Making connections where people are born, grow, live, work and age.
Susan was living out of a hotel with her dog, Buddy. As a homeless veteran with chronic MS, she would call 911 multiple times a day to get transferred from her scooter to the bed, as the hotel was not set up for her disability. She also did not have any health insurance at the time and was unable to obtain her medications for her MS.
The only way to get immediate help
In 2020, Tucson Fire Department received 89,386 calls to the 911 system. Many of those calls were from people like Susan, who felt like 911 was their only option.
People at risk, often the elderly or those with behavioral health conditions are overwhelmed and confused when trying to get assistance. They resort to the only number that gets them immediate help – 911.
A partnership that creates connections
TMC HealthCare, Tucson’s largest and only locally governed non-profit community hospital, has joined a program – started by Tucson Fire – to reduce those calls and relieve the burden on emergency services.
The program – Tucson Collaborative Community Care (TC3) – connects Tucson’s most vulnerable population to the community and medical resources they need. This has proven to reduce a person’s 911 usage and improve quality of life.
After connecting with TC3, Susan was able to be placed into a full-time residence with Buddy.
It took many people and multiple agencies, but Susan was able to obtain health insurance, reengage with her health care plan and secure food, housing items and much needed durable medical equipment to help her in her new residence. TC3 also made sure Buddy had plenty of food, treats and a dog bed.
In 2020, TC3 worked with 204 people, up from 139 the year before, thanks to a generous gift from the Buehler Foundation that allowed for a larger team and workflow improvements.
Those 204 people were responsible for 967 calls to 911 before connecting with TC3. Within the first 30-90 days, that number of calls went down by 80%, or 774 calls. After a year of involvement with TC3, there was a sustained call reduction of 64% with those same clients.
In 2018, the waiting list of people who needed help was approaching 400. With the addition of the new TMC staff in 2019 and 2020, the team was able to get the waitlist down to under 20.
TC3 continues to connect people who don’t know where to turn to address their needs. “There is a new sense of empowerment that clients experience when they have the tools to solve their health care needs,” said Julieta Scroggs, TMC RN program manager.
Investing in social needs
Investing in helping with housing, socialization, employment and getting people connected to what they need, as well as medical intervention, results in better quality of life.
Take the man who wouldn’t leave his house to seek medical care because he had a hole in his roof. He had to call 911 to receive care at home. TC3 got his roof repaired. He no longer dials 911 for non-emergent doctor’s visits, and he can freely leave his house without worry.
During the COVID-19 pandemic, TC3 quickly adjusted to address the needs of patients within the new parameters.
TC3 started by calling all current and former TC3 referrals to make sure they had basic necessities such as food and medications. Using a city of Tucson stimulus grant called SOMAS, TC3 was able to provide food boxes, PPE and paper products to clients in need.
TC3 also created COVID resource bags for the homeless population. Each bag contained water, protein drinks, snacks, masks, hand gel, sanitizing wipes, an emergency blanket and socks. A resource card was also included that contained information where someone experiencing homelessness could access resources such as food, shelter and health care during the pandemic.
In addition, TC3 provided assistance to residents of the Tucson House, a public housing development. This building historically has been the largest generator of 911 calls to Tucson Fire. TC3 delivered 465 warm meals with an additional frozen meal and paper products to the residents. Through this outreach, TC3 was able to address other health and safety concerns.
Durable medical equipment was distributed along with referrals to community partners as needed. One resident in particular, was a paraplegic who had a broken wheel on his wheelchair. TC3 was able to connect the resident to a local volunteer group that fixes wheelchair parts. He was also in need of food and paper products. He was grateful and happy that he was able to get all of his concerns handled just by answering his door that day.
“When we look at the whole person and incorporate all of their needs, it results in improved health outcomes for our clients,” Scroggs said.
It’s really about improved quality of life
Susan’s calls to 911 have dramatically decreased, but she does call 911 a few times a month for lift assist on her bad days. TC3 has identified a huge gap in care for those in Susan’s predicament, and it is continuing to assist her in securing long-term care in her home.
By addressing all of Susan’s social determinants, she was able to improve her health conditions and quality of life. It is stories like Susan’s that drives the TC3 team.