Using paramedics to help hospice patients avoid unwanted care

Alcoholism affects homeless people around the world, a condition that makes them physically and mentally dependent on alcohol to maintain stable functions. The Oaks shelter in Ottawa serves free daily pours to severe alcoholics in order to stabilize their physical and mental states, and to help them control the amount of alcohol they intake. These measures in Ottawa have proven cost effective, humane, and offer specialized aid to those suffering from alcoholism.

A coordinated care program is helping provide in-home care to those who are considered pre-hopsice and who are combatting chronic health issues. While the program doesn't always financially help the hospitals it operates out of due to a reduction in emergency room visits, the patient is able to save almost half of what they would have spent on regular hospital visits.

The Advanced Illness Care Program was founded within local Black churches and offers free, individualized support for people with advanced illnesses and their caregivers, helping them navigate various life and health issues and plan for end-of-life care. Since starting in 2015, the AICP has helped more than 1,600 patients, the majority of which are Black, and 55% of them have gone on to complete advance directives for end-of-life care.

The Frederick Police Department’s Crisis Response Team combines law enforcement with paramedics and mental health professionals to respond to calls. The team can showcase each person’s expertise as needed, providing more individualized care when responding to mental health emergency calls.

The Crisis Assistance Response and Engagement (CARE) team aims to help people experiencing mental health crises without resorting to force or arrests. The CARE team is a three-person model including a paramedic, clinician, and police officer. Since September 2021, the team has responded to calls about 440 times, none of which have included force or arrests.

The Violence Intervention Program at the University of Maryland Medical Center's Shock Trauma Center helps people meet basic needs after they have suffered a gunshot injury. Along with clothing, transportation vouchers, and toothbrushes, the program's social workers also provide talk therapy. The goal is to keep victims of violence from becoming victims again, and the approach is to build trust by giving the help without strings attached. Many people return for the help, and the therapy.

In Scotland, the Navigators program performs violence interruption work in seven hospitals, at the bedside of victims of violence, with counseling and connections to social services to nudge people into safer lifestyles. Because Navigators act independently of the police and other authority figures, and because their service follows clients into the community, they are able to win the cooperation of 65-90% of those they approach. A survey of 100 clients showed 23% fewer emergency room visits in the year after cooperating with the program. Navigators started after violence in Scotland raged in 2005.

Street medicine eliminates barriers to health care and reduces emergency room costs. In Atlanta, Mercy Care’s Street Medicine program works to meet individuals where they are at. The program has been working since 2013 to build trust and provide basic healthcare services to homeless populations before their problems become severe enough to require emergency room treatment.

Access to medical resources improves the effectiveness of health centers. In the village of Fuka, in Nigeria’s Niger State, NGOs such as the RAiSE Foundation and TY Danjuma Foundation have stepped in to support the local Primary Health Centre (PHC). Multiple initiatives, including home visits and the distribution of mosquito nets, have built relationships with the community; the most successful aspects have been the Mama Kit, given free of charge to pregnant women at the PHC, and the donation of an emergency ambulatory tricycle.

Senior citizens can often face many barriers when trying to set up end of life care, and this is exacerbated for minorities due to language and cultural barriers. On Lok Senior Health Services, however, is a program now offered across the United States that helps seniors "age in place, and live independent, active lives," while still planning for the end of life.