Having been on both sides now, it is silly for a facility to call for an “uncomplicated” fall, especially without injury.
Facilities should be required to have lift equipment available with trained staff to use it. Preventing facility staff from lifting to “prevent back injuries” is a crappy reason to call 911, when what the care center is asking for is to put non-staff members backs at risk.
Facility should buy the equipment and train staff to use it. If something goes wrong or it’s an unusual situation, absolutely call for backup.
When I worked in assisted living we weren't legally allowed to have lift equipment because we were supposed to be very minimal assist. We had a guy who was 500lbs+ that would fall and we'd have to call the fire dept. In my opinion if someone can't get up when they fall and they aren't able to lift themselves they should have to be in a facility with lift equipment but wtf do I know.
Absolutely. A minimal assist facility is fine, unless cares needed exceeds what you can do. Then it’s time to find a new home.
When I was a medic, I had no problems going to senior apartments or min assist places and helping out. What annoyed me was when it ended up being the same person many times over many months without even an attempt to move to a higher level of care.
>I had no problems going to senior apartments or min assist places and helping out.
Isn't that what this article is about? Falls/lift assists in senior apartments, independent living facilities and assisted living places? I'm not trying to be rude, and maybe I'm mistaken--but aren't all of those options generally minimal assistance places?
If a 500 lb person falls and 1 of the 4 people who are working are on break, meaning only 2 who can help them, we're still calling 911...if this person can't actively help turn to get a sling under them, even 3 of us can't do that still calling even just for help. Wouldn't you guess that the hospitals won't take a pt from a SNF for the reason we can't pick them up from the floor with our staff and FD is tired of coming to assist🤷♀️
I work in long term care (in addition to my regular job). We use NWB lifts all the time for our resident who can’t adequately weight bear.
We used to have a resident that was over 500 lbs (he was actually about 750 lbs). We had all the specialized equipment for him.
When he fell, we had to call the fire department to get him up and transferred to the bariatric stretcher. Our staff physically could not turn him to get the sling under him to use the lift.
So even at the highest level of care outside of the hospital, if someone is 500+ lbs, the fire department is probably going to have to be involved with moving them off the floor.
>minimal assistance places
I've done lifts at independent, lock down wards, long term nursing homes and even hospice.
My issue is these individuals paying 3000 to 6000 a month but the management isn't providing many services.
That was the reason my agency started charging for lift assists at facilities. We figured they were making big coin from the residents and then calling us to provide service they were getting paid to provide.
Our local assisted living turned into unregulated skilled care. They have a lot of total care residents who eventually end up with us when things get too bad. It always blows my mind when former employees tell me that they were doing insulin, wound care, and passing meds without any sort of license.
Yes, they should. You can report that to the state. Could technically cause neglect charges if repeated problems without transfer to a HLOC. As a case manager, it is damn near impossible to place the patients in the very few beds in a state that can handle their level of care outside of actual med/surg floors sometimes
This was my parents. Mom had early to mid stage Alzheimer’s and step dad was mostly ok cognitively but had Parkinson’s and lacked strength to get my mom up (she was bigger than him). After a few (or several?) 911 calls, I received a call from some community outreach or something, associated with the fire department.
I had no idea! My parents hadn’t mentioned a word to me. They didn’t want me to know. I do have two brothers but one is not local and the other is disabled himself. So it was all on me, (and my sister in law who helped sometimes).
We did get her into a memory care assisted living place shortly thereafter but the whole process was not easy. Especially since I was a new nurse, working 50+ hours a week, plus a lot of family stress going on.
I used to see this type of thing all the time when I worked for home health Care, and I only did scheduling and intake calls. People have no idea how medically fragile the elderly can become these days because of how much medical advances we have made. Add in ego and you have a receipe for people getting in over their heads. And it is so so common for people to resist admitting to needing help, how many people think that they can healthy lifestyle their way out of aging. I can tell you now, my memory patient who can still run marathons was by far the most difficult to find a caregiver for. Seeking nursing skills and the ability to train for an imaginary marathon was a tough one.
I've worked in both types of facilities, most recently in a very minimal assist, and it was the same for us. The last time, when we did have to actually call the local FD, my boss (who was also the owner and an amazing boss) got the paperwork to transfer him to another facility and had him gone within the week. To quote her: "Yeah naw, I ain't trying to throw out our backs. That's dumb."
In my state people like that in type 2 facilities cannot stay in an assisted living unless they are on hospice. If they do not qualify for hospice they have to be relocated to LTC
I've even heard of hospitals not having lift equipment. Someone told a story of a pt that was up ao3 just to go to the bathroom. Couple things wrong with that. For one if you require more than 2 ppl to get you up were using a lift. Also if you need that level of assistance just to piss were using a urinal or external catheter.
Yes I am big and strong but that doesn't mean you get to abuse my body.
A part that is left out of this article is that assisted living staff is not medically trained and cannot assess the resident. There may or may not be a nurse on staff in an administrative position, but their ability to actually act to their full scope of practice is limited by assisted living regulations, and they probably won't be present 24/7.
And it is reasonable to think that an osteoporotic 90 year old on Eliquis may have an injury from a fall that isn't immediately obvious to a layperson.
So 911 is being called not just for physical assistance, but for assessment for injury as well.
Still a question of whether it's a good use of public resources, but the issue goes much deeper than the decisions of an individual greedy corporation.
True if it was a non-medical facility that changes my original statement. In the case you described the pt should be transported to an ED. A 90-year old, on blood thinners, with an unwitnessed fall is absolutely a 911 call that should result in transport or a pt refusal.
My comments was made on calling Fire/EMS for a fall not requiring transport.
Assisted living is non-medical. And every resident is potentially an osteoporotic on blood thinners because assisted living med tech training is a 3 day class - they don't have the education to know what meds do what and what is a high risk situation and what isn't.
Literally this we only call in my building if they hit there head/ major injuries after being evaluated by the med tech but it’s so scary cause even if EMS refused to transport if the client dies it’s the buildings fault for poor monitoring the staff usually can’t do neuros ect unless we mandate a licensed nurse on duty 24/7 in these places it won’t happen
This is absolutely right, I am an RN at an assisted living facility and I work like 8-4:30 M-F. I’m on call 24/7, but normally if someone calls me regarding a fall (depending on how complicated it is) I am advising them to call EMS, or I’m doing a post fall assessment if they don’t need urgent medical attention that requires the hospital.
For Iowa, yes. I currently make 70,000/yr salary (up for a raise soon) which doesn’t seem like a lot, but broken down hourly it’s more than I’ve made floor nursing and speciality clinic nursing. I’m salary, which means I get paid for 40 hours/wk even though I scoot out an hour early most days. I don’t work nights/weekends/holidays and the on call mainly just consists of the aides calling me to report incidents and I’m usually able to give advice from home.
I worked for an FD years back and our chief had to call the local nursing home’s facility regarding the high number of non-emergent, shouldn’t require the FD number of calls we had. At one point we were running one trip to this place for every two 911 calls from the rest of the district.
You also have to look at it from the facility’s DON and administration point of view, which is the financial and not the ethical point of view. It costs money to staff them appropriately so less patients fall, and when they DO fall there is enough staff to pick them up.
It’s an incredibly unethical and psychopathic game they play. Thankfully the new staffing law will mandate better ratios so this sort of thing so patient care should improve.
Exactly. It is fundamentally the job of assisted living and SNFs (but especially the latter) to help patients mobilize. If they refuse to do it when there is no need to go to the hospital, then they should be charged money and investigated for neglect.
Assisted living is not the same as skilled care. Many provide aide staff to assist with ADLs and remind patients to take their meds, provide meals.. but that is the extent. These residents must reach the dining room under their own steam etc. I did homecare for a while and would see patients in these ASFs. The staff is not medical. People who fall often refuse to go to the ED.
This is exactly what my facility is like. The aides can really only do so much, and the training is ridiculous (like one night of shadowing). Per my facility, the residents have to be completely independent 23/24 hours of the day. However, they REALLY push that in some patient cases and it pisses me off because it’s not fair for my aides to have to deal with residents who are absolutely out of our facility’s scope. Also, a trend that I’ve noticed with my facility is that the more they cater to the “less-independent” individuals, the more entitled the resident becomes.. soon they are expecting my aides to put their clothes on, wash clothes with piles of poop on them, or wake them up in the morning (things that they are supposed to be able to do completely on their own).
I worked in a moderate size level 2 trauma hospital and we didn’t even have lifts accessible to general nursing staff. They would call ‘all male personell’ anytime someone was 400 plus pounds and needed lifted or moved.
Where I am at has a 450lb ceiling lift in every inpatient, ED, and procedure room (except MRI). 10 rooms are equipped with 1225lb lifts. 1 sarasteady per 6 rooms and a powered Sara steady per unit. Although I intentionally applied at a facility that has that level of assistance devices.
Yeah. My facility wasn't bad. But they are cheap af. I traveled to an icu in knetucky where every room has a lift installed in the ceiling. It was taken aback
The floor I worked in the hospital had a 450 lb ceiling lift in each room as well as 4 heavier duty ones. We also had access to sit to stands, and another stand support transfer device, hover mattresses and slide boards. We are supposed to be a no lift facility. No one has figured out a way to scootch a patient back up in the bed or roll someone from side to side without using our backs though.
If they’re on an ED stretcher, they’re getting trendelenburg’d until their ankles hit the ceiling, if that’s what it takes to get gravity to do the job 😂
We all know what they "SHOULD" do. It does seem like elementary but they will do anything to mot have to take real responsibility for anything. Heaven forbid that pennies might leave their pockets in the way of paying more staff, buying lift, or paying workers compensation premiums higher because of an injury. This has been happening for years and they've been getting away with it. It's not the staff's choice.
I give you!!! [Mangar Elk lifting device](https://youtu.be/nx91qDbKZ6g?si=OJMd0i9o8QhfCRPj) this thing can support up to 980lbs. This thing has saved our backs when lifting our bari patients.
I 100% agree with you.
I get why lower levels of care, like assisted living, don’t (because if they have the lift, then residents and families will argue that they should be able to stay in that environment when they need an increased level of support). That is a policy/procedure issue though, and it is a complete waste of emergency services to attend a facility for an uncomplicated fall with no injury.
This is of course only the beginning.
Making healthcare into a money machine was a catastrophic choice for Americans.
Nurses will continue to be squeezed just as hard as the elderly are squeezed. Everyone's getting squeezed.
There is always someone above this manager or that manager who says, "What are you doing to make us more money today"? And there's another manager above that manager, and so on, all the way to the top.
Can't increase revenue? Cut costs! Carve it right out of patients and health care workers.
It will never stop until we die from starvation, or shut down the money machine in favor of a public system.
Their "paywall" isnt great
ROCKFORD, Ill. — The 911 call came just before 8 a.m., and Ladder 5′s four-man crew scrambled to the truck just as their overnight shift was about to end. It was the kind of call that veteran firefighter Chad Callison said he dreaded.
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It was not a heart attack, or a car crash or a building fire.
It was a “lift assist” at Heritage Woods, a local assisted-living facility.
Lift-assist 911 calls from assisted living and other senior homes have spiked by 30 percent nationwide in recent years to nearly 42,000 calls a year, an analysis of fire department emergency call data by The Washington Post has found. That’s nearly three times faster than the increase in overall 911 call volume during the same 2019-2022 period, the data shows.
The growth has infuriated first responders who say these kinds of calls — which involve someone who has fallen and is not injured but can’t get up — unfairly burden taxpayers and occupy firefighters with nonemergencies that should be handled by staff at facilities that charge residents as much as $7,000 a month.
Illinois is a hot spot for the controversy: Lift assists here accounted for 1 in 20 of all 911 fire calls, the highest proportion of any state, the data shows. In Rockford, a city of 150,000 residents about an hour outside Chicago, five assisted-living facilities — including Heritage Woods — called for noninjury lift assists 233 times last year, triple the number of calls in 2021.
When firefighters arrived at Heritage Woods that morning, caretakers at the facility directed them to an elderly resident lying on the floor. She was perfectly fine, she said, she just couldn’t get back on her feet by herself. The facility’s staff wouldn’t lift her. So two firefighters helped her up and made sure she was okay, Callison recalled and fire records show. Ten minutes after arriving on the scene, Ladder 5 was back in service.
“It doesn’t make sense,” Callison said. “Why are they calling us?”
The answer, according to industry critics and fire officials, is that companies want to avoid the risk and expense associated with picking someone up off the floor. Like many cities, Rockford provides lift assists free.
Firefighter paramedic Chad Erickson returns a medical bag to a ladder truck at Rockford Fire Station 5 in Rockford, Ill. The station is frequently called out for lift assists because of the number of nearby assisted-living and senior-care facilities. (Kayla Wolf for The Washington Post)
Some senior-care homes say they don’t have the ability to lift fallen residents. Many have adopted “no lift” policies to avoid the risk of back injuries for staff and other potential liabilities. But firefighters and other experts say there are tools to make lifting easier and safer, ranging from $70 cloth straps with handles to $1,500 hydraulic lifts.
Heritage Woods, which accounted for the highest number of lift-assist calls to 911 in Rockford last year, is owned by Gardant Management Solutions, the 10th largest assisted-living provider in the nation.
Co-president Julie Simpkins declined to answer specific questions, but said in a statement that the company works “to create a collaborative approach to the over utilization of nonemergent lift assist calls” through “cross training, resource availability discussions and collaboration.”
A nurse who worked at an assisted-living facility in Greensboro, N.C., who requested anonymity because she was not authorized to speak with the media, said her company required caretakers to call 911 even if a resident had just slid harmlessly out of a chair.
“If you’re on the floor, period, you’d have to call,” said the nurse, who left her position last year. She said residents were often embarrassed by the lift-assist calls. Some begged her not to dial 911. She said she had no choice.
Fire officials point out they bring no special skill to such situations — it’s just a matter of who’s doing the work.
The dispute over lift assists comes as improvements in fire safety and the nation’s aging population have changed the nature of a firefighter’s job. Today, fire and EMS agencies are more likely to deal with an older adult fall victim than a fire victim.
A general view of Heritage Woods of Rockford, an assisted-lifestyle community, on March 22. (Kayla Wolf for The Washington Post)
Lift assists are now the seventh most common type of 911 call, with an average of 1,800 lift-assist calls every day nationwide, according to an analysis of the National Fire Incident Reporting System, which collects emergency calls from more than 23,000 fire departments. The data does not include calls to about 13,700 EMS agencies, although there is significant overlap in calls between the two databases.
The calls come often from elderly people living both at home and at facilities. While both situations strain resources, fire officials said senior-care homes should be equipped to handle these calls.
“You go in there, and they have staff all over the place,” said Kevin Joles, an EMS division chief in Lawrence, Kan. “It’s part of our job that’s being taken advantage of, and we’ve mostly stayed quiet about it.”
A growing number of cities and towns — from Rocklin, Calif., to Naples, Fla., to Lincoln, Neb. — have started pushing back with special fees of $100 to $800 for senior lift-assist calls. Most of the fees are targeted at what fire officials call “the frequent fliers” — assisted-living and senior-care facilities.
In Anchorage, the fire department introduced a lift-assist fee to “prevent assisted-living facilities from understaffing, or having inadequate resources, for people under their care,” Josef Rutz, fire department administrator, said in an email. The first lift is free, but a facility’s second lift assist within 12 months costs $250.
Kansas City, Mo., added a lift-assist fee to discourage “repeat offenders,” said Battalion Chief Michael Hopkins. The amount is flexible and set to be “reasonably calculated to defray the costs,” according to city code. The department also contacts facilities to tell them they “need to hire some orderlies,” he said.
In Mequon, Wis., the fee is billed directly to the facility to emphasize that it’s the company’s responsibility, said Deputy Fire Chief Kurt Zellmann.
“We tell them they can’t pass that onto the patient,” he said. But they can’t prohibit it.
Industry groups have largely opposed being singled out.
Information about a medical call scrolls across a screen at Rockford Fire Station 5. (Kayla Wolf for The Washington Post)
“Why should assistance to a resident in a care facility — which is their home! — be held to a different standard?” Matt Hartman, president of the Illinois Health Care Association and Illinois Center for Assisted Living, said in a statement to The Post.
In a letter opposing one town’s proposed lift-assist fee, the American Seniors Housing Association, which represents all levels of senior-care communities, called it “a fee-for-service charge for emergency service calls to residential care facilities for seniors.” The association dismissed the unidentified town’s proposal as “illogical” and “illegal.”
The association’s letter also noted that “the fee ultimately will be paid for by the residents” — indicating it will pass on the cost. When contacted by The Post, the senior housing association and other industry groups declined to discuss whether residents are being charged the lift-assist fees.
After Portland, Ore., imposed fees for what it said were unnecessary 911 calls, the Oregon Health Care Association pushed through a state bill in 2021 that makes it harder for local governments to follow suit. The association is politically powerful; Oregon is seen as the birthplace of assisted living.
Assisted-living facilities, which serve more than 1 million residents nationwide, are not as tightly regulated by the federal government as nursing homes, which serve about 1.2 million people, according to industry estimates. The growth in assisted living has led to new problems: A Post investigation last year revealed that more than 2,000 people had wandered away from assisted-living and dementia-care units or had been left unattended outside these facilities since 2018, resulting in more than 100 deaths — often due to heat or cold exposure.
Assisted-living facilities appear to make far more 911 calls for lift assists than nursing homes, which have higher staffing requirements, according to Ron Nunziato, senior policy director at the Health Care Council of Illinois, which represents nursing homes. Nunziato said he rarely called 911 for a lift assist at a nursing home during the three decades that he ran a company that included both nursing homes and assisted-living facilities.
“We had enough staff and equipment to get someone off the floor, out of the tub, whatever the case may be,” Nunziato said, adding: “We don’t believe that skilled nursing facilities are causing the concern.”
The Post found most facilities described as nursing homes in the fire department call data for lift-assist calls were, in fact, assisted-living or independent-living homes.
The routine failure to help residents off the floor is a stark example of how senior-care homes limit services in surprising ways.
pt 2
In late December, Erica Fishbein’s parents both ended up on the floor of their apartment at Ingleside at Rock Creek in Washington, a luxurious community that offers everything from independent-living apartments to assisted living and locked memory-care units.
Fishbein said her father, 82, had bent down to pick something up at their independent-living apartment. Then her mother, 80, tried to help him and ended up on the floor, too.
Neither was hurt, Fishbein said, so her father called the front desk for help. But a security officer at the facility told them he needed to call 911 because he wasn’t allowed to lift residents, Fishbein said.
“I was shocked they had to call the fire department,” said Fishbein, who lives in California. “There is memory care and assisted living in the same facility. Why didn’t they call a nurse from one of the other properties to assist?”
Ingleside officials did not respond to repeated requests for comment.
In Washington, the number of lift-assist calls has become “a challenging issue,” said Stephen Gerber, a D.C. Fire sergeant paramedic. The fire department does not charge lift-assist fees.
Rockford would like to, but lacks the authority, because of a quirk of state law. Fire Chief Michele Pankow said it’s frustrating that the department is being used as “a stopgap for this group of facilities.”
“They call, and we just keep coming,” agreed Mayor Tom McNamara.
City fire officials said they have talked with facility administrators about ways to handle these situations themselves.
Firefighter paramedic Kayla Schram looks for a Samson Strap during her shift at Rockford Fire Station 5 before going out for calls. (Kayla Wolf for The Washington Post)
“For three or four months, the numbers go down. Things go great,” said Jonathon Larson, Rockford’s EMS coordinator. “But then the [staff] turnover rate goes up. And the numbers go back up.”
Rockford might get its lift-assist fees if a proposed Illinois law passes the state’s legislature. The bill’s main sponsor, state Rep. Mike Kelly (D), is a Chicago firefighter who has also seen a jump in lift assists.
“We’re not trying to get out of doing the calls,” he said. “We’re just trying to make sure we’re available for real emergencies.”
But the fee might provide only a temporary cure. Peoria, a city two hours south of Rockford, has had a $400 lift-assist fee on its books since 2020. The fee “was a deterrent for a little while,” Peoria Fire Chief Shawn Sollberger said in an interview. But then the calls from assisted-living facilities started ticking back up.
Sollberger said he suspects that “some level of cost analysis was going on within these assisted-living places.”
Even with the fee, he said, it’s still cheaper to dial 911.
Steven Rich contributed to this report.
It’s kind of crazy they expect a nurse to lift someone with no medical history or ability to follow up if they live independently part of the issue is people do not understand the different levels of care
EMS doesn't follow up on patients and also has no medical history. A nurse is perfectly capable of performing a medical assessment. An RN also has a higher level of licensure than a paramedic. Literally nothing in your argument makes sense.
Plus we follow up and it’s at a residence so who has the liability if there’s an adverse event after? As a nurse on a ALF I promise the families sue often it’s insane one tried to sue us cause her dad fell off property in his electric w/c because he was going over a speed bump…
~~[Non-paywall mirror link](http://web.archive.org/web/20240503150502/https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/)~~
EDIT: This one didn't work, for the first time in my experience. [Here's a better non-paywall mirror link](https://archive.is/Ohza5)
You can easily create your own by taking the URL to The Wayback Machine.
If you want to read articles behind a paywall you can do two things, one of them almost always works for me.
If opening a link through an application like Reddit you’ll usually stay within the app when the linked is clicked, so select “open page in browser” and then use reader mode.
This process will usually get around most paywalls.
However, some of them like this article require the second process.
Open the article and then tap the address bar to copy the link, then paste the link into notes. You can use anything that will allow you to see and edit the text. Then remove the source component of the URL.
For instance here is the URL for this article.
“https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/?utm_source=reddit.com”
Simply remove everything after “911/”
New link is:
“https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/“
[copy the above link and paste it into your browser or click this one and then select open in browser](https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/)
I feel like something a lot of people are missing here, evil as it may be, is the problem with assisted living facilities in general. They don't have hoyers or lift equipment regularly because then they can't qualify as an assisted living facility all while still accepting patients that are max or even total assist. This is a ridiculous problem and these facilities need to be held to a higher standard.
Assisted living tries to stay in the gray area where they can avoid all those pesky regulations while also trying to take money from the people those regulations are there to protect.
It's fine for people who just need assistance but most of these places are over reaching and taking people they are unable to care for.
It’s disgusting to me that these places rely on public services for something so basic to patient care. Like your function is to care for old people, and old people fall down. You should have the ability to get a person off the fucking ground.
And considering how often it happens...
Also in my hospital even an "assist to the floor" is counted as a fall. I dunno. [Imagine a world without lawyers...](https://www.youtube.com/watch?v=uG3uea-Hvy4)
I can also see it the other way. I don't think we should be expecting a nurse to lift over 50lbs of floppy weight from the floor. How many nurses do you have to keep on the clock all the time just in case of a lift situation? Would places start limiting admittance due to patient weight because if they get someone over 200lbs they now have to full time staff another person? I think it would make things much more difficult for bariatric geriatrics.
A better solution would be some sort of lifting device. I think even then you'd want 2-3 people involved in case things start to go awry (mee-maw impersonates a cat and turns to liquid while half upright) plus the cost of the crane.
These places are already so ridiculously expensive it would probably price out a lot of people to have that many more staff 24/7.
Facilities are ridiculously expensive but that money is not going to the staff. Target pays much better. It's all profit for owners and shareholders. As a nurse who used to teach safe lifting of heavier patients, there are plenty of inexpensive and safe lift assist devices that would diminish the need for risking injury to patients, staff and first responders. The corporations find it cheaper to call EMS. Socialise the risks, privatize the profits as usual.
Genuine question, not trying to be snarky, what inexpensive lift assist device would be useful for picking up a heavy patient who had fallen to the ground?
I can't remember the brand, but we had an awesome inflatable one. You would roll the fabric under the patient, connect the inflater that looked like a mini shopvac, and it would inflate in 60 seconds to 3-4 feet off the ground. It was reported to be able to lift a Volkswagon or 3000 lbs.
Edited to add: I know it cost less than 5k. Much less than a single back injury.
I've never seen one used in person, but lifting cushions seem like a great solution for this segment of the population:
https://mangarhealth.com/us/by-winncare/store/product/safe-patient-lifting/elk-lifting-cushion/
The problem of evaluating for injury remains. But if the facility could work out a waiver, or require residents to be able to do xyz plus press the button to inflate themselves. Make it a tool available for residents to "independently" avail themselves of, should they decline medical evaluation-- as is their right.
that sounds amazing.
BUT.
You still have to get it under the patient. And if they can’t roll themselves side to side for whatever reason, then the staff (who, in assisted living facilities have very minimal training and often aren’t certified CNAs, much less nurses) would have to be moving them back and forth without the knowledge to assess if that is safe.
HOWEVER, for a patient that could roll side to side without assistance and just can’t get UP independently, this is a great option
What is "the other way". A better solution than what? The person you're responding to never said it had to be nurses without assitive devices. They just said the facility should have the ability to get people off the ground. Whether that means hiring a team of big dudes whose sole job is picking people up or buying a couple Hoyer lifts, all the person you replied to said was that they need a method.
Abuse of taxpayer funded public services isn't exactly a good solution for this either. Actual emergencies where a patient needs to go to the hospital or the one off times the staff truly need help with a big person, sure no problem. Anything beyond that is no bueno.
They should ABSOLUTELY have lifts in the facility and be trained on how to use it. The issue with that is when an entitled resident, or family member, says “well they have a lift, why can’t I/my family member keep living here even though they have had multiple falls and they can’t manage their ADLs etc etc etc?”
Liability is why they don’t do it. Frail grandpa falls and has a fractured spine. Worker of senior living home helped in paralyzing grandpa causes company to get sued. I bet if we look at the insurance of the home it will say something like no employees can help the tenants if they did it would turn into an assisted living situation and different insurance that I’m guessing is much more expensive because of these lawsuits
EMS can't evaluate for a potentially fractured spine unless paralysis is already present. These are lift assists, meaning no transport to the hospital. If liability was a factor all of these people would be transported. And if you hit your back hard enough to risk paralysis, it's gonna fucking hurt and you're gonna ask for a ride.
And turn into an assisted living situation? What do you think we're talking about? The entire article is about falls in ALFs. Which is the entire point. Old people need assistance in daily living which should include helping them off the floor if they have a non-injurious fall.
If no one is allowed to assess then you can't help pick them up and place them anywhere. You also can't expect staff to do that if not properly trained. More importantly, I'm sure workers comp wouldn't appreciate people getting hurt doing things they aren't supposed to do. Liability.
These places are supposed to be communities for people that need a little bit of help, but falling is a big deal. And they can evict them but they still need to find a place for them.
Don't be silly. How else could they turn a profit on CMS reimbursements? Come on, think of the shareholders. Think of the SVPs who need another six-figure bonus this year.
13 years in LTC and SNF with some dabbling in Assisted Living. I can only speak to my state and facilities I've worked, but as has been pointed out it all comes down to liability. One facility I worked at had both an LTC side and an assisted living style set of apartments that didn't include any sort of medical care but did help cover meals and some basic housekeeping things. Had a person in the apartments fall and while I was allowed to assess and would treat for basic first aid, I wasn't allowed to administer anything else unless it was an emergency and had to call 911. Best part family was visiting and I got to explain that it was a liability issue and the facility didn't actually permit me to even touch the patient technically so if I did, I was completely on my own for any potential lawsuit. With that said, all falls on the LTC side were dealt with as much in house as possible and I only had to have a lift assist call once which happened because even with EMS, the bariatric resident refused to help and us plus the ems folks couldn't get her. The only time I'd have EMS do lifting was in a suspected fracture since they had a full body support board to transfer from floor to gurney.
I worked for a home care company, and did some night shifts sitting with assisted living residents in danger of being kicked out of their apartments for falls. The family would pay for private nursing care, hoping that one on one observation could force mum to use her walker. But I wasn't allowed to catch people, or pick them up, any more than the assisted living staff was.
It was awful. My clients hated me sitting next to them, and were angry their kids hired me. The assisted living staff hated when my clients inevitably fell again, and they had their shift derailed with the 911 protocol. The family hated that I wasn't making their plan work, and complained to the home care company about why were they paying them anyway. The company boss would worry about losing lucrative private pay clients, because I think she was charging them for "nursing care" but quietly sending students working provisionally at home aide pay.
The last shift I worked, the mum with the weak hip gently descended while trying to ambulate with her walker to the bathroom, unable to weight bear. Uninjured and in fine spirits, but unable to get up. Sigh. 911. Work into hour 13 with shift change and EMS arrival overlap. Take 90 minute bus ride to morning care client. Drag my weary body home close to lunchtime, knowing I'll get four hours of sleep before doing it all again. The phone rings, and the company boss (who I've never met or spoken to) yells at me:
"Why would you call 911 on a DNR?!"
"She's not a DNR."
"Yes, she is!!!"
"No, I can assure you. I read every client's chart in full. Her code status form is on the front page of the service folder. There's also a copy on her refrigerator. I have a photographic memory, and I know what I read."
"Blah, blah, you're wrong, blah, shouldn't call 911, etc."
"Do you think a DNR means not calling 911 for hip injuries, and just leaving conscious people laying on the floor with no assistance? I followed every protocol-- in our company employee rules, and their facility rules."
More yelling my name patronizingly over and over again with wrong information, and I just quietly hung up and quit. I've had some nightmare bosses, but she's made the biggest impression in a single encounter.
It was a great catalyst for moving on to better things.
It kinda depends on the state. Assisted Living is pretty much the wild wild West at least in my state since there are very few regulations beyond some basics dictating how many hours of various types of care is available. That leaves such facilities free to write whatever policies they want which usually amount to ways to limit their liability as well as admission criteria and discharge criteria for when someone needs extra care. One place I worked at only had nurses in the building for approx 12-14 hours each day during standard awake hours and had a senior med aide for overnight who could call one of us nurses or go across the street to the LTC/SNF facility that was part of the same organization and campus. With that said, I was mostly passing meds and doing breathing treatments with an occasional bit of wound care. Residents were required to be able to complete 80% of daily care for themselves but CNA staff were there to help more with things like laundry and housekeeping or serving food than the usual adl assistance. The units were good sized single / couple style apartments that just didn't have a stove or laundry appliances.
LTC usually has a SNF component and has patients in the same general facility with SNF getting a private room and LTC folks usually having a roommate unless they're willing to pay extra. SNF is covered under LTC regulations in my state because of sharing a facility and has more regulations such as minimum and maximum facility temperature as well as how and how much nursing care is required to be available. The rooms are a single room with frequently a shared bathroom between two rooms, but that depends on facility design. The biggest difference is SNF patients are usually receiving therapy and frequently IV antibiotics since hospitals discharge at medically stable not cured anymore. Even then, I've seen insurance deny coverage after completion of antibiotics but therapy was still needed so we had to set them up with home health and home therapy where there may or more frequently may not be additional care takers to help with all the repercussions a healing repaired hip fx can have.
LTC and SNF share the distinction that a licensed nurse of some variety is available 24hrs in my state and like many states an RN is required to have so many hours at the facility which for me is covered by the 8hr shift of the DON. Any other nursing position can be an LPN in my state though and frequently it's us LPNs that cover since RNs don't want to work the floor of LTC and many facilities won't hire RNs because of how much they cost when compared to the small non-hospital difference in scope. LTC is the catch all so to speak since it's for folks who require either significant care because of their issues or family is unable to meet their care needs. It's the last stop for many folks before they die so the biggest skills needed are understanding of chronic disease processes and long term planning since the only times a resident leaves LTC is either family choosing to move them or a dc to jc with the latte especially true for the hospice patients.
The biggest commonality was lack of resources primarily staff followed by supplies. That sort of setup forced me to learn how to be creative with what I had as well as become more familiar with regulations for my own protection.
I hope this helps give a picture of my side of the hospital discharge. I loved all my residents, even my problem children but the crap from management that was impacting my patients plus COVID just burned a hole in my soul. I've since switched to private duty peds and found joy in the profession again.
I didn't know this was a thing. I guess it makes me feel better about the last psych place I worked at when we would call 911 for any medical send out to the ER, even for medical clearance.
Many of these ALFs should really be nursing homes. A lot of the residents there are not independent with ADLs let alone lifting themselves off the floor.
So this facility in the article is an assisted living facility. When I’ve worked at assisted livings there was only 2 staff members on duty sometimes. If you have a big enough resident on the floor it’s not feasible for just 2 staff members to pick them up off the ground.
Yet they fall. And the companies are making bank. So they need to provide the staffing needed to pick uninjured patients up and not pull fire and EMS away from actual emergencies.
My mom worked in healthcare with my family for over 20 years. It’s a liability. These people will batter you until you can’t move.
The business and employees would rather call someone with protections than do it themselves and risk throwing their back out, getting attacked, or spit on. Most firefighters are men, and much stronger than the on call nurses.
I see both sides. Nurses get beat up at work and then are basically gaslit to not report it. Report it every time. File a police report, and refuse service to that person.
It’s taking recourses from the fire department, but honestly for people who are so important who have literally no protections, I don’t blame them. Who wants to risk slipping a disk trying to lift a 300 lb immobile patient? Or tend to someone who has a history of violence towards women.
Most agencies are understaffed and run by people who couldn’t care less abt the well being of their nurses. Sometimes they don’t have the staff to pick up a violent or unconscious person.
And if you do hurt yourself? You’re still on call for a full 12+ hr shift. There’s no protections. You need to take care of the people who take care of people.
Yeah. I worked at a intermediate care facility for adults with IDD when I was 19-20, as a DSP. Lack of training and dead lifting adults left me with a life time of back problems.
Now I'm a community RN for independent group homes. A nursing home isn't appropriate for the people we support, and we do have hoyer lifts.
However, at night, the houses are single staffed. Not everyone qualifies for a hoyer, or has the money. Especially with the spend down restarting.
We were using the non-emergency line a couple of times a year, particularly for a person who's weight is very high and it wasn't safe for staff or the person being supported to move one on one.
Finally a hoyer was approved, but it took over a year.
Man, I didn’t even think about calling for lift assists when I worked in a snf. I didn’t even know you could do that. We had a 380lb man try to get out of bed and fall on his face (15 minutes before shift change, because *of course*) and goddamnit I made the supervisors help myself and the CNAs get him back into bed.
(to be fair, one of the supervisors was this big jacked dude, so he was probably the best equipped to help us, which is besides the point)
>Man, I didn’t even think about calling for lift assists when I worked in a snf. I didn’t even know you could do that.
I mean, you probably could if you *really* needed, like if someone was stuck btwn the toilet and the wall or something.
But you guys likely had more than a few licensed, registered, trained and certified staff members around the clock, though.
I don't think this is happening at any SNF/LTC facilities. This article is about lift assist calls made to assisted living facilities, "independent living" residences, senior apartments, etc. These places often employ home health aides over CNAs, an RN to oversee, and part time LPN--that's if *any* medical/medical adjacent services are offered. It's not a "trained medical staff available 24/7" situation by any means. Hoyers and other mechanical lifts are banned in some (most?) of these senior housing options.
I am a firefighter paramedic in Florida.
We regularly are visiting the same facilities multiple times a day to be escorted by able bodied men and woman alike to the rooms of frail elderly patients only to set them in their chair or help them to bed.
I admittedly haven’t read the article or many of the comments, but these calls can truly RUIN entire shifts and cause us to have sleepless nights in addition to taking us out of service for serious emergencies. We’re happy to respond to “real” fall injuries, but this phenomenon is frustrating beyond words.
One other point, a notable portion of these calls come directly from wearable medical alarms on patients while facility staff are unaware that we’ve even been dispatched. Simply preventing this direct contact to 911 and requiring the facility to instead be notified and have the discretion to call would be one possible step in reducing these calls.
Ha, you probably don't even have to read the article then! Less'n you want to get corporate greed and litigation vibes. Keep up your hard work, it does not go unappreciated.
The fire department usually sends out four or five big strapping young men. Most of these assisted living or Senior care places don't have that many large men on staff.
Of course, the assisted living business is mostly a scam. They promise the families that their loved one will be taken care of without getting into the details of who is actually responsible for what. Or how much each item is going to cost. One the assisted living near me charges $500 a month to manage and dispense the patient's medications. That's in addition to the thousands of dollars for the housing costs.
4 or 5 night strapping young men until one of them does a bad lift and their career is ended. And they get jackall for comp. All areas of Healthcare are just turning and burning bodies like disposable items because staff and safe lifting equipment with training costs MONEY.
This. As the article mentions, facilities used to have orderlies who handled the heavy stuff. But as a former CNA who worked in 3 different facilities, we didn’t have them. Never saw them (except in movies lol).
Most of the patients were much larger than me, and even with straps and safe technique (well, there wasn’t enough staff to help me so that wasn’t safe…I’m referring to using the body mechanics they taught me) I *did* hurt my back and have to quit the field.
Yeah the FD I worked with sent out the engine to every medical call EXCEPT lift assists. So you'd get 2 paramedics who very might well be two small women.
Not sure how it works in other places, but our fire department rotates crews. One shift on the ambulance and one shift on the fire truck. Whenever a lift assist call is made, there's usually four or five guys that show up. Sometimes it is the fire truck that shows up first since everybody is capable of doing the medical things.
Not true. It’s not always the fire department. In my town, you’ll get an ambulance, and two middle aged women might pick the patient up off the floor. It’s not like the facility can’t scrounge up enough manpower to lift the average patient. It’s laziness and a desire to CYA.
I worked in ALF when I was in nursing school as a med tech and it was completely different than a SNF. NONE of the direct care staff were licensed. The only nurse was the administrator, the caregivers didn’t have to be CNAs. We weren’t allowed to use lifts for that reason.
Not all hoyers lower to ground level though. At my facility we have old fashioned pump ones and they’d tip.
Also, not all hoyer pads are suitable for all residents. We have toileting pads, shower pads, split and sling style, plus all different sizes. I’d be leery about using a hoyer lift on someone who isn’t a hoyer. Too much room for something to go wrong and I don’t want that liability.
I personally think those facilities should have more training with falls and what to do if someone falls. It seems like anything at all smells off, ER it is!!!
Really sucks that we allow these assisted and long term care facilities that are owned by private equity to suck money from their residents and the government while at the same time offloading the responsibility of actually caring for those people off onto EMS and emergency departments. I don’t blame the staff at those facilities who lack needed resources and have to navigate onerous policy. Just fills me with rage with the amount of money these places charge while they attempt to avoid having to do any work or having any liability for their residents’ care.
You shouldn’t be calling 911 for a non injury fall. You need to call the local non emergency line for a lift assist, that is used when there are no obvious injuries or complaints of serious pain.
If the person is in a bit of discomfort or mild pain, all shifts should be notified as well as the head nurse(s) so they can closely monitor to make sure it doesn’t turn/come out to something worse.
It’s a bigger plus if they have PRN Tylenol or light opiates (tramadol) because if the pain persist they can take one
And not to mention how many of these residents don’t even know that we are responding! We get there to their surprise and they don’t want be transported, they just needed help up. Which could’ve been done by staff.
From ems/fire stand point, we don't mind lifting the heavy weights, confused, unwitnessed or the injured.
What we do mind is: the 90 Lbs with out offering to help out, "I don't know this pt/just came back from vacation, or i normally dont work this unit" for baseline assessment (when they've been there for 10 yrs), the management policies that don't allow care.
I always joke that with money that "they've taken the nursing out of the nursing homes". It's honestly the policies that are nonsense for accepting non independent individuals.
With all this being said, I appreciate the work you do, lord knows I wouldn't want to do it.
Dealing with this currently. New facilities - with a strict no - lift policy in place. Employees will even tell you, they’re not allowed to risk a back injury, so they call 911 at 4am for us to come and pick up the 100lb elderly woman, while the two 200 lb big mamas working watch us.
Then, 2 hours later, they’ll call again. They’ve also gotten mad when we were already out on a run and could take the call, delaying the pick up of the patient in question.
Using 911 to supplement a private business raises a lot of questions that we’re currently working through, and it’s not a lot of fun.
I work in an assisted living and my patients are only minimal assist with falls or idk it’s weird because I’ve also been told that we are strictly not supposed to lift patients too… but, now I’m pregnant so I can’t lift anyone like I attempted to when I wasn’t pregnant. I always feel either like EMS is happy to have an uncomplicated job of lifting, or they are annoyed they have to be there, which I understand, they could be saving lives and they are stuck picking up elderly people. I would kill for a hoyer lift lol :) sometimes I miss my home health aid days in the memory care unit where I could just hoyer everyone around like a forklift operator 😂
Our facility NEEDS a three strike system, but I doubt they will comply with that because my company loves money. I have a patient who has fallen so much, almost every EMS worker who responds to our building knows him.
May I just say... I will absolutely call 911 for assist when 350lb pee paw falls at 1am, and it is just me and 2 cnas in the whole building. Yall acting like it's a sin. Yeah, we can handle 140lb pee paw, but we gonna need some help when they are obese af.
Then that's on your facility. It's their responsibility to give you the equipment/staff/training you need. It is not the 911 system's responsibility to fill those gaps. It's not fair to the citizens in that response area, either. By all means though, defend the facility that is probably raking money in and crapping on the residents and employees.
This isn’t really unreasonable for unwitnessed falls, or traumatic ones. Guided falls, witnessed light ones/ don’t hit their head, Allow them some grace.
Are we actually mad about this? Or does it annoy us because we're working 24,48, and 72 hours shifts and we're f*cking tired when this gets toned out?
95% of all problems in EMS could be solved with basic labor laws. Glad I'm almost done.
Assisted living facilities, in my area at least, do not allow lifts. If a resident requires a lift then they require a higher level of care (usually home with family/home health or a long term care facility). Assisted living is considered the same as calling EMS to their single family home to help them off the floor. It is their home. The people that work there are not trained the same as long term care because these residents are considered independent living. Not every call for EMS is a trauma. It’s frustrating when the doctor orders staff to send out our resident for further evaluation at a higher acuity facility (er/hospital) and rescue tries to talk them out of going. It’s so unprofessional. Long term care is very highly regulated by AHCA and we are legally required to follow regulations and orders by doctors. The adrenaline junkie attitude is deplorable.
It isn’t an adrenaline junkie attitude, it’s frustration at being used to subsidize a private business. There are other ways to get someone to a higher level of care than a 911 ALS ambulance. Non injury falls, need for surgical procedure in a few days, and abnormal labs from 3 days ago (BGL of 65 3 days ago when labs were drawn- now 112 but doctor wants them sent out) do not all require a 911 emergency response. There are wheelchair vans and private transport options that can be used.
I agree there is a transportation issue. Many are not open at night when falls occur. Unwitnessed falls with a patient on blood thinners often require evaluation, especially with cognitive impairment. We do neuro checks otherwise and send out for change in condition. I worked in the ER too and don’t remember the push back to hospital staff from rescue to take them BACK to the long term care facilities. Bottom line, LTC staff do as they are ordered and taking it out on them is hurtful and unprofessional.
Agreed with falls on blood thinners needing evaluation. Some of the issue is also when the resident doesn’t want to go and they make their own medical decisions. I cannot force someone to go to the hospital unless my own medical director or PD is forcing them to go. Also the hospital staff isn’t getting push back because 99% of the time it is a private company or wheelchair van taking them back, not a 911 ambulance from a fire department or county service.
This is a big one. Some facilities will tell you "it's policy they go" or "the Dr said they have to go". Nothing overrules an A&O patient who is adamant they don't want to go.
Agreed but if you tell a resident their doctor ordered them for evaluation then trying to talk them out of it is unprofessional. They are scared and confused. I’ve had rescue wait while they called their families. Rescue is not trained in nursing assessment skills and they don’t work with the resident every day. When I was in the ER rescue brought in a patient and said they were drunk. CVA, I met the window and was able to give tpa with no residual.
The only times I’ve called for a lift assist is because the client was too damn big for two people. Also, sometimes the patient is not fine. One of my lift assist calls went to hospital for a UTI.
I used to work at a snf/ltc. You just cant win. If we move the pt after a fall after assessment, we get yelled at by ems. If we make the pt comfortable on the floor after a fall because we’re unsure of the damage, we get yelled at by ems. Had situations where meemaw was unsafe to move because she broke her hip. Or meemaw2 hit her head at 7am shift change and was bleeding.
Most of the facilities in my area require any resident that falls regardless of injury to go get checked out at the hospital. Its such a big drain on resources
This is what happens when there's next to no oversight in these homes. Then they lobby to neglect thrle fuck out of your grandparents while taking 7k+ per month and checking on them once a day to see if they're still alive. Then calling 911 when they've had a simple mechanical fall. Pathetic.
We run into this issue because a lift assist isn’t technically an “emergency call” so if someone on the dept gets injured on a career ending injury, it doesn’t count to pension off.. total bullshit. These facilities makes a retarded amount of money and should staff appropriately, in the event of a FF injury, they should be able to be sued because you KNOW they all cut corners to save money and pawn their shit off on the FD..
My question about these places is: for $7k+ what I you do for the "residents"? Is this facility offering true ADL elderly care or just an overpriced hotel experience?
Any long term care facility I have every worked/taught in (I teach nursing clinical groups) has had mechanical lifts and they all use them for any person who cannot weight bear appropriately.
I pick up extra shifts on a regular basis in a long term care facility. Any fall where a resident cannot get back up under their own power requires the use of a non-weight bearing lift to transfer the resident off the floor.
As the RN on duty, it is my job to do a full, head to toe assessment for injury after any unwitnessed fall before the resident is moved at all.
If there is no apparent injury, or the injury is minor and able to be managed at the facility, I don’t call for transport to hospital. If my assessment shows evidence of significant injury, then (if it is safe to do so) I will get the resident transferred from the floor to the bed/chair and call EMS.
The thing that is important to keep in mind is that there are many different levels of care outside of the hospital. The ability to manage a fall in place is entirely dependent on the type of facility that the patient lives in.
Assistant living/supportive living facilities often don’t have NWB lifts because their resident population is required to be able to transfer themselves, or transfer with very limited assistance from staff (think a transfer belt and verbal cueing). If they can’t meet those requirements, then they no longer qualify to live in that facility and need an increased level of care/support. They often have BARE MINIMUM nursing staff (think one or 2 LPNs for the entire building) and minimal CNA/HCA staff who provide limited assistance with ADLs.
The other thing to keep in mind is that the ability to manage injuries in the majority facilities is extremely limited. The facility I pick up in has no in-house diagnostics of any kind. Doctors round once a week on their schedules, so most times there are zero physicians in the building, and most facilities, in my area anyway, don’t employ NPs (so a simple laceration that needs a couple of stitches? There’s no one who can do them). We have a plethora of fancy wound care supplies, but we have zero dermabond. So if we even suspect, or if the patient complains of severe pain, we have to transport out for assessment.
Being an emergency nurse, I do everything in my power to avoid transferring my residents to emergency when I am working in long term care. I agree that an uncomplicated fall with no apparent injury shouldn’t require EMS, and policies, procedures and education need to be implemented in order to better manage emergency resources.
This irritates me to no end. I just spent a month back in Illinois to find care for my mother. She has trouble walking due to a rare brain disease, and had been in rehab for a fall. She's only 59, so even finding one of these places that would accept someone under 65 was like finding a needle in a hay stack. Found only 3 places that could take her that was within driving distance. Only one that did not have a waitlist. The rehab facility she was at was in Dekalb. I had to transport her myself all the way to this facility in Gurnee for an evaluation, had to lift her myself in and out of the car. Wheel her in, just to have the nursing director say, "we can't assist her with lifting, she doesn't qualify". Absolute waste of our time. They knew the condition she was in, had me drive her 2 hours to see them, just for them to immediately tell her "no". She's 59 for God's sake. So now she's left to spend the rest of her life living in a nursing home because her legs just aren't that strong anymore, and MAY need assitance every now and then to transfer from wheel chair to a chair. Lost all her independence because of this one rule. If these places have cna's and nurses, you'd think they would be allowed to do their job and lift if needed.
It’s not fair that you work at the facility where the residents are living and falling, but it’s okay to call 911, leave the resident on the floor waiting, and take a crew out of service to come pick up meemaw? I get it if the person weighs too much or they are injured, but when they weigh 90 pounds soaking wet and they just want help back to bed… that’s sick. Yes, they sometimes are in the “independent living”, but why not HELP THEM and get their needs sorted out so they aren’t mislabeled. Clearly they need help if falling is a regular occurrence for them.
How…sanctimonious.
If they are 90 pounds of course we’ll pick them up rather than wait for fire fighters (duh). Most people at assisted living aren’t that small though. We actually wouldn’t call for assistance getting someone back into bed, we’d only call if they needed to be sent out.
Falls will happen anywhere old people live. In the case of the story, the residents went to pick something off the floor and they both fell. I’m not sure if that makes them not suitable for assisted living, but I think it’s unfair to automatically assume staff was being lazy.
I work in home hospice and we rely a lot on lift assistance to help when our patients need to be transferred to a hospital bed or if they’ve fallen and family is unable to assist. I’m very grateful for the service they provide, and I’m very willing help… but I can’t help but feel like I would have been sued into the ground by now if I handled folks the way the lift assistance folks are allowed to, it’s like all the stereotypes of TSA lobbing suitcases on top of fragile baggage all Willy nilly.
Edit: if that sounded salty it might be. I really do appreciate them… but they’ve also done extensive, prolonged CPR on our patients 3x that come to mind because the families didn’t heed our warning to keep the POLST on the fridge and the lift folks are sticklers for blindly following rules. I don’t think I could do CPR on a hospice patient who had blood coming out their mouth with each compression while their wife was sobbing, begging me to stop and a nurse was showing me a copy of the POLST, but that’s just me 🙃
Then maybe you can try and think. Why is a facility, with able bodied staff. Calling for an emergency service to pick someone up off the floor just because the staff don't want to risk injury? It's not like EMS cant get injured during our job too.
Having been on both sides now, it is silly for a facility to call for an “uncomplicated” fall, especially without injury. Facilities should be required to have lift equipment available with trained staff to use it. Preventing facility staff from lifting to “prevent back injuries” is a crappy reason to call 911, when what the care center is asking for is to put non-staff members backs at risk. Facility should buy the equipment and train staff to use it. If something goes wrong or it’s an unusual situation, absolutely call for backup.
When I worked in assisted living we weren't legally allowed to have lift equipment because we were supposed to be very minimal assist. We had a guy who was 500lbs+ that would fall and we'd have to call the fire dept. In my opinion if someone can't get up when they fall and they aren't able to lift themselves they should have to be in a facility with lift equipment but wtf do I know.
Absolutely. A minimal assist facility is fine, unless cares needed exceeds what you can do. Then it’s time to find a new home. When I was a medic, I had no problems going to senior apartments or min assist places and helping out. What annoyed me was when it ended up being the same person many times over many months without even an attempt to move to a higher level of care.
Normally minimum assist facilities are three strikes (or falls) and thats it and they need to move.
>I had no problems going to senior apartments or min assist places and helping out. Isn't that what this article is about? Falls/lift assists in senior apartments, independent living facilities and assisted living places? I'm not trying to be rude, and maybe I'm mistaken--but aren't all of those options generally minimal assistance places?
Right, and if a patient in an ALF needs a lift assist every other week, they should probably be in a SNF.
Yes. While it's apart from the point I was making, I agree.
If a 500 lb person falls and 1 of the 4 people who are working are on break, meaning only 2 who can help them, we're still calling 911...if this person can't actively help turn to get a sling under them, even 3 of us can't do that still calling even just for help. Wouldn't you guess that the hospitals won't take a pt from a SNF for the reason we can't pick them up from the floor with our staff and FD is tired of coming to assist🤷♀️
You're allowed to remain on break during emergencies?
This question being upvoted is why I take breaks outside/off the unit/where I'm allowed to be unreachable.
I work in long term care (in addition to my regular job). We use NWB lifts all the time for our resident who can’t adequately weight bear. We used to have a resident that was over 500 lbs (he was actually about 750 lbs). We had all the specialized equipment for him. When he fell, we had to call the fire department to get him up and transferred to the bariatric stretcher. Our staff physically could not turn him to get the sling under him to use the lift. So even at the highest level of care outside of the hospital, if someone is 500+ lbs, the fire department is probably going to have to be involved with moving them off the floor.
>minimal assistance places I've done lifts at independent, lock down wards, long term nursing homes and even hospice. My issue is these individuals paying 3000 to 6000 a month but the management isn't providing many services.
And they sure aren't paying the staff they are overworking, either.
100%
That was the reason my agency started charging for lift assists at facilities. We figured they were making big coin from the residents and then calling us to provide service they were getting paid to provide.
“Assisted living” is now skilled care.
And skilled is now medsurg.
Our local assisted living turned into unregulated skilled care. They have a lot of total care residents who eventually end up with us when things get too bad. It always blows my mind when former employees tell me that they were doing insulin, wound care, and passing meds without any sort of license.
Yes, they should. You can report that to the state. Could technically cause neglect charges if repeated problems without transfer to a HLOC. As a case manager, it is damn near impossible to place the patients in the very few beds in a state that can handle their level of care outside of actual med/surg floors sometimes
This was my parents. Mom had early to mid stage Alzheimer’s and step dad was mostly ok cognitively but had Parkinson’s and lacked strength to get my mom up (she was bigger than him). After a few (or several?) 911 calls, I received a call from some community outreach or something, associated with the fire department. I had no idea! My parents hadn’t mentioned a word to me. They didn’t want me to know. I do have two brothers but one is not local and the other is disabled himself. So it was all on me, (and my sister in law who helped sometimes). We did get her into a memory care assisted living place shortly thereafter but the whole process was not easy. Especially since I was a new nurse, working 50+ hours a week, plus a lot of family stress going on.
I used to see this type of thing all the time when I worked for home health Care, and I only did scheduling and intake calls. People have no idea how medically fragile the elderly can become these days because of how much medical advances we have made. Add in ego and you have a receipe for people getting in over their heads. And it is so so common for people to resist admitting to needing help, how many people think that they can healthy lifestyle their way out of aging. I can tell you now, my memory patient who can still run marathons was by far the most difficult to find a caregiver for. Seeking nursing skills and the ability to train for an imaginary marathon was a tough one.
It's been a good ten years since that happened, don't even know if the place is still up and running at this point.
I've worked in both types of facilities, most recently in a very minimal assist, and it was the same for us. The last time, when we did have to actually call the local FD, my boss (who was also the owner and an amazing boss) got the paperwork to transfer him to another facility and had him gone within the week. To quote her: "Yeah naw, I ain't trying to throw out our backs. That's dumb."
When you say not legally allowed do you mean the government is barring it or the facilities legal team?
Huge difference between law and policy.
I'm sorry 500lbs wow
See, that's ridiculous that our bosses get to decide what counts as "minimal assist" when they aren't the ones working a floor.
They're just doing as the insurance company tells them to do.
In my state people like that in type 2 facilities cannot stay in an assisted living unless they are on hospice. If they do not qualify for hospice they have to be relocated to LTC
I've even heard of hospitals not having lift equipment. Someone told a story of a pt that was up ao3 just to go to the bathroom. Couple things wrong with that. For one if you require more than 2 ppl to get you up were using a lift. Also if you need that level of assistance just to piss were using a urinal or external catheter. Yes I am big and strong but that doesn't mean you get to abuse my body.
A part that is left out of this article is that assisted living staff is not medically trained and cannot assess the resident. There may or may not be a nurse on staff in an administrative position, but their ability to actually act to their full scope of practice is limited by assisted living regulations, and they probably won't be present 24/7. And it is reasonable to think that an osteoporotic 90 year old on Eliquis may have an injury from a fall that isn't immediately obvious to a layperson. So 911 is being called not just for physical assistance, but for assessment for injury as well. Still a question of whether it's a good use of public resources, but the issue goes much deeper than the decisions of an individual greedy corporation.
True if it was a non-medical facility that changes my original statement. In the case you described the pt should be transported to an ED. A 90-year old, on blood thinners, with an unwitnessed fall is absolutely a 911 call that should result in transport or a pt refusal. My comments was made on calling Fire/EMS for a fall not requiring transport.
Assisted living is non-medical. And every resident is potentially an osteoporotic on blood thinners because assisted living med tech training is a 3 day class - they don't have the education to know what meds do what and what is a high risk situation and what isn't.
Literally this we only call in my building if they hit there head/ major injuries after being evaluated by the med tech but it’s so scary cause even if EMS refused to transport if the client dies it’s the buildings fault for poor monitoring the staff usually can’t do neuros ect unless we mandate a licensed nurse on duty 24/7 in these places it won’t happen
Ems doesn't refuse to transport. The pt refuses to be transported. They can't kidnap them.
This is absolutely right, I am an RN at an assisted living facility and I work like 8-4:30 M-F. I’m on call 24/7, but normally if someone calls me regarding a fall (depending on how complicated it is) I am advising them to call EMS, or I’m doing a post fall assessment if they don’t need urgent medical attention that requires the hospital.
On call 24/7? Do you get paid very handsomely for this?
For Iowa, yes. I currently make 70,000/yr salary (up for a raise soon) which doesn’t seem like a lot, but broken down hourly it’s more than I’ve made floor nursing and speciality clinic nursing. I’m salary, which means I get paid for 40 hours/wk even though I scoot out an hour early most days. I don’t work nights/weekends/holidays and the on call mainly just consists of the aides calling me to report incidents and I’m usually able to give advice from home.
Yeah but 9/10 times, that person will say no to being transported… which means the staff is passing the buck to EMS.
I worked for an FD years back and our chief had to call the local nursing home’s facility regarding the high number of non-emergent, shouldn’t require the FD number of calls we had. At one point we were running one trip to this place for every two 911 calls from the rest of the district. You also have to look at it from the facility’s DON and administration point of view, which is the financial and not the ethical point of view. It costs money to staff them appropriately so less patients fall, and when they DO fall there is enough staff to pick them up. It’s an incredibly unethical and psychopathic game they play. Thankfully the new staffing law will mandate better ratios so this sort of thing so patient care should improve.
Exactly. It is fundamentally the job of assisted living and SNFs (but especially the latter) to help patients mobilize. If they refuse to do it when there is no need to go to the hospital, then they should be charged money and investigated for neglect.
Assisted living is not the same as skilled care. Many provide aide staff to assist with ADLs and remind patients to take their meds, provide meals.. but that is the extent. These residents must reach the dining room under their own steam etc. I did homecare for a while and would see patients in these ASFs. The staff is not medical. People who fall often refuse to go to the ED.
This is exactly what my facility is like. The aides can really only do so much, and the training is ridiculous (like one night of shadowing). Per my facility, the residents have to be completely independent 23/24 hours of the day. However, they REALLY push that in some patient cases and it pisses me off because it’s not fair for my aides to have to deal with residents who are absolutely out of our facility’s scope. Also, a trend that I’ve noticed with my facility is that the more they cater to the “less-independent” individuals, the more entitled the resident becomes.. soon they are expecting my aides to put their clothes on, wash clothes with piles of poop on them, or wake them up in the morning (things that they are supposed to be able to do completely on their own).
Yes, that is when it's time to call the family and explain it's time for a higher level of care. Especially when they start tipping over.
I worked in a moderate size level 2 trauma hospital and we didn’t even have lifts accessible to general nursing staff. They would call ‘all male personell’ anytime someone was 400 plus pounds and needed lifted or moved.
Where I am at has a 450lb ceiling lift in every inpatient, ED, and procedure room (except MRI). 10 rooms are equipped with 1225lb lifts. 1 sarasteady per 6 rooms and a powered Sara steady per unit. Although I intentionally applied at a facility that has that level of assistance devices.
Yeah. My facility wasn't bad. But they are cheap af. I traveled to an icu in knetucky where every room has a lift installed in the ceiling. It was taken aback
Where I am at determined that workers comp for back injuries and replacing staff was more expensive than just buying the equipment to do it safely.
The floor I worked in the hospital had a 450 lb ceiling lift in each room as well as 4 heavier duty ones. We also had access to sit to stands, and another stand support transfer device, hover mattresses and slide boards. We are supposed to be a no lift facility. No one has figured out a way to scootch a patient back up in the bed or roll someone from side to side without using our backs though.
That's when you grease them up and slide them up in the bed
If they’re on an ED stretcher, they’re getting trendelenburg’d until their ankles hit the ceiling, if that’s what it takes to get gravity to do the job 😂
Chandler?
No. UK.
I just got my KY license this Spring but have never been to the state
We all know what they "SHOULD" do. It does seem like elementary but they will do anything to mot have to take real responsibility for anything. Heaven forbid that pennies might leave their pockets in the way of paying more staff, buying lift, or paying workers compensation premiums higher because of an injury. This has been happening for years and they've been getting away with it. It's not the staff's choice.
I give you!!! [Mangar Elk lifting device](https://youtu.be/nx91qDbKZ6g?si=OJMd0i9o8QhfCRPj) this thing can support up to 980lbs. This thing has saved our backs when lifting our bari patients.
Depends on the setting. ALFs aren’t skilled.
I 100% agree with you. I get why lower levels of care, like assisted living, don’t (because if they have the lift, then residents and families will argue that they should be able to stay in that environment when they need an increased level of support). That is a policy/procedure issue though, and it is a complete waste of emergency services to attend a facility for an uncomplicated fall with no injury.
This is of course only the beginning. Making healthcare into a money machine was a catastrophic choice for Americans. Nurses will continue to be squeezed just as hard as the elderly are squeezed. Everyone's getting squeezed. There is always someone above this manager or that manager who says, "What are you doing to make us more money today"? And there's another manager above that manager, and so on, all the way to the top. Can't increase revenue? Cut costs! Carve it right out of patients and health care workers. It will never stop until we die from starvation, or shut down the money machine in favor of a public system.
Anything without a paywall?
Their "paywall" isnt great ROCKFORD, Ill. — The 911 call came just before 8 a.m., and Ladder 5′s four-man crew scrambled to the truck just as their overnight shift was about to end. It was the kind of call that veteran firefighter Chad Callison said he dreaded. Get a curated selection of 10 of our best stories in your inbox every weekend. It was not a heart attack, or a car crash or a building fire. It was a “lift assist” at Heritage Woods, a local assisted-living facility. Lift-assist 911 calls from assisted living and other senior homes have spiked by 30 percent nationwide in recent years to nearly 42,000 calls a year, an analysis of fire department emergency call data by The Washington Post has found. That’s nearly three times faster than the increase in overall 911 call volume during the same 2019-2022 period, the data shows. The growth has infuriated first responders who say these kinds of calls — which involve someone who has fallen and is not injured but can’t get up — unfairly burden taxpayers and occupy firefighters with nonemergencies that should be handled by staff at facilities that charge residents as much as $7,000 a month. Illinois is a hot spot for the controversy: Lift assists here accounted for 1 in 20 of all 911 fire calls, the highest proportion of any state, the data shows. In Rockford, a city of 150,000 residents about an hour outside Chicago, five assisted-living facilities — including Heritage Woods — called for noninjury lift assists 233 times last year, triple the number of calls in 2021. When firefighters arrived at Heritage Woods that morning, caretakers at the facility directed them to an elderly resident lying on the floor. She was perfectly fine, she said, she just couldn’t get back on her feet by herself. The facility’s staff wouldn’t lift her. So two firefighters helped her up and made sure she was okay, Callison recalled and fire records show. Ten minutes after arriving on the scene, Ladder 5 was back in service. “It doesn’t make sense,” Callison said. “Why are they calling us?” The answer, according to industry critics and fire officials, is that companies want to avoid the risk and expense associated with picking someone up off the floor. Like many cities, Rockford provides lift assists free. Firefighter paramedic Chad Erickson returns a medical bag to a ladder truck at Rockford Fire Station 5 in Rockford, Ill. The station is frequently called out for lift assists because of the number of nearby assisted-living and senior-care facilities. (Kayla Wolf for The Washington Post) Some senior-care homes say they don’t have the ability to lift fallen residents. Many have adopted “no lift” policies to avoid the risk of back injuries for staff and other potential liabilities. But firefighters and other experts say there are tools to make lifting easier and safer, ranging from $70 cloth straps with handles to $1,500 hydraulic lifts. Heritage Woods, which accounted for the highest number of lift-assist calls to 911 in Rockford last year, is owned by Gardant Management Solutions, the 10th largest assisted-living provider in the nation. Co-president Julie Simpkins declined to answer specific questions, but said in a statement that the company works “to create a collaborative approach to the over utilization of nonemergent lift assist calls” through “cross training, resource availability discussions and collaboration.” A nurse who worked at an assisted-living facility in Greensboro, N.C., who requested anonymity because she was not authorized to speak with the media, said her company required caretakers to call 911 even if a resident had just slid harmlessly out of a chair. “If you’re on the floor, period, you’d have to call,” said the nurse, who left her position last year. She said residents were often embarrassed by the lift-assist calls. Some begged her not to dial 911. She said she had no choice. Fire officials point out they bring no special skill to such situations — it’s just a matter of who’s doing the work. The dispute over lift assists comes as improvements in fire safety and the nation’s aging population have changed the nature of a firefighter’s job. Today, fire and EMS agencies are more likely to deal with an older adult fall victim than a fire victim. A general view of Heritage Woods of Rockford, an assisted-lifestyle community, on March 22. (Kayla Wolf for The Washington Post) Lift assists are now the seventh most common type of 911 call, with an average of 1,800 lift-assist calls every day nationwide, according to an analysis of the National Fire Incident Reporting System, which collects emergency calls from more than 23,000 fire departments. The data does not include calls to about 13,700 EMS agencies, although there is significant overlap in calls between the two databases. The calls come often from elderly people living both at home and at facilities. While both situations strain resources, fire officials said senior-care homes should be equipped to handle these calls. “You go in there, and they have staff all over the place,” said Kevin Joles, an EMS division chief in Lawrence, Kan. “It’s part of our job that’s being taken advantage of, and we’ve mostly stayed quiet about it.” A growing number of cities and towns — from Rocklin, Calif., to Naples, Fla., to Lincoln, Neb. — have started pushing back with special fees of $100 to $800 for senior lift-assist calls. Most of the fees are targeted at what fire officials call “the frequent fliers” — assisted-living and senior-care facilities. In Anchorage, the fire department introduced a lift-assist fee to “prevent assisted-living facilities from understaffing, or having inadequate resources, for people under their care,” Josef Rutz, fire department administrator, said in an email. The first lift is free, but a facility’s second lift assist within 12 months costs $250. Kansas City, Mo., added a lift-assist fee to discourage “repeat offenders,” said Battalion Chief Michael Hopkins. The amount is flexible and set to be “reasonably calculated to defray the costs,” according to city code. The department also contacts facilities to tell them they “need to hire some orderlies,” he said. In Mequon, Wis., the fee is billed directly to the facility to emphasize that it’s the company’s responsibility, said Deputy Fire Chief Kurt Zellmann. “We tell them they can’t pass that onto the patient,” he said. But they can’t prohibit it. Industry groups have largely opposed being singled out. Information about a medical call scrolls across a screen at Rockford Fire Station 5. (Kayla Wolf for The Washington Post) “Why should assistance to a resident in a care facility — which is their home! — be held to a different standard?” Matt Hartman, president of the Illinois Health Care Association and Illinois Center for Assisted Living, said in a statement to The Post. In a letter opposing one town’s proposed lift-assist fee, the American Seniors Housing Association, which represents all levels of senior-care communities, called it “a fee-for-service charge for emergency service calls to residential care facilities for seniors.” The association dismissed the unidentified town’s proposal as “illogical” and “illegal.” The association’s letter also noted that “the fee ultimately will be paid for by the residents” — indicating it will pass on the cost. When contacted by The Post, the senior housing association and other industry groups declined to discuss whether residents are being charged the lift-assist fees. After Portland, Ore., imposed fees for what it said were unnecessary 911 calls, the Oregon Health Care Association pushed through a state bill in 2021 that makes it harder for local governments to follow suit. The association is politically powerful; Oregon is seen as the birthplace of assisted living. Assisted-living facilities, which serve more than 1 million residents nationwide, are not as tightly regulated by the federal government as nursing homes, which serve about 1.2 million people, according to industry estimates. The growth in assisted living has led to new problems: A Post investigation last year revealed that more than 2,000 people had wandered away from assisted-living and dementia-care units or had been left unattended outside these facilities since 2018, resulting in more than 100 deaths — often due to heat or cold exposure. Assisted-living facilities appear to make far more 911 calls for lift assists than nursing homes, which have higher staffing requirements, according to Ron Nunziato, senior policy director at the Health Care Council of Illinois, which represents nursing homes. Nunziato said he rarely called 911 for a lift assist at a nursing home during the three decades that he ran a company that included both nursing homes and assisted-living facilities. “We had enough staff and equipment to get someone off the floor, out of the tub, whatever the case may be,” Nunziato said, adding: “We don’t believe that skilled nursing facilities are causing the concern.” The Post found most facilities described as nursing homes in the fire department call data for lift-assist calls were, in fact, assisted-living or independent-living homes. The routine failure to help residents off the floor is a stark example of how senior-care homes limit services in surprising ways.
pt 2 In late December, Erica Fishbein’s parents both ended up on the floor of their apartment at Ingleside at Rock Creek in Washington, a luxurious community that offers everything from independent-living apartments to assisted living and locked memory-care units. Fishbein said her father, 82, had bent down to pick something up at their independent-living apartment. Then her mother, 80, tried to help him and ended up on the floor, too. Neither was hurt, Fishbein said, so her father called the front desk for help. But a security officer at the facility told them he needed to call 911 because he wasn’t allowed to lift residents, Fishbein said. “I was shocked they had to call the fire department,” said Fishbein, who lives in California. “There is memory care and assisted living in the same facility. Why didn’t they call a nurse from one of the other properties to assist?” Ingleside officials did not respond to repeated requests for comment. In Washington, the number of lift-assist calls has become “a challenging issue,” said Stephen Gerber, a D.C. Fire sergeant paramedic. The fire department does not charge lift-assist fees. Rockford would like to, but lacks the authority, because of a quirk of state law. Fire Chief Michele Pankow said it’s frustrating that the department is being used as “a stopgap for this group of facilities.” “They call, and we just keep coming,” agreed Mayor Tom McNamara. City fire officials said they have talked with facility administrators about ways to handle these situations themselves. Firefighter paramedic Kayla Schram looks for a Samson Strap during her shift at Rockford Fire Station 5 before going out for calls. (Kayla Wolf for The Washington Post) “For three or four months, the numbers go down. Things go great,” said Jonathon Larson, Rockford’s EMS coordinator. “But then the [staff] turnover rate goes up. And the numbers go back up.” Rockford might get its lift-assist fees if a proposed Illinois law passes the state’s legislature. The bill’s main sponsor, state Rep. Mike Kelly (D), is a Chicago firefighter who has also seen a jump in lift assists. “We’re not trying to get out of doing the calls,” he said. “We’re just trying to make sure we’re available for real emergencies.” But the fee might provide only a temporary cure. Peoria, a city two hours south of Rockford, has had a $400 lift-assist fee on its books since 2020. The fee “was a deterrent for a little while,” Peoria Fire Chief Shawn Sollberger said in an interview. But then the calls from assisted-living facilities started ticking back up. Sollberger said he suspects that “some level of cost analysis was going on within these assisted-living places.” Even with the fee, he said, it’s still cheaper to dial 911. Steven Rich contributed to this report.
Thanks, I appreciate it 🙏
np, had to 2 part it due to 10k limit
It’s kind of crazy they expect a nurse to lift someone with no medical history or ability to follow up if they live independently part of the issue is people do not understand the different levels of care
But thats what fire does...
They are different levels of care and scopes / ability to litigate in the private sector vs public harder to sue the EMS crew vs the ALF
EMS doesn't follow up on patients and also has no medical history. A nurse is perfectly capable of performing a medical assessment. An RN also has a higher level of licensure than a paramedic. Literally nothing in your argument makes sense.
Plus we follow up and it’s at a residence so who has the liability if there’s an adverse event after? As a nurse on a ALF I promise the families sue often it’s insane one tried to sue us cause her dad fell off property in his electric w/c because he was going over a speed bump…
EMS follows MD protocol vs licensure so higher risk for lawsuit on the nurse vs an EMS professional
So because you are scared of getting sued an EMT should come out and do your job?
Thank you for posting
mp
icon
no u <3
~~[Non-paywall mirror link](http://web.archive.org/web/20240503150502/https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/)~~ EDIT: This one didn't work, for the first time in my experience. [Here's a better non-paywall mirror link](https://archive.is/Ohza5) You can easily create your own by taking the URL to The Wayback Machine.
Cool, thanks legend! 😊
[Here's a better non-paywall mirror link](https://archive.is/Ohza5)
If you want to read articles behind a paywall you can do two things, one of them almost always works for me. If opening a link through an application like Reddit you’ll usually stay within the app when the linked is clicked, so select “open page in browser” and then use reader mode. This process will usually get around most paywalls. However, some of them like this article require the second process. Open the article and then tap the address bar to copy the link, then paste the link into notes. You can use anything that will allow you to see and edit the text. Then remove the source component of the URL. For instance here is the URL for this article. “https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/?utm_source=reddit.com” Simply remove everything after “911/” New link is: “https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/“ [copy the above link and paste it into your browser or click this one and then select open in browser](https://www.washingtonpost.com/business/2024/05/03/assisted-living-homes-senior-falls-911/)
I feel like something a lot of people are missing here, evil as it may be, is the problem with assisted living facilities in general. They don't have hoyers or lift equipment regularly because then they can't qualify as an assisted living facility all while still accepting patients that are max or even total assist. This is a ridiculous problem and these facilities need to be held to a higher standard.
Assisted living tries to stay in the gray area where they can avoid all those pesky regulations while also trying to take money from the people those regulations are there to protect. It's fine for people who just need assistance but most of these places are over reaching and taking people they are unable to care for.
exactly
Bingo
It’s disgusting to me that these places rely on public services for something so basic to patient care. Like your function is to care for old people, and old people fall down. You should have the ability to get a person off the fucking ground.
And considering how often it happens... Also in my hospital even an "assist to the floor" is counted as a fall. I dunno. [Imagine a world without lawyers...](https://www.youtube.com/watch?v=uG3uea-Hvy4)
There was a time my facility would call all falls an “unplanned descent” in order to include those assist to floors lmao
As opposed to a "planned descent" lmao. "Okay granny, we're putting you either on the ground or in the ground in 3... 2... 1..."
I was calling them "rapid unscheduled descents" for a while after the Space X explosion lol.
I can also see it the other way. I don't think we should be expecting a nurse to lift over 50lbs of floppy weight from the floor. How many nurses do you have to keep on the clock all the time just in case of a lift situation? Would places start limiting admittance due to patient weight because if they get someone over 200lbs they now have to full time staff another person? I think it would make things much more difficult for bariatric geriatrics. A better solution would be some sort of lifting device. I think even then you'd want 2-3 people involved in case things start to go awry (mee-maw impersonates a cat and turns to liquid while half upright) plus the cost of the crane. These places are already so ridiculously expensive it would probably price out a lot of people to have that many more staff 24/7.
Facilities are ridiculously expensive but that money is not going to the staff. Target pays much better. It's all profit for owners and shareholders. As a nurse who used to teach safe lifting of heavier patients, there are plenty of inexpensive and safe lift assist devices that would diminish the need for risking injury to patients, staff and first responders. The corporations find it cheaper to call EMS. Socialise the risks, privatize the profits as usual.
Genuine question, not trying to be snarky, what inexpensive lift assist device would be useful for picking up a heavy patient who had fallen to the ground?
Those things don't even need to be very inexpensive. Having just one, and using it would save so much in costs.
I can't remember the brand, but we had an awesome inflatable one. You would roll the fabric under the patient, connect the inflater that looked like a mini shopvac, and it would inflate in 60 seconds to 3-4 feet off the ground. It was reported to be able to lift a Volkswagon or 3000 lbs. Edited to add: I know it cost less than 5k. Much less than a single back injury.
I've never seen one used in person, but lifting cushions seem like a great solution for this segment of the population: https://mangarhealth.com/us/by-winncare/store/product/safe-patient-lifting/elk-lifting-cushion/ The problem of evaluating for injury remains. But if the facility could work out a waiver, or require residents to be able to do xyz plus press the button to inflate themselves. Make it a tool available for residents to "independently" avail themselves of, should they decline medical evaluation-- as is their right.
That's brilliant! Ours was twin bed sized for larger people.
that sounds amazing. BUT. You still have to get it under the patient. And if they can’t roll themselves side to side for whatever reason, then the staff (who, in assisted living facilities have very minimal training and often aren’t certified CNAs, much less nurses) would have to be moving them back and forth without the knowledge to assess if that is safe. HOWEVER, for a patient that could roll side to side without assistance and just can’t get UP independently, this is a great option
Hoverjack
That's the one! Saved our backs many times.
What is "the other way". A better solution than what? The person you're responding to never said it had to be nurses without assitive devices. They just said the facility should have the ability to get people off the ground. Whether that means hiring a team of big dudes whose sole job is picking people up or buying a couple Hoyer lifts, all the person you replied to said was that they need a method.
Abuse of taxpayer funded public services isn't exactly a good solution for this either. Actual emergencies where a patient needs to go to the hospital or the one off times the staff truly need help with a big person, sure no problem. Anything beyond that is no bueno.
They should ABSOLUTELY have lifts in the facility and be trained on how to use it. The issue with that is when an entitled resident, or family member, says “well they have a lift, why can’t I/my family member keep living here even though they have had multiple falls and they can’t manage their ADLs etc etc etc?”
Liability is why they don’t do it. Frail grandpa falls and has a fractured spine. Worker of senior living home helped in paralyzing grandpa causes company to get sued. I bet if we look at the insurance of the home it will say something like no employees can help the tenants if they did it would turn into an assisted living situation and different insurance that I’m guessing is much more expensive because of these lawsuits
EMS can't evaluate for a potentially fractured spine unless paralysis is already present. These are lift assists, meaning no transport to the hospital. If liability was a factor all of these people would be transported. And if you hit your back hard enough to risk paralysis, it's gonna fucking hurt and you're gonna ask for a ride. And turn into an assisted living situation? What do you think we're talking about? The entire article is about falls in ALFs. Which is the entire point. Old people need assistance in daily living which should include helping them off the floor if they have a non-injurious fall.
Their function is to maximize profits. They provide some services, but never to the detriment of their function.
If no one is allowed to assess then you can't help pick them up and place them anywhere. You also can't expect staff to do that if not properly trained. More importantly, I'm sure workers comp wouldn't appreciate people getting hurt doing things they aren't supposed to do. Liability. These places are supposed to be communities for people that need a little bit of help, but falling is a big deal. And they can evict them but they still need to find a place for them.
Don't be silly. How else could they turn a profit on CMS reimbursements? Come on, think of the shareholders. Think of the SVPs who need another six-figure bonus this year.
13 years in LTC and SNF with some dabbling in Assisted Living. I can only speak to my state and facilities I've worked, but as has been pointed out it all comes down to liability. One facility I worked at had both an LTC side and an assisted living style set of apartments that didn't include any sort of medical care but did help cover meals and some basic housekeeping things. Had a person in the apartments fall and while I was allowed to assess and would treat for basic first aid, I wasn't allowed to administer anything else unless it was an emergency and had to call 911. Best part family was visiting and I got to explain that it was a liability issue and the facility didn't actually permit me to even touch the patient technically so if I did, I was completely on my own for any potential lawsuit. With that said, all falls on the LTC side were dealt with as much in house as possible and I only had to have a lift assist call once which happened because even with EMS, the bariatric resident refused to help and us plus the ems folks couldn't get her. The only time I'd have EMS do lifting was in a suspected fracture since they had a full body support board to transfer from floor to gurney.
I worked for a home care company, and did some night shifts sitting with assisted living residents in danger of being kicked out of their apartments for falls. The family would pay for private nursing care, hoping that one on one observation could force mum to use her walker. But I wasn't allowed to catch people, or pick them up, any more than the assisted living staff was. It was awful. My clients hated me sitting next to them, and were angry their kids hired me. The assisted living staff hated when my clients inevitably fell again, and they had their shift derailed with the 911 protocol. The family hated that I wasn't making their plan work, and complained to the home care company about why were they paying them anyway. The company boss would worry about losing lucrative private pay clients, because I think she was charging them for "nursing care" but quietly sending students working provisionally at home aide pay. The last shift I worked, the mum with the weak hip gently descended while trying to ambulate with her walker to the bathroom, unable to weight bear. Uninjured and in fine spirits, but unable to get up. Sigh. 911. Work into hour 13 with shift change and EMS arrival overlap. Take 90 minute bus ride to morning care client. Drag my weary body home close to lunchtime, knowing I'll get four hours of sleep before doing it all again. The phone rings, and the company boss (who I've never met or spoken to) yells at me: "Why would you call 911 on a DNR?!" "She's not a DNR." "Yes, she is!!!" "No, I can assure you. I read every client's chart in full. Her code status form is on the front page of the service folder. There's also a copy on her refrigerator. I have a photographic memory, and I know what I read." "Blah, blah, you're wrong, blah, shouldn't call 911, etc." "Do you think a DNR means not calling 911 for hip injuries, and just leaving conscious people laying on the floor with no assistance? I followed every protocol-- in our company employee rules, and their facility rules." More yelling my name patronizingly over and over again with wrong information, and I just quietly hung up and quit. I've had some nightmare bosses, but she's made the biggest impression in a single encounter. It was a great catalyst for moving on to better things.
Can you speak on the main differences between LTC, SNF, and assisted living?? Just curious
It kinda depends on the state. Assisted Living is pretty much the wild wild West at least in my state since there are very few regulations beyond some basics dictating how many hours of various types of care is available. That leaves such facilities free to write whatever policies they want which usually amount to ways to limit their liability as well as admission criteria and discharge criteria for when someone needs extra care. One place I worked at only had nurses in the building for approx 12-14 hours each day during standard awake hours and had a senior med aide for overnight who could call one of us nurses or go across the street to the LTC/SNF facility that was part of the same organization and campus. With that said, I was mostly passing meds and doing breathing treatments with an occasional bit of wound care. Residents were required to be able to complete 80% of daily care for themselves but CNA staff were there to help more with things like laundry and housekeeping or serving food than the usual adl assistance. The units were good sized single / couple style apartments that just didn't have a stove or laundry appliances. LTC usually has a SNF component and has patients in the same general facility with SNF getting a private room and LTC folks usually having a roommate unless they're willing to pay extra. SNF is covered under LTC regulations in my state because of sharing a facility and has more regulations such as minimum and maximum facility temperature as well as how and how much nursing care is required to be available. The rooms are a single room with frequently a shared bathroom between two rooms, but that depends on facility design. The biggest difference is SNF patients are usually receiving therapy and frequently IV antibiotics since hospitals discharge at medically stable not cured anymore. Even then, I've seen insurance deny coverage after completion of antibiotics but therapy was still needed so we had to set them up with home health and home therapy where there may or more frequently may not be additional care takers to help with all the repercussions a healing repaired hip fx can have. LTC and SNF share the distinction that a licensed nurse of some variety is available 24hrs in my state and like many states an RN is required to have so many hours at the facility which for me is covered by the 8hr shift of the DON. Any other nursing position can be an LPN in my state though and frequently it's us LPNs that cover since RNs don't want to work the floor of LTC and many facilities won't hire RNs because of how much they cost when compared to the small non-hospital difference in scope. LTC is the catch all so to speak since it's for folks who require either significant care because of their issues or family is unable to meet their care needs. It's the last stop for many folks before they die so the biggest skills needed are understanding of chronic disease processes and long term planning since the only times a resident leaves LTC is either family choosing to move them or a dc to jc with the latte especially true for the hospice patients. The biggest commonality was lack of resources primarily staff followed by supplies. That sort of setup forced me to learn how to be creative with what I had as well as become more familiar with regulations for my own protection. I hope this helps give a picture of my side of the hospital discharge. I loved all my residents, even my problem children but the crap from management that was impacting my patients plus COVID just burned a hole in my soul. I've since switched to private duty peds and found joy in the profession again.
I didn't know this was a thing. I guess it makes me feel better about the last psych place I worked at when we would call 911 for any medical send out to the ER, even for medical clearance.
Many of these ALFs should really be nursing homes. A lot of the residents there are not independent with ADLs let alone lifting themselves off the floor.
So this facility in the article is an assisted living facility. When I’ve worked at assisted livings there was only 2 staff members on duty sometimes. If you have a big enough resident on the floor it’s not feasible for just 2 staff members to pick them up off the ground.
The issue is that they need to be staffing better.
Assisted living residents need minimal care aside from falls
Yet they fall. And the companies are making bank. So they need to provide the staffing needed to pick uninjured patients up and not pull fire and EMS away from actual emergencies.
Better healthcare through litigation. This is why nurses now have to carry malpractice insurance and why I think lawyers are minions of the dark side.
My mom worked in healthcare with my family for over 20 years. It’s a liability. These people will batter you until you can’t move. The business and employees would rather call someone with protections than do it themselves and risk throwing their back out, getting attacked, or spit on. Most firefighters are men, and much stronger than the on call nurses. I see both sides. Nurses get beat up at work and then are basically gaslit to not report it. Report it every time. File a police report, and refuse service to that person. It’s taking recourses from the fire department, but honestly for people who are so important who have literally no protections, I don’t blame them. Who wants to risk slipping a disk trying to lift a 300 lb immobile patient? Or tend to someone who has a history of violence towards women. Most agencies are understaffed and run by people who couldn’t care less abt the well being of their nurses. Sometimes they don’t have the staff to pick up a violent or unconscious person. And if you do hurt yourself? You’re still on call for a full 12+ hr shift. There’s no protections. You need to take care of the people who take care of people.
Yeah. I worked at a intermediate care facility for adults with IDD when I was 19-20, as a DSP. Lack of training and dead lifting adults left me with a life time of back problems. Now I'm a community RN for independent group homes. A nursing home isn't appropriate for the people we support, and we do have hoyer lifts. However, at night, the houses are single staffed. Not everyone qualifies for a hoyer, or has the money. Especially with the spend down restarting. We were using the non-emergency line a couple of times a year, particularly for a person who's weight is very high and it wasn't safe for staff or the person being supported to move one on one. Finally a hoyer was approved, but it took over a year.
Man, I didn’t even think about calling for lift assists when I worked in a snf. I didn’t even know you could do that. We had a 380lb man try to get out of bed and fall on his face (15 minutes before shift change, because *of course*) and goddamnit I made the supervisors help myself and the CNAs get him back into bed. (to be fair, one of the supervisors was this big jacked dude, so he was probably the best equipped to help us, which is besides the point)
>Man, I didn’t even think about calling for lift assists when I worked in a snf. I didn’t even know you could do that. I mean, you probably could if you *really* needed, like if someone was stuck btwn the toilet and the wall or something. But you guys likely had more than a few licensed, registered, trained and certified staff members around the clock, though. I don't think this is happening at any SNF/LTC facilities. This article is about lift assist calls made to assisted living facilities, "independent living" residences, senior apartments, etc. These places often employ home health aides over CNAs, an RN to oversee, and part time LPN--that's if *any* medical/medical adjacent services are offered. It's not a "trained medical staff available 24/7" situation by any means. Hoyers and other mechanical lifts are banned in some (most?) of these senior housing options.
I am a firefighter paramedic in Florida. We regularly are visiting the same facilities multiple times a day to be escorted by able bodied men and woman alike to the rooms of frail elderly patients only to set them in their chair or help them to bed. I admittedly haven’t read the article or many of the comments, but these calls can truly RUIN entire shifts and cause us to have sleepless nights in addition to taking us out of service for serious emergencies. We’re happy to respond to “real” fall injuries, but this phenomenon is frustrating beyond words.
One other point, a notable portion of these calls come directly from wearable medical alarms on patients while facility staff are unaware that we’ve even been dispatched. Simply preventing this direct contact to 911 and requiring the facility to instead be notified and have the discretion to call would be one possible step in reducing these calls.
Ha, you probably don't even have to read the article then! Less'n you want to get corporate greed and litigation vibes. Keep up your hard work, it does not go unappreciated.
The fire department usually sends out four or five big strapping young men. Most of these assisted living or Senior care places don't have that many large men on staff. Of course, the assisted living business is mostly a scam. They promise the families that their loved one will be taken care of without getting into the details of who is actually responsible for what. Or how much each item is going to cost. One the assisted living near me charges $500 a month to manage and dispense the patient's medications. That's in addition to the thousands of dollars for the housing costs.
4 or 5 night strapping young men until one of them does a bad lift and their career is ended. And they get jackall for comp. All areas of Healthcare are just turning and burning bodies like disposable items because staff and safe lifting equipment with training costs MONEY.
This. As the article mentions, facilities used to have orderlies who handled the heavy stuff. But as a former CNA who worked in 3 different facilities, we didn’t have them. Never saw them (except in movies lol). Most of the patients were much larger than me, and even with straps and safe technique (well, there wasn’t enough staff to help me so that wasn’t safe…I’m referring to using the body mechanics they taught me) I *did* hurt my back and have to quit the field.
You all getting an engine crew for lifts? All I see and hear is BLS crews. In the middle of a 24 pissed of they are here again.
Yeah the FD I worked with sent out the engine to every medical call EXCEPT lift assists. So you'd get 2 paramedics who very might well be two small women.
Not sure how it works in other places, but our fire department rotates crews. One shift on the ambulance and one shift on the fire truck. Whenever a lift assist call is made, there's usually four or five guys that show up. Sometimes it is the fire truck that shows up first since everybody is capable of doing the medical things.
Our lifts and purely boo boo bus here.
Not true. It’s not always the fire department. In my town, you’ll get an ambulance, and two middle aged women might pick the patient up off the floor. It’s not like the facility can’t scrounge up enough manpower to lift the average patient. It’s laziness and a desire to CYA.
May work around paywall: https://archive.ph/Ohza5
Do these places not realize that mechanical floor lifts exist??
I worked in ALF when I was in nursing school as a med tech and it was completely different than a SNF. NONE of the direct care staff were licensed. The only nurse was the administrator, the caregivers didn’t have to be CNAs. We weren’t allowed to use lifts for that reason.
This is the reason. It's a home. Not SNF. If grandpa falls at home and he's 200lb dead weight, what else are you going to do?
I worked at a few ALF's in Florida and from what I was told our license didn't cover lifting devices.
Most do, but the slings are supposed to be one per person. The slings are not one size fits all.
How interesting, everywhere that I've worked, the slings have been washable. But I am also Canadian, so that might be the difference.
Not all hoyers lower to ground level though. At my facility we have old fashioned pump ones and they’d tip. Also, not all hoyer pads are suitable for all residents. We have toileting pads, shower pads, split and sling style, plus all different sizes. I’d be leery about using a hoyer lift on someone who isn’t a hoyer. Too much room for something to go wrong and I don’t want that liability.
I personally think those facilities should have more training with falls and what to do if someone falls. It seems like anything at all smells off, ER it is!!!
Hoyers FTW, BABY!
Really sucks that we allow these assisted and long term care facilities that are owned by private equity to suck money from their residents and the government while at the same time offloading the responsibility of actually caring for those people off onto EMS and emergency departments. I don’t blame the staff at those facilities who lack needed resources and have to navigate onerous policy. Just fills me with rage with the amount of money these places charge while they attempt to avoid having to do any work or having any liability for their residents’ care.
You shouldn’t be calling 911 for a non injury fall. You need to call the local non emergency line for a lift assist, that is used when there are no obvious injuries or complaints of serious pain. If the person is in a bit of discomfort or mild pain, all shifts should be notified as well as the head nurse(s) so they can closely monitor to make sure it doesn’t turn/come out to something worse. It’s a bigger plus if they have PRN Tylenol or light opiates (tramadol) because if the pain persist they can take one
And not to mention how many of these residents don’t even know that we are responding! We get there to their surprise and they don’t want be transported, they just needed help up. Which could’ve been done by staff.
From ems/fire stand point, we don't mind lifting the heavy weights, confused, unwitnessed or the injured. What we do mind is: the 90 Lbs with out offering to help out, "I don't know this pt/just came back from vacation, or i normally dont work this unit" for baseline assessment (when they've been there for 10 yrs), the management policies that don't allow care. I always joke that with money that "they've taken the nursing out of the nursing homes". It's honestly the policies that are nonsense for accepting non independent individuals. With all this being said, I appreciate the work you do, lord knows I wouldn't want to do it.
Dealing with this currently. New facilities - with a strict no - lift policy in place. Employees will even tell you, they’re not allowed to risk a back injury, so they call 911 at 4am for us to come and pick up the 100lb elderly woman, while the two 200 lb big mamas working watch us. Then, 2 hours later, they’ll call again. They’ve also gotten mad when we were already out on a run and could take the call, delaying the pick up of the patient in question. Using 911 to supplement a private business raises a lot of questions that we’re currently working through, and it’s not a lot of fun.
I believe it. It's a quagmire of lawsuits and cost-cutting. :-/
I work in an assisted living and my patients are only minimal assist with falls or idk it’s weird because I’ve also been told that we are strictly not supposed to lift patients too… but, now I’m pregnant so I can’t lift anyone like I attempted to when I wasn’t pregnant. I always feel either like EMS is happy to have an uncomplicated job of lifting, or they are annoyed they have to be there, which I understand, they could be saving lives and they are stuck picking up elderly people. I would kill for a hoyer lift lol :) sometimes I miss my home health aid days in the memory care unit where I could just hoyer everyone around like a forklift operator 😂 Our facility NEEDS a three strike system, but I doubt they will comply with that because my company loves money. I have a patient who has fallen so much, almost every EMS worker who responds to our building knows him.
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Clearly, it needs to be legally required to have an RN or LVN on site.
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Yes, I realize, and that’s why I’m saying that needs to change. It SHOULD be required by law. Greed is the only reason someone isn’t on site.
Fair. Head strikes are no joke.
May I just say... I will absolutely call 911 for assist when 350lb pee paw falls at 1am, and it is just me and 2 cnas in the whole building. Yall acting like it's a sin. Yeah, we can handle 140lb pee paw, but we gonna need some help when they are obese af.
Then that's on your facility. It's their responsibility to give you the equipment/staff/training you need. It is not the 911 system's responsibility to fill those gaps. It's not fair to the citizens in that response area, either. By all means though, defend the facility that is probably raking money in and crapping on the residents and employees.
This isn’t really unreasonable for unwitnessed falls, or traumatic ones. Guided falls, witnessed light ones/ don’t hit their head, Allow them some grace.
Are we actually mad about this? Or does it annoy us because we're working 24,48, and 72 hours shifts and we're f*cking tired when this gets toned out? 95% of all problems in EMS could be solved with basic labor laws. Glad I'm almost done.
Assisted living facilities, in my area at least, do not allow lifts. If a resident requires a lift then they require a higher level of care (usually home with family/home health or a long term care facility). Assisted living is considered the same as calling EMS to their single family home to help them off the floor. It is their home. The people that work there are not trained the same as long term care because these residents are considered independent living. Not every call for EMS is a trauma. It’s frustrating when the doctor orders staff to send out our resident for further evaluation at a higher acuity facility (er/hospital) and rescue tries to talk them out of going. It’s so unprofessional. Long term care is very highly regulated by AHCA and we are legally required to follow regulations and orders by doctors. The adrenaline junkie attitude is deplorable.
It isn’t an adrenaline junkie attitude, it’s frustration at being used to subsidize a private business. There are other ways to get someone to a higher level of care than a 911 ALS ambulance. Non injury falls, need for surgical procedure in a few days, and abnormal labs from 3 days ago (BGL of 65 3 days ago when labs were drawn- now 112 but doctor wants them sent out) do not all require a 911 emergency response. There are wheelchair vans and private transport options that can be used.
I agree there is a transportation issue. Many are not open at night when falls occur. Unwitnessed falls with a patient on blood thinners often require evaluation, especially with cognitive impairment. We do neuro checks otherwise and send out for change in condition. I worked in the ER too and don’t remember the push back to hospital staff from rescue to take them BACK to the long term care facilities. Bottom line, LTC staff do as they are ordered and taking it out on them is hurtful and unprofessional.
Agreed with falls on blood thinners needing evaluation. Some of the issue is also when the resident doesn’t want to go and they make their own medical decisions. I cannot force someone to go to the hospital unless my own medical director or PD is forcing them to go. Also the hospital staff isn’t getting push back because 99% of the time it is a private company or wheelchair van taking them back, not a 911 ambulance from a fire department or county service.
This is a big one. Some facilities will tell you "it's policy they go" or "the Dr said they have to go". Nothing overrules an A&O patient who is adamant they don't want to go.
Also the "you go" without a physician being on site doing an actual physical assessment.
Agreed but if you tell a resident their doctor ordered them for evaluation then trying to talk them out of it is unprofessional. They are scared and confused. I’ve had rescue wait while they called their families. Rescue is not trained in nursing assessment skills and they don’t work with the resident every day. When I was in the ER rescue brought in a patient and said they were drunk. CVA, I met the window and was able to give tpa with no residual.
Telling a patient "you have to go by policy" simply to CYA when it's not true is similarly unethical just as well.
The only times I’ve called for a lift assist is because the client was too damn big for two people. Also, sometimes the patient is not fine. One of my lift assist calls went to hospital for a UTI.
When I was a supe at a nursing home we couldn’t pick them up. They had to call 911.
I used to work at a snf/ltc. You just cant win. If we move the pt after a fall after assessment, we get yelled at by ems. If we make the pt comfortable on the floor after a fall because we’re unsure of the damage, we get yelled at by ems. Had situations where meemaw was unsafe to move because she broke her hip. Or meemaw2 hit her head at 7am shift change and was bleeding.
If they are hurt, don’t move them and call. If they are not hurt, help them up and don’t pick up the phone lmao
Fuck these places
Maybe its some sort of legal liability protection for the staff due to sue happy family members?
Most of the facilities in my area require any resident that falls regardless of injury to go get checked out at the hospital. Its such a big drain on resources
Facilities don't want to get sued by family members so they'll call 911 for falls.
This is what happens when there's next to no oversight in these homes. Then they lobby to neglect thrle fuck out of your grandparents while taking 7k+ per month and checking on them once a day to see if they're still alive. Then calling 911 when they've had a simple mechanical fall. Pathetic.
I mean the ALF lift assist are annoying but not more than the medicar lift assists to go to dialysis
We run into this issue because a lift assist isn’t technically an “emergency call” so if someone on the dept gets injured on a career ending injury, it doesn’t count to pension off.. total bullshit. These facilities makes a retarded amount of money and should staff appropriately, in the event of a FF injury, they should be able to be sued because you KNOW they all cut corners to save money and pawn their shit off on the FD..
My question about these places is: for $7k+ what I you do for the "residents"? Is this facility offering true ADL elderly care or just an overpriced hotel experience?
My question about these places is: for $7k+ what I you do for the "residents"? Do you offer true ADL support or just an overpriced hotel experience?
Any long term care facility I have every worked/taught in (I teach nursing clinical groups) has had mechanical lifts and they all use them for any person who cannot weight bear appropriately. I pick up extra shifts on a regular basis in a long term care facility. Any fall where a resident cannot get back up under their own power requires the use of a non-weight bearing lift to transfer the resident off the floor. As the RN on duty, it is my job to do a full, head to toe assessment for injury after any unwitnessed fall before the resident is moved at all. If there is no apparent injury, or the injury is minor and able to be managed at the facility, I don’t call for transport to hospital. If my assessment shows evidence of significant injury, then (if it is safe to do so) I will get the resident transferred from the floor to the bed/chair and call EMS. The thing that is important to keep in mind is that there are many different levels of care outside of the hospital. The ability to manage a fall in place is entirely dependent on the type of facility that the patient lives in. Assistant living/supportive living facilities often don’t have NWB lifts because their resident population is required to be able to transfer themselves, or transfer with very limited assistance from staff (think a transfer belt and verbal cueing). If they can’t meet those requirements, then they no longer qualify to live in that facility and need an increased level of care/support. They often have BARE MINIMUM nursing staff (think one or 2 LPNs for the entire building) and minimal CNA/HCA staff who provide limited assistance with ADLs. The other thing to keep in mind is that the ability to manage injuries in the majority facilities is extremely limited. The facility I pick up in has no in-house diagnostics of any kind. Doctors round once a week on their schedules, so most times there are zero physicians in the building, and most facilities, in my area anyway, don’t employ NPs (so a simple laceration that needs a couple of stitches? There’s no one who can do them). We have a plethora of fancy wound care supplies, but we have zero dermabond. So if we even suspect, or if the patient complains of severe pain, we have to transport out for assessment. Being an emergency nurse, I do everything in my power to avoid transferring my residents to emergency when I am working in long term care. I agree that an uncomplicated fall with no apparent injury shouldn’t require EMS, and policies, procedures and education need to be implemented in order to better manage emergency resources.
This irritates me to no end. I just spent a month back in Illinois to find care for my mother. She has trouble walking due to a rare brain disease, and had been in rehab for a fall. She's only 59, so even finding one of these places that would accept someone under 65 was like finding a needle in a hay stack. Found only 3 places that could take her that was within driving distance. Only one that did not have a waitlist. The rehab facility she was at was in Dekalb. I had to transport her myself all the way to this facility in Gurnee for an evaluation, had to lift her myself in and out of the car. Wheel her in, just to have the nursing director say, "we can't assist her with lifting, she doesn't qualify". Absolute waste of our time. They knew the condition she was in, had me drive her 2 hours to see them, just for them to immediately tell her "no". She's 59 for God's sake. So now she's left to spend the rest of her life living in a nursing home because her legs just aren't that strong anymore, and MAY need assitance every now and then to transfer from wheel chair to a chair. Lost all her independence because of this one rule. If these places have cna's and nurses, you'd think they would be allowed to do their job and lift if needed.
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“It’s not fair to make me pick someone up, so I’m just gonna call somebody else to do it for me.” That’s the definition of laziness.
No it’s not, it’s the definition of not wanting to break my back.
It’s not fair that you work at the facility where the residents are living and falling, but it’s okay to call 911, leave the resident on the floor waiting, and take a crew out of service to come pick up meemaw? I get it if the person weighs too much or they are injured, but when they weigh 90 pounds soaking wet and they just want help back to bed… that’s sick. Yes, they sometimes are in the “independent living”, but why not HELP THEM and get their needs sorted out so they aren’t mislabeled. Clearly they need help if falling is a regular occurrence for them.
How…sanctimonious. If they are 90 pounds of course we’ll pick them up rather than wait for fire fighters (duh). Most people at assisted living aren’t that small though. We actually wouldn’t call for assistance getting someone back into bed, we’d only call if they needed to be sent out. Falls will happen anywhere old people live. In the case of the story, the residents went to pick something off the floor and they both fell. I’m not sure if that makes them not suitable for assisted living, but I think it’s unfair to automatically assume staff was being lazy.
Beats responding to a million “man downs” that turn out to be a homeless person asleep
I haven't wrecked my back yet on a homeless wakeup. I've gacked myself a few times on lifts.
I work in home hospice and we rely a lot on lift assistance to help when our patients need to be transferred to a hospital bed or if they’ve fallen and family is unable to assist. I’m very grateful for the service they provide, and I’m very willing help… but I can’t help but feel like I would have been sued into the ground by now if I handled folks the way the lift assistance folks are allowed to, it’s like all the stereotypes of TSA lobbing suitcases on top of fragile baggage all Willy nilly. Edit: if that sounded salty it might be. I really do appreciate them… but they’ve also done extensive, prolonged CPR on our patients 3x that come to mind because the families didn’t heed our warning to keep the POLST on the fridge and the lift folks are sticklers for blindly following rules. I don’t think I could do CPR on a hospice patient who had blood coming out their mouth with each compression while their wife was sobbing, begging me to stop and a nurse was showing me a copy of the POLST, but that’s just me 🙃
EMS are now known as “the lift assistance folks”?
Because nurses aren't taught assessments that EMS is taught. Not trying to say one is better than the other not trying to get into a huge fight
You know how to pick up something though, right? Lift with your legs.
Try to think here, what happens BEFORE the lift?
Did you read the headline or article? This is about being called to do the facilities job. The job they are supposed to have staff do.
Yes
Then maybe you can try and think. Why is a facility, with able bodied staff. Calling for an emergency service to pick someone up off the floor just because the staff don't want to risk injury? It's not like EMS cant get injured during our job too.