The senior living industry is pushing back against a Washington Post story about senior living providers’ use of 911 for lift assists, saying that where an older adult lives should not determine whether he or she has access to emergency services, including lift assist services.
Emergency lift assist calls from assisted living communities and other long-term care settings spiked 30% nationwide in recent years, to almost 42,000 calls annually, making it the seventh most common type of 911 call, according to an analysis of fire department emergency call data from the National Fire Incident Reporting System analyzed by the Post.
The article was published Friday.
In a letter to the editor written the same day, American Seniors Housing Association President and CEO David Schless said that the story “fails to get to the essence of the issue” of the dramatic aging of the US population.Numerous implications are related to those demographic changes, including an increase in calls for emergency response, he added.
“Importantly, fee-for-service charges for emergency service calls to assisted living or other residential care facilities — when these services are made available to other multifamily households without charge — constitutes unreasonable and unlawful discrimination against disabled seniors,” Schless wrote in a letter to the media outlet. “If the seniors residing in assisted living had remained in their single-family or multifamily residences, and did not move to assisted living, they would still require emergency services — but would not be penalized with a charge.”
Argentum took a similar stance, noting that older adults are entitled to the same rights and services as individuals living in a private residence.
“Our goal is to ensure the safety of the seniors we care for, including contacting emergency services when necessary to provide proper medical evaluations,” Argentum President and CEO James Balda told McKnight’s Senior Living. “Our communities are the homes of seniors, and as such they are entitled to the same services as any other taxpayer.”
Schless added that several states, such as California, require assisted living residences to call 911 if a resident falls. Such regulations are intended to ensure that a medical professional examines a resident for injury, since residents can’t always articulate the circumstances of a fall due to cognitive impairment.
In addition, Schless said, the article does not include information about the falls prevention programs implemented by many assisted living communities.
National Center for Assisted Living Executive Director LaShuan Bethea told McKnight’s Senior Living that resident safety is a top priority for the association, adding that the providers want to prevent the need for emergency services and unnecessary trips to the hospital.
“We deeply appreciate the role that emergency responders have in helping residents of senior, independent and assisted living communities receive the medical care they require at certain times,” Bethea said.
A LeadingAge spokesperson similarly said its nonprofit members rely on local and state laws and regulations, which can vary greatly, for guidance on lift assist calls.
Cities implement fees
Fire officials said that senior living communities call first responders when a resident falls to avoid the risk and expense associated with picking the resident up off the floor, according to the Post. Several cities have started to push back on the calls, instituting fees for lift assist calls to senior living communities.
The media outlet reported that the city of Anchorage, for instance, provides the first lift for free per community and charges $250 for a second call within 12 months. Kansas City, MO, added a flexible lift assist fee to discourage “repeat offenders.” In Wisconsin, the city of Mequon bills senior living communities to reinforce the fact that the operator is responsible for the call, whereas assisted living communities in Pewaukee filed appeals over new fire and EMS fees, saying they are almost five times higher than fees charged for other apartment units.
Decatur City Council in Illinois adopted an ordinance charging senior living communities for fire department responses to lift assist calls, billing $500 per assist call. The ordinance was adopted after city officials said those calls take firefighters away from their care responsibilities.
At the state level, Illinois state Rep. Mike Kelly (D), a Chicago firefighter, is sponsoring a bill to implement lift assist fees for independent living communities, assisted living communities, nursing homes and other congregate care facilities.
The Illinois Health Care Association / Illinois Center for Assisted Living previously told McKnight’s Senior Living that local governments and municipalities have an obligation to provide emergency services regardless of where individuals live. LeadingAge Illinois similarly said that senior living residents should have access to lift assistance and other emergency services and supports regardless of their residence.
Sterling, MI, instituted a similar ordinance last year for what it deemed a “misuse” of 911, which drew the ire of senior living communities. The ordinance charged independent living and assisted living communities and nursing homes a $800 fee for lift assist and a $500 fee for a non-emergency medical response.
Waltonwood Senior Living, which offers assisted living, memory care and independent living on its Sterling Heights, MI, campus, didn’t fight the charges for assisted living residents, but it argued that the fee should not apply to independent living communities, which do not employ caregivers. In response to the fees, the provider informed its independent living residents that it would institute an $800 charge to residents who receive a lift assist from the city, to recover its costs.
Senior living groups push back
After Tacoma, WA, implemented a lift assist ordinance in 2019, the Washington Health Care Association and LeadingAge Washington partnered with city safety forces to decrease the number of 911 calls for lift assistance for long-term care facilities. The organizations educated first responders on the training and staffing requirements of assisted living communities compared with skilled nursing facilities, and provided education to community and facility staff members.
The Oregon Health Care Association worked with Portland fire and city officials to craft legislation that protected that city’s lift assist ordinance, but preempted more expansive moves by other cities. The 2021 bill was adopted in response to a bill instituted around the same time by the City of McMinnville, that contained regulatory care requirements for long-term care facilities that “significantly conflicted with state and federal law” and included expensive fines, fees and taxes on senior living facilities, OHCA Senior Vice President of Strategy Rosie Ward told McKnight’s Senior Living.
McMinnville voters repealed that ordinance by referendum. Ward said the ordinance it supported would limit other cities from implementing more extensive requirements on and fines against senior living facilities.
In Wisconsin, lawmakers are considering two bills addressing lift assists in assisted living.
AB 943 would provide grants that would enable assisted living communities, nursing homes, residential apartment complexes and hospices to buy resident lift devices. The bill requests $300,000 to launch a pilot program to put 100 lifts into different facilities across the state and study their effect. The program’s goal is to reduce 911 calls and worker’s compensation claims from first responders injured while lifting on the job, and to reduce costs for senior living residents who don’t need medical treatment but need help getting up from a fall.
Although senior living organizations said they support AB 943, they are united in their concern over AB 942, which would impose a “duty” on assisted living communities to administer CPR and first aid and to make an attempt to lift residents who have fallen.
Assisted living in the crosshairs
Assisted living and memory care communities have captured the attention of national lay media and legislators in recent months.
Publication of the Post’s lift assist article follows its previous report in December on the deaths of residents who wandered from assisted living communities. The New York Times and KFF Health News in November scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of providers.
Congress kicked off 2024 with a focus on assisted living through a US Senate Special Committee on Aging hearing that focused on assisted living quality. The committee requested an investigation by the Government Accountability Office into senior living cost and transparency of assisted living, sought stories and bills from residents and their families, and requested that three large providers answer a list of questions.
Recently, three federal agencies — the Department of Labor, the Federal Trade Commission and the Centers for Medicare & Medicaid Services — announced several rules affecting senior living providers, other providers on the long-term care continuum and others.
Argentum recently called on providers to tell their stories and share the positive impacts of assisted living in light of various legislative initiatives “percolating” at the federal and state levels that could affect senior living provider operations. The association also launched an “I love assisted living” campaign to share stories and information about the sector’s contributions to caring for older adults.
