heres how a new type of ambulance service is helping older people stay out of the hospital the new old agecreditjoshua bright for the new york timesnov 4 2016for a while paramedics were rushing maria vitale to the emergency room at long island jewish medical center every few weeksit was constant said her son paul vitale she would fall and the ambulance would come and take her to the hospital her blood sugar would be low and shed go to the hospitallike most older people mrs vitale now 88 wanted to continue living in her home a cape cod house on long island that she and her late husband bought 60 years agoand like many older people she contended with an array of chronic diseases diabetes kidney disease a heart arrhythmia dementiaher children and medicaid had managed to keep her at home with fulltime aides but every 911 call led to hours of waiting in the emergency department often followed by admission to the hospitalsometimes we felt like the hospitalization hurt her said mr vitale 60 a health care executive who too often found himself driving from his manhattan home to long island in the middle of the night she came home worse than when she went insince march 2015 however paramedics have visited mrs vitales home 10 times and whisked her to the hospital just oncewhen mrs vitale falls or seems lethargic or short of breath her aides no longer call 911 they dial the house calls service at northwell health the system that includes long island jewish medical center and that dispatches what it calls community paramedicsthey often arrive in an suv instead of an ambulance and with 40 hours of training in addition to the usual paramedic curriculum they can treat most of mrs vitales problems on the spot instead of bustling her awaya lot of whats been done in the er can safely and effectively be done in the home said karen abrashkin an internist with the house calls program and mrs vitales primary care physician for frail older people with many health problems dr abrashkin noted the hospital is not always the safest or best place to begeriatricians have warned for years about the ways in which hospitalization can accelerate older patients decline even when physicians succeed in fixing the medical problem at handemergency rooms often serve as gateways to longer stays and the time spent in bed leads quickly to deconditioning older people who walked in on their own often cannot walk out and need rehab and physical therapy to try to regain their mobilitytheyre also vulnerable to hospitalacquired infections including the rampant c difficile that can prove difficult to eradicate newly prescribed medications can interact badly with those they already takedelirium strikes as many as half of hospitalized older patients studies have shown its especially common among the cognitively impairedmrs vitale perceived nonexistent threats for example shed be telling me there was a dog under her bed or someone trying to get into