Heartland

The city is considering charging according to the average cost per call of $486.83.

El Cajon officials say the city is being swamped by 911 calls that aren't real emergencies. That is, no one leaves in an ambulance or requires medical aid.

The calls are random, some medical, some not, and a smaller number are lift assist requests where someone needs help moving or getting up.

Many of the calls come from skilled nursing and psychiatric care homes. The city has 20 licensed group care facilities, which accounted for over 2,700 calls in the last fiscal year.

"They have a huge demand on our services," city manager Graham Mitchell said last week as the council weighed options to end what they call "misuse" of public resources.

It's not always an easy judgement, however, especially when fragile seniors or a mental health crisis is involved. California law requires licensed facilities to call 911 "if an injury or other circumstance has resulted in an imminent threat to a resident’s health.”

As the city sees it, the skilled facilities should rely more on their own staff, rather than emergency services. On average, 7.5 calls per day summon the city’s six engine, truck, or squad companies. Twelve of the top twenty addresses the fire department visited last year were group homes (the city calls them "congregate care facilities.")

There were also 372 lift assist requests, most coming from private homes.

The solution? Giving the group homes a "bank" of calls. Go over the allotted number, and fees kick in. The city is considering charging according to the average cost per call of $486.83, which reflects the amount of time for a captain, engineer and firefighter to respond, wear and tear on the vehicle, the actual 911 call the city gets charged for by Heartland, and another fee on top.

If the city approves the idea, they'll be among the first to do so, Mitchell said. "We have not discovered anyone who's doing this right now. We would be on the cutting edge."

Prior efforts to curb the call volume with educational outreach failed in 2022, after a city-conducted study showed that about 44 percent of calls from congregate care centers were non-emergencies.

The city has already tried carrots, councilmember Phil Ortiz pointed out. Mitchell agreed that penalties would encourage some to purchase new equipment, hire more staff or make other needed changes. 

"The minute they get a bill for $29,000, now they have some incentive to do the low hanging fruit."

The 2022 study revealed stark differences among the operators, about half of which were "heavy users." One facility had less than 10 percent of 911 calls classified as non-emergencies, while three others were over 65 percent.

"We have this range of operators, some of which are relying on the city's 911 system as part of their business plan," Mitchell said.

Avocado Post Acute, a 120-bed nursing home with a record of abuse and neglect, had the most calls per bed at 324, and was one of six to decrease the volume since 2022, while 14 have increased their own, some dramatically. VOA Carlton G. Luhman Center for Supportive Living, for example, went up 670 percent.

One of the challenges is extremely high turnover in the industry of operations staff, he said.

Next, the city will seek feedback from operators as they consider how to charge the $486 fee, which would kick in for each call that exceeds a certain percent over the median of all facilities. Another option discussed would charge $243 per call for each call over the median.

An appeal process was also considered, since many calls deemed non-emergency will likely be challenged. 

Some of the facilities will just pass the costs along, said councilmember Michelle Metscher.

"I hate to see private pay patients get stuck with the extra bills, because I know that's what they're gonna do."