Fla. Community Paramedicine Program Reduces Hospital Visits

The Gainesville Sun, Fla.

May 25—Vanessa Henry had no expectation of helping herself when she called 911 to have her friend transported to the hospital.

But when Gainesville Fire Rescue arrived on scene and saw the living conditions that she, the friend and four children were living in, rescue workers had other ideas.

Henry, 52, is one of about 80 people who have benefited from the city's new Community Resource Paramedic program, a collaborative effort between the fire department and other area organizations that aims to reduce 911 calls and hospital visits by helping those who struggle with social, health and mental issues.

Patients are referred to Gainesville's CRP program by health clinics and first responders who arrive on an emergency scene. Sometimes they quickly realize it's not a life-threatening issue but that the caller struggles with basic necessities. CRP workers follow up and visit patients at their home to get to the root of the caller's problems by connecting them with help from partner organizations and resources in hope of reducing non-emergency room visits and 911 calls that often inundate the systems and cost both sides thousands of dollars.

"They're like from heaven," Henry said. "They literally have been a blessing to me and they constantly stay in touch with you."

Though Henry's friend was ultimately treated at the hospital, first responders saw that Henry—who had no place to go after helping her friend—also needed help.

Gainesville Fire Rescue employees stepped in last summer and asked Henry to let the city's new CRP program be that help. They addressed most of her concerns, including helping find Henry an apartment.
Henry's two children are adopted. Their birth mother was murdered in Tallahassee, she said. She is disabled and struggles to make ends meet and often grapples with the kids' behavior and schoolwork.

Deputies with the Alachua County Sheriff's Office have frequently been called to her residence to intervene, but have since given Henry a different number to call when she needs assistance with her boys.
"It's been challenging," she said.

Henry said her $2,200-a-month income is too high to qualify for food stamps. City employees occasionally pick up food from Bread of the Mighty Food Bank and drop it off at her home. Firefighters help the boys with homework at a fire station and are seeking to find them a therapist. The CRP program is also helping her manage her finances and deal with food insecurities.

"The goal is to connect the patient with a resource so that they will be able to depend on themselves," said Ariella Bak, the city's CRP program coordinator.

Bak is CRP's only salaried employee and has been the program's lifeblood. Firefighters can participate in the program while working overtime.

Bak first began volunteering with GFR in 2016 by handing out medical supplies at Dignity Village, a homeless camp of nearly 200 people in northeast Gainesville. She was hired by the city in 2017 and joined the CRP program, along with firefighter David Sutton.

Around the same time, the University of Florida announced it would provide $50,000 to help launch the program and pay for Bak's position. Those funds have come and gone but UF Health has since provided another $100,000 in an effort to reduce hospital visits and keep the program going.

The city estimates the average cost of an emergency room visit ranges between $900 to $1,200, based on UF Health costs. A UF Health spokeswoman would not confirm or provide pricing information, saying costs vary depending on the severity of the case. But with some patients visiting the ER multiple times a year for issues easily corrected, the costs stack up for the patients and hospitals.

Since the program has launched, Bak estimates that it's reduced its clients' hospital visits by 28% and hospital admissions by 62%.

"Ultimately, at the end of the day, we want to avoid an unnecessary emergency room visit," she said.

Bak receives most client referrals from GFR and clinics. Bak then reaches out to the person in need and does a wellness check to identify problems. Clients are then enrolled in the program.

The at-home visits last about an hour and a series of follow-up visits are scheduled to form a plan and build a rapport. Some of the issues CRP tackles include medication management, in-home mobility, transportation to doctor appointments, chronic disease management and food insecurity.

People are in the CRP program for 152 days, on average, and graduate when they've become self-dependent or when their issues are resolved. Patients sometimes re-enter the program.

Across the city, CRP's services are spread almost evenly.

Though east Gainesville residents have talked about the need for emergency clinics and health services, southeast residents—among the poorest in the region—use the free help the least.

According to CRP data, northwest and northeast residents use the program the most, making up 27.5% of calls. Southwest residents make up 25%, while southeast residents account for 20% of the calls.

Firefighter Jason Hendricks, who has been with the city 13 years, is new to the program. At first, he said, fellow firefighters were skeptical of CRP and what it aimed to do. He said he's starting to see that change.
Firefighters are trained to address the immediate threats and keep people stable, safe and can transport them where they need to go. They aren't trained social workers.

CRP, however, makes firefighters rethink their engagement efforts and allows them to see how their clients improve over time by taking more preventive measures.

"It gives us a point of some follow through," Hendricks said. "Some of these patients we go to don't have just one set of problems. They're kind of in this limbo stage where they get overlooked by the system."

Hendricks said he's seen how Bak and others are steadily growing the program throughout the community.
CRP has more than 50 community partners, many of which help sustain the program. Some include UF Health, The Salvation Army, Meridian Behavioral Healthcare, Hospice, Reichert House Youth Academy, Home Depot and Bread of the Mighty Food Bank.

The food bank, 325 NW 10th Ave. in Gainesville, is sometimes the first stop before CRP workers make a home visit. The food bank receives support from donations and other local grocery stores, like Publix, Save-A-Lot and Lucky's Market.

"It takes all of us," said Marcia Conwell, the food bank's president and CEO.

Rebuilding Together North Central Florida is a home repair organization that serves the region with help from UF student volunteers and various grants. It frequently helps CRP clients by building ramps and walkways to help those with mobility challenges.

Dwayne Bryant, a 41-year-old amputee, was one of those people. Bryant was helped soon after losing his leg due to complications after a hospital stay.

He was, by his own admission, unmotivated and rarely left his home prior to being helped. He struggled getting around his home and had mental health challenges, he said.

"Before they built the walkway, I was walking on top of pallets and thin sheets of plywood that I put down," Bryant said. "And when it rained, the pallet would be underwater so I'd walk through the water on one leg with a walker."

Bryant has since graduated from the program and says he now rarely struggles with mobility. His mental health has also improved. He has found work at the VFW Post 2811 off Waldo Road in Gainesville. His emergency room visits have also significantly declined, he said.

Aside from the funding from UF and the city's overtime costs, the program doesn't have much financial wiggle room.

The program is run out of the GFR training headquarters off Northeast 14th Street. There, a little room holds a small pile of donated items that go to clients, such as bed rails, walkers, clothing and some dry foods.

The program, still in its infancy, has seen a fair amount of success in a short time, but its resources limit its ability to make a larger impact. Bak said more resources would allow the program to grow in capacity and serve more people.

"I believe CRP is a true patient-centric program. We want people to use the system," Bak said. "I can tell you from when CRP first emerged, it's been a huge culture shock. It's about addressing inequities in Gainesville. But what CRP has learned is that there are sick people all over."