The Administration for Community Living’s (ACL’s) mission is to maximize the independence, well-being, and health of older adults, people with disabilities, and their families and caregivers. ACL’s programs provide individualized, person-centered home and community-based services and supports, as well as invest in research and best practices, to make community living a reality for millions of people.  Delivered through the national aging and disability services network and their partners, ACL supports effective and efficient programs and services that address the social and behavioral determinants of health for millions of older adults and persons with disabilities each year.  The aging and disability networks reach into every community across the nation and function as the trusted “eyes and ears” of a person’s home and community environments. When essential social and behavioral determinants of health, i.e., adequate nutrition, safe housing, and access to health care services go unmet, we know that this puts older adults and adults with disabilities at greater risk for falls and other threats to their health and independence. 
Across the nation, many aging and disability networks are engaged in community integrated health networks in an effort to provide older adults, individuals with disabilities, and other high cost, high need populations with streamlined access to services to help them remain healthy, in ways that respect individual preferences, goals, and interests. Community Integrated Health Networks are comprised of a group of visible and trusted aging and disability organizations, led by a Network Lead Entity (NLE), who have formal partnerships with health care and other relevant sectors to address health and social needs in a coordinated way. NLEs function as a one-stop-shop for contracting with health care entities, and often deploy a multi-payer strategy to ensure individuals have access to needed programs and services; beyond contractual arrangements with health care entities, other sources of financing that networks may draw upon are federal grants (e.g. Older Americans Act and discretionary) or other publicly-funded resources at the state or local levels, philanthropic support, private pay arrangements, and civic/community investment (e.g. local businesses, United Way, etc.). An important part of any robust community integrated health network is the inclusion of evidence-based health promotion and disease prevention programs. Indeed, results from the Aging and Disability Business Institute’s 2020 Request for Information indicate that evidence-based programs are the second most common service provided through contracts (behind case management/care or service coordination). A March 2020 Community Integrated Health Network Report provides more information about the intent, guiding principles, and function/structure of community integrated health networks, and an example of one network.
Over nearly two decades. ACL’s Administration on Aging has worked to increase access to, and the sustainability of, evidence-based programs that help older adults make positive changes to maintain and/or improve their health. This portfolio of programs includes programs focused on chronic disease self-management, behavioral health, medication management, physical activity, falls prevention, and other important areas. These proven programs, alongside the other services and supports the aging and disability networks provide, are essential in helping older adults and older adults with disabilities live healthy and independent lives.
In later life, falls can have a widespread and significant impact on health, can be deadly, and often result in high costs. One out of four older adults fall each year . In 2014, 2.8 million older adults were treated in emergency departments for falls injuries and more than 800,000 of these patients were hospitalized . From 2007-2016, fall death rates in the U.S. increased by 30% . In 2015, the total medical costs for falls totaled more than $50 billion . Addressing falls requires a multi-factorial approach and comprehensive strategy that includes a combination of clinical and community-based interventions . Multiple evidence-based community programs have been shown to reduce falls and/or falls risk factors , as well as provide a positive return on investment .
Between FY2014 and FY2020, ACL/AoA awarded 67 discretionary grants to states, community-based organizations, and tribal organizations to implement evidence-based falls prevention programs. Since September 1, 2014, over 126,000 individuals have participated in an AoA-supported evidence-based falls prevention program. For more information about ACL’s Falls Prevention Program – including profiles of current grantees – please visit: https://www.acl.gov/programs/health-wellness/falls-prevention.
This funding opportunity has two goals:
Goal 1: Strengthen state or regional community integrated health networks that address the social and behavioral determinants of health of older adults and adults with disabilities.
These Networks should have the capacity to deliver, strategically incorporate, and embed evidence-based falls prevention programs within their broader context that includes other programs and services that address social and behavioral determinants of health (e.g. nutrition, transportation, etc.).
These networks should have:
A Network Lead Entity that is working in partnership with a variety of community-based organizations across a geography to provide a centralized, coordinated model for service provision, administrative functions, and qualify improvement. The collective network should have the ability to provide a range of services, including evidence-based falls prevention programs. Beyond the partnering community-based organizations, the network should also include state level partnerships (i.e., State Units on Aging, Public Health, etc.), local level partnerships (i.e., AAAs, Centers for Independent Living, etc.), and strategic engagement of health care entities.
Sustainability strategies including, but not limited to, a business plan with clear strategies, contracts, and/or other means to secure and expand sustainable financing (including non-federal funding), infrastructure to receive reimbursement for services, and information technology solution(s) that allows for referral management (including closed loop referrals), participant tracking across interventions, and outcome measurement.
Strategic partnerships with other entities involved in evidence-based falls prevention work (i.e., Falls Prevention Coalitions, CDC grantees, etc.).
Multi-site delivery partners who have the delivery infrastructure/capacity to increase access to evidence-based falls prevention programs with a defined geographic or population base, and a commitment to embedding these programs into their routine operations and budget.
Coordinated public awareness, education, marketing, and recruitment processes.
Ongoing quality assurance efforts including fidelity monitoring and continuous quality improvement.
Goal 2: Significantly increase the number of older adults and adults with disabilities who participate in evidence-based community programs to reduce falls and falls risk.
All programs proposed to be implemented using ACL funding must be on the list of pre-approved programs in Appendix A.
Applicants should use the guidelines in the Evidence-Based Falls Prevention Program Risk Continuum to assist them in selecting their proposed falls prevention programs. Applicants must propose to offer at least two programs on the pre-approved list in Appendix A that address different levels of risk on the Continuum. All applicants must propose to implement at least one program that can be delivered in a remote format, i.e., by video conference or some other modality that does not involve an in-person component. The National Council on Aging (NCOA) maintains a website that tracks remote program guidance by program (https://www.ncoa.org/news/ncoa-news/center-for-healthy-aging-news/track…). However all applicants should contact the program administrator(s) for any program(s) they are interested in delivering remotely to confirm that: 1) the programs are allowed for remote delivery; and 2) that training is readily available for applicants who need it. Note that the NCOA website includes programs on the pre-approved list in Appendix A, as well as other programs not on the list. For this funding opportunity, applicants may ONLY propose programs on the pre-approved list in Appendix A.
All applicants who do not have adequate existing capacity for any in-person and/or remote program(s) they are proposing must include a letter from the program administrator in their application indicating that they will be able to get training in the program no later than three months after the start date of the grant (if selected for funding).
Related Federal Activities
This opportunity does not duplicate nor overlap with existing Federal efforts related to falls prevention; it aligns with current efforts to maximize the impact of this funding. Some examples of existing national, state, and local falls prevention efforts that could be leveraged may include:
The Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control uses data to report the latest burden and health implications for various injuries including falls, the leading cause of both fatal and nonfatal injuries among older adults. Using these data, CDC is building partnerships with health systems, providers of health care, and those who pay for health care services. These partnerships will improve what is known about the burden of falls and the integration of effective fall prevention strategies and patient care. The CDC’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) initiative provides resources and tools for health care providers. These tools include online trainings, screening tools, case studies, videos and information on how to conduct functional assessments, and patient educational materials. CDC is also working with suppliers of electronic health records systems to facilitate the adoption and use of the STEADI tools in the clinic setting. CDC also supports opportunities to broaden and improve the linkage between primary care providers and evidence-based community falls prevention programs supported by ACL. Related resources include:
Related resources include:
CDC STEADI Initiative
CDC Facts on Older Adult Falls
CDC Compendium of Effective Fall Interventions: What Works for Community- Dwelling Older Adults
The ACL-funded National Falls Prevention Resource Center (NFPRC) based at the National Council on Aging, works to increase public awareness about the risks of falls and how to prevent them, support the implementation of evidence-based falls prevention programs, and serve as a national clearinghouse of tools and best practices. The NFPRC also leads the Falls Free® Initiative, a national effort to address the growing public health issue of falls, fall-related injuries, and deaths. The initiative includes 70 national organizations and a 43-member State Coalition on Falls Prevention Workgroup charged with collaboratively promoting effective strategies to address falls.
Related resources include:
National Falls Prevention Resource Center Webpage
Falls Free® Initiative
Falls Prevention Awareness Week
2015 Falls Free® National Action Plan
Fall Prevention Facts
Resources for Older Adults and Caregivers
Evidence-Based Fall Prevention Programs
State Policy Toolkit for Advancing Falls Prevention
 U.S. Department of Health and Human Services, Administration for Community Living. (2019). FY2016 Report to Congress: Older Americans Act.
 World Health Organization (2019). Social Determinants of Health, Accessed October 2, 2019 from https://www.who.int/social_determinants/en/.
 ACL Office of Performance and Evaluation (2019). Program Evaluations and Reports. Accessed October 2, 2019 from https://acl.gov/programs/program-evaluations-and-reports.
 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2019). Healthy People 2020: Social Determinants, Accessed October 2, 2019
from https://www.healthypeople.gov/2020/about/foundation-health-measures/Det…- Health#individual%20behavior.
 U.S Centers for Disease Control and Prevention. (2016). Facts About Falls. Accessed November 10, 2020 from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
 U.S. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online], accessed August 5, 2016 at http://www.cdc.gov/injury/wisqars/.
 U.S. Center for Disease Control and Prevention. National Center for Injury Prevention and Control. Important Facts about Falls. Accessed September 20, 2019 from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
 Florence CS, Bergen G, Atherly A, Burns ER, Stevens JA, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. Journal of the American Geriatrics Society, 2018 March, DOI:10.1111/jgs.15304
 U.S. Centers for Disease Control and Prevention. (2015). Compendium of Effective Fall Interventions: What Works for Community-Dwelling Older Adults, available at: http://www
 Fuzhong L, Harmer P, Fisher JK, Mcauley E. (2004) Tai Chi: Improving Functional Balance and Predicting Subsequent Falls in Older Persons. Med Sci Sports Exerc. 36 (12): 2046-2052.
 Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. (2004) The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. J Am Geriatr Soc., 52 (9): 1487–1494.
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 Carande-Kulisa, V., et al. (2015), A cost–benefit analysis of three older adult fall prevention interventions, Journal of Safety Research, Accessed January 4th, 2016 from: http