When paramedics first set up a drop-in clinic in an apartment building in the community of Georgetown, residents rarely interacted with one another, says Peter McMurrough, deputy chief of Halton Region Paramedic Services. But soon, word spread, and for many residents, the clinic, which started in 2015, became more than a medical appointment: it turned into a social event. “We try to give them privacy, but they're all discussing what's going wrong with them, discussing who's on what pills, but it's great — they're interacting,” says McMurrough, who was inspired to try out the program after hearing about it at a conference in 2014. “Now they’ve got a social circle.”
The clinic, which has been temporarily replaced with over-the-phone supports during the second lockdown, is part of CP@Clinic (CP stands for community paramedicine), a program founded in Hamilton through which paramedics hold routine drop-in sessions at social-housing buildings, at no cost to residents.
In these sessions, they assess participants’ health by looking at factors including blood pressure, medication, and risk of social isolation. From there, paramedics can share a person’s health records with their physician, help them connect with other health-care professionals, and follow up on progress. As the COVID-19 pandemic brings increased attention to the health of seniors and low-income earners, the team of health professionals and researchers behind it say their model of care could help keep vulnerable people out of emergency rooms and long-term-care homes.
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“Just having more available emergency resources for the people that are needed — especially in a pandemic situation, where people are unwell and need to be transported — is very, very crucial,” says Gina Agarwal, the program’s principal investigator and one of its co-founders. She and other advocates say the program offers “upstream” benefits because it helps people get needed care before their health problems become severe enough to warrant a 911 call. “The key here is that, actually, the effects of the program free up resources that can be used for other needs,” says Agarwal, also a family physician and professor at McMaster University’s Department of Family Medicine. “You want to have paramedics being able to be on the road for the acute care that needs to be delivered in emergency situations.”
The demographic that the program targets, older adults, makes EMS calls at a disproportionately high rate. The average 911 call, and subsequent trip to the hospital, costs about $1,600 in Ontario, a 2019 report on CP@Clinic states. By preventing emergencies, and therefore reducing calls — by around 20 per cent, the program’s studies indicate — CP@Clinic relieves pressure on the overall health system, Agarwal says.
While the clinics started in Hamilton about a decade ago, the program is not currently running in the city, due to a reallocation of resources during the pandemic, Agarwal says. An emailed statement from CityHousing Hamilton states that “while many of the services have been put on hold due to COVID restrictions, since March [CityHousing's] CP program has continued with wellness checks via phone calls and conducted flu clinics this fall, ensuring approximately 550 seniors living in CHH buildings got their flu shot.” The City of Hamilton tells TVO.org via email that it “participated in the original research program with McMaster when it began as a trial/research program. Hamilton’s program has since expanded in scope beyond the original model. Our current program is independent, though we do use their software for our clinics.”
The program is, however, available through about 35 per cent of the paramedic services around Ontario, Agarwal says; Oxford was the latest to adopt it and is rolling it out now.
Since the program’s launch six years ago, Halton has seen excellent results, says McMurrough, who is on the CP@Clinic’s executive committee. Halton has an elderly population, and many over the age of 65 are isolated, he notes, which makes the seniors-focused program a good fit. The pilot in Georgetown reduced the host building’s 911-call volume by 23 per cent within six months (Halton’s program has since expanded to five locations, and there are plans to add a sixth).
While the call reduction is a plus, McMurrough says, the primary goal is for paramedics to act as go-betweens for different supports to keep people healthy at home. “The vast majority of seniors, regardless of what people think, do not want to be in hospital for long periods of time,” he says. “Any way that we can support keeping them at home, we have to look at.”
One of the most important things about CP@Clinic is the impact it has on patients’ social lives, McMurrough says. “There's a very large number of seniors that are literally alone” or far from family, he notes, and the community paramedic may be the most social interaction they get in a week.
To reach isolated people, paramedics advertise clinics with flyers, posters, and information sessions, but McMurrough says word of mouth also attracts new patients. “The social-isolation piece alone has been a huge eye-opener for us as medics, because we went initially to deal with the physical, and it became obvious that we’re dealing very much with the mental.”
Brent McLeod, a paramedic researcher and supervisor who’s a member of the CP@Clinic executive committee, describes similar community-building experiences in the early programs in Hamilton. One paramedic, he says, worked with residents to install an aquarium in their building; another helped them get a community kitchen started: “Those are some of those initiatives within the community-paramedic piece that weren't highlighted in our literature but really went that extra mile to help out the people in these buildings.”
Samir Sinha, the director of geriatrics at Mount Sinai and the University Health Network Hospitals in Toronto, is not affiliated with CP@Clinic but says he is familiar with the program and the work community paramedics do. It and similar models, he says, have “been seen as a useful way to better support people to age in the place of their choice.”
Sinha tells a story about a person who was calling 911 frequently for chronic conditions. Community paramedics worked with them and learned that they weren’t taking their medication, because their scooter had broken down, and they couldn’t get to the pharmacy. Paramedics bought a new wheel and fixed the scooter. Sinha calls that “a classic example of where community paramedics can be incredibly useful.” When people come to the hospital, he says, health-care workers often aren’t aware of the barriers they might be facing at home.
When the pandemic started, the CP@Clinic model had to adapt. In Halton, paramedics sent patients notices, and their programs switched to phone-call check-ins. For a period before the second wave, some clinics, including Halton’s, could operate in-person — but, now, they are back to remote operations.
McLeod says that paramedics have told him they’re seeing more people dying in their homes during the pandemic — and that that emphasizes the importance of check-ins: “We know how important it is to keep the health-promotion piece and getting them active and keeping tabs on people who are not supported in other means.”
Agarwal agrees, saying, “The pandemic has highlighted the need to continue this program, because older adults in those social-housing buildings are so much more vulnerable.”
In 2019, Agarwal and her team received funding from Health Canada to scale up and expand across the country. She hopes that CP@Clinic will be able to continue its work and qualify for new provincial funding earmarked for community-paramedic programs targeting people on wait-lists for LTC homes. (According to a study she co-authored, the direct-program and staffing costs of five sites for one year was $128,462.)
Agarwal says that older adults in social housing are about five times more likely to end up in long-term care than those not in social housing — and that social housing may be the next COVID-19 hotspot.
If deployed correctly, Sinha says, community paramedics could help some people stay out of LTC homes altogether, because seniors sometimes just need regular support to remain healthy and independent.
“The only good thing that's coming out of [the pandemic] is that there are people in positions of authority and finance looking at this and thinking, ‘We have to do things differently. We need to try and find a way to support people,’” McMurrough says. “We've been trying to say this for years.”
This article has been updated with comment from the City of Hamiton.
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