Hospice nurse Kurt Rice (right) and Teri Helton (left), program manager for Livingston Memorial Visiting Nurses Association, visit Shirley Sarah Heller in her Leisure Village home in Camarillo.
Ventura County’s 911 Hospice Program
Using paramedics to help hospice patients avoid unwanted care
Before end-stage heart failure confined Shirley Sarah Heller to bed, her life was a swirl of non-stop activity. The 90-year-old resident of Camarillo's Leisure Village swam 40 laps a day, played golf and won trophies on the green, and performed in the “Happy Hoofers Tap Dancing Troupe”.
It has been a vibrant life that she hopes will end with a quality death. That means avoiding aggressive medical interventions. "This is my house and I’m going to go right here," she said.
To help ensure that happens, Heller enrolled in hospice. A team of health professionals comes to her home to provide her with pain relief and care for her psychological, social and spiritual needs. Its comfort care in lieu of life-sustaining and expensive end-of-life medical treatments that can require patients be hooked to feeding tubes and pumps in a hospital ICU.
There are times when hospice isn't able to protect patients from unwanted care.
A person’s end-of-life desires can be thwarted when well-meaning loved ones see the patient in distress, says Teri Helton, Program Manager for LMVNA, a nonprofit hospice program in Ventura County. Instead of calling the hospice nurse, they call 911.
"The paramedics will take them to the hospital and they go through extra trauma instead of being treated with the dignity and kindness they would in their home," she says.
Mike Taigman, General Manager of American Medical Response serving Ventura County has long wanted to change that paradigm. Several years ago, he learned of a program in which paramedics work with hospice to honor a person’s end-of-life wishes. Local hospice managers eagerly embraced it.
"They were just bouncing off the wall, super excited about having paramedics who were trained to understand hospice and be part of the hospice partnership," he says. That led to the creation of Ventura County’s 911 Hospice Program.
Heller's hospice nurse, Livingston’s Kurt Rice, says the patient signs a consent form that describes what will happen if a friend, relative, or caregiver calls 911.
"If the paramedics come, instead of hauling her to the ER, they will interact with our triage nurses to take are of everything here in the home.”
Countywide, Taigman says, 14 paramedics have received specialized training from hospice teams.
"I was skeptical at first because for so many years I had been trained to treat and transport the patient," says Mike Sanders, a paramedic supervisor who received the hospice training. But the pilot program changed his mind.
"I’m able to treat somebody with comfort care and contact the hospice provider and make a decision from there," he says. "Nine times out of ten, we don’t end up needing to transport that patient."
So far the project seems to be having the intended impact. County data shows before the pilot began August 1st, about 80% of this year’s 911 calls for hospice patients landed them in the hospital. Since then, only about 25% of the calls have resulted in a trip to the ER.