Assistant Fire Chief Brian Schaeffer knew something had to change three years ago when he responded to a 911 call from an elderly woman in north Spokane.
The woman’s husband had fallen and she couldn’t get him off the floor.
A four-person paramedic team and a ladder truck “capable of bringing people back to life” was dispatched from Fire Station 13, Schaeffer said, but it was “completely unsuited to taking care of this couple’s problems.”
When the paramedics arrived at the scene, they knew the couple by name. They had been there five times in the past two days.
Last year the Spokane Fire Department responded to nearly 23,000 calls for emergency medical services, about 40 percent of which were not life threatening. At an estimated $820 per call, the cost of responding to these non-emergency requests for help was nearly $7 million.
In an effort to reduce the number of non-emergency calls, the Fire Department established the Community Assistance Response Team, CARES, in collaboration with Eastern Washington University’s College of Social and Behavioral Sciences and Social Work.
Since 2007, EWU social work interns have been trained to visit households where first-responders determine there is a need for a long-term solution to a chronic problem.
In many cases, the household has misused the 911 emergency system for lack of a more cost-effective medical or social service.
The CARES team visits the home, assesses the situation and helps the resident contact an appropriate in-home social service to deal with the underlying problem. In more than 54 percent of CARES cases last year, the resident was above the age of 60.
“Socioeconomic conditions have caused the Fire Department to become the primary responder,” said Erv Williams, a retired fire captain who now coordinates the CARES program.
Williams said age and morbid obesity are the top reasons people call 911.
“A lot of times, they call us because they don’t know what else to do,” Williams said. “By the time they ask for help, they have waited way too long.”
When a fire or paramedic crew refers a case to CARES, the team tries to respond within 72 hours, said Brittany King, a second year master’s of social work student at EWU.
King is one of seven interns assigned to the Fire Department this quarter. She is supervised by veteran social worker and former EWU instructor Patty Gregory.
The team can provide crisis intervention and emotional support for families burned out of their homes. But more often, it is called to provide an alternative to 911 misuse.
King said that when a CARES team enters a home, it evaluates the surroundings and determines whether an underlying medical, mental or socioeconomic condition is causing a resident to call 911 for help.
“We tell them, ‘We are not here to take you out of your home,’ ” King said. “This is their first fear.” Then the team helps the resident contact a provider such as Elder Services.
In the most extreme cases, the team will contact Adult Protective Services.
“We have seen elderly parents neglected” by adult children, primary caregivers who are not doing their jobs, King said. Sometimes they even steal medications or money and scrimp on food.
In most cases involving the elderly, team members encounter problems caused by residents’ resistance to leaving their homes when they are long past needing assisted living.
That was the case Schaeffer encountered in 2007 in the home where the husband had fallen. The refrigerator was bare and medicine bottles sat empty on the table.
“The couple was trying to avoid going into a nursing home,” he said.
It is difficult to determine the cost benefit as a result of CARES, but with a paramedic team and truck costing $400 an hour, heading off unnecessary 911 calls could amount to thousands of dollars in savings.
This year, the CARES program was budgeted for less than $44,000. Interns are not compensated for their work, but last year the Fire Department was able to provide the team a stipend through a grant from the Inland Northwest Community Foundation.
Schaeffer said the CARES program has expanded in the past year to include coverage of Spokane County Fire Districts 1 and 8.
He hopes it will continue to grow.
With expected cuts in Medicaid and Medicare next year, Schaeffer said, the CARES team will be even more important as elderly and low-income residents’ access to preventive care is further eroded.
“We are ahead of most fire departments in the country in providing a mechanism to deal with it,” he said.