In cities and states across the country, assisted living communities and nursing homes that call their local fire departments for lift assist services increasingly are being told to pay up, and sometimes that are being asked to provide care that seemingly goes against regulations and without legal protections.
Decatur City Council in Illinois is the latest local government group to adopt an ordinance charging communities for fire department responses to lift assist calls. In Decatur, facilities will be billed $500 per assist call for at least the next year.
The ordinance addresses what city officials say is a growing problem: an increase in lift assist calls that take fire department staff members away from their core responsibilities. According to the Decatur Fire Department, the number of lift assist calls it received increased from 430 in 2014 to more than 1,000 in 2023.
The assisted living communities said they call for injury assessment, which is outside the scope of practice of a certified nursing assistant.
Senior living providers organizations in Illinois said that Decatur’s move is part of a greater effort on the issue, including a bill in the Illinois Legislature, HB 2216, that would make this type of fee applicable statewide for independent living, assisted living and similar congregate care facilities. Sterling, MI, instituted a similar ordinance last year, which drew the ire of senior living communities.
“Our position is that local governments and municipalities employing these emergency personnel have an obligation to provide the services offered by these personnel to their citizens, whose taxes fund the salaries of these individuals, regardless of where they live,” Illinois Health Care Association / Illinois Center for Assisted Living President and CEO Matt Hartman told McKnight’s Senior Living. “If municipalities feel that the usage of fire and other emergency personnel are being abused, they have recourse at the state and local level to curtail that appropriately, without targeting seniors in need of assistance or those who provide care for them.”
Emergency assistance is excluded from the legislation, which Hartman said makes the bill more “palatable” but does not negate arguments against the action.
“LeadingAge Illinois considers it inappropriate and wrong to deny and penalize our seniors who need emergency services and related supports they have paid for their whole lives because they now live in a community that provides them the comfort, convenience and services they need and deserve,” LeadingAge Illinois President and CEO Angela Schnepf told McKnight’s Senior Living. “Our seniors should have access to lift assistance and other emergency services and supports regardless of the residence they have chosen to live [in].”
Wisconsin takes its own approach
In Wisconsin, lawmakers are considering two bills addressing lift assists in assisted living.
AB 943 would provide grants that would enable assisted living communities, nursing homes, residential apartment complexes and hospices to buy resident lift devices.
The bill requests $300,000 to launch a pilot program to put 100 lifts into different facilities across the state and study their effect. The program’s goal is to reduce 911 calls and worker’s compensation claims from first responders injured while lifting on the job, and to reduce costs for senior living residents who don’t need medical treatment but need help getting up from a fall.
Although senior living organizations said they support AB 942, they are united in their concern over AB 942, which would impose a “duty” on assisted living communities to administer CPR and first aid and to make an attempt to lift residents who have fallen.
The Wisconsin Assisted Living Association said it has concerns about the bill as well as a recently introduced amendment that would remove liability protections for meeting the proposed “duty” requirement.
WALA President and CEO Michael Pochowski told McKnight’s Senior Living that performing CPR on frail elderly residents is dangerous, as would be requiring it to be performed by nonmedical and unlicensed staff members. He said the bill also does not address the liability ramifications if CPR were administered accidentally to a hospice resident or to a resident with a do-not-resuscitate order.
“Assisted living communities in Wisconsin, by law and by legislative intent, are meant to be residential settings, not medical or nursing homes,” Pochowski said, adding that state law does not allow the provision of 24/7 medical or skilled care in the setting.
Wisconsin law limits the number of nursing hours that can be provided in assisted living communities — community-based residential facilities can provide no more than three hours per week, per resident, and residential care apartment complexes can provide no more than 28 hours per week of supportive, personal and nursing services. Further, Pochowski said, assisted living communities may not employ licensed nurses or nursing assistants as a home- and community-based residential setting.
Wisconsin Health Care Association / Wisconsin Center for Assisted Living CEO Rick Abrams told McKnight’s Senior Living that the bill ignores the different staffing levels and training requirements in each long-term care environment, as well as the industry’s challenge to retain and attract staff members. Abrams said the bill also does not provide funding to support the training and staffing requirements.
“Essentially, this legislation would require unlicensed staff to medically assess residents that are found on the floor for an injury, even though that employee does not have the education or qualifications to do so,” he said, adding that an improper assessment could exacerbate injuries by lifting or moving a resident. “In addition, if further injury does occur because the assisted living community was mandated by law to try and move the resident, the recent amendment removes any liability protections, assuring the provider and its staff will face lawsuits.”
According to a Wisconsin EMS and falls report from the Wisconsin Department of Health Services, the state has the highest fall-related death rate of all states among older adults. In the past three years, a 24% increase in fall-related 911 calls occurred.
