Community paramedicine bringing care into homes
By Jenn Watt
Some of paramedic Chris Parish’s clients saw him once a month, others could plan on his visits each week. Sometimes he would check in to make sure everything was OK, other times he was spending an hour with a patient, evaluating their immediate condition and factors that could jeopardize their health in the future.
From checking blood pressure and making sure medication was taken to looking for working smoke detectors and making referrals to external agencies, Parish’s role as one of Haliburton County’s two community paramedics has been a transition.
“It’s a difference pace and a more thorough assessment,” Parish says of his new role.
Haliburton County’s community paramedicine program launched at the end of October and is hitting its stride in 2018 providing a travelling health-care provider to assist frail seniors living at home. It’s a collaboration between Haliburton Highlands Health Services’ Community Support Services, its Geriatric Assessment and Intervention Network (GAIN), and the Haliburton County Paramedic Service.
Bringing together the mobility and expertise of paramedics with the detailed holistic approach of the GAIN team, community paramedicine is seeking to improve health care and fill some of the gaps that exist.
“The ultimate goal of the program is to minimize visits to the emerg. for individuals, to help them stay in their home longer, but also to identify those patients … [who] need something more right now. Maybe they do need to go to the emerg. department,” says Tim Waite, chief and director of the Haliburton County Paramedic Service.
The community paramedic has the flexibility to check in on patients who may not have had home visits from personal support workers or family members. They can then report back to the GAIN team on the status of the client and make sure they’re getting the care they need.
The community paramedicine program came about in a whirlwind of paperwork last year.
“I just happened to be on a teleconference when they said they had this LHIN [Local Health Integration Network] funding for community paramedicine except there was a very short timeline,” Waite says. The deadline was only a couple of weeks away.
An alignment between the paramedic service and HHHS allowed the two organizations to work together on the submission, with the blessing of Haliburton County council.
“It was something we weren’t sure exactly what it was going to look like,” Waite says. “Stephanie [MacLaren] came up with the [idea to] align with the GAIN team and Rehana [Rahaman], as the nurse practitioner, to get the program started.”
MacLaren is VP of community programs with HHHS and Rahaman is a nurse practitioner with the GAIN team.
Community paramedicine isn’t a new concept, but it also isn’t a common one. While several rural Ontario communities have a version of the service, none look the same.
A few years back, Haliburton County launched a pilot paramedicine program that sent paramedics during their downtime to homes of those in need of a check up. It received one-time funding and ultimately the model wasn’t a fit for the region.
This program is much different and benefits from base funding from the LHIN, meaning as long as it shows results, it will continue to run.
“We decided we weren’t going to utilize crews on downtime because we just saw that as an obstacle to the whole program because [with] paramedics, it’s a dynamic world. We don’t know when we’re going to get a call. … A lot of these clients are quite rural … so we can’t send our vehicles out of the main population which can affect our response times [negatively],” Waite says.
While MacLaren and Waite knew what the program would look like in general, it wasn’t until they put the program into practice that it took shape.
“We’ve integrated Chris [Parish]’s work, the paramedic’s work, into the workflow process of our whole cohort of GAIN clients recognizing we mostly see frail seniors,” MacLaren says. “We build the relationship right off the bat so it’s not so strange later on if we want to have the community paramedic go into the home. The relationship is there.”
Rahaman says the GAIN team wasn’t sure how a paramedic would fit into the operation, which includes specialists such as a pharmacist, physiotherapist, dietitian and home support worker.
They decided the community paramedic would be part of the group discussions, which Rahaman says has been working well.
“We were able to put all of our hats together as a team to assess each individual patient we were looking at. It was great because Chris had a different perspective to give from his experience. For example, when I walk into a home, I don’t look at fire alarm systems,” she says. “He had different interventions to offer the team as well. We would discuss clients and how we thought they were coping, what things they were struggling with and other possible interventions.”
Parish worked the first three months of the program and then rotated back into his role as a paramedic with the county as the second community paramedic took over the role. The two paramedics will rotate in three-month intervals, which allows them to keep up their certifications as front-line paramedics.
Parish said the experience has enhanced his knowledge of patient care.
“Certainly I’ll take back to my regular job a far better understanding of geriatric care,” he said.
For the GAIN team, the community paramedic enhances their reach.
“Chris is going out to Cardiff, Highland Grove, to areas that it is hard for us to get out to … check on the clients,” Rahaman said.
“I think the biggest impact it could make a difference on is reducing caregiver stress. One of the positive outcomes has been hearing from family members about how much Mom or Dad enjoys Chris coming out to check on them,” she said. “That at least gives the caregiver a sense of relief.”
MacLaren foresees adding services such as friendly visiting to supplement the program.
By the end of January, 59 clients were enrolled in the program with 148 visits conducted.
“It certainly has grown faster than I expected in terms of number of clients,” Waite said.
With the demographics of the Highlands weighted heavily on the senior side, having enhanced services to keep people in their homes longer is of particular value to the community.
“Given the aging population and the long wait list of long-term care, it’s needing to find a way to keep our seniors safe in the community,” Rahaman said.
“I think that’s the difference I’ve seen with our GAIN team,” MacLaren said, “is the level of follow-up and intervention that happens with our clients.”