In 2014, the Decatur (Illinois) Fire Department responded to 430 calls for lift assist services. By 2023, the number had risen to more than 1,000.
Even with the large Baby Boomer generation moving into their twilight years, city officials did not believe the increase in lift assist requests was related to the aging population.
“We had facilities that were – I hate to use the word abuse, but they were utilizing our resources rather than the people that are paid to do that,” DFD Chief Neil Elder said. “They were taking liability off themselves and putting it on our taxpayers and our resources.”
The department was responding daily to multiple requests to “just go out and lift an uninjured person off the floor,” Elder said. He recalled several occasions where crews were delayed responding to a first alarm because they were in the middle of a lift assist call.
Something had to give.
Lift assist fees: A one-year trial
Concern for the increasing volume of lift assist calls was not new for the city of Decatur; one city council member acknowledged the problem had existed for years: “We’ve been talking about this since I’ve been here – nine years.”
In February 2024, the city council unanimously approved a one-year trial run implementing a $500 lift assist fee for any skilled nursing facility or nursing home in which the patient was only moved and not medically cared for by fire department personnel.
The amount of the fee was determined by averaging how much time and department resources are used during a non-medical lift assist call.
“We did our research,” Elder said. “If our engine company goes, there’s a certain amount per hour. We took the apparatus charge into consideration, and of course we have a minimum of three firefighters on every rig.”
Rounding up to $500 made sense, Elder said, both to fully cover the use of taxpayer funds and to act as a deterrent for facilities who may have paid a lower fee to avoid the liability of picking up a patient.
The fee was also waived for nursing home residents who required any medical attention during the call, and residential calls for lift assists were also exempt from the fee.
Lift assists: One year later
Over the next 12 months, the DFD generated $13,500 from nursing homes that chose to pay the new $500 fee. However, the big revelation was not the revenue generated, but the decrease in requests – the department saw a 60% drop in the number of lift assist calls “compared to the previous two-year average at commercial facilities.”
Despite Abbot’s earlier prediction that the fee would not be the final solution, Elder saw the trial as a clear success, which he conveyed to the city council ahead of their near-unanimous vote to make the fee permanent.
“This change has effectively achieved its intended goal, as fewer lift assist calls have been placed, and commercial facilities are now more responsible for the care of their residents,” he said in a memo with City Manager Tim Gleason.
Elder believes the high cost of the fee was a major factor in reducing the amount of calls.
“We wanted to have nursing home administrative staff say, ‘Let’s think of other ways outside the box to fulfill those needs,’” he said. “If [the fee] was $100, I don’t think we would’ve seen the change we saw. It’s not enough of an impact on their budget.”
For nursing homes who rely on the fire department or EMS agencies to pick uninjured residents off the ground, Elder suggested investing in products that allow the facility’s staff to safely assist their own patients who do not need medical attention, such as a Hoyer lift.
“[These types of devices] will not cause injuries to their staff, and yet get their patients off the floor,” he said, “The bonus of having these devices on hand is their patients aren’t laying on the floor for an extended period of time, because by the time they call us out, that patient’s going to lay on the floor for probably 10-15 minutes.”
He also recommended that nursing homes encourage and train employees on how to properly lift patients, as fear of injuries to the nursing home employee was one of the common reasons given for calling in a lift assist.
“Well, we have injuries to our employees as well, from lifting and back injuries,” Elder said, “so I think just teaching proper ways to lift and the best ways to get patients off the floor would be helpful.”
The future of lift assist fees
Following the vote to approve the fee’s one-year trial run, Jeff Abbott, who was serving as fire chief at the time, did not believe the fee would be the magic solution, but was optimistic it would, at the very least, lower the amount of requests.
“I’m definitely not suggesting that this ordinance tonight is going to change our lift assist problem, because it’s not,” he said following the vote. “Hopefully, it will help reduce the number of calls to these care facilities.”
In hindsight, Elder believes it actually did solve the problem they were hoping it would.
“I think [it solved the problem] with commercial facilities,” he said. “We still have a problem residentially, but the numbers show that it definitely reduced the number of times we go [to those types of elder care homes].”
For fire/EMS agencies wondering how to tackle their growing lift assist call volume, Elder suggests learning from his department’s approach.
“If [the lift assist call volume] is impacting the services they provide to citizens, they really should pursue [a fee],” he said. “However they want to structure that fees is up to them, but they need to make it significant enough that it’s impactful to the nursing homes.”
Elder knows other departments are considering similar fees … because they’re contacting him with questions and requests for advice.
“I can tell you by my emails that [concerns with lift assist volume] are happening everywhere,” he said. “I’ve received emails from Texas, California, Wisconsin.”
The city of Decatur, however, now has a handle on the call volume and processes in place to deter abuse of the system and the available time of fire department personnel.
Elder: “I think it’s a win.”
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