“Help, I’ve fallen and I can’t get up” is no laughing matter to our aging population. According to the National Safety Council, an injury sustained in a fall caused or led to the death of 15,400 Americans in 2001.

And while people of any age are susceptible to falls, 60% of fall-related deaths occur among people 75 and older, say two identical bills (S 1922 and HR 3695) introduced in Congress earlier this year.

Senator Tim Hutchinson (R-Ark) sponsored the Senate version, and Representative Frank Pallone, Jr, (D-NJ) sponsored the House version of the Elder Fall Protection Act of 2002 in part because the medical expenses associated with injuries from falls are as staggering as the actual fall statistics. According to the Centers for Disease Control and Prevention (CDC), medical expenses for fall-related injuries cost Americans more than $20 billion a year. Direct costs for these injuries will exceed $32 billion by 2020, reports the Elder Fall Protection Act.

When one considers that more than half of all falls occur in the home—where environmental conditions should be easier to control than in public places—it is obvious that more could be done to prevent falls. An area of particular concern is the bathroom. More than 200,000 fall-related injuries occur there each year, reports Mississippi State University. In addition, the US Consumer Product Safety Commission reports that among the most frequent accidents involving older people are falls in the bathroom.

The Provider’s Role
Proactive and preventative approaches to geriatric falls have long been a goal of HME providers who recognize the importance of “fall-proofing” the home. Environmental assessments to determine home safety and accessibility are established services in these companies’ everyday routines. Bathroom safety products, such as elevated toilet seats, grab bars, bath benches, toilet safety frames, and handheld showers, are standard inventory for these companies. In addition, the companies often strongly recommend the use of these products for their clients because the products offer the end-user an economical and effective means of reducing the risk of injury from a fall while improving or maintaining the end-user’s level of independence.

However, as HME suppliers and consumers alike often complain, insurance coverage for these relatively inexpensive items that may prevent falls and/or additional injuries is slim to none. For example, Medicare, which provides health care coverage for the age groups at greatest risk for injuries from falls, does not cover bathroom safety products, or other types of preventative equipment.

Logic says it would be more cost-effective to provide coverage for a piece of equipment to prevent an injury from a fall than to cover the health care costs associated with injuries sustained in a fall. Consider the case history of a 74-year-old woman who was scheduled to undergo a hip transplant. Prior to the surgery, her physician referred her to a local HME provider to purchase an elevated toilet seat. When the provider explained to her that Medicare would not pay for the item, she refused the purchase, explaining her limited financial resources. After a successful surgery, she returned to her home. Several days later, she slipped off her toilet and injured her hip. She subsequently developed osteomyelitis and required home nursing care for intravenous antibiotics for an extended period, a wheelchair and hospital bed during the recuperative period, and an additional, more extensive surgery to repair the damage to the original hip replacement. Certainly, the costs of the additional health care treatment required far outweighed the cost of an elevated toilet seat.

Act Promises Help
The Elder Fall Prevention Act of 2002 could be the first step in preventing future occurrences of this nature. It requires that the federal government devote additional resources to research regarding the prevention and treatment of falls in residential as well as institutional settings. In addition, if passed into law, it would require the Secretary of Health and Human Services to evaluate the effect of falls on the costs of Medicare and Medicaid and the potential for reducing costs by covering fall-prevention products.

Providers interested in the status of the bills can look them up through the Library of Congress’ THOMAS Web site at www.thomas.loc.gov, fax Sen Hutchinson’s office at (202) 228-3973, or call Rep Pallone’s office at (202) 225-4671.

Helen M. Farrell is a billing consultant in Chesapeake, Va, and a former senior consultant with Jane’s Billing & Consultation Services Inc of Marietta, Ga. Contact JB&CS at (678) 445-1221 or visit its Web site at www.jbcservices.com.