Mobile Integrated Health (MIH) teams are stepping up to fill critical gaps in care throughout the country. Hospice services are underfunded, yet provide immeasurable benefits to individuals and families. With many hospice agencies facing staff shortages, regulatory constraints, and a growing complexity of patient needs, MIH teams can step in to reach patients and extend the services of these agencies.
MIH teams are already adding these services to their programs. We talked with two of those teams to hear how they do it and how their communities respond.
The MIH Model: Responding to Community Needs
Stanly County is located in a more rural area of North Carolina, with an older, less affluent population. Mike Campbell, Deputy Chief of Stanly County EMS, realized the EMS crew were getting low-acuity calls for patients who were already qualified for hospice or palliative care. Often these needs included symptom management or lift assistance, both within the scope of the MIH team. To address these needs and better use EMS resources, he began partnering with a local hospice agency, Tillery Compassionate Care, to help them expand the services they offer. Despite some initial skepticism from members of his team, Campbell says his paramedics would “revolt” if he took away hospice services from their jobs.
Although patients may have been enrolled in a hospice program, the local agency only had one nurse and one nurse practitioner. After-hours calls went to EMS. However, transporting these patients to the hospital results in high costs for an already cash-strapped hospice agency.
“When a family within the hospice agency calls in the middle of the night, they’re often told to call EMS,” Campbell explained. “We realized that many of these calls could be managed right at home.”
Now, community paramedics can evaluate patients and connect them to the right resources if referral to hospice is warranted, and once under the community paramedic/hospice umbrella, those patients can avoid unnecessary 911 calls.
The MIH team at Scott Township Fire & EMS in Indiana sees a primarily older patient population with multiple chronic diseases. Dawnyel Flavin, NRP, CP-C, CCHW, realized that she and other paramedics were spending a lot of time tending to patients with terminal illness, triaging acute clinical needs and supporting their families.
“It is always our first focus to help our patients remain healthy, but we also recognize some patients have life-limiting illnesses,” she said. “We spend time with these patients and families as they share their frustrations, fears and desires for their remaining time. Through this relationship, we noticed the need to provide better quality of life.”
That’s when Scott Township Fire & EMS reached out to Compassus Hospice and began a collaboration.
Enhancing Hospice Support
Paramedics can assess and treat symptoms like pain, anxiety, and nausea at the patient’s residence, alleviating the burden on families and the healthcare system. The community paramedics in Stanly County have also learned to change Foley catheters, provide wound care, and provide end of life services.
It does require a bit of a shift in thinking and training to provide new services. But the close collaboration between hospice providers and EMS makes for truly patient-centered care at a person’s last moments.
“It was hard at first having paramedics learn that it’s okay for someone to die in their home without having to do CPR,” Campbell said. “We can alleviate symptoms immediately. If we have to give someone morphine to make dying easier, we can do that. No one should be suffering in their last moments. We have the community paramedics ride with hospice nurses at least once a quarter to reinforce the hospice perspective.”
Flavin said the partnership for her team has been amazing for patients and their families.
“Combining the unique services we each provide has given our patients a true wrap around care model,“ she said. And when it all comes together, patients and their families can make some beautiful final memories. Flavin shared one example.
“One of our patients loved cats but was never able to have one as a pet, so we planned a trip to a local cat café. Transportation, medical care, medication, oxygen and equipment needs were coordinated, and we spent an afternoon filled with laughter, pictures and kitties. The patient asked that we stay with her while she passed. She was able to pass away peacefully, in her home, in her bed with her husband and dog laying beside her, just as she wanted. The family included all of us by name in her obituary, and we continue to provide community paramedic services to her husband.”
Lessons Learned and Future Directions
Transitioning from a fast-paced emergency treat-and-transport environment to a slower, more long-term approach to care requires a cultural shift within teams. Initially, Campbell said some paramedics were hesitant to perform tasks typically associated with hospice care, like managing Foley catheters.
However, Campbell shared that as they’ve adapted, they’ve developed a passion for the work and formed stronger connections with patients and families.
“Our CPs have more job satisfaction on hospice calls than in other facets of their work,” he said. “I’m proud of them. They have compassion, effective communication; they’ve grown a lot. And the community loves these services.”
Flavin said patients have reported better pain control, improved quality of life and less fear of dying. Families have also said they feel more in control, less anxious and more prepared for their loved one’s passing.
Captain Ryan Bosecker, NRP, CP-C, lead community paramedic of the Scott Township team, said that offering these services has allowed the care team to discuss hospice earlier in a patient’s healthcare journey.
“We see many patients seemingly stuck in a vicious cycle of readmissions and aggressive treatments,” he said. “It often seems like the visits and procedures are set to autopilot, rather than considering what patients truly want, especially in the case of end-stage chronic disease management.”
He said being able to connect patients to hospice has improved many factors that were previously contributing to 911 calls and readmissions.
“Due to the nature of the home hospice service model, many of our MIH patients, who were previously some of our area’s highest 911 utilizers, have been able to stop relying on EMS and the ED to treat their symptoms,” Bosecker said. “Instead, they have a system (both in-home and on-call) to support their care plan and symptom management through hospice.”
Looking Ahead: Sustainability and Community Impact
Although the MIH program currently relies on grants and opioid settlement funds, Campbell is optimistic about future opportunities for sustainable funding. For his program, partnerships with large local health systems provide the best path for funding.
Bosecker said collaboration without duplicating services is a key for them. They do that through close communication where all members of the care team share notes and patient information. In addition, once patients are placed under hospice, his team notifies the county dispatching system so that they know how to contact the hospice team in a medical emergency.
As with all MIH services, collecting data and demonstrating value is key to growth. Hospice agency partnerships help with this. For example, in Stanly County, a hospice patient called a community paramedic to come out because of nausea and vomiting. If that patient were taken to the hospital, the hospice agency would have been on the hook for thousands of dollars in patient care. However, the community paramedic was able to give the patient fluids and medications, keeping them at home.
At a recent presentation, Tillery Compassionate Care reported that establishing community paramedicine visits for patients receiving palliative care reduced hospitalizations by 82%. Their experience found that the partnership between community paramedicine and the hospice agency added an extra layer of support and allowed the hospice agency to offer expanded services and more timely assessments.
Overall, providing hospice support through a community paramedicine model promotes compassionate end-of-life care and fills a vital community need. Over time, teams can further develop partnerships with agencies, medical practices, and health systems, and demonstrate MIH benefits by reducing costs and improving quality of life at the most vulnerable time for patients across the spectrum of healthcare delivery.