▶ 0:17:24>> the special committee on aging aging welcome to order. More than 14 million older americans experience a fall. Many of them end up in emergency rooms. Many seniors never recover and lose the independence they spent a lifetime building. Falls are leading cause of injury, hospitalization, for americans over the age of 65. This is not something we should ever accept as a statistic. It is a crisis we need to solve. The numbers are staggering. Nonfatal medical spending related to falls among older adults reaches approximately $80 billion in 2020.
▶ 0:17:47With medicare bearing the majority of that pop -- costs, the number will only arise unless they address this issue head on and we are talking about tens of billions of dollars spent treating injuries that in many cases were preventable. As bad as those numbers are, it's much more than the budget. Every one of those cases is an individual. This is a grandfather who breaks his hip and never returned to his home.
▶ 0:18:14Someone's grandmother who falls in with hours before anyone finds here and it's about family to worry if they are getting the call every time the phone rings. Falls don't just injure people physically, they take an emotional toll, create -- create isolation and cause a loss of confidence that accelerates decline. Once seniors stop moving, going out, and engaging with the community, the consequences begin to compound and that is because none of us were put on this earth to sit alone and stare out the window.
▶ 0:18:43We need family, friends, hobbies, purpose. These things are what make life worth living. Nobody has to just accept this fate. There are solutions that I was across the country. Our area agencies on aging on the front lines delivering programs that work can strength and balance training, home safety assessments, medication reviews that are just a glimpse of what these organizations could do.
▶ 0:19:14I'm thankful of the work in the role of the whole agency in supporting and stealing these efforts through a nationwide network of partners. The work with the a.c.l. And the aa pays for itself many times over and that is why I am proud to be leading the reauthorization of the older americans act with ranking member gillibrand and ranking member sanders.
▶ 0:19:42They are opening new doors we never had before, remote monitoring systems, predictive analytics, and smart home platforms are changing what is possible in fall prevention and emergency response. It's when a senior falls and no one is home to him every minute matters. Technology is cutting response time, reducing long-term competitions, and giving families everywhere peace of mind. That me be direct.
▶ 0:20:05The older american act is a foundational law governing community-based services for older americans and its far past time congress actually re-authorizes it. This hearing is an opportunity to continue building the record, documenting what is working, identifying where gaps exist given a lapse in reauthorization. I want to thank our witnesses for taking the time to be here and for the work they do every day on behalf of older americans and I would like to recognize ranking member gillibrand for opening statements. >> appreciate all our witnesses.
▶ 0:20:34Every year, an estimated one in four adults will fall. Which can result in injury, hospitalization, and even death. Today's hearing explores the role technology and innovation can play in senior safety. For example, smartphone apps can assess and older adults fall risk and in-home sensors can other caregivers when a loved one falls, wearable devices can even cushion the blow of a fall.
▶ 0:21:05Before today's hearing, I worked with senators to ask the government accountability office, the gao, to report on new technologies that provide promise in helping our older adults and people with disabilities live safely and independently. We also asked gao to examine the challenges older adults face with adopting such new technologies. We know these challenges are real. For example, technology is expensive. Ai can be biased.
▶ 0:21:35Communities can lack high-speed internet access. This promise in technology but the promise does have limits. This means we cannot stop investing in programs that have proven track record of working and this includes federal law fall prevention programs authorized by the altar american act delivered through the administration of community living as well as the programs afforded by cdc and hud. Finally, we need to remember how much technology and innovation is built upon federally funded research.
▶ 0:22:05I look forward to hearing more about the opportunity this emergen -- emerging technology plays as well as the role of our current successful falls prevention program and I would personally say as I have watched how falls affected my own family members, when my grandmother -- my great grandmother fell and broke her hip which is the story every time, it took a lot of work, effort, using the walker, using the walker, sometimes, you
▶ 0:22:37Don't graduate from the walker because you never have the confidence again. Another one of my friends in her 90's recently fell and it kept her indoors for two months until she was fully recovered and could be back on the sidewalks where they are uneven and where your eyesight is not strong enough to catch those uneven surfaces. When my mother-in-law fell, she had such a serious shoulder injury, it took three surgeries to fix it so I personally know the tragedies and complexities that arise because of falls.
▶ 0:23:10And they are life-changing. Something, your loved one does not regain their capability that they had before the fall. Sometimes, the psychological impact of the fall restricts their movement, restricts their ambition, restricts their willingness to travel or explore . It reduces the size of their world. It changes their confidence level. It can affect them emotionally and physically and psychologically. Personally, I know how urgent and important this is so I am eager to hear your solutions.
▶ 0:23:43>> thank you, ranking member. For a first witness, I would like to introduce christine didion from my home state of florida, director of programs at the agency on aging in st. Petersburg, florida. She has dedicated her career to connecting older adults in our communities with the services and support they need to stay safe, healthy, and independent at home. Thank you for being here today and please begin your testimony. >> thank you.
▶ 0:24:09Distinguished members of this committee, thank you for the opportunity to speak from her are you today. I am honored to represent my colleagues, our partners, and the work we do at the area agency on aging in st. Petersburg, florida. It is a distinct thousands of seniors and caregivers we serve and to speak on this vital topic that impacts one in four americans age 65 and older each year.
▶ 0:24:35If I were to ask you what your plans are for your golden years, most of us are not making plans to limit our activities because we will have a fear of falling or worse, making plans on how we are going to care for ourselves after experiencing a fall that results in a serious injury. Unfortunately, the stark reality of falls in the reverberating impact suggests maybe we should be making these plans.
▶ 0:24:59More than 14 million older adults report experiencing a fall each year and falls remains a leading cause of fatal and nonfatal injuries among older adults. $80 billion in health care costs were estimated to be spent in 2020 on the treatment of nonfatal injuries from a fall among older adults with an estimated 71% of those costs paid for by medicare or medicaid. That cost is expected to rise to $101 billion by 2030.
▶ 0:25:28Even if an older adult never experiences a fall, the fear of falling still exists for majority of those over the age of 65. A fear of falling can lead to an avoidance of physical activities, functional limitations, and increases in social isolation. This can all compounds to reduce and older adults quality of life and impact their ability to live well and independently. Through the older americans act, older adults and communities are not powerless against the growing impacts of falls and the fear of falling.
▶ 0:25:59For more than 50 years, the oaa represented the national commitment to assisting older adults to age at home and is the cornerstone of the nation's non-medicaid home and community-based services system. Each year through the oaa, more than 14 million older americans received supportive services from the nationwide aging network which consists of state units on aging, area agencies on aging, title vi native american imaging programs, and thousands of local service providers.
▶ 0:26:27Though it -- it addresses the social determinants of health and supports evidence-based falls prevention programs and safety technology. The area agency on aging with funds that are contracted through the florida department of elder affairs has forged over 61 partnerships to provide the evidence-based falls prevention programs of a matter of balance and enhanced fitness for 153 older adults over the last year.
▶ 0:26:59Because of our partnerships -- we are meeting older adults where they are in the community and equipping them with more than just a few tips on how to reduce falls. These programs are proven to empower older adults to reduce their fear of falling, increase their coordination and balance, engage in strength training and other physical activity and build environmental awareness.
▶ 0:27:25These outcomes prevent falls from happening and these falls yield an estimated savings of over $1 billion in health care costs. While the work to prevent falls will continue, we must work to reduce the long line where the time and older adult remains on the floor after a fall. Oaa funding can provide fall detection technology that allows for 24/7 monitoring and emergency assistance at the detection of a fall or the press of a button.
▶ 0:27:53In west central florida, over a quarter of older adults live alone and are often far away from family. Beyond dispatching emergency services, this technology keeps remote families informed in real time. A recent activation in our area allowed a daughter to coordinate directly with paramedics and provide vital medical history after her mother, who lives alone, had fallen.
▶ 0:28:14This technology enabled to transform potentially fatal isolation into a connected responsive network that supports the independence of older adults. Falls do not have to be an inevitable part of aging. They can breed of preventable health event using existing and proven interventions.
▶ 0:28:33The reauthorization and adequate funding of the older americans act gives congress the opportunity to ensure that the more than 600 area agencies on aging that serve every area of the united states can continue to provide evidence-based falls prevention programs and safety technology that is cost effective and community focused. Not only will this reduce the risk of falls but it will increase the overall wellness of older adults to live well where they choose to and alleviate fall-related injury costs on an already strained health care system.
▶ 0:29:06I think the members of this committee for their leadership and support -- thank the members of this committee for their leadership and support. Thank you. >> thank you for your testimony. I would like to introduce laura mitchell, cofounder and ceo of grandcare systems based in san marcos, california. She is a nationally recognized leader in remote monitoring to help older adults and their caregivers manage health, safety, and communication from home.
▶ 0:29:36Thank you for being here from so long away. Please begin.
▶ 0:29:40Laura: Thanks. My name is laura mitchell. I am the ceo of grandcare systems which empowers independence using touch screens for medication and integrated activity and telehealth sensors. It is truly an honor to be with you here today. I would like to start my testimony with the true story about one of our grand care -- grandcare, clients from florida.
▶ 0:30:08Laura: Her daughter did not know until four critical hours later when she found her mom confused and disoriented. Doctors advised assisted living as her only option but jean wanted to stay home and instead, she began to use grandcare. It tracked her daily patterns and could alert her daughter if something seemed off like wandering or inactivity and he also tracked her blood pressure and reminded her went to take her medications.
▶ 0:30:36Laura: Jean stayed in her home for another four years until something shifted. She became agitated and she was not sleeping and showed signs of some downers. That might lead to additional medications and maybe even a diagnosis that could alter her life. Her daughter, carol, had data.
▶ 0:30:56Laura: Using grandcare's motion reports, she was able to pinpoint exactly when jean's behavior changed and she brought the information to the doctor and together, they saw that this change aligned perfectly when jean's blood pressure medication changed. They switched the medication and the symptoms disappeared. Think about that for just a minute.
▶ 0:31:18Laura: Without this technology, jean could have been treated for the wrong condition, medicated unnecessarily, or even prematurely forced into a higher level of care and instead she remained home for an additional two years due to the power of proactive, data-driven care, jean stayed in her own home beyond the initial diagnosis for over six years, saving her family over $180,000.
▶ 0:31:41Laura: When people think about falls, we picture, help, I have fallen and I cannot get out, a commercial that aired almost 40 years ago and while falls are absolutely serious, they are not the root problem but merely a symptom. Studies have shown that falls can be caused by things like medication noncompliance, dehydration, or other underlying health issues and by the time a fall occurs, we are already in crisis mode and the outcomes, like we said, can be devastating. We have to ask ourselves why are we still waiting for the fall?
▶ 0:32:13Laura: Why should technology activate only after something goes wrong? The good news is that today, we have technology tools to shift from reactive to proactive, predictive, and preventative care. Imagine a simple tablet in a home, something accessible. It reminds mom to take her medication, to drink more water, to take her blood pressure reading.
▶ 0:32:38Laura: Unobtrusive smart home centers are working quietly and they can recognize when something seems amiss like the kitchen has not been accessed at mealtime. Medications were not taken. Or if mom's vitals are out of thresholds. And only then, only when true support is actually needed will it notify a designated caregiver. This is not about surveillance. It's about independence. It's about connection to family and giving older adults the confidence and security to live where they want.
▶ 0:33:08Laura: While ensuring that someone is there whenever needed. Access to this type of technology is not a luxury. It's a moral obligation deserved regardless of age or cognitive function. Through simple video chat messaging and even brain gains, individuals can stay engaged and mentally acute. Technology does not isolate. It connects.
▶ 0:33:32Laura: Beyond the improved happiness, health, and safety outcomes that technology provides, it also saves a lot of money. The cost of this technology compares to a mere 15 days in average assisted living community, 15 days. Not every person has the option to stay home but if technology can support one person to delay additional care, they can save roughly $50,000 a year but is not only saving money.
▶ 0:33:59Laura: It's about preserving dad's dignity, securing independence for mom. It's about adult children having peace of mind. It's about taking care of our parents and loved ones when they need us the most. Now, we are at a turning point. Our nation is at an age in crisis exacerbated by stacking shorter -- staffing shortages and high health care. We cannot solve tomorrow's challenges with yesterday's tools. Let's move beyond crisis management and turn towards proactive and person centered technology.
▶ 0:34:28Laura: It's time to reimagine aging in america not as a loss of independence but as an opportunity for personal growth, purpose, and the ability for our greatest generation to live life on their own terms. Thank you. >> thank you, miss mitchell. I would like to introduce martha, the director of grand management and health strategies at the alliance of new york state ymcas.
▶ 0:34:58Laura: She oversees scaling of evidence-based chronic disease prevention programs to reduce fall risk and lower long-term health care costs for seniors. Thank you for being here. Please begin your testimony. >> chairman scott, ranking member gillibrand, distinguished members of the committee. Thank you for inviting me to testify on this important topic. I am here on behalf of the 35 ymca associations in over 140 branches and program sites across the state of new york.
▶ 0:35:26Laura: In my role as director of grand management and health strategies at the alliance of new york state ymcas, I support healthy aging initiatives, community partnerships, and evidence-based programs that strengthen health and well-being across the lifespan. For 175 years, ymcas have been dedicated to strengthening communities through youth development, healthy living, and social responsibility.
▶ 0:35:54Laura: As the largest provider of afterschool programming in new york state, ymcas also support communities through early childhood education, food access, housing, and life-saving swimming instruction. This broad community presence allows y's to support older adults through programs that promote healthy aging, independence, and well-being.
▶ 0:36:19Laura: As this committee examines the role of technology, community programs, and innovation in senior safety, the y's experience delivering both in person and statewide virtual falls prevention programs demonstrates that technology can be a powerful tool to expand access for older adults facing barriers such as transportation, mobility, or isolation.
▶ 0:36:43Laura: At the same time, we have learned technology is most effective when pared with trusted community-based relationships and local support. Falls remain the leading cause of injury and accident related deaths for adults over the age of 65. According to the cdc, one in four adults reports falling every year. Falls are devastating for individuals and families and are a major driver of long-term health costs. Now for the good news.
▶ 0:37:13Laura: Falls are not a normal part of aging. They are preventable and proven, evidence-based falls prevention programs like those offered every day at ymcas are changing stories for people like marianne. Fear of falling kept marianne isolated in her new york city apartment, afraid to venture outside onto the busy city streets with her walker.
▶ 0:37:39Laura: But marianne took a virtual matter of balance class. She learned strategies to reduce falls risk in her home and exercises to improve her strength and balance. Through the virtual class, she found encouragement, connection, and confidence. The alignment -- alliance of new york state ymcas is currently managing an administration for community living grant award -- awarded to the new york state ymca foundation to support a statewide falls prevention initiative.
▶ 0:38:10Laura: The initiative both complements and expands the ymcas broader healthy aging work. Through technology and acl funding support, y's have reached more older adults then would have been possible through traditional in person programming alone particularly in rural, underserved, and homebound communities.
▶ 0:38:35Laura: In just two years, more than 1000 people have participated in falls prevention programs through this initiative. In addition to falls prevention programming, ymcas have long partnered with federal, state, and local health organizations to deliver evidence-based programs that support chronic disease prevention, arthritis management, cancer survivorship, diabetes prevention, and healthy aging.
▶ 0:39:01Laura: We urge congress to support the highest level of funding possible for the cdc so wise can continue to deliver these supportive programs and preserve funding for the acl so community-based healthy aging and falls prevention programs like the new york state initiative can continue. Every dollar invested in community-based organizations like the ymca create lasting impact and strengthens the health of communities.
▶ 0:39:30Laura: Federal investment and prevention help older adults remain independent, connected, and healthier longer. There are investments in dignity, healthier communities, and changing stories for people like marianne. New york state ymcas look forward to continuing this critical work in communities across the state. Thank you again for the opportunity to testify and for the work of this committee on the behalf of older adults. >> I think each of you for your testimony.
▶ 0:39:59Laura: I think we are going to turn it over to senator king. Welcome to the aging committee. >> I appreciate your accommodating me. I am halfway between a witness and a senator today. I am not a normal member of this committee but this is an issue I have taken a deep interest in. One of the principal problems facing our society today is the high cost of health care. Prevention is the low hanging fruit to combat the high cost of health care.
▶ 0:40:27Laura: The cheapest health intervention is the one that does not have to happen. That is why I think this hearing is so important because as you testified, falls are a tremendously important and significant and dangerous part of the aging process but they can be prevented. I have done my own falls prevention work by selling my harley a couple years ago which was a very hard decision but I had an attack of prudence.
▶ 0:40:57Laura: My second thought is an old friend of mine once said the secret to a long life is to always use the banister and that is something I follow all the time. And that sounds funny but it's really true. How many times have we gone down the steps with our hand on the banister and one foot -- one foot sort of slips and if you don't have the banister, you are in trouble. The steps behind the U.S. senate where they always take the pictures are a death trap. They are granted and there is no banister.
▶ 0:41:28Laura: So I have a couple of suggestions along this line. One is this. This is an $11 bathmat. I am the johnny appleseed of bath mats. Whenever I go to see somebody and they don't have one of these in their shower, I buy one and send it to them. Here's the proposal. Why doesn't cms send one of these to every medicare recipient in the country? I did the back of the envelope calculation. It would pay for itself in about nine months. This is $11.
▶ 0:41:58Laura: I suspect if cms bought them by the millions, they could get a deal and it would have a noticeable effect on the number of falls. Very simple idea. Along with that is -- I have some legislation along this line. Allow cms to spend money on prevention, things like bath mats. Right now, medicare will pay for a broken hip but they will not pay for a grab bar in your shower.
▶ 0:42:28Laura: That is just insane. So I think, Mr. chairman, that is one of the things we need to do is authorize medicare to get much more active in the prevention area. And to provide things like this. I mean, I am not kidding. Send out 20 or 30 million of these and you will see that $100 million cost of falls fall significantly.
▶ 0:42:53Laura: I am proposing that we should have an office in hhs dedicated to falls prevention and one in the veterans administration. The initial medicare home visit should include an analysis of the house in terms of fall risks. Medicaid, as I mentioned -- medicare, rather, should cover equipment like grab bars, bath mats, and others.
▶ 0:43:18Laura: There should be a tax credit, I believe, for home improvements that prevent these kind of injuries and again, this would be a tax credit that paid for itself because of the savings to medicare and medicaid that are occasioned by treatment of falls. Finally, Mr. chair, I suggest right now the congressional budget office when we legislate things, the budget office estimates costs but they are not allowed under their rules to estimate projected savings.
▶ 0:43:50Laura: So I believe we should instruct the congressional budget office to look at the savings as well as the cost of these kinds of preventive measures. So you all have nodded. Can you all say yes? You have some good ideas here. Just for the record. But this is -- I am very passionate about this because all of us have experienced falls. My sister had a bad fall just about a year ago.
▶ 0:44:21Laura: And if she had had a bathmat, she would not have had that fall in the shower and a disproportionate number of these falls occur in the bathroom. So that is why something like this I think makes sense so Mr. chairman, I deeply appreciate your allowing me to come and testify today. I hope that I look forward to working with the committee on some of these legislative proposals that I think can really make a significant difference. I appreciate it. Thank you. >> if you are in business, you would clearly do it, right? You can save money.
▶ 0:44:53Laura: Everybody is better off. Why we don't do this in government? >> the return on investment is infinite. Senator kim? >> thank you, chairman. Thank you for those thoughts. It's important for us to be thinking so much more about the preventative space.
▶ 0:45:19Laura: I shared a lot of this committee as well as more broadly about how my father was diagnosed with alzheimer's but what I don't talk about as much about is what initially caused this crisis we are dealing with him is that he fell and he is somebody that broke his femur and was originally sent to the hospital that way.
▶ 0:45:42Laura: And it was that kind of change in location and the surgery and the medication involved that very much spirit his cognitive decline as well. We are kind of in this doom loop right now as a family because he cannot walk but he cannot remember that he cannot walk and constantly stands up and falls and constantly stands up and falls and goes back to the hospital and we have now -- we now have sensors within his or her to let us know when he has tried to stand up.
▶ 0:46:09Laura: We have sensors that let us know when he is on the ground so this technology is something that I am using in my father's room right now while I am here to try to help make sure we are understanding of his fall risk as well as be able to quickly remedy -- I have an app that lets me know whether or not any of the sensors have been triggered so you know, I just share that with you as I feel it and see it in my own way and you know, I am interested, trying to figure this out more deeply.
▶ 0:46:39Laura: If you don't mind, I would like to just start with you. You know, can you share how access to fall prevention technology could have an impact on a families considerations, whether they are weighing long-term care facility or care at home and what is the better option? How is this technology now being utilized to help people make those types of decisions? What's absolutely and thank you for sharing that story. About your father because you are right.
▶ 0:47:05Laura: Technology can really make a difference for a senior or older adult being able to remain in their own home. We know a vast majority of older adults want to remain in their own home or want to remain with family, living with family or living with the memory condition or other chronic condition that otherwise they would not be able to live alone without that support of the caregiver or family and technology can only leverage the time, effort, and care that a caregiver or family can provide to a senior or
▶ 0:47:38Laura: Leverage that additional independence for a senior to live on their own. Like I mentioned, in west central florida come a quarter of older adults lived alone and we often see in florida that they are not living anywhere near their family. Their family lives up north. My call -- my colleague's state of new york or all over and that is the great thing about emergency other response technology is a family or caregiver or whoever does not have to live in the same home. They don't have to live on the same street. They could live in a different state.
▶ 0:48:08Laura: Like I mentioned to my testimony, the daughter who got the call about her mom who had fallen actually lived in a completely state, on a different coast. In california, actually. But she was able to be connected right away so not only our emergency services able to be contacted like caregivers or other loved ones can be contacted and it can really set up that step process to may be emergency services do not need to be called.
▶ 0:48:33Laura: Maybe just a caregiver who needs to come over and check on that person. So you may be eliminating a trip to the emergency room after all even with emergency technology. >> I find that it just allows me to operate without this constant anxiety of wondering whether he is ok at any given moment. Having to check in and that kind of thing.
▶ 0:48:56Laura: It gives that reassurance that I think, you know, allows for caregivers when they are a to have that respite that they absolutely need in addition to just, you know, hopefully, you know, proceeding in other ways. I wanted to turn to you.
▶ 0:49:12Laura: I think what I find interesting here is there is a lot of potential here, the potential dual applications that this technology can be used for with older adults as well as with people with disabilities and I just feel like as we are thinking through how to be able to harness this, you know, that is something we could potentially build upon but I wanted to kind of get your thoughts about that potential there.
▶ 0:49:35Ms. Mitchell: Well, thank you so much. Yes, I think the individuals living with intellectual and develop mental disabilities have a pretty high fall risk as well. I think that it is in the 25 to 33% for adults 65 plus.
▶ 0:49:50Ms. Mitchell: It's about 35% to 40% in adults living with intellectual and develop mental disabilities but then when we are talking about adults with intellectual and develop mental disabilities that are 65 plus, it goes up to the highest risks of 45 to 70% so the good news is people with intellectual and develop mental disabilities are living longer than ever and that is great.
▶ 0:50:12Ms. Mitchell: But we do have some added fall risks because of balance issues so I think technology can play a pivotal role in not only supporting the individual to to proactively prevent the fall with reminders, take more water, take your blood pressure medication, whatever medications they are taking, but also take your vitals readings. There is lots of different ways we can determine before a fall occurs. Of course, there's accessibility things. We have the bathmat. We have banisters.
▶ 0:50:44Ms. Mitchell: I definitely agree with that. But then you know, how do we prevent the flock? If a fall does occur, it is critical that we know right away. So maybe we are detecting excessive motion in the bathroom. Maybe we are detecting that, hey, this person did not get up and get out of bed or we are detecting that that person did not access the fridge at mealtime. All these different checkpoints are just sort of notifying us that something may be wrong.
▶ 0:51:11Ms. Mitchell: >> I am going to get a bathmat of my own. Ok. I am making progress here. [laughter] >> did you bring one for everyone? >> I know. My wife can no longer say that I don't get any benefit out of this job. The last thing I will just say here is the question now is how do we scale this?
▶ 0:51:38Ms. Mitchell: You know, how do we try to actually proliferate this in a meaningful way? I will be honest, it it was hard for me to explain and convince my dad that the sensors are ok. Even for me, I did not know about this. I needed someone to tell me about this.
▶ 0:51:54Ms. Mitchell: I am busy with my life and I don't always have the latest understanding of where the technology is and as senator king was mentioning, you know, I think government can play a big role in trying to scale this so it's not just sort of a case-by-case type of situation so I guess I just wanted to ask you, miss mitchell, as I close out here, what is the role of the federal government?
▶ 0:52:16Ms. Mitchell: What should we be considering not only in terms of knowing about this technology but how we might be able to play a role to be able to proliferate this and get this in good hands -- the hands of men or people that could very well benefit from it? >> I think reimbursements and waivers play a pivotal role. There seem to be more reimbursements going on on the medicaid side of things for individuals with intellectual and develop mental disabilities, more so than medicare.
▶ 0:52:43Ms. Mitchell: I think that it's really too bad because I think that the government should actually proactively support this type of technology. It is clearly less expensive than the cost of hands on caregiving and we are at such a need for hands-on caregiving that individuals that actually do not need it 24/7, we are wasting it on an individual that may be staying overnight and watching netflix or sleeping while this person is also sleeping and instead, the individual could be delegated to somewhere where that person --
▶ 0:53:16Ms. Mitchell: Where somebody needs that 24/7 hands-on support. If government put some money towards this type of proactive technology, it would not only save, you know, everybody money, the cost of health care, if someone is healthier, it is going to save money. If someone is happier, it's going to save money. If someone is less isolated, they are at much less risk for falls and all sorts of other bad outcomes.
▶ 0:53:39Ms. Mitchell: So when you mentioned your father may be not being willing to try out this type of technology, I think there's some ways we can get around that so that is why we have the technology that helps to connect individuals. For the story I told you about with jean, she was the one who contacted us in 2005 and asked for us to do the technology in her home and asked if we would please call her daughter, carol, and convince her that she could do it.
▶ 0:54:06Ms. Mitchell: And the reason was his she said I need carol to live her own life. She's calling me constantly and I want her to live her own life. She also wanted to stay independent at home. She was a swimmer. She grew orchids in her kitchen. She was not ready for assisted living so it was that need for independence and the desire for her daughter to be notified if something was wrong but having the independence where she was not going to have her daughter be contacting her every minute of the day just to check in and so there was some technology
▶ 0:54:37Ms. Mitchell: That was playing the role and it allowed her daughter to actually spend that time with her mom, being her daughter. Not being her caregiver. Because she knew what was happening in the home and did not have to spend time talking about it. >> thank you for sharing that. Chair, I yield back. >> senator justice. >> thank you, Mr. chairman. Thank all of you all for being here. It was a big time on it was a big-time honor for me to introduce this bill and be part of that and everything in every way.
▶ 0:55:08Ms. Mitchell: I have got a confession to make. You know, there's three ways in the world you can make a friend. You can ask a favor, make a confession, or tell a secret. Think about that and carry that with you in your life. Make a confession, ask a favor, tell a secret. Well, I'm going to make a confession and tell a secret right now.
▶ 0:55:32Ms. Mitchell: First of all, you know folks that some way grow older, we don't really believe that we are older. For a long time. You know? And all of a sudden, I still think I am 25 years old. I have climbed every mountain, followed every bird dog in the world all over kingdom come.
▶ 0:55:57Ms. Mitchell: I love to hunt and fish and play golf and do everything in the world and I am kind of broke up now because I was too slow to get out of the way and I got hit a lot. You know? But with all that being said, let me just tell you just this. This past basketball season, I am the girl's high school basketball coach at a high school. Public school, big school and everything.
▶ 0:56:25Ms. Mitchell: And my team just happened to be really rolling along and all of a sudden, we are in the quarterfinals of the state tournament. And we win. Now, we are going to the final four and if I can fast forward, we finished -- we won the whole state championship and ended up 27-0 in the whole season.
▶ 0:56:46Ms. Mitchell: They are an incredible team, to tell you the truth, and great kids, but after the quarterfinal game, you know, you go into this room where all the media is there and all the cameras and everything and they tell us -- and then you go up on a platform and you're sitting there with probably three of your players and everything that they want to interview and talk to you, too. And so I am sitting there and everything and they tell us that when we go in the room, watch all these wires now right here and everything because just maybe you can trip over that and everything.
▶ 0:57:18Ms. Mitchell: So I get through all the wires, on the stage, everything is all good in the world and remember, I don't think I'm 75 years old. And at that time, really, I was still 74 years old. But the next thing, I come off that stage, and the next thing I know, I am flying through the air and I am going just like this and I face plant right into the floor.
▶ 0:57:44Ms. Mitchell: I dislocate my shoulder and I hit right on a knee that has had some knee surgery -- so many surgeries, it's unbelievable. And it was a really, really bad day, you know? I can tell you just this, that since that time now, I am three times more disabled than I was right before that happened.
▶ 0:58:08Ms. Mitchell: Now, I need two knee replacements and a hip replacement and all that and I got to get all that done and I hope to goodness after that happens that things will be better. But let me tell you, not long ago, there was a group of physical therapists that I met with, and they told me about this incredible, incredible idea . You know, safe act. I thought, well, what in the world is that?
▶ 0:58:34Ms. Mitchell: We went through all the different stuff and lo and behold, all of a sudden, they said something that at the time may be did not mean near as much to me as a means today. And that is a way to improve potential balance and a way to avoid falls.
▶ 0:58:56Ms. Mitchell: Because we all know that as we age, $80 billion a year --are you kidding me? I just came out of the ag committee meeting and really and truly, we are scrambling around trying to figure out how we can have x number of dollars because our farm community is upside down and we are hurting like you cannot imagine. So with all that being said, $80 billion?
▶ 0:59:26Ms. Mitchell: Attributed to faults in this country. And this is our opportunity and this is our moment. Our moment is right now. To do something that really and truly a lot of us, as we grew a little bit older, we never really would have believed it would be us. But as I was flying through the air, believe me be, I knew it was sand I was the s. -- it was us and I was the us.
▶ 0:59:58Ms. Mitchell: I commend you in every way. I really only have one question and basically, it is just this. You know, and maybe this is -- in your work, how many people show up after they have had a fall? Versus how many people show up trying to prevent a fall?
▶ 1:00:19Ms. Didion: That is a great question, senator, and it actually is a mix that we see just anecdotally. Under our evidence-based falls prevention programs that we offer anywhere, we actually get a lot of people who come because they said their friend the -- their friend took the class so they had a great time. They cannot believe they actually had fun talking about falls for eight weeks. And their friend suggested it.
▶ 1:00:50Ms. Didion: They have never had a fall but they just thought it might be a fun thing to do. And then of course on the flip side, we do have those people that do come to us after they have experienced the fall. They have broken a limb or experienced a serious injury and they don't want it to happen again. And we don't care how you came to the area agency on aging to take an evidence-based falls prevention class or access any of the support services that the older americans act can provide to keep a senior in their home.
▶ 1:01:20Ms. Didion: We just want to keep a senior in their home as safe as possible. >> well, I commend you. You are doing great work and we have got to get this across the finish line because this is really, really, really important. And maybe it took, you know, hard headedness for me to believe but I believe, I will promise you that. Thank you so much. Thank you, Mr. chairman. >> sorry.
▶ 1:01:51Ms. Didion: Polypharmacy is one of the most overlooked fall -- how many have you seen on drug combination programs that nobody has flagged as dangerous? Do they have the resources and clinical support to address that systematically? >> great question.
▶ 1:02:08Ms. Didion: We do see that a lot and as you said, one of the biggest fall risks or risks for causing a fall is living with a chronic condition and being on multiple different medications that can have side effects like dizziness or confusion that can increase the chance for a fall.
▶ 1:02:28Ms. Didion: We do see that a lot with older adults that we serve that is the great thing about especially a matter of balance class that can be offered with funding from the older americans act because we can address or empower an older adult to advocate for themselves or learn how to advocate with their family to talk to their doctor about their different medications or different treatment options for their chronic conditions.
▶ 1:02:54Ms. Didion: Because the other great thing about the older americans act is we don't just offer evidence-based classes for falls prevention. We are able to offer evidence-based classes that address chronic conditions like living with diabetes, chronic pain or just general chronic conditions in teaching older adults how to self manage those and that includes looking at their medications and asking the right questions with their doctor.
▶ 1:03:19Ms. Didion: About what kind of medications they are on and then on the other side, again, on the older americans act, it's really looking at that holistically of how we can prevent falls in the older americans act really allows area agencies on aging and state units on aging and local service providers to do that because we can address other factors and chronic conditions that can help prevent falls like meals and again, those emergency alert response technology systems. >> thank you.
▶ 1:03:51Ms. Didion: You have been building aging technology for quite a while which means you watched a lot of promising products fail to reach the people who need them most. What is the single biggest structural barrier preventing fall prevention technology from achieving widespread adoption among older adults and is it a funding problem and reimbursement problem or something else entirely?
▶ 1:04:09Ms. Mitchell: I think there's a couple things. First, I think funding is definitely a problem. I would say the biggest problem might be internet connectivity. That sounds crazy because internet has been around since the 19 90's but it is especially access to this type of telehealth or tele-medicine or activity of daily monitoring technologies.
▶ 1:04:37Ms. Mitchell: You need internet for it to function and particularly in remote areas, it is great for them to have internet connectivity which is where it is the hardest to get intimate. So I think it's a twofold funding for this type of technology and also funding for internet connectivity and you know, sort of turning that into more of a utility versus nice to have because it is really a need to have.
▶ 1:05:04Ms. Mitchell: And also really about awareness, letting individuals know that this is a technology that works. There is a return on investment. It is proven. It is not new. The 40 year ago help I have fallen, I can't get up, it has changed since then. A complementary piece of crisis management but for the proactive preventative technologies, that's really where we are going to save the money.
▶ 1:05:31Ms. Mitchell: >> what is frustrating as the federal government has spent a fortune to do broadband but it does not pay to connect the home. It just pains to lay the fiber so fortunately now with satellite technology, we don't have to rely on that. But don't worry. We are still spending the money. The ymcas evidence-based fall prevention programs have data behind them.
▶ 1:05:58Ms. Mitchell: What does the research to show in terms of fall rate reduction and why hasn't evidence been sufficient to drive the reimbursement these programs have earned? >> what doesn't make sense to me is medicare advantage. Because you don't have to worry about a federal law. Are the medicare -- are the medicare advantage players doing this? Because they have an economic interest in doing it.
▶ 1:06:20Ms. Mitchell: Unfortunately, no. I would love to talk to you about the return on investment and exactly this point. We talked already about one and four older adults will experience a fall every year. Of those false, more than half will result in a trip to the hospital. So if we could talk about what that means in money terms, the average er visit for a fall is over $1000.
▶ 1:06:46Ms. Mitchell: The average inpatient trip for falls is over $18,000. The cost for an individual to take a virtual matter of balance program, $250. So according to a recent study by the national council on aging, individuals who took evidence-based falls prevention programs saw a 52% reduction in the number of falls.
▶ 1:07:18Ms. Mitchell: That is a $250 investment in prevention that can help an older adult stay independent, connected, and out of the hospital. >> let me ask you a question. If you -- would you take the financial risk, if I went to mena oz who is cms, and said, you, you know, medicare, you pay for this program or medicaid, whatever, and then if it does not save that amount of money, you have to give the money back.
▶ 1:07:48Ms. Mitchell: Would you guys all do that? >> yes. >> you would take that financial risk, right? It doesn't make sense. As a business guy, I would do that in a heartbeat to save the money. It's not just save money. You change people's lives, right? Ok.
▶ 1:08:08Ms. Mitchell: If any of you want to do that and you give me a debt something, I will take it to see a I mean, just try it for whatever it you are responsible for. They have all the data. Right? They know exactly -- they know what they have been spending so you could do a program -- they know exactly what they are spending on this. We had to file for medicare. It's pretty specific so you know exactly what that is.
▶ 1:08:35Ms. Mitchell: You know what this costs and so take a portion of the savings. So ok. All right. Area agencies on aging receive a mix of funding and they operate within a significant amount of federal, regulatory, and reporting overhead. I bet you love all of that.
▶ 1:08:56Ms. Mitchell: How much of your staff's time goes towards compliance and paperwork rather than actually serving seniors and what federal requirements could be -- when I was governor of florida, I was a business guy. You know what you get frustrated with? Government. Crazy, stupid government regulations. I am sure that ever happened to you, right? >> not at all. [laughter] I do have to brag about our area agency on aging.
▶ 1:09:26Ms. Mitchell: The great thing about the older americans act and setting up that aging infrastructure or network is that there is a constant feedback loop of monitoring and fiscal responsibility and programmatic responsibility so to an extent, having that regulation and having that follow-through is very important because that is how we know that things are doing what they are supposed to be doing and that it is working for seniors.
▶ 1:09:54Ms. Mitchell: We have gone 17 years with -- from the florida department of elder affairs not having a finding so we are all too familiar with being in compliance. Following those regulations. And when we are monitored by our state unit on aging, so all that to say, you know, especially on the evidence-based side, is actually very important that we do follow that regulation.
▶ 1:10:23Ms. Mitchell: Again, for those specific evidence-based programs because that is how we know that those programs are working. Like my colleague said, those evidence-based falls prevention programs result in a 52% reduction in falls. In addition to that, there is a 58% reduction in falls that result in serious injury and we don't necessarily have to keep tracking that after every balance class because that evidence-based programming tells us that that is what that programming does for us.
▶ 1:10:53Ms. Mitchell: >> have you gone to a medicare advantage program and just asked them? Because they should pay you. I mean, if you can prove this, they should pay you and you should take a cut of the savings because it sounds like each and every one of you can defend it, right? You should go to the medicare advantage because they don't have to worry about what cms does and just ask them and go with the proposal of whatever, you know, a cut of the savings.
▶ 1:11:25Ms. Mitchell: They pay for your programs and then you get a cut of the savings. So if they don't -- if they -- he does not make any sense if they would not do it. >> you know, it is certainly important that there should be private investment in falls prevention. Medicare advantage plans, private insurance companies, there definitely should be that private public partnership.
▶ 1:11:51Ms. Mitchell: We do want to make sure that we are reaching all of those seniors in older adults including the one sanchez have straight medicare. They don't have access or are able to afford those medicare advantage plans or other private insurance options and that is why those public-private partnerships are so important and like you said, there should be that investment. >> you should be able to make a profit. If you can save them that much money, you should make a profit off the medicare advantage that you can do the others.
▶ 1:12:21Ms. Mitchell: On top of that, if you give me the information, I will see if I can get cms to do a pilot with you and that would help make it happen across the country. So florida has been a leader in state-level innovation to elder services. To what extent do federal oaa requirements and funding conditions constrain florida's ability to design programs that fit its population and would you support giving states more flexibility in how they use dollars even if it meant less federal prescription over how programs are run?
▶ 1:12:53Ms. Mitchell: >> thank you. Yes, we would enjoy any kind of flexibility to be able to use funding to support seniors. But the main issue is that the funding is just inadequate across the board. It does not matter if we are shifting funding between title three b supportive services or from both buckets to title 3c nutrition services.
▶ 1:13:23Ms. Mitchell: We have over 7000 seniors waiting for at least one kind or one type of older americans act service. We just do not have the funding to serve the needy in our communities. So yes, while flexibility is always welcome, we really have to pivot to know what seniors need and where they needed the most. To be able to help them and again, the older americans act really helps that holistic approach to preventing falls.
▶ 1:13:54Ms. Mitchell: It's not just that evidence-based programming. >> when I became governor of florida, a lot of the regulations -- somebody did the wrong thing and took advantage of the program and then everybody else pays for it and then the consumer, however, the senior in this case gets less. Predictive analytics are increasingly being discussed as a way to identify fall risk before a fall happens. How mature is that capability today and real-world deployment?
▶ 1:14:22Ms. Mitchell: What would it take that kind of tool to move from a premium product to something the agency could integrate into its program? >> so I think that is what we are always going towards is being able to predict versus being able to just, you know, assess based on what has already happened. At grandcare, we like to call our data that we receive little data.
▶ 1:14:45Ms. Mitchell: So we are taking a grandcare system and monitoring or managing somebody's chronic conditions and we are saying, ok, so if jim has congestive heart that if jim has congestive heart failure, I want to know if he gains weight.
▶ 1:15:07Ms. Mitchell: That sort of predictive, that type of thing, or I want to know if somebody is having a seizure, I want to detect if there is wondering motion, I want to be notified so I can intervene before something else occurs. That type of stuff exists already today.
▶ 1:15:27Ms. Mitchell: Some of the ai and predictive analytics, in my mind, it is hey , I want to know if gene gets out of bed like this for weeks and weeks, what happens if he used to get out of bed every night, what happens if she gets out of bed every night to use the restroom -- and now she's using it three or four times.
▶ 1:15:57Ms. Mitchell: That could be a lot of things. Being able to assess that information and comparing information from something that this person used to do something they are doing later is super helpful. What if my mom used to win at solitaire all the time and now she is losing? It used to take her this long to play the memory game and now it is this long. Being able to assess that information, it all exists right now.
▶ 1:16:26Ms. Mitchell: We can take a look and see how many times they are playing games, which videos they are watching, how much they are video chatting with family and friends. All of that is untapped and ready to be either put, delegated into a greater analytics system so somebody can create algorithms and determine, we've determined this person who is about to have a stroke, here are the motion patterns and blood pressure and the amount of times they use the restroom.
▶ 1:16:56Ms. Mitchell: All of that would be exciting for us to know in order to predict events and also prevent them.
▶ 1:17:02Chair Scott: That makes sense. A lot of seniors and their families are enthusiastic about technology in the abstract but resistant in practice, often because of privacy concerns. How do you approach that tension and what have you learned about designing systems that people use and keep using?
▶ 1:17:24Ms. Mitchell: That's a great question. I often feel like older adults are not scared of technology -- this is a population that went from potentially walking to flying in their lifetime. They use technology every day, they watch tv -- all sorts of different technology. They have fancy cars and fly and do the things. It all comes down to the interface.
▶ 1:17:52Ms. Mitchell: Are we providing something we feel is accessible, usable and friendly to what their needs are and what they want to do? Or are we forcing them to use the technology like here is my tablet, use this, and it may not have been designed with them in mind?
▶ 1:18:11Ms. Mitchell: We designed initially in 2005 with the older adult in mind and now we have individuals with intellectual and develop mental disabilities we also work together with. We designed for both populations and it's designed to sew an individual who can read or look at pictures or touch buttons can participate.
▶ 1:18:33Ms. Mitchell: We have folks in hospice who cannot touch the touchscreen at all and family members that live far away -- in hospice you might not necessarily know how much time you have. If you are flying in from another state, you may say for the next six weeks I'm going to be on edge and wonder, but with technology like this I can video chat with mom and dad. She doesn't even need to be able to touch the touch screen.
▶ 1:19:01Ms. Mitchell: If I'm designated, I can do that and communicate in connect. It's giving those advantages over the disadvantages. It's about somebody feeling more secure and we don't have any sort of access to remotely monitoring or assessing that ourselves, we provide it for family members to be able to assess the tools and set up rules.
▶ 1:19:26Ms. Mitchell: They are not poring over motion graphs, that would be boring. We say if there is excessive motion in the bathroom in the middle of the night for more than 45 minutes, I want to be notified. In that case, I might be able to support somebody if they are sick, did a fall occur? It's just an outlier.
▶ 1:19:52Ms. Mitchell: It is not about monitoring, it's about providing independence and letting individuals be connected to family and friends wherever they want to live.
▶ 1:20:01Chair Scott: The ymca is in areas across the country where there may be limited reach. How do you think of the network as a network for fall prevention and where are there gaps?
▶ 1:20:21Ms. Petteys: Thank you. We are -- across new york state we have 140 different locations and we work with area offices of aging and of those locations. We see the use of technology to expand that reach to fill in those gaps, meet those individuals wherever they are at.
▶ 1:20:45Ms. Petteys: For our falls prevention programs, we not only offer apps at ymca facilities across the state but we bring those programs into other community settings like senior centers and libraries, or my favorite, we have a program happening at an old joanne's fabric in a mall in upstate new york.
▶ 1:21:09Ms. Petteys: Then technology is allowing us to fill in those gaps and reach those individuals who have various barriers, mobility, transportation or maybe they are caregivers and they are at home. We are always about connecting with partners through the region because we know we can't do this alone. We are absolutely open to partnerships.
▶ 1:21:37Chair Scott: I want to thank each of you for everything you do every day. If there is anyway I can help you and work with cms or medicare advantage, let me know. Thank you everybody for being here today and participating. What we heard today reinforces something I came into this hearing already believing -- falls are not an inevitable part of aging, they are preventable crisis and we have the tools and knowledge to do some thing about it.
▶ 1:22:05Chair Scott: I will continue working with members across the aisle and on the dais. The record will be open until next wednesday at 5:00 p.m. Thank each of you for being here.