| The Senate is holding a hearing on falls this afternoon. Here’s what I’ll be looking for.

| Observations of a Newly Minted Older Person
| Louis Tenenbaum

| I’m paying careful attention to the Senate Special Committee on Aging’s hearings—“Preventing Falls, Preserving Independence: Technology, Community Programs, and Innovation in Senior Safety” — and watching what follow-up moves they make closely. I have been installing falls prevention interventions and advocating prevention for over three decades. Too often it feels like treading water. The evidence gets stronger, the death toll climbs, and the policy response stays frozen somewhere between underfunded and invisible.

How do we get the Senate and the agencies to fund and act on what should be seen as a national emergency — rather than a soft topic perpetually consigned to the margins?

Make no mistake about what we are talking about. Falls kill more than 38,000 older Americans every year. An Airbus A320 holds about 150 passengers. For 38,000 people to die in A320 crashes, one would have to go down five days a week, every week, all year long. If that were happening, we would not be holding a committee hearing. We would be declaring a national emergency, mobilizing federal agencies, and demanding answers on the Senate floor.

Instead we have a line item in a CDC budget document.

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This is not a mystery illness awaiting a cure. The interventions exist, and the evidence base is solid. Exercise programs designed to build strength and balance work. Grab bars and targeted home modifications work. Medication reviews that identify and eliminate drugs causing dizziness — and many commonly prescribed drugs do exactly that — work. None of this requires research or innovation. It requires deployment, at scale, with real funding behind it.

The economics should make this an easy call. A hip fracture costs $30,000-$50,000 to treat, and roughly a third of older adults who suffer one will not survive the following year. Every serious analysis of falls prevention spending shows that each dollar invested saves many multiples in averted emergency and long-term care costs. Medicare’s stubborn resistance to covering prevention while generously covering acute treatment is a fiscal absurdity, and everyone in this field knows it.

What I have watched over thirty years is a policy ecosystem that knows all of this and acts on almost none of it. The CDC’s STEADI initiative — solid, evidence-based, underutilized — runs on budgets that would embarrass a county health department. Community-based programs that work are perpetually grant-dependent, unable to scale, and wear out well-intentioned caring professionals who should be implementing great programs rather than begging for money. The political will to treat aging as a serious policy domain rather than a feel-good sidebar or an unending fight to maintain underfunded status quo programs has been missing across administrations of both parties.

So I will be watching. And I will be looking for something specific: not sympathy, not acknowledgment that falls are a problem, not a promise to study the issue further. I will be looking for Senators who are willing to say plainly that 38,000 deaths a year is unacceptable, and who are prepared to back that up with three concrete commitments: 

• Substantially increased funding for CDC falls prevention programs
• A directive to Medicare to cover evidence-based prevention with the same seriousness it covers acute care
• Real investment in the community infrastructure that reaches people before they fall, not after

The tools exist. The evidence is in. The fiscal case is overwhelming.

What has been missing is the will — and that is squarely within the Senate’s power to change.

Five planes a week. Senators, the hearing is yours. Do something with it.

Louis Tenenbaum is a longtime advocate for aging in place, co-founder of the HomesRenewed™ Coalition, the HomesRenewed™ Resource Center, and HomesRenewed Ventures, LLC and a nationally recognized expert on home modifications that support independent living. Discover more columns in this series.