Community Paramedicine in Hospice Care

Nearly every sector of healthcare is evolving, including community paramedicine and hospice care. As branches of healthcare take on new roles, communication may get murky.

Terms that used to mean one thing have morphed into new definitions. Mobile integrated healthcare community paramedicine (MIH-CP) is there to provide the oil that keeps the gears of community health running. 

The variability of hospice care creates situations that can make paramedics, physicians, and family a little confused. In this article, we’ll discuss some of the barriers between hospice care and EMS, and then we’ll talk about how community paramedicine provides solutions. 

Community paramedicine exists to create a unified system – to bridge the gaps. Instead of saying, “that’s not my department,” community paramedicine aims to provide answers when patients ask. Below we’ll outline how MIH-CP is bridging the gaps in hospice and palliative care.

The Barriers Between Hospice and EMS 

When a patient is in hospice care, it can be difficult to get all parties on board. There is usually a hospice nurse who coordinates with the physicians and the family to determine treatment plans. 

However, some family members often find it burdensome to wade through medical jargon and protocols. The hospice nurse will often visit, but they may only be in contact by phone. High-stress situations can make relatives overwhelmed – especially when they’re alone. Do I give them their medication? Do I call 911? Do I just wait? 

Often, they will call 911. And, when the paramedics arrive, there is potential for confusion about the care plan. Thankfully, community paramedicine alleviates much confusion and helps patients get the care they require. 

Here are three ways community paramedics play a part in hospice care: 

  1. Fill in the gaps
  2. Increase care coordination 
  3. Create a secure hub for communication 

You’ll find more information on each of these points in the sections below. 

Community Paramedics can Fill Gaps in Hospice Care 

There are some areas where the community paramedic can take over some of the roles of a hospice provider, acting as the point of contact between patients and physicians. Paramedics can administer medication, watch for signs of duress, and execute palliative treatment plans. 

Unfortunately, there is a national nursing shortage, meaning that many RNs who work with hospice patients are stretched. In these cases, the RN may need to delegate more tasks to family members, leaving the door open for confusion. Most family members need a constant and consistent point of contact to feel confident.

If there are areas where hospice needs more providers (often rural environments or understaffed urban areas), then community paramedics may step in. The NAEMT has even developed modules to train community paramedics in hospice care.

Community Paramedics can Reduce Hospice Coordination Errors 

For hospice patients to get the care they need, they require a high degree of synchrony between their healthcare providers. Unlike many other areas of healthcare – which largely rely on the physician’s expertise and established guidelines – hospice, and palliative care allow the patients maximum control throughout their treatment.

Of course, this isn’t to say that physicians don’t allow their patients to make decisions. However, it is to say that certain medical conditions have a clear treatment pathway, whereas hospice can be more ambiguous (though, not in a bad way) and unique to individual patients. 

It’s this uniqueness that makes hospice care so meaningful to patients. Many of them face terminal diseases, and they have specific desires for treatment and care. However, this versatility in the hospice system also requires a high degree of coordination among the healthcare team; otherwise, the patient’s desires could be lost, leading to a total failure.

Here are just a few of the coordination challenges healthcare providers face when caring for hospice patients: 

  • Navigating DNR patients
  • Understanding palliative care 
  • Protecting patient wishes and advanced directives 

The difference between good and bad hospice care hinges on a knife’s edge, so mobile integrated healthcare must get this right. 

MIH-CP and Navigating DNR (Do Not Resuscitate) Patients 

The erroneous assumption that all hospice patients are DNR patients creates confusion within healthcare all the time. It’s true that many patients who enroll in hospice may choose to be DNR or DNI (do not intubate); however, there is a group of people who may choose some or all resuscitation even while in hospice care. 

Many hospice programs do not require a DNR for a patient to be enrolled, though some might. And many allow the patients to specify the degree to which they would like to be resuscitated. Some may want the full degree of treatment, and others may prefer chest compressions but no intubation. 

The point? Hospice can vary in depth and scope; however, it’s still incredibly important to follow the patient’s wishes. Community paramedics providing care to hospice patients are there to bridge these divides and help families and providers get the treatment decisions right. 

Community Medics Understanding Palliative Care 

While hospice and palliative care share similarities, they are not the same things. Palliative care is the idea of treating a patient’s symptoms and improving all aspects of comfort. Palliative care takes place across healthcare and in all age groups. 

Palliative care may or may not be confused with hospice. Unfortunately, even within the profession of healthcare, terms are used rather loosely. And, unless the healthcare provider is directly involved in this field (hospice and palliative care), they may be unaware of the nuances involved. 

The goal is to keep the patients comfortable and give them what they need. Certified community paramedics can be trained to deliver high-quality care to hospice patients. They can help the broader group of EMS and emergency medicine understand the intricacies of hospice and palliative care. 

Advanced Directives and Community Paramedics 

Many patients in hospice who sign DNR paperwork will require hospitalization and treatments in some cases. However, these further treatment decisions are often specified in advanced directives.

For example, say a patient falls from their bed and fractures their hip – just because they are a hospice patient does not mean providers ignore the injury. Something like a fractured hip can be extremely painful, even for patients who take regular pain medications. This patient still requires stabilization, often in the ER and sometimes with further hospitalization. 

However, fractures and falls are not the only stipulations. If there is a condition causing the patient discomfort, the family and the patient may need to seek care beyond the palliative environment. 

Often, family members are unsure what all this means for their loved ones. Will they be taken off the hospice program? Will they be hospitalized?

At the crux of these hard decisions, community paramedics can step in to help guide the patient, the family, and the emergency team. 

Community Paramedicine Provides a Hub for Hospice Communication and Documentation

The world of medicine has more access to instant information. Health organizations see the value of staying connected – this value couldn’t be more real when discussing hospice care and community paramedicine. 

When a paramedic unit responds to a hospice patient, there is no reason they shouldn’t have access to that patient’s full health record, especially documentation pertaining to their current situation. 

Many people misunderstand health privacy rules and believe they are not allowed to share information with EMS providers. While providers must protect patient information when translating it to other qualified professionals, there is no reason a licensed health professional involved in the patient’s care should not have access to pertinent health records. 

For example, if an ambulance responds to an unconscious hospice patient, it can be a frightening scenario for the family members. They may not have all the documents ready to show the EMS crew. And, even if they have written statements, these can be difficult to verify in a high-stress moment – when seconds count. 

As a result, there may be a hasty choice in the decision-making. And though this is understandable within the confines of emergency care, particularly out-of-hospital, it shouldn’t be the standard. 

What if – when the EMS crew arrives – they could easily pull up the patient’s complete health information on their computer? This would allow them to read the physician and patient notes themselves – maybe even while they are on their way to the call – giving them a better understanding of how to treat the patient. 

Through better documentation, Julota is paving the way for intuitive, common-sense care. Julota provides a documentation platform that allows all providers: physicians, community paramedics, and hospice nurses, to share patient information securely. 

When healthcare teams follow the same map, they ensure no one gets lost in the jungle – this is better for the healthcare providers, and it’s better for patients. 

Final Words on Community Paramedicine in Hospice Care

Community paramedicine is still growing and learning. However, good things are on the horizon, and many health systems see community paramedics as an asset and compliment to hospice care. 

Community paramedics can fill gaps when hospice lacks providers and improve communication and coordination – which is foundational to ensuring patients receive their wishes. 

Contact Julota to learn more about how their platform can help your MIH-CP program. One of Julota’s representatives would be happy to answer questions and demonstrate how their software is reshaping community care.