Seniors and ambulance service

December 10, 2003

SEARCHING for ways to pay for growing demand on its strained paramedics-ambulance service, an Anne Arundel task force recently considered charging an impact fee on developers of nursing homes and other group living facilities for seniors. The same idea surfaced in Carroll County discussions.

There's no question that the growing segment of older residents disproportionately increases demand on emergency medical services; local demand is magnified by concentrations of seniors in group living facilities. With ambulance responses accounting for more than two-thirds of ever-increasing fire department calls in Central Maryland, there's an understandable impulse to find a way for users to pay for it.

But singling out seniors housing for a special impact fee is not sound policy, because ambulance calls by elderly citizens aren't limited to group facilities; they come from private homes and apartments, too. Certain geographic areas generate more ambulance runs, seniors or no, than others.

Instead, counties should look at other mechanisms that can improve service to seniors facilities without overburdening the public ambulance system.

One alternative, for existing as well as new facilities, is better screening of emergency calls by facilities staff to reduce the number of 911 calls that are not true emergencies. In Mount Airy, for example, one nursing home says staff screening, in coordination with the local Fire Department, has cut by 80 percent the number of 911 ambulance calls made from there. And in Baltimore County, an agreement between the Fire Department and a Towson retirement community produced a model of cooperation, from periodic emergency training at the complex to the preparation of medical information sheets on each patient that can be given to responding paramedics.

Charging for fire department ambulance runs -- a direct user fee -- is not a popular option; only Baltimore City and Carroll and Prince George's counties do so in this region. Anne Arundel approved that approach several years ago but quickly pulled back, for reasons that included paramedic legal liability, higher administrative costs and low collection rates.

Emergency ambulance service is an essential service for the community, but one that can be preserved without creating another earmarked fee.

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