community paramedics instead of home care nurses?

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Any thoughts on why AHS would have laid off 200 home care nurses last year and coincidentally started a community paramedic program? It sounds like they are doing home care nursing to me. See below for the article:

Program brings care to Calgary seniors, prevents ED visits

December 16, 2013

Community paramedics made nearly 1,500 home visits in past year

Glad Bury is grateful that house calls are not a thing of the past. When the 85-year-old Calgary woman was discharged from the Peter Lougheed Centre earlier this year, she returned home knowing her chronic conditions would still be closely monitored without having to step outside her front door.

Bury is one of hundreds of Calgary seniors who have received medical care by specially trained paramedics as part of Alberta Health Services' Community Paramedic Program, which launched in the city one year ago.

"The care I received from the paramedics who treated me was superb," says Bury.

"They were able to do many of the things I otherwise would have had to go to the doctor for, like getting my blood taken or making sure I'm getting the right medications. But perhaps more important, the paramedic gave me confidence everything was under control and I wasn't alone."

Ten specially trained paramedics within the Calgary-based Community Paramedic Program made 1,480 trips to seniors' homes over the past 12 months. Most of those trips were for the treatment of conditions such as infections, breathing problems or pain management that, if left untreated, would likely have required a visit to an emergency department.

"The Community Paramedic Program delivers mobile health care before emergencies begin. Community paramedics do that by providing patient-focused care in a home setting which reduces EMStransports and emergency department and hospital admissions," says program operations manager Ryan Kozicky.

"By bringing care to patients who have difficulty accessing traditional primary care services, we are providing a service that prevents serious issues before they arise."

Referrals are made by family physicians, specialty clinics, and caregivers primarily for seniors living in supportive living facilities, community lodges and at home.

The Complex Chronic Disease Management Clinic at the Peter Lougheed Centre referred Glad Bury to the program.

Dr. Ian Scott, the clinic's lead physician, worked with the paramedics providing care to Bury.

"The advanced assessments and specimen collection performed by the paramedics allowed us to add and adjust medication, and obtain lab results while the patient remained at home. They administered an injection she otherwise would have had to travel to receive," says Dr. Scott.

"Collaboration with the Community Paramedic Program was an invaluable extension of the work our clinic normally does in supporting the health needs of many complex clients."

Treatments provided by community paramedics include electrocardiograms (ECG), vital sign monitoring, blood collection, administering oral and IV medication, providing wound care and focused assessments, all under the medical direction of a physician.

In addition to their past training and experience, these specialized paramedics also undergo six additional weeks of classroom training, followed by a four-week practicum with nurse practitioners in supportive living facilities.

Ty Eggenberger, one of the community paramedics who cared for Glad, says working as a community paramedic is very rewarding.

"It lets me bring in-depth care to my patients that is not possible as a traditional paramedic," he says. "I am able to spend more time with them to provide thorough assessments, treatments and followup care. Treating health conditions before they result in a trip to the emergency room is less stressful for my patients and their families."

Community paramedics are not part of the traditional Calgary Metro EMS fleet. They travel in SUVs that carry the equipment and medications they need but do not have lights or sirens and cannot transport patients.

http://www.albertahealthservices.ca/9469.asp
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Specializes in NICU.

It must be some kind of scope of practice issue. It seems that they are able to provide care and treatment that the home nurses can't.

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Specializes in Home Care.

I work for one of the contracted home care providers in Alberta.

Under the new contract the private home care providers have been given additional tasks which used to be done by AHS home care nurses. Examples include simple wound care, changing catheters, and insulin injections.

The Community Paramedic Program has nothing to do with home care. The article quoted above explains the role of the program.

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Specializes in Emergency.

This program is not homecare. It is directed at the EMS version of "frequent flyers" to try and mitigate some of the factors in their lives that result in the multiple 911 calls.

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Specializes in Emergency Department.

Probably a better way to think of the role of Community Paramedics as Preventative EMS. Concentrate on the frequent fliers (by referral) who probably aren't candidates (yet) for home health visits by a nurse and you probably cut down a lot of the volume going to the ED and subsequent hospitalizations, all because nobody caught a festering problem early. In the long run, it's probably going to be very cost-effective...

Yes, there are various tasks that the CP may do that overlaps with what a home health nurse does, but it's really not that uncommon as there are tasks that Paramedics do anyway that overlap with nursing. I don't see where a Community Paramedicine program would take over the role of home health nursing.

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Saw this on the evening news a while back. It was for those who go to emerg because they can. They don't go to or have a family doctor and so would go in for "reassurance" BP monitoring, glucose checks. You know the ones.

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Specializes in Home Care.

I worked home care in Calgary when the CPP was started on a trial basis at some seniors' lodges.

CPP was available as an additional resource for home care clients in seniors lodges where there isn't 24 hour care. Its important to note that these facilities are considered "independent" living even though we're providing home care to at least 50% of the residents. Plus many of the residents don't have any family or friends to assist them with doctor appointments etc.

The CPP was utilized for clients who had a change in condition that didn't necessarily require a visit to the ER. This could be a new wound, new swelling, a recent fall, increasing pain, constipation, etc. The CPP had direct access to an MD when needed, they also followed up with the client's home care case manager. "reassurance" checks are done by home care when present.

The CPP has been proven effective, I hope it comes to Edmonton soon.

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Where I live, paramedics and EMTs are paid substantially less than nurses.

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Specializes in geriatrics.

The goal is to keep people out of the emergency rooms and reduce complications. That's a positive.

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