Assisted Living Facilities And Falls

[wedgeclose 59]

I agree with the poster about the epidemic and it is almost always THE ATRIA in every town!  Used to be the nursing homes that were abusers.  Friday and Saturday they call and send all their "problems" to the hospital for the weekend..now everytime its meal time at the Atria we might as well station a rig at each one for two hours.  These people are making TONS OF MONEY without providing and medical emergency care on property.  They do not contribute to the organizations at all.  So, we are burning up resources for lift assists and the like.  Hey the fuel and wear and tear on the vehicles AND the staff costs something.  Solution,  A $200 service fee EACH TIME there is NO TRANSPORT!  Draw it up so it is binding and they will stop calling.  It really is a scam by Atria who do nothing for their "guests" except feed them...amen

[velcroMedic1987 330]

15 hours ago, wedgeclose said:

I agree with the poster about the epidemic and it is almost always THE ATRIA in every town!  Used to be the nursing homes that were abusers.  Friday and Saturday they call and send all their "problems" to the hospital for the weekend..now everytime its meal time at the Atria we might as well station a rig at each one for two hours.  These people are making TONS OF MONEY without providing and medical emergency care on property.  They do not contribute to the organizations at all.  So, we are burning up resources for lift assists and the like.  Hey the fuel and wear and tear on the vehicles AND the staff costs something.  Solution,  A $200 service fee EACH TIME there is NO TRANSPORT!  Draw it up so it is binding and they will stop calling.  It really is a scam by Atria who do nothing for their "guests" except feed them...amen

 

Do they pay taxes?  Does EMS receive tax-funded support?  Then they DO contribute.

 

Besides complaining about it here, is anyone doing anything anywhere to remedy the situation?

 

[velcroMedic1987 330]

If the problem is "lift assist" calls where they are not requesting medical intervention or transport to a medical facility, why does EMS get assigned at all?  Simply tell your dispatch center to stop sending you to lift assists unless an injury or illness is being reported as well. 

 

Now if you keep doing them and they agree to pay $200/call, are you saying that will suddenly make it OK?

 

 

[antiquefirelt 994]

29 minutes ago, velcroMedic1987 said:

If the problem is "lift assist" calls where they are not requesting medical intervention or transport to a medical facility, why does EMS get assigned at all?  Simply tell your dispatch center to stop sending you to lift assists unless an injury or illness is being reported as well. 

 

Now if you keep doing them and they agree to pay $200/call, are you saying that will suddenly make it OK?

 

 

You have brought up two decent points. First, the issue for our dispatch center is that they are required by our state to dispatch EMS if the call sounds like EMS, basically the EMD system is utilized and a dispatch code is assigned, even if it's an Omega (non-EMS). Trying to make the dispatch center deny the caller a response is passing the buck to a department less qualified to argue the case when the facilities complain.

 

The second part is the $200 doesn't make it OK, it serves as a monetary factor which is what this whole issue is about. They are using 911 EMS resources for non-EMS calls to save money on their WC, so if they start to pay they'll address the best way to handle these patients and continue with their profit margins. 

[wedgeclose 59]

I only suggested the "call fee" because after all Atria is a money making business not a government funded or insurance funded nursing facility.   So perhaps they may consider adding a nursing staff or even EMT's to staff the "pick me up desk".  Do you not consider 3 to 5 calls per day to be ABUSING the system?  We are a two rig gang with a fly car dedicated to the other "two abusers' and the towns in which they are located.  We used to be an all volunteer agency but over the years the one or two calls per shift became 8 or 9 with these facilities creating the bulk of the calls.  Volunteers burned out and now we are predominantly a paid service supplemented by some volunteers.  It is bottom line a profit for them and a loss for us......

[mikeinet 37]

Aren't there laws around charging for an RMA though...? At minimum, insurance won't pay it because "it's not a medical necessity" (hence the reason for the RMA)

 

I agree if you start charging it'll drive change... but hands are tied a lot of times in doing that

Edited May 5, 2016 by mikeinet

[sympathomedic 383]

FYI The Atria's do pay taxes. When my parents lived in the Briarcliff one, they had an annual picnic for the VFD and EMS- no idea how well that went.

FYI #2 not all these places are equally licensed.  Some are independent living with NO help staff, the one in Rye has a bar, with a two drink per resident daily max- so no EMT bravo retirees likely to go there. Some are assisted living with a lower level of care, which I learned  meant NO modified food, so when my dad couldn't chew due to a dental issue, he had to leave because they were not allowed to have a resident needing modified food.  Others have a higher level, and can deal with less firm folks.

 

When Heritage Hills was built in Somers, they were required to have a 24X7 EMT that the FD could conscript to make a full crew.  We did that all the time, but we still failed to cover calls, hence our going to a 24X7 paid first crew. Can't blame Heritage and the old folks for that- they give us an EMT whenever we ask.

[Dinosaur 844]

On 5/5/2016 at 1:45 PM, mikeinet said:

Aren't there laws around charging for an RMA though...? At minimum, insurance won't pay it because "it's not a medical necessity" (hence the reason for the RMA)

 

I agree if you start charging it'll drive change... but hands are tied a lot of times in doing that

 

So bill the facility directly for a service call.  Get the town to pass a local law like they do for alarms that keep going off.

 

[AFS1970 504]

A law allowing billing for non transport service calls might have an unintended bad effect. There are still significant callers who despite their symptoms will delude themselves into thinking EMS will just come and check them out. They do not think they need transport and thus in their minds are not calling for transport. If they see a fee for non transport calls then they may not call when they have an emergency.

 

A better law, although likely not very enforceable, would be one that forbids facilities that care for individuals to have a policy that requires an emergency service to respond. This is because strictly speaking, it is up to an agency to respond or not to every call, subject to relevant laws. It is not up to the patient / facility to demand that we A) respond or upgrade or downgrade a response based on their policy.

 

Many years ago our local homeless shelter had no day time programs, so everybody had to be out by 8AM. The only allowable reason for a daytime bed was illness. Their internal policy only allowed for illness that was confirmed by the doctor at the E/R and they did not accept even that if you went to the E/R under your own power. Thus anyone who wanted to stay in bed all day had to go to the hospital in an ambulance. The shelter would call 9-1-1 and not be able to provide a chief complain other than someone needs to go to the hospital to get checked out.

 

That situation as well as the lift assists where staff is not permitted to lift up a patient would both be curtailed by such a law, thus allowing for all legitimate calls, but not allowing facilities to use EMS to supplement their staff or lack there of.

[Remember585 815]

If you're in emergency services and you're complaining about actually helping someone who needs help - you might need to rethink what you're doing with your life.  If you don't like waking up and going to a call that isn't "juicy" or "salty" enough for you, cry me a river. It's what you signed up for.

 

 

[sympathomedic 383]

OMG!

THANK YOU, MR. MUNSON!

[mikeinet 37]

I don't think anyone is complaining about "helping people"... I think they are saying are we the right ones to be helping...

 

If you fall and can't get up in your home/private residence... I have 0 quarams.

 

If you fall and can't get up at an assisted living facility and the staff who are well trained refuse to help... THAT is where I have the issue.

[dpfd144 5]

I think there are several issues going on here:

 

1.  Is the facility REQUIRED by law or regulation to have an appropriately trained provider on site to respond and provide emergency medical care?

 

Probably not for most assisted living facilities. 

 

2. Even If there is an appropriately trained provider on site, do they actually have a "duty to act" and go to the side of the person who fell, and provide care?

 

I'd really like to know the answer to this.  I mean, if an RN was contracted by the assisted living facility to just give insulin injections to residents, and an emergency occurs while they are onsite, is responding considered outside of their scope of employment?  Can they purposely stay down the other end of the hall, away from the patient/resident even though they are told about the fall?   It would be great if DOH could clear that up so that EMS providers can at least understand why the people onsite aren't really helping/handling this themselves.

 

3.   Regardless of 1 & 2 above, it may still be in the patients best interest to be evaluated by a well trained, well experienced EMT or Medic anyway, rather than someone else onsite:  good injury assessment skills are lacking at a lot of facilities.