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Rising concern for Minnesota firefighters: Calling 911 for help standing up

December 8, 2018

Firefighters across Minnesota are increasingly responding to 911 calls to lift elderly people off the floor, even at some senior care facilities with their own staff.

More than 7,100 times last year, fire departments across the state were dispatched to assist frail but uninjured people, a nearly threefold increase from a decade prior. The unreimbursed runs come at a cost to taxpayers — $825 per call, by one estimate — summoning a fire truck and several firefighters to perform a “lift assist” without medical treatment.

It is a worrying trend for many local fire departments already responding to mounting medical calls, since it can leave them shorthanded for major emergencies and puts firefighters at risk of back injuries. It also underscores the sometimes uneven care offered by senior housing complexes springing up across the metro area.

“These assisted living facilities charge a pretty hefty fee each month for the residents to stay there,” said Coon Rapids Fire Chief John Piper, who reduced the lift calls in his city after meeting with assisted living facilities. “As the name implies, it’s our view that that’s a service that they should provide.”

“Lift assist” calls typically involve people who fall doing routine tasks, like moving around the bathroom, and do not need medical help. These runs now make up almost 4 percent of all fire department medical runs, though the data probably understates the actual number, according to the state fire marshal. It includes people who call from their homes.

Cities across the country have begun charging facilities for lift assist runs, most recently Omaha, Tacoma, Wash., and Kansas City, Mo.

“I think it’s a growing problem with everyone,” said Dale Specken, Hopkins fire chief and president of the Metropolitan Fire Chiefs Association. “The busier that we’re getting with just calls in general and then lift assists ... a lot of them are ones that we end up at nursing facilities.”

Even people needing a lift are sometimes surprised to see firefighters. In July, four firefighters arrived at a senior living complex in Minneapolis to pick up an uninjured woman, who asked why three nurse aides in the room hadn’t lifted her. The aides cited instructions from their supervisors not to lift any patients. The facility does not lift residents who do not pay for home care services.

Several local departments now follow up in person with callers who are living independently to help them prevent future falls. But a number of departments have also had to outline the appropriate uses of the 911 system for staffed senior facilities, some of which call because of a staff shortage or policies against lifting.

Roseville, which has a large number of senior care facilities, handles about 300 lift assist calls per year. About half the city’s on-duty fire crew responds, potentially leaving the department shorthanded if three calls occur simultaneously. Fire Chief Tim O’Neill said they are trying to rein in the calls while still providing the service, since they want people get appropriate care.

“We kind of look at it and go, ‘Well, are there ways to reduce the number of lift assists?’ One of them of course is if the facilities themselves took care of the problem,” O’Neill said. “The other one is trying to reduce the number of falls proactively.”

911 dispatch records from around the metro area show that nursing homes, assisted living and independent senior living facilities are among the most common dispatch destinations for local fire departments, based on a Star Tribune analysis. Unlike skilled nursing homes, which are closely regulated by the federal government, assisted living and other residential care facilities are not licensed in Minnesota. Many older people living in these facilities are frail and have complex needs, but the level of care they receive varies widely and is often dependent on what they will pay for.

911 as a last resort

Mark Paul said he was terrified leaving his 88-year-old father at Elk River Senior Living, a large senior community, after visiting and finding few staff around. “It felt like a huge empty shell,” said Paul, 63.

Staff reassured the family that conditions would improve. But a month later when their father Robert Paul fell, no one was around to help. Another of his sons rushed to the scene and tried to find staff. He ultimately called 911.

“[Staff] bragged to us about how our father would get the best quality of care,” said Mark Paul. “But he could have died there on the ground and no one would have found out for days.”

Kylie Larson, executive director of the facility, said the building only offered independent living when it first opened — before assisted living and memory care programs started — and therefore was not staffed 24 hours a day. She said this was disclosed to Paul and his sons. Larson said that a home care provider will help residents who fall if they are enrolled in a service plan, but Paul did not request those services.

Jennifer Segal, a registered nurse in the Twin Cities who has worked in assisted living, said a contributing factor for the calls is that many people in assisted living need more help than the facilities can provide. They often have limited staff available, she said, particularly at night. Staff are often instructed to call 911 after a fall to avoid injuring themselves and ensure the resident is evaluated.

“Our fundamental problems are our elder care is a mess and people aren’t getting the right amount of care,” Segal said. “And so because of that, these types of systems end up being overused.”

Cheryl Hennen, Minnesota’s long-term care ombudsman, which investigates senior facility complaints, said her office fields calls from people who had to dial 911 after failing to get help from their long-term care facility after a fall. Her office wasn’t hearing similar complaints a number of years ago, she said.

“The feeling is one of, ‘Good, help is on the way. I’m not alone. But yet I shouldn’t have to call 911 to get this kind of help,’ ” Hennen said. “Because they may feel like I’m not as critical as someone else that needs the help from a firefighter.”

‘Cry for help’

Patti Cullen, president of Care Providers of Minnesota, an industry group, said if a medical professional does not assess someone after a fall, facilities get blamed for not calling 911.

“When people fall, especially if they’re older and they have brittle bones, we don’t really know that they’re not injured,” Cullen said.

St. Louis Park officials meet with nursing home and assisted living staff to reduce lift assist calls. For people who fall while living independently, the department sends “community EMTs” to determine why it happened and help get appropriate care — like adding grab bars or reconfiguring medication.

“In an independent living environment, a lift assist in our perception is a cry for help,” said St. Louis Park Fire Chief Steve Koering.

Maplewood recently took a similar prevention tack after a team of researchers closely studied a decade of fall calls in the city. They found that while fall calls overall had risen nearly threefold over that period, the number resulting in transportation to the hospital declined — a sign of more calls for less severe falls. The study found that nearly a third of people who call for help after a fall will call again — one person called 75 times over the decade.

“Once we see someone two or three times, the frequency in which we’re responding with the 911 system increases and duration in between the calls decreases,” said Mike Mondor, Maplewood’s chief of EMS. “So really then if we’re being thoughtful about our resources, we need to ask ourselves is this the most effective way of handling these calls?”

State Sen. Karin Housley, chair of the Minnesota Senate Aging and Long-Term Care Policy Committee, said she heard repeatedly from public safety officials around the state while campaigning for U.S. Senate this year that they need help handling growing senior fall calls.

“We have to work collaboratively with first responders and [determine] what is it that they need,” said Housley, R-St. Mary’s Point. “Because this isn’t going away.”

Staff writer Chris Serres contributed to this report.

Eric Roper • 612-673-1732 Twitter: @StribRoper