2022 Quality




Hospital Quality Improvement Showcase - Clement J. Zablocki VA Medical Center, Milwaukee

Ground-breaking Partnership Aids Veterans

An innovative partnership between the Milwaukee VA Medical Center and a neighboring municipal fire department reaped big dividends in 2021—and likely saved the life of a Veteran.

Members of the Mobile Integrated Healthcare program with the West Allis Fire Department stand ready to help Veterans.
The Mobile Integrated Healthcare (MIH) program was established in 2020, involving the emergency department at the Milwaukee VA and the West Allis Fire Department.
“This is a first-in-the-nation relationship between VA and fire departments,” said Ben Thelen, nurse manager for the Milwaukee VA emergency department (ED). The program seeks to find out why some Veterans make numerous trips to the ED and then figure out ways for the Veterans to better manage their health to decrease visits to the ED.

It starts with a team of specially trained paramedics who make house calls to Veterans known to make frequent visits to the ED. These aren’t emergency lights-and-sirens calls; instead, the paramedics are working proactively. They talk with the Veterans about their medications, check out their surroundings and make sure they are in contact with the right resources.

“We get eyes on them in their house, in their environment, to see what issues they have that can be mitigated,” said Capt. Armando Suarez Del Real, MIH program coordinator for the West Allis Fire Department. “If they are utilizing the ED a lot, chances are they are not complying with some area of their care plan.” 

“They find things that we can’t see here in the ED,” said Ann Baggett, social worker for the Milwaukee VA Emergency Department. “It helps us a lot.”

West Allis is the first fire department in the state to have an MIH program, said Suarez Del Real. “It’s not the norm, but in our opinion, this is the future of EMS. It’s a very proactive approach to EMS. We’re trying to reduce the inherent risks that are involved in most people’s lives.”

Veteran rescued
That became evident in April of 2021 when the program saved an elderly Veteran who was living in squalor and being preyed upon by neighbors and crooks. Baggett asked the West Allis crew to check on the Veteran—referred to in this article as Mr. H to protect his confidentiality as a VA patient—after his actions and visits to the hospital raised some red flags.

Milwaukee VA social worker Ann Baggett, left, talks with Lt. A.J. Ottow of the Mobile Integrated Healthcare program with the West Allis Fire Department. Their collaboration helped save a Veteran who was living in squalor and being preyed upon by neighbors and crooks.
Baggett discovered that Mr. H—who was a frequent visitor to the Emergency Department—had not been seen by his primary care team in four years—despite Mr. H continually telling VA staff he was seeing his doctor and that everything was fine. And he seemed to be in good health.

But during visits in early 2021, Mr. H showed signs of physical decline and cognitive impairment, Baggett said: His shoes were ragged; he was complaining of foot pain, and his Parkinson’s disease appeared to be getting worse.

“He seemed more disheveled — not all the way confused, but you knew something was going on,” she said.

Mr. H had lived in the same rooming house for decades — a building he owned until recently, when he lost it due to financial hardship. He then became a tenant in the house, and it wasn’t long until unsavory neighbors and others started taking advantage of him.
Milwaukee VA social worker Ann Baggett, left, talks with Lt. A.J. Ottow of the Mobile Integrated Healthcare program with the West Allis Fire Department. Their collaboration helped save a Veteran who was living in squalor and being preyed upon by neighbors and crooks.

It got so bad at one point that Mr. H spent a week sleeping under the porch.
When Baggett heard that, she alerted the county’s Adult Protective Services as well as the MIH team in West Allis. 

And when Lt. A.J. Ottow, a lieutenant with the West Allis Fire Department’s MIH team, arrived at Mr. H’s home, he was shocked and appalled.

‘Absolutely atrocious’
“His room was absolutely atrocious,” he said, saying it was the worst situation he had ever seen. “The bedsheets were threadbare, and the mattress — I wouldn’t have my worst enemy sleep on that mattress. And he had no clothes, no food.”

There was no kitchen, no refrigerator or even a microwave oven. Mr. H had been subsisting on sweet rolls given to him by a neighbor.

Ottow learned that Mr. H’s Meals on Wheels deliveries were being stolen routinely, along with clothes he would receive via the county. He had been robbed at gunpoint just weeks prior, and a 22-year-old woman he referred to as his “fiancée” was continually scamming him out of cash.

Mr. H would go to his bank regularly to withdraw cash — often large sums of it — and when his neighbors caught on, the scamming, bilking and thefts escalated.

“This was by far the worst because it was on so many levels: It was on a health-care level. It was on a mental level. It was on a living situation. It was a safety consideration. It was neglect and malnutrition. And you had criminal aspects,” Ottow said.

Ottow took immediate action, contacting the Milwaukee VA and county authorities.
Ottow personally cleaned up Mr. H’s room, hauling out multiple bags of garbage, repairing furniture and putting away his new clothes.

But more significantly, Ottow was able to convince Mr. H he needed to see a VA doctor, and an appointment was set for one week later.

Mr. H was admitted to the hospital, which triggered a chain of events that led to a room in the Community Living Center. Family members were contacted, and plans were put in motion to get Mr. H into an assisted living facility.

Reinforcing the mission
The outcome reinforces the mission of the Mobile Integrated Healthcare program. Such programs — sometimes referred to as “community paramedics” — are relatively new but gaining traction throughout the country, Ottow said.

“I really enjoy the program. It allows the Vets to realize they are not out here on their own,” Ottow said. “We’re there to help them with their needs and wants. The goal is to keep people as healthy and as happy as they can be.”

Since the Milwaukee VA cemented its relationship with the West Allis MIH, and the partnership has shown big dividends: Thelen said unnecessary Emergency Department visits have been reduced by 50%.

“It’s been really great,” Thelen said. “The Vets love it, and the staff likes knowing they have that option.”