Evaluation of an Emergency Medical Services–Based Social Services Referral Program for Elderly Patients

Abstract

Objective. To describe the preliminary experience of an emergency medical services (EMS)-based follow-up program providing elderly patients access to community-based social services. Methods: This was a retrospective, case series report. Inclusion criteria were adults aged 60 years and older requesting EMS for fall or lift assist; against medical advice (AMA) refusal of transport for a medical complaint; any social service or home care needs; request for nonmedical transportation; multiple prior EMS visits; or cases of elder abuse or neglect. Patients were identified either by paramedics at the time of the call or an EMS physician during routine chart review of “no-transport” calls. Patients were then contacted and offered referral follow-up with a social services worker. Data were collected for age, gender, presence of established social services, referral strategy, complaint type, referral acceptance rate, and follow-up plan. Results: Seventy patients were referred over eight months. Paramedics provided 33% of referrals (23/70) as well as a significantly higher number of social service–related complaints (48% vs. 15%, p = 0.005). Follow-up from a fall occurred more often after EMS physician chart review (53% vs. 30%, p = 0.07). Rates of established social services were similar for patients who accepted and those who declined follow-up (89% vs. 90%, p = 0.95) and between patients who were referred by paramedics and those who were referred by EMS physicians (93% vs. 90%, p = 0.72). Paramedic referral was associated with a significantly higher rate of acceptance (94% vs. 28%, p < 0.001). Conclusion: EMS provides an invaluable opportunity to connect the elderly with social services at the time of contact. In this study, paramedics appeared to refer more social service–related complaints compared with other categories such as fall assistance. This highlights a difference in perception of social service needs among paramedics and represents an area for further training and education.

Key words:

• elderly
• emergency medical services
• social services
• follow-up
• prehospital
• referral