Mobile Medics Give Care At Homes Across State

After having surgery to fix a broken hip, Marion “Skip” Barnes was determined to return to normal. And to stay home.

His recovery, and his wife’s peace of mind, were bolstered by mobile integrated health care — a twist on the house calls of yesteryear. The service is offered by the fire department in Barnes’ hometown of Monticello, about 90 miles northwest of Indianapolis, as well as by communities across the state and country. But even as the programs have grown in recent years, money to support them has remained piecemeal, leading to ongoing efforts to secure permanent funding.

Monticello’s program is one of the newest in the state, and in February 2022, Barnes — now 93 — became its first patient. The idea is for hospitals to refer patients to community paramedic Nick Green, with the goal of avoiding readmission. Green regularly visited to check on Barnes’ recovery, address the cause of the fall that led to his hip injury, and assess other needs that, if met, would enable Barnes to remain in his home.

He developed a good relationship with Green. “I would rather call him, honestly, than go to a doctor because he will talk to you,” Barnes says. When concerns arise, adds his wife, Jean, “It’s a comfort to know that maybe there is an explanation that we don’t have to get at the hospital.”

Green makes home-based appointments with his patients, who stay on his roster for a minimum of 30 days after hospital discharge. They may call him anytime to triage a health concern or handle another need. He says it’s an important service in a community where it may take three weeks to get an appointment with a primary care doctor.

Programs across the state

The Indiana Emergency Medical Services Commission has approved more than 30 community paramedicine programs offered by public and private concerns that cover all or parts of more than 50 of the state’s 92 counties. The programs offer a range of services, including diabetic monitoring, disease management, vaccinations, substance abuse and mental illness mitigation, and maternal and infant care — all free to patients. Green sets up meal deliveries, installs smoke detectors, arranges rides, connects patients with the Department of Veterans Affairs or Medicare advisers and helps with tech needs — anything, Green says, to ease patients’ lives.

Programs try to curb costs by reducing hospital readmissions and inappropriate use of emergency departments.

In 2021, the Monticello Fire Department partnered with IU Health White Memorial Hospital on a six-month pilot in which none of 50 patients were readmitted within 30 days. The IU Health West Central Region then gave $100,000 to help start a permanent program.

The Crawfordsville Fire Department in west-central Indiana started its program in 2017 by focusing on heart-failure -patients; in two years, no one was readmitted to the hospital within 30 days, says Crawfordsville Division Chief of EMS Paul Miller. That enticed Franciscan Health Crawfordsville to pay the salary of three community paramedics.

Similar programs are funded with grants or hospital partnerships, since permanent funding isn’t available. State EMS Director Kraig Kinney, chair of the Mobile Integrated Healthcare Advisory Committee, says the state agency that handles Medicaid funding is interested in seeking sustainable funding pathways. Beyond that, AARP Indiana is advocating for permanent Medicaid support.

Meanwhile, programs hustle for funding, to help people such as Elverda Pace, 87, from Monticello’s program. “Us old people,” she says, “we’d just sit all by ourselves, no matter what, if it wasn’t for guys like Nick.”

Mary Dieter is a writer living in Zionsville. 

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