Accidental Falls – How to Reduce Your Risk + Cover Medical Costs

Cathy Jakicic
February 12th, 2020 February 11th, 2020 |
Read time: 11 minutes

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While it’s often played for laughs in comedies, falling down is no joke – especially for an older person. The numbers can be pretty sobering.

In 2017, for instance, 8,591,683 Americans were injured in falls.[1] While that number includes all ages, people age 65+ are at the greatest risk of suffering a fatal fall.[2] By 2030, the Centers for Disease Control and Prevention (CDC) estimates that 49 million older adults will fall each year.[3]

In fact, every year, 3 million older people are treated in emergency departments for injuries from falls and more than 800,000 people are hospitalized – usually because of a hip fracture or head injury.[4]

Many people who fall, even if they’re not injured, become afraid of falling again. This fear may cause them to be less active, lead them to become weaker and eventually increase their chances of experiencing the fall they had been fearing.[5]

In the remainder of this blog post, you’ll learn about:

  • Some risk factors for accidental falls
  • How to reduce your risk
  • The potential cost of fall injuries
  • Supplemental insurance to help pay those costs

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Are you at risk for a fall?

A number of factors can contribute to your fall risk, including:

  • Age and gender
  • Health status and underlying medical conditions
  • Lifestyle, occupation and socioeconomic factors

Let’s take a closer look and see if you may be at an increased risk for an accidental fall.

Age

Age is a key risk factor for falls, according to the World Health Organization (WHO), with older adults and younger children seeing the highest incidents of falls and more serious injuries as a result.[6]

After adults aged 65 years or older, young adults aged 15–29 years and children aged 15 years or younger account for the highest level of fatal falls.[7]

According to the CDC the adult age groups with the fewest falls (at least according to emergency room records) are those in the 25-34 and 35-44 year age ranges.[8]

Why are seniors at a greater risk of falls and serious injury? There are a number of potential contributing factors.

For example, as they age, seniors may be at a greater risk for:[9]

  • Difficulties with walking and balance
  • Weakness in the lower body
  • Vitamin D deficiency
  • Use of medications that can affect balance
  • Vision problems
  • Foot or footwear issues

In addition, while it’s common knowledge for parents to take precautions for babies and toddlers that are at risk for falls as they’re learning to stand and walk, it’s not always as easy to know when an older adult needs changes to their environment to provide additional safety.[10]

Seniors can benefit from a number of mobility and safety aids like walkers,[11] hand-rails and shower chairs or handicap-accessible bathtubs.[12] Unfortunately, sometimes realization and acceptance of these types of aids only comes after an accidental fall.

Gender

While in some geographic regions men are more likely to die from a fall, women experience more non-fatal falls.[13] In fact, women experience three-quarters of all hip fracture injuries. Women are also more likely to have osteoporosis, which can weaken bones and result in more serious injury from falls.[14]

In addition, osteoporosis may actually increase an individual’s fall risk by increasing their fear of falling.[15]

According to studies that have been conducted in this area, “fear of falling is known to be related to a decrease in physical and mental performance, and to higher risk of falling.”[16] In one study, individuals with osteoporosis reported “significantly” more fear of falling, as measured by the Falls-Efficacy Scale (FES), than those in the healthy control group.[17] Previous studies have reached similar conclusions.[18]

Lifestyle, Occupation + Socioeconomic Factors

The environment you live in, your habits and the behavior you engage in can impact your risk for an accidental fall. For example, potentially hazardous working conditions and use of alcohol or other substances can affect fall risk.[19]

The WHO has also found that socioeconomic factors such as poverty, overcrowded housing and single parenthood can be considered risk factors.[20]

Health Status, Underlying Medical Conditions

Medical conditions – such as low blood pressure, or a neurological condition – and the medication that may be required to manage them, can potentially increase fall risk.[21]

According to a 2017 study, certain chronic health conditions increases the risk of falling. The following were linked to a higher risk of falling among those individuals studied.[22]

  • Heart attack
  • Angina
  • Stroke
  • Asthma
  • Cancer
  • Chronic obstructive pulmonary disorder (COPD)
  • Chronic kidney condition
  • Arthritis
  • Depression
  • Diabetes

The study findings suggested that in older people, having a medical history of stroke, kidney disease, arthritis, depression, and diabetes could indicate a greater risk of first-time and subsequent falls. However, having a heart attack, angina, asthma or COPD were only linked to a risk of repeat falls.[23]

Another study found that seniors with chronic conditions fell up to 40% more often than those with no chronic health conditions.[24] According to the National Council on Aging, 80% have at least one chronic health condition and 68% have two or more.[25]

How to Reduce Your Fall Risk

While the range of potential risk factors can seem daunting, the good news is that there are ways to reduce your chances of falling, particularly if you fall into that 65+ age group.

A good start can be a visit to your doctor to evaluate your risk level and discuss conditions, such as low blood pressure, that may increase your chances of falling.[26]

While at the doctor, you may want to also:

  • Review your medicines (prescription and over-the-counter) to see if any might make you dizzy or sleepy
  • Get your vision checked
  • Discuss supplementing your diet with additional vitamin D and/or calcium
  • Find out if an exercise program to increase strength and balance would be beneficial[27]

You can also review your living environment to identify and correct any hazards you find. For instance:

  • Remove clutter and other obstacles
  • Add handrails and seats to showers and tubs
  • Install railings on both sides of stairs
  • Add more or brighter light bulbs if needed
  • Place non-slip mats in some areas
  • Remove rugs that may cause tripping[28]

More Helpful Resources for Seniors
There are some helpful fall prevention resources for older adults (or their caregivers) at the CDC website, as well as from Consumer Reports and the Mayo Clinic.

And you can find detailed information on “Modifying Your Home for Healthy Aging” from Eldercare Locator (a public service of the Administration on Aging (AoA)).

You can also perform a quick fall self-assessment using the questions in the CDC’s “Stay Independent” brochure.

Costs for Common Injuries from Accidental Falls

Reducing risk factors may prevent a fall, but accidents still can happen. When a serious fall occurs the most common injuries are:

  • Broken or fractured arms, legs, ribs or hips
  • Head or spinal injuries
  • Abdominal injuries[29]

For older adults, the risks/costs can be even greater. When adults aged 75 or older fall, their injuries are more likely to be severe and they are three times as likely to die following a fall according to a report in the Journal of the American Medical Association (JAMA).[30]

The result of fall injuries can range from pain and inconvenience to permanent disability or death. And they can strain your budget.

For example:

  • Arm Fracture: $400 to $980+ to treat and set the lower arm.[31]
  • Arm Fracture (with hardware): $6,221 to $19,933+ to treat a lower arm fracture, including the insertion of hardware via a surgical procedure.[32]
  • Leg Fracture: $5,697 to $24,417+ to treat a femur fracture, including a 4-day hospital stay and surgical procedure.[33]
  • Hip Fracture: $6,676 to $26,187+ to repair a hip fracture, including a 3-day hospital stay, postoperative care, and surgery.[34]

The average inpatient hospitalization cost in the United States (in 2017) was between $1,996 and $2,574 per day depending on the type of facility.[35] That means a seven-day hospital stay recovering from fall injuries could cost anywhere from $13,972 to $18,018 (or even more today).

Overall, the CDC projects that 49 million older adults will fall each year by the year 2030, and that this will result in more than $100 billion in health-related spending.[36]

Lost Income and Other Expenses

Even though seniors often face a greater fall risk, younger people and those still in the workforce can also suffer injuries from accidental falls that can lead to unplanned medical costs and other financial issues, including:

  • Lost wages during recovery
  • Potential out-of-pocket costs from needed or preferred out-of-network healthcare specialists
  • Long term care[37]

In cases like these, supplemental health insurance options, Long- or Short-Term Disability or Accidental Death + Dismemberment (AD&D) insurance can offer some financial protection. Learn more about insurance and financial products to help with coverage gaps.

Health Insurance for Accidental Falls

When looking at coverage for injuries from an accidental fall, a major medical policy is usually the best bet. The Affordable Care Act (ACA) requires that all medical insurance plans being sold as ACA-compliant major medical coverage be guaranteed issue and meet a set of minimum coverage standards.

You can get major medical insurance from a number of places, including:

Supplemental Health Insurance

Even with major medical insurance, it’s a good idea to check whether you have enough health benefits to cover the costs associated with a fall. If not, a supplemental health insurance policy may help pay for costs that aren’t fully covered by your major medical policy such as:

  • Co-insurance and deductibles
  • Out-of-network costs
  • Income replacement[38]

Let’s briefly overview a few common types of supplemental medical coverage.

Hospital indemnity insurance can help pay for additional out-of-pocket costs resulting from an accident. This type of policy may cover things like hospital room and board, doctor’s visits, or medication while you’re hospitalized, inpatient or outpatient surgery or ambulance services.

Get a Hospital Insurance Quote

Accident insurance usually pays a fixed amount if you’ve suffered injuries such as sprains, fractures or concussions. Benefits typically cover hospitalization and inpatient rehab and ambulance, urgent care or ER services.

Get an Accident Insurance Quote

Gap insurance can include critical illness + accident insurance coverage that provides a fixed lump-sum benefit as a result of a covered critical illness or if you’ve had a fall resulting in injury.

Get a Gap Insurance Quote

Supplemental Insurance is NOT ACA Coverage

Supplemental insurance is not ACA-qualifying coverage. This means policies are not guaranteed issue (you can be denied coverage based on your medical history), there may be limits on pre existing conditions, and policies typically include annual and/or lifetime benefits limits.

When shopping for a supplemental policy, make sure you’re aware of limitations that may apply and verify if it will cover the types of injuries and services you anticipate needing. Also, validate if the coverage comes with a waiting period.

When considering whether supplemental insurance is right for you, consider the following:

Are you at greater risk for a fall? Not sure? Request a fall risk assessment from your doctor, or start with the CDC’s self-assessment questionnaire.

What are your total out-of-pocket costs before you can access your medical policy’s benefits? (E.g., annual deductible and/or annual out-of-pocket maximum.) Not sure? Find out if you may be underinsured.

Do you have savings, disability insurance or another way to replace income if you’re unable to work while you’re recovering from your injury? If not, then supplemental benefits may be one option to help.

Does the extra premium cost of a supplemental insurance policy make sense with your finances? You can request quotes to see premium costs for any plans you’re considering (and to see if you qualify).

Summary + Next Steps

Falling, especially for an older person, can lead to painful injuries and unexpected costs. But there are things you can do to both reduce your chances of falling and ease the potential financial consequences.

  • Evaluate your risk of falling.
  • If you’re at a higher risk, take proactive precautions to reduce it.
  • Make sure you have the ability to pay for costs associated with accidental falls. That may mean enrolling in an ACA-qualifying major medical policy, and/or supplemental insurance or other financial products if they make sense for you.

Learn more about supplemental insurance today. Or call 888-855-6837 to speak with an insurance agent to discuss your options.

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