Seniors’ simple falls prompt costly paramedic visits

A newly published study shows London-area paramedics are spending at least a month’s worth of time each year literally picking up seniors who have called emergency services for help in getting up, usually after a fall, but who refuse transport to hospital for further care.

And the authors – who include a Western University gerontologist and five Health Studies students – suggest those numbers will increase unless better ways are adopted both to help fall-prone seniors and to prioritize emergency resources.

“It’s an emerging problem that we need to address in North America as baby-boomers age,” says Western gerontologist Aleksandra Zecevic, an associate professor in Western’s School of Health Studies.

Her fourth-year undergraduate students crunched the data and analyzed paramedics’ notes as part of their community-service course, Gerontology in Practice.

The peer-reviewed study published in the journal Prehospital Emergency Care examined only instances in which patients did not need medical care and chose not to go to hospital – the seniors’ only pressing need was help to get up to a sitting or standing position.

“It was heart-wrenching to read some of the patient stories,” says Dustin Carter, Superintendent of Community Paramedicine with the Middlesex-London Paramedic Service and an innovator in remote patient monitoring to keep seniors living longer and healthier in their homes.

The majority of patients they interviewed said they would have preferred not to call, but said there was no other resource available to them.

“Some of these people would say, ‘I don’t have anybody else to call, so I have to call you and wait on the floor until you arrive,’” adds Carter.

Some calls also came from home-care staff and long-term-care facilities with do-not-lift policies. The study authors say the lift-assist calls aren’t necessarily the most timely, cost-effective or medically appropriate use of paramedics’ expertise.

Before this study, Middlesex-London Paramedic Service hadn’t been able to quantify the number and demographics of lift-assist calls: because they aren’t covered under provincial funding envelopes, they are “uncoded” and their cost of about $200 per visit must be absorbed by the service.

The numbers:
• paramedics responded to 1,121 seniors’ lift-assist calls from 611 individuals in 2015.
• Two-thirds were single visits, but about 200 people needed lift assists multiple times during the year (including four who received 16 – 20 visits).
• Lift assists required 801 hours of paramedics’ time – or the equivalent of more than 33 around-the-clock days – at an unrecovered cost of about $160,000.

The authors recommend: early referrals by paramedics for fall-prone seniors because falling can be a marker of diminishing health or medication issues; stronger collaborations with home-care, retirement care and long-term care organizations that call 911 because of the agencies’ do-not-lift policies; and specifically target naturally occurring retirement communities with lift-assist management and education programs.

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