In Evergreen, paramedics provide preventative care to help older residents stay in their homes

As paramedic Jeff Henson takes 93-year-old Dorothy Moore’s pulse,  she gently teases him.

“Basically, this one’s my father, checking my blood pressure, watching my stress, making sure I’m doing the right thing,” she said during one of Henson’s weekly visits to her home in Evergreen.

Henson is one of five community paramedics who make up Evergreen Fire/Rescue’s ECARES team. Evergreen Community Assistance Referral & Education Services is aimed at filling gaps in the local health care system, helping residents stay  out of the hospital and in their homes.

The free program’s effects are evident not only in statistics, but the words of its clients, like 89-year-old Amanda Elder.

“My doctor says I’m one fall away from being disabled,” said Elder, who has lived alone in her Evergreen condominium since 2005. “But since I met Jeff and the crew, I have just felt so much more secure in this place. I just know they’re there.”

Founded in 2018, ECARES has grown to 50 clients, and those numbers are expected to keep climbing.

Evergreen’s population — along with all of Jefferson County’s — is aging.  By the year 2040, it’s estimated that about 25% of the county’s population will be over 65, with almost 10% over 80 years.

Because of the quality of life they enjoy, many seniors want to stay right where they are, according to a Jefferson County demographics study.

But when health care issues arise, options for older residents are often limited. Family members may be out-of-state or have little time to help, and in-home health care is typically expensive. Moving out of their mountain home may be not only emotionally difficult but financially impractical.

“Some of them are house-rich and cash-poor,” said Annie Dorchak, the ECARES team lead who helped create the program along with EMS Division Chief Dave Montesi. “The cost of assisted living can be $5,000 to $6,000 a month. Your average person does not have that kind of money and most insurances won’t cover it. They can’t afford to go. And there aren’t that many places to move to down the hill.”

Moving to the metro area can also mean leaving behind support systems and friendships Evergreen residents have built over the years.

“You give up your home, your neighbors, the life you know to move to the Denver metro area and a totally different lifestyle,” Dorchak said. “People don’t want to do that. They’d rather live and die in their home. Even if it means less access to health care, they believe they have a higher quality of life in their home.”

Born of community need and demand

Programs like ECARES fill gaps in the health care system. Evergreen residents saw the need for such a program in 2016 and asked for help during community meetings leading up to the passage of a mill levy increase for the fire district. Funds generated from those taxes formed the springboard for ECARES.

The tax increase is also helping save money in the forms of fewer 911 calls. Dorchak said it’s a model for other agencies, and she frequently gets calls from departments across the state that want to start a similar program.

Community paramedics must be licensed, with most obtaining a community paramedic certification from the International Board of Specialty Certification. ECARES is also endorsed by the state public health department’s  Emergency Medical Services Division.

Most clients are referred to ECARES by their doctors after a hospitalization. During weekly visits to clients, community paramedics check vitals, ensure clients are taking medication when and how they should, and assess them for any physical, cognitive or emotional changes.

“We’re in a sense in a medical desert, and we’re able to bridge that gap at no cost to the patient,” he said. “We are an extra set of eyes on these people. We can also catch things that might otherwise go unnoticed.”

Rarely, community paramedics may recommend stepped-up care or a change in a client’s housing situation. The goal is always to keep a client in the home they know.  

“We noticed early on there’s a concern or fear that we’re going to make them move out of their house,” Dorchak said.  “If we don’t think someone is safe at home, there are options. We try to work with family and find resources. Maybe someone from a home care agency comes in a couple times a week. Or maybe family is interested in having them live with them, or family member can move in with them.”

‘Doing God’s work’

The level of help community paramedics provide is detailed and often highly personal. Community paramedics speak with clients’ doctors and families, and Henson said he has often stood in line at the pharmacy to pick up prescriptions. He shrugs off any suggestion that these tasks extend beyond his job description.  

“We tend to wear many hats,” he said. “They need these meds yesterday, and who’s going to get them for them?”

For Henson, his three-year community paramedic career is a dream come true. Certified as a chiropractic physician and EMT, Henson ran a Chicago-based wellness clinic for 25 years before moving to Colorado and falling into “this amazing job.”

“ECARES is extremely unique,” he said. “It’s hard to comprehend this is even possible. Show me a better example of a community that takes care of its own more than Evergreen Fire.”

“It’s kind of like doing God’s work,” he continued, adding, “and I’m not religious.”

In his three years with the program, Henson’s built close relationships with his clients, and the comfort they feel with him is clear.

“You’re like a little old woman,” Elder lightly chides him when he asks if she’s taken her medication.

“It takes one to know one,” Henson shoots back, and the two smirk at one another.

Elder moved to her Evergreen condo after her husband’s death. She was 69 then, and her daughter and son were not comfortable with the decision.

“They didn’t think I was able to live alone and wanted me to move into assisted living, but I’d been waiting 50 years to move to the mountains,” she said. “I’m a mountain girl. I’m happy here.”

She credits her genes and ECARES for much of her health and happiness, as does Moore, who’s lived alone since 1982.

“I’m never lonely,” she said. “I have a lot of friends. I knit, needlepoint, read and garden. I’m very fortunate.”

She also has ECARES.

“It’s hard for some seniors to have people intrude into their lives, but it’s a great program,” she said. “I’ve recommended it to many people.”

ECARES fills another, less clinical purpose. While some seniors have active social lives, the community paramedic may for others be the only person they see in a week.

For Henson, the social connection goes both ways.

“I think we like coming to see them as much as they love us coming,” he said. “It is a fairly emotional job. You get to know these people really well.”

“If they pass away or leave their homes to go somewhere else, it’s a gut punch.”

Dorchak echoes that sentiment, but underneath the grief triggered by a client’s death, she said she also feels a sense of peace.  

“There’s a different type of satisfaction from helping somebody age — and in multiple cases die — with grace,” she said. “We’re really giving autonomy and choice.”

Program spreading through foothills

Neighboring fire agencies, faced with the same aging demographic, are getting on board. Two years ago, Inter-Canyon Fire started a Mountain Area Community Paramedics program.

Inter-Canyon Fire Captain Suzannah Epperson, who leads the program, said she modeled it after EFR’s ECARES. MACP has about 20 clients, a medical director and two community paramedics.

“I especially worry about the people that are living alone,” she said. They’re kind of living on the edge. I’m so happy when they use this resource.”

The Elk Creek Fire Protection District is also talking about a program there, trying to balance the funding, staffing and other elements needed to launch it.  

“We know there are a lot of elders in the community who want to age in place, and this is where some of them want to die,” said Elk Creek spokesperson Bethany Urban. “We would love to help them have the opportunity to age in place.”

“It would make sense for us to work together (with neighboring agencies,” she said. “It’s on our radar and we’re exploring options.”

Epperson, who also volunteers with Indian Hills Fire Rescue, said that agency also plans to start an ECARES-style program.