Target 8

Same patient, different day: GR homeless fill EMS

GRAND RAPIDS, Mich. (WOOD) — When you call 911, you expect your emergency to take priority. But first responders near downtown Grand Rapids worry nonemergency calls from repeat customers will delay getting help to those who really need it.

“That’s the thing that I fear the most,” said Grand Rapids Fire Chief John Lehman, who witnessed just such a case at his last department in Aurora, Illinois.

“I had a couple paramedics who came into my office and they were visibly upset,” Lehman recalled.

The crews had been dealing with a nonemergency patient for the third time that day when a call came in a block from the firehouse about a baby who was not breathing.

“It took an additional three minutes to get a unit to the baby because this unit was tied up, and that baby didn’t make it.”

There’s no way to know if a faster response would have saved the baby, but the possibility is there and it’s devastating for first responders.

“Seconds count in this business,” Lehman said.

That’s part of the reason the Grand Rapids Fire Department is collaborating with police and other agencies to brainstorm ways to reduce nonemergency 911 calls from so-called “super users.”

“We’re clogging the emergency rooms with people who don’t need to be there,” Lehman said.

15 "SUPER-USERS" RESPONSIBLE FOR 305 CALLS

It’s a big problem for the LaGrave Fire District, which makes up just 2.05 percent of the city geographically, but accounts for 16.36 percent of the city’s total EMS calls. That’s the highest call volume density in the city, and an overwhelming majority of those calls involve Heartside’s homeless population.

LaGrave covers one square mile, including Heartside, an impoverished pocket dotted with missions, soup kitchens, art galleries, retail shops and new, upscale apartments.

GRFD reported that 15 “super-users” of EMS in Heartside were responsible for 305 EMS calls last year. Some patients were seen more than 40 times.

The total cost of each call ranges from $930 to $2,140, depending on the level of care needed.

Last April, Lehman told city leaders if the volume of EMS calls from Heartside does not ease up, LaGrave will need an additional unit, likely an engine, and a million or so dollars to staff it. It was at the point, according to Lehman, that 2nd Ward Commissioner Ruth Kelly asked the department to examine the issue and look for ways to reduce call volume.

Thus began a collaborative effort between GRFD, police and multiple health care and social service organizations, many of which have been working on the issue for years.

GRPD'S 'SUPER USERS' ARE HOMELESS MEN

After the group of stakeholders met at GRFD’s training center on Monroe Avenue NW earlier this year to conceptualize solutions, the Grand Rapids Police Department created its own list of “super users” in the Central City District.

“That’s what kickstarted me,” GRPD Capt. Scott Rifenberg said, referring to the collaborative effort. “We’ve got people interested in solving this problem. Maybe we can get some traction now.”

Rifenberg’s Central City District has long grappled with its own version of “super users,” people with whom patrol officers have constant contact. His area also covers the downtown business district and North Monroe, but his officers spend the majority of their time in Heartside.  

A city IT specialist analyzed records from a seven-month period, February to August 2018, to come up with the top 24 or so individuals who had the most police contact in that time. The Central City’s top “super users” are homeless men with an average age of 50. All have problems with alcohol. The man who ranked No. 1 had more than 40 contacts with GRPD, despite being in jail for a large portion of the time in question.

Rifenberg plans to use the list to identify people GRPD and other agencies can target for intensive social services in an effort to help them get off the street.

HOMELESS MAN: GR IS THE 'BEST CITY IN THE U.S.'

Officer Jenny Rood, who has patrolled the Central District for two years, has always made an effort to keep track of Heartside’s homeless.

“Jenny is certainly one of my stars,” Rifenberg said. “It takes a different kind of officer to work, survive and thrive in Heartside and Jenny is certainly one of those individuals. She has a heart for service.”

Target 8 investigators witnessed that dedication during a ride-along with Rood. Toward the end of her shift, she responded to a 911 call regarding a man in wheelchair possibly suffering a heart attack on Pearl Street near Fifth Third Bank headquarters.

“I know absolutely that it’s Jeff,” Rood said as she headed toward the call.

She was right.  

Jeff, a 60-year-old homeless man, talked to Target 8 from the back of the ambulance.

“Grand Rapids is the best city in the United States,” he declared. “They help out the homeless the most. ... You can eat here, what, eight times a day.”

Jeff has long called the city’s streets home.

"I'm a panhandler. I ask you for 50 cents every time I see you," he told Target 8 as he lay on a stretcher in the ambulance.

In recent years, he has racked up 58 misdemeanor cases, including public consumption of alcohol, urinating in public, trespassing and being a pedestrian on the freeway, among other things. He has third-highest number of vagrancy charges in 61st District Court. The defendant with the highest number had 99.

Kent County’s jail has 66 mug shots on file for Jeff, and that’s just for the last 20 years. The mug shots from the 1980s were not available. The progression of the photos tells Jeff's story: time, alcoholism and homelessness weathering his features.

Jeff was taken to the emergency room, but he turned out to be fine.

Target 8 found him back on the street early the next morning. A caseworker from Network180, Kent County's mental health services authority, was talking with him about potential next steps to help him get off the streets.

It’s that kind of targeted social service assistance that Grand Rapids police and fire hope will help even a couple “super users" so they're not trapped in a cycle that ties up the emergency system we all pay for and rely on.

"This is a societal problem that needs to be dealt with. ... It stretches us beyond where we really should be," Chief Lehman said.

Among the takeaways from stakeholder meetings this summer was a list of proposed “countermeasures” to help reduce nonemergency calls from repeat EMS customers. GRFD will present the findings and proposed remedies to city commissioners.

Chief Lehman stresses that the fire department is far from the first organization to try to address the "super user" problem.

While police and  fire are new to the collaboration aimed at reducing repeat EMS customers, other agencies, including health care and social services, have been working together to try to solve it. 

Mercy Health Saint Mary's, which is impacted significantly by "high utilizers," sent Target 8 the following statement regarding its efforts:

"One of the ways Mercy Health addresses high utilizers is through the Complex Care department. Nurse Navigators look for and address root causes behind the patients' repeated visits. They do this by communicating the individual patient story to the care team and follow the patient through the continuum of care. Additionally, Nurse Navigators collaborate with community partners to improve efficiencies of care delivery across systems. This collaboration includes utilizing Community Health Workers who assist patients with system, resource and community navigation, including health insurance and medical connections."

Carrie Hamilton, BSN,  RN, Clinical Services Manager of Complex Care


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