These house calls save money for EMS, social services
Bellingham Fire Capt. Jeff Brubaker carries a pager like any other firefighter, and he still uses his paramedic skills to help people. But these days he’s not riding a fire engine or an ambulance and most of his patients haven’t called 911.
Not as much as they used to, at least.
Brubaker is Bellingham Fire Department’s community paramedic, a relatively new position that puts him in touch with people who are frequent 911 callers but who don’t need emergency care. On any given day, he’s seeing people with chronic illnesses at their homes – where he delivers medication, makes sure they’re eating well, and that they’re taking care of themselves. Several homeless men are on his list of clients, and usually he must find them by scouting the places they frequent.
“It’s really a mind shift from the standard fire department idea that within an hour, your call is over,” Brubaker said. “We’ve done such a good job of marketing 911 – three numbers and problem solved. But now we need to do more with less.”
“This is a different end game, but ultimately more satisfying,” Brubaker continued. “If there’s nothing you can do immediately for them, at least you can put them in touch with someone who can.” He said the 3-year-old program saves money and resources by not sending firefighters repeatedly to the home of someone who needs medical attention or other help, but not necessarily an ambulance ride to the hospital. It’s funded through the city’s general fund, and its success prompted officials to include funding to make the program countywide in an EMS property tax levy that Whatcom County voters approved in November 2016.
Brubaker’s 30 to 50 regular clients fall into six categories with problems related to aging, disabilities, mental health, substance abuse, mobility or homelessness. They must have called 911 at least six times in the past year. Often, his clients meet multiple criteria for the program, such as a homeless person with mental health and substance-abuse issues. They must be receptive to accepting help.
“Emergency services doesn’t manage a chronic problem. Same with the ER. But if they’re not seeing their own doctor … ,” Brubaker trailed off and shrugged. “Sometimes it’s just managing their needs, keeping them out of the system. And that’s a win.”
These days, Brubaker travels in a fire department SUV equipped with paramedic supplies to see clients with Andrea Day, a case manager for the Whatcom Alliance for Health Advancement. Day has a master’s degree in public health and acts as a social services and medical liaison between clients and doctors. Another WAHA case manger works with Brubaker’s clients who have mental health troubles.
“Almost 30 percent of my client base is homeless, coupled with substance abuse and mental health issues,” Brubaker said.
The WAHA case manager positions are funded through a property tax levy for low-income housing that Bellingham voters approved in 2012.
“One guy at the (Lighthouse) Mission for example, we see him quite a bit for respiratory issues,” Brubaker said. “So he has chronic, legitimate COPD, and chronic asthma. Just because he’s homeless and has a tough time getting to and from his doc, and to the people that deliver his meds, we’ll go deliver nebulizer equipment, we’ll check out his air compressor, we’ll give him some Xopenex, some nebulizer equipment, nebulize him and make sure that he’s at least stable for a couple days.”
A recent city report said the program is showing “significant results.”
Calls to 911 from Brubaker’s clients were reduced from 500 two years ago to 428 last year, according to fire department statistics. Most recent data shows EMS calls are 50 percent less for enrolled patients so far in 2017.
Station captains at firehouses around the city said they are seeing advantages of the program that leave their firefighters available for more serious alarms.
“Some of those folks in our community that have special needs, maybe that’s helping them get to appointments on time, maybe that’s helping them get hooked up to that social network,” said Capt. David Stephan of Engine 1 and Aid 1 at the Broadway Street station. “By having someone assist them, that means that they may not call 911 as frequently, and that frees us up to help other people that may be in our first-in territory or our first-due area.”
Brubaker recalled one person who was the focus of repeated 911 calls for true emergencies related to her blood sugar levels.
“Her only problem was that she couldn’t get a handle on her diabetes,” Brubaker said. “She’s a smart gal, she started doing some research and found some phone apps to help her manage it. Sometimes that’s all it takes, is a nudge in the right direction.”
On a recent weekday, Brubaker and Day visited clients such as Carlos Abitia, 63, who’s homeless and living outdoors, most frequently in the Cordata area. Brubaker and Day talked to several of his friends, finally finding him at a nearby fast-food eatery. He agreed to discuss his medical information with Brubaker and Day in a public setting, details that otherwise would be private.
Abitia, a diabetic and an alcoholic, needs his blood sugar checked and a shot of medication to control his alcohol and opiate cravings. Day and Brubaker asked where he’d been sleeping, and if he’d been eating and staying hydrated. Another person manages the assistance money that Abitia receives, so that he doesn’t spend it all at once.
“How many times has he fallen from being drunk? He falls, gets hurt, ends up in the ER with a total cost to the EMS and health care systems of nearly $100,000 annually,” Brubaker estimated. “Yes, he could take a daily pill that costs a few cents. But he tends to sell them, or take them all at once. Or he could get the shot once a month that costs $1,200. It seems like a shot is a better value.”
Day said helping Abitia is difficult because he can’t or won’t stop drinking and using drugs. His behavior when intoxicated means he has few social services choices and no housing options left, she said.
“What he wants to do right now is be homeless and continue drinking, which is his choice,” Day said. “But we need to figure out as case managers and EMS how to reduce the amount of harm he’s causing to himself and to others around him in the community.”
Also that afternoon, Brubaker and Day visited Robert and Lindy Brazzel, a married couple in the Birchwood area, who have several chronic health issues between them. They also agreed to discuss medical information that otherwise would be private.
Robert has a weakened heart from heart attacks and infection, he’s suffered a recent mild stroke and has diabetes. He doesn’t always eat well, and he smokes.
“I had to go to the hospital constantly for falls, cuts, minor things. They’re helping me with the do’s and don’ts of my life,” Robert Brazzel said. “I don’t think that I would be here right now without caring people like Jeff and Andrea.”
Lindy Brazzel said Brubaker and Day have become part of her support network, almost like family.
“They make you feel like somebody cares,” she said.