Cincinnati's fire department answers roughly 1,600 lift assist calls a year from nursing homes and care facilities. City council is weighing a fee of $800 to $1,000 per call, which the sponsoring motion estimates would recover between $1.28 million and $1.6 million annually. Councilman Mark Jeffreys, who introduced it, describes the current arrangement as a cost quietly shifted onto taxpayers.

It isn't an unusual proposal anymore. Bellingham, Washington approved a $1,000 fee for non-emergency lift assist calls at licensed care facilities. Methuen, Massachusetts proposed $500 per call alongside an ambulance rate increase of about 19%. A California jurisdiction set $565. Raleigh operates a standing lift assist ordinance. Freeport, Illinois has a proposal covering extended care facilities and private ambulance operators.

The national volume figure comes from a 2024 Washington Post analysis of National Fire Incident Reporting System data, which found lift assist calls from senior living up 30% to roughly 42,000 a year nationally, ranking it the seventh most common type of 911 call.

David Ferris made the case for charging in JEMS in June. He ran a county EMS department in northwest Indiana and put an $875 lift assist fee in place there. His argument is that skilled nursing and assisted living facilities use 911 as a rapid-response lifting service instead of staffing and equipping for a need that's entirely predictable. He points at OSHA's nursing home ergonomics guidance, which recommends lifting equipment and training to keep staff from getting hurt doing the lifting, and at the CMS participation requirements on staffing. The OSHA document is guidance rather than a standard, so it recommends and does not require.

A 2025 study of geriatric lift assist calls that ended in transport refusal found about a third of those patients generated another 911 encounter within 30 days. The median time to that repeat was just over a day, and most repeats landed inside three days. On the first repeat, 78% were transported to a hospital. A separate analysis of falls-protocol dispatch data from 2017 and 2018 put the repeat rate at 3.82%. Other work has placed lift assists at 4.8% of total EMS call volume with more than half generating a return inside 30 days.

Those figures don't reconcile. The studies don't define a lift assist the same way and don't draw on the same denominator, one counting dispatch codes and another counting patient encounters that ended in refusal. Blending them into a single rate would be inventing a number, but all three still point the same way. A lift assist that ends with the patient staying put is followed by a second call often enough that the research treats it as a marker rather than a null event.

Read one way, that's an argument for sending EMS, because the call is the earliest externally visible sign that a resident is deteriorating. Read the other way, it describes a facility that had licensed clinical staff on site and did not act on the first fall. During my time in EMS, I transported many uninjured fall patients to the hospital at the direction of facility staff because it was their policy.

A skilled nursing facility has nurses, and nurses are a higher medical authority than EMTs and paramedics (a debate for later), so the early warning the literature describes is one its own nurses are positioned to catch. EMS becomes necessary after the second incident, not the first, and none of the ordinances address what happens clinically after the first call.

All of that assumes, of course, the nurses are actually there. Whether a facility has enough of them is not something a city fee measures, but it's been federal ground for decades.

Any nursing home that takes Medicare or Medicaid already has to keep enough nursing staff on hand to keep residents safe, under 42 CFR 483.35. State inspectors check it, and hitting a state minimum headcount doesn't by itself satisfy it.

A city can't trigger a federal inspection, so the fee isn't an alternative to the staffing rule. The obligation is already there, and a facility that can't lift its own residents is already short of it. The fee just puts a bill on the gap between the rule and the practice.

Cincinnati council members raised two of them. Facilities would pass the fee through to residents, and a priced call creates hesitation on the one that turns out to be real. Senior living leaders quoted in McKnight's argued that a person's residency shouldn't determine their access to emergency services.

The first and third are the same objection. The fee bills the facility, not the resident, so nothing about it turns anyone away from 911. Residency affects access only if the facility passes the cost down, which is the first objection restated.

The hesitation objection stands on its own. It says a facility that has been billed will wait on the next call, and it's the only one of the three that's about a patient rather than a budget.

Decatur, Illinois put a $500 fee on lift assists at skilled nursing and nursing home facilities in February 2024 as a 1-year trial and later made it permanent. Fire Chief Neil Elder reported to city council a 60% drop in lift assist calls at commercial facilities against the previous 2-year average. Decatur had gone from 430 of those calls in 2014 to more than 1,000 by 2023.

A 60% drop is what a fee working looks like, and it's also what the hesitation objection predicts. Nothing in a call count separates a facility that hired and bought lift equipment from one that decided to handle the next fall in house. Elder's figure is a memo to council rather than an independent evaluation and doesn't carry the underlying counts, and Ferris reports that requests plummeted in his county without publishing figures at all.

The fee collected $13,500 in the trial year, against Cincinnati's estimate of $1.28 million to $1.6 million a year on roughly 1,600 calls, and Decatur was running a comparable number before its fee. A fee that deters calls collects less than a fee that does not, and the Cincinnati motion scores the revenue and not the deterrent.

Ferris's $875 is the highest fee named here, so it's the strongest case the argument has. BLS put the 2024 median wage for a nursing assistant at $39,530, about $19 an hour. Add roughly 30% for payroll taxes and benefits and a 12-hour aide shift costs a facility around $296. The fee buys 3 of them.

Covering 12 hours a day year round is about 4,380 hours, or roughly $108,000 for one aide. A facility would have to be billed about 123 times a year, once every third day, before the fee cost more than the hire. Nurses cost more, so the gap widens if the added staff is an LPN or an RN. Decatur collected $13,500 at $500 a call, which is 27 calls across every commercial facility in the city.

A city budgeting fee revenue is betting that call volume holds. Cincinnati's $1.28 million assumes 1,600 calls keep coming at $800 each, but in Decatur they saw a 60% drop. Apply that drop to 1,600 calls and Cincinnati is billing 640 of them, which is $512,000 at the low end of its own fee range and $640,000 at the high end. Roughly 40% of what the motion scores. That borrows Decatur's percentage for a different population, since Decatur's call count includes private residences that were never billable and Cincinnati's 1,600 are all from facilities.

But here I am focusing on the money when the reduction in calls is the whole point. 1,600 lift assists a year is engine time and crew hours Cincinnati isn't spending on anything else, and a Decatur-sized drop returns most of it. A 60% decrease in calls means the city doesn't have to pay costs for responding to 960 lift assists.

At the rates above, a facility with less than one lift assist call every third day is better off financially not hiring that aide.

Both cities and facilities are hoping the other doesn't notice.

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When a 911 dispatcher disconnects a call, they always tell the caller to have someone meet the responders at the door to guide help to the patient. Unfortunately in my experience, this didn't happen nearly as often as it should.

On one occasion I responded on the ambulance to an ice skating rink for an injury. We spent several minutes asking everyone we saw where the patient was. Turns out the patient had been brought to the locker room by what seemed to be every staff member and nobody else knew what was going on.

Fortunately the patient's injury was minor, but the same delay on a cardiac arrest call can drastically decrease the chances of survival.

On a medical call a security team member is often available to guide help in, but not always, and security might be tied up with police on the way. Talk to your staff while touring and tell them that if security can't get to the door, somebody else has to.

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Control Risks counted 154% more mass kidnappings in 2025 than in 2020, and 60% more kidnapping events overall. A mass kidnapping in their data is five or more victims taken in one incident. The numbers rose in every region except Asia Pacific.

Nigeria is the clearest case. ACLED recorded more than 400 kidnappings in the northwest in the first six months of 2026, and it's started showing up in southwest states too.

Control Risks expects more of it through 2026 and points at widening socioeconomic gaps, unstable geopolitics, and organized crime groups operating across more borders.

They say themselves that kidnapping is underreported, so what rose is the recorded count. The coverage also gives percentages without base numbers, and mass kidnapping is a small category, so 154% might be thirty more incidents or three thousand.

Control Risks sells kidnap response and consulting, so the count comes from a firm with an interest in it. It's a count of incidents rather than a survey, and it points the same direction for five straight years.

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Ice machine on the dock is making that noise again, third time in the book now.

Mikey wants somebody standing outside at the door every time we call a rescue. I'll be honest I thought that was the dumbest thing I ever read on a shift sheet. The 911 lady says it on every call, meet us at the door, and in 40 years I don't think I ever did it one time, because you're already moving and there's somebody on the floor and the last thing in your head is go stand in a parking lot.

Then Ronnie went down by the pallets around 2. Not his heart thankfully, got dizzy and sat down hard and then stayed down. I called it in and gave the street number and door B, had to say bravo twice because this phone kept hearing D.

So I went out and stood there. Felt like an idiot. 4 minutes in the dark with nothing to do.

Rig comes in, I put my hand up, they came straight over and I walked them through the back hallway around the stack and they were on Ronnie inside a minute.

Then I get back there and there's 9 people standing around him. 9! Every one of them could have walked out front and not one of them was going to, and I wouldn't have either.

Anyway, report filed. He's fine. That boy needs a helmet, I swear...

Who goes out to meet the rescue should be written down somewhere. Perhaps in a policy?

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