers and others about potential dangers and share proven fall-prevention strategies.

The Senate Health Committee approved the bipartisan legislation Tuesday, with $11.7 million in state funding included for the work. The bill also calls for DHS to study the impact these falls have on Medicaid, which pays for much of the hospitalization, rehabilitation and after-care for older long-term care residents. DHS figures show these costs added nearly $1.9 billion in total charges to the Medicaid tab in 2017.

In their proposal, lead sponsors Sens. Joseph Vitale (D-Middlesex), the committee chairman, and Joseph Cryan (D-Union), noted that similar programs have proved highly successful in other states in recent decades.

Successful programs in other states

A Pennsylvania initiative, which involved similar outreach, cut fall-related hospitalizations by nearly two-thirds and cut related acute-care Medicaid costs by 80 percent over three years, according to the bill. Florida’s version cut falls by 60 percent and saved $2.40 for every $1 invested through Medicaid.

“New Jersey should join these states in reducing the frequency, severity, and cost of geriatric falls by establishing a comprehensive geriatric fall prevention pilot program modeled on successful programs adopted in other states,” the bill states.

A sign about fall prevention in an Essex County rehabilitation facility: Click to expand/close
In addition, the legislation notes that the Medicaid savings that come from fewer falls, and lower long-term care admissions, will outweigh any cost for the program. “The Medicaid program is funded equally by federal and State money, and increased costs from the falls of elderly people receiving health care benefits under the program mean additional costs to the State,” the text reads.

The Senate bill (S-3379) now heads to the Appropriations committee; a companion measure by Assemblywoman Annette Quijano (D-Union) awaits action.

To counteract the high rate of falls among elderly New Jerseyans, a decade ago DHS launched the NJ Falls Prevention Workgroup to help county agencies and community-based organizations reduce fall risks. The group created a fall-prevention tool kit and marks Falls Prevention Awareness Week in late September; Gov. Phil Murphy issued a proclamation earlier this year commemorating the annual event, which runs from Sept. 22 through 28.

How to prevent falls

The workgroup’s message is that falls are preventable and can be reduced through regular exercise to increase and maintain strength and flexibility; proper footwear and eyeglasses, if needed; plus keeping floors, stairs, and walkways well lit, slip-proof, and free of throw rugs, clutter, and other tripping hazards. Carefully monitoring medication to avoid dizziness is also important, they note.

Some studies have shown Garden State elders have room to improve when it comes to regular exercise.

“Everyone who cares about the health and well-being of older New Jerseyans should care about falls prevention,” said Louise Rush, director of the division. “That is why we recognize Falls Prevention Awareness Week and call attention to the steps we can all take to make it safer and easier for older friends, family, and neighbors to remain mobile and live as independently as possible,” she added.

The legislation — introduced in January, but first scheduled for hearing Tuesday — calls for DHS to target at least 6,000 Medicaid recipients over age 60 in long-term care facilities for fall prevention education and services; a similar control group would not get the same attention. It envisions the Division of Aging hiring an organization to administer the program and requires a report to lawmakers after three years.

Among other goals, the pilot seeks to spread awareness about the risk and share prevention tools and strategies with a wide variety of stakeholders involved in the care of this group — elderly individuals, doctors, pharmacists, long-term care providers, family members, and community-based organizations. It also seeks to make individual fall-risk assessments available to some groups and counsel clinicians on medication strategies to avoid tumbles, among other things, according to the bill.
“A Statewide approach, which focuses on the daily life of elderly people in residential, institutional, and community settings and includes input from a wide range of organizations and individuals, including family members and health care professionals, is needed to help reduce elder falls,” the bill states.