What do you think?
Earlier this week I attended a 3-hr of public hearing in Sacramento where a variety of speakers were debating a pilot program proposal for an increased role of PARAMEDICS in managing chronic care diseases when attending to home care needs of patients (in rural on inner city areas they say).

While I fully support the notion that something must be done with the dreadful state of CA public health, access to medical care and adherence to home care / discharge plans, with all due respect and deference to paramedics, to manage a chronic condition in a home setting takes fine tuning and years of studies and practice. Just because nobody is bleeding does NOT mean it is not critical, problematic or very complexed issue to deal with.
There is a reason new grad RNs are NOT hired for home health because you MUST have experience in dealing with the disease management before you will be even considered to be sent out there making decisions on location!

It is usually the patients who are not bleeding or vomiting or collapsing that are the biggest problem in a home health setting, those who sit quietly, those who if you don’t know what and how to ask OR if you don’t know what signs to look for – usually, they are the ones who don’t even tell you! They don’t wanna be a ‘bother’ – I’ve heard that SO MANY times from grandmas and grandpas
(Again, I am talking about chronic disease management in home care, not discharge home from tonsillectomy, for example)

To manage chronic care diseases, you must know and understand the disease process, the disease signs & symptoms, to know how it was managed in a hospital, what can be the side effects of any of the above, what to look for, how probable complications look like even before they become major problems…. And finally, you must understand how to fine-tune the care!
Again, paramedic are GREAT and FANTASTIC at what they do, which is the FIRST phase of giving emergency care, I worked with them for many years on 2 continents (and in Czech I worked in the department!), so my hats off to you, but to manage the last part so-to-speak of care such as COPD or CHF or HTN or DM – that takes years of training, learning and practice!

Also, I am NOT saying we, the nurses, are fine-tuning or managing the treatments, that’s why we have specialists such as fantastic pulmonologists, but we the nurses are fine-tuning the plans of care upon discharge, the follow ups and the adherence to those. At least that’s what the nurses should do – but we don’t have them!
WHY?
Because the State cut the budget in 2011 and DHS and DSS just don’t have the funding! Those positions got cut. …Now we see how much it actually cost us because just because you cut a position or access to care here does NOT mean those patients will not seek the treatment or medical attention elsewhere. Now, all those trips to ERs – they get very expensive for the State! And now with added millions of new patients via Obamacare – don’t get me even started!

While I fully support the need for a change and innovation in our roles and in health care system delivery overall, in fact I have been calling for it for some time now, I do not believe paramedics as chronic care managers or home health caregivers are the long-term solutions to our much bigger problem.
They are trained as ‘ready to go’ as first responders, and I believe they are the BEST in the WORLD, but not as chronic care or home health care giver, and 16-18 hours of added education will not change that.
… At the same time, I absolutely understand what they are trying to do or accomplish and WHY!
I get it, I understand.
But I don’t believe this is the right solution.