Community Resource Paramedicine and Homebound Vaccination with Ariella Bak

Ariella Bak, NREMT, pioneered and manages the Community Resource Paramedicine Program within the Gainesville Fire Rescue department. She created this program while working as a volunteer  for GFS and attending The University of Florida. Her team goes into the community to address the complex needs that are present and helps to identify the needs that align with the services that CIL provides, such as, access to affordable housing, home modifications, wheelchair ramps, to name a few. It’s this level of community collaboration that allows CIL to serve the independent needs of many people within their community.

Ariella shares with us the innovative program they’re facilitating to address the access and functional needs that people are challenged with for getting the COVID vaccination. People with disabilities, the most vulnerable population to COVID, are experiencing many barriers when it comes to receiving the vaccination. The Homebound Vaccination Program has Ariella and her team going into communities with disabled people to administer the vaccination. She talks about the logistics and the challenges in getting the COVID vaccination out to the community.

SPEAKERS: Ariella Bak, Tony Delisle

Ariella Bak  00:00

Hard days always come. And it just comes down to like the community members that we’re serving individually. And these are people’s lives that we’re able to change.

Tony Delisle  00:12

Alone, we can do so little together, we can do so much. Comes to us from Helen Keller and Henry Ford tells us that coming together is the beginning. staying together is progress. And working together is success. And that comes to us again from Henry Ford, who led perhaps one of the biggest entrepreneurial industries and really set the economic prosperity for a country together. And Helen Keller, who obviously, is one of the biggest historical persons with a disability that is to this day still has a lot of wisdom to share with us. And today’s episode continues the theme of the importance for Centers for Independent Living, to collaborate with community based partners, to make sure that we do the good work that we’re doing to the best level possible. Having these partnerships is critical to fulfilling our mission. It’s not easy for us to collaborate with other organizations because we are so busy doing what we’re doing that often time is a huge barrier, along with other barriers that are out there. So today’s guest really talks to us about how to practically get around those barriers and how to address those barriers. Her name is Ariella Bak. She comes to us from Gainesville Fire and Rescue local fire department who has what they’re calling a community resource paramedic program where they go into the community where people live to address the needs that they have the complex needs that they have. We work with CRP, Gainesville Fire and Rescue and Aereo. A very closely because when they identify certain needs in the community that align with the services that we provide, such as durable medical equipment, access to affordable housing, home modifications, wheelchair ramps, we’ve worked with Ariella, Gainesville Fire and Rescue and cprp to serve the Independent Living needs of many people. And without them, identifying certain people in the community, we wouldn’t know that they were there because there’s many issues that are related to getting to the people that we need to get to, in order to do the services that we’re doing. Ariella talks to us a lot about the innovative program that they are doing in order to address some of the access and functional needs that people have to getting the COVID vaccination. So people with disabilities right now being the most vulnerable population to COVID are experiencing some major issues in regards to getting the vaccination. The CRP program is going to people in the community where they live to administer the vaccinations. They’re calling it a homebound vaccination program that they’re doing. She talks about the logistics and the challenges and the facilitators into getting the COVID vaccination out to people. So I think there’s a lot there to take away. I don’t know of too many programs that are out there doing this, but it definitely underscores a huge need that is very pervasive within our community. I think one of the highlights of this interview is where she takes the time to explain some of the things that she’s working on, to be able to be a better person so that she can be a better leader and then a better servant. She talks a lot about having perspective, having focus, having gratitude and grace, and the importance of leadership and embracing all those qualities in order to be an excellent leader. A lot to offer us, a lot to get into here. I’m very excited for you to meet a good partner, a good person, someone that is really making the world a better place. And I think for Centers for Independent Living, I encourage them to find people in organizations to partner with that are in line with a lot of the attributes and values that someone like Ariella Bak brings to the table. So enjoy the interview with this very exceptional person who works for a very exceptional department doing incredible work for our community to ensure that the people in it can live as independently as possible. Welcome back to another edition and episode of the independent life. If you hear any enthusiasm behind my voice, it is because we have one of I think, the most powerful collaborators I’ve seen it in our local community here Ariella Bak, who comes to us from Gainesville Fire and Rescue, community resource and paramedic program, amazing program that is doing so many different things. And she’s coming to us to really drive home a few points. One of them is that she’s got a very innovative program, related to vaccinations, homebound COVID vaccinations that they’re doing, but also the art of collaboration and why it’s so important that we come together and do all the wonderful things that we do. So I’m so excited to have you on and just wanted to say that, in addition of being a very big fan of your work, I think you have like the coolest name in the world. Right? You sound like it I can X game like competitor with that name. Ariella? Right?

Ariella Bak  05:50

Thank you Tony, kind words.

Tony Delisle  05:54

Oh, yeah, it’s just, you’re amazing. And and so, so busy. So thank you for taking the time to come talk to us. And before we dive into all the wonderful things that we do, if you could just take a moment to explain to the audience what it is that you do so you you run a program within our city firefighting department. So you’re Gainesville Fire and Rescue, and you run the community resource paramedic program, CRP. What is that? And why is it important?

Ariella Bak  06:23

Is it the name is quite a mouthful. So I like to just refer to it as CRP because community resource paramedicine program is, you need a big breath for all of that. But…

Tony Delisle  06:34

Let’s roll with the alphabet soup. We’re good.

Ariella Bak  06:36

All right, all right, I’ll try not to throw too many acronyms at you. My family members hate that. But to make a long story short, the program was designed to meet a need that we saw from a boots on the ground level of our operational units, you know, our fire trucks running 911 calls for things that were not emergency based. So these were the you know, they were running on people who needed to go to a primary care doctor, because they had, you know, thousands of pill bottles scattered all over their house. These were homeless individuals, these were people without food. And, you know, we all know that our bodies don’t operate in silos and without, you know, with that big negative social determinant of health, it perpetuates the cyclical nature of negative health problems and negative health outcomes. So we were seeing that in real time, we were seeing people misutilize what 911 was designed for. But we had this problem at our on our hand, because the fire department traditionally has done such a good job at giving people three numbers to dial and you get, you know, four to six people showing up at your door willing to help you and we have people using that system because they needed help and they didn’t know where else to get the help. So we launched CRP to mitigate that issue by giving them another number to call and that number for a long time, that’s just my personal cell phone number. And we would tell these people call this number if you’re in trouble, as long as it wasn’t an emergency and we would work with them in their homes, it would be myself and a paramedic going out into these patients homes. And really just putting our problem solver hats on, you know. I’m an EMT by trade I was with a paramedic, so we had advanced level medical training. But really my role in that whole scenario was to figure out how to get these people long term solutions, whether that be food assistance, housing, safe devices to navigate their homes, like grab bars, and, and walkers. And you know all about that because a lot of our stuff came from you. And over time that program has evolved to more than just that individualized patient care component, but a population or community health-based program where we’re doing COVID testing, flu vaccines, now COVID vaccine, so you 2020 was a year of evolution for the program, no doubt. And we’ve we’ve grown beyond our initial use for the program.

Tony Delisle  09:12

Well, I’m really glad that you brought up the terminology social determinants of health, which have been shown to be the most impactful factors related to how long people live, resiliency to chronic preventable diseases and quality of life and the social determinants of health are education, employment, income, access to housing, transportation, things that happen outside the clinic are the most impactful according to science and all these epidemiologists that are out there, happen outside the clinic in the community. And if we want to do better in terms of mitigating the flow of people that come into the clinic for unnecessary or preventable treatment, at least, we need more people like you out there in the community, working to prevent, whether it’s a first responder call, or if it’s just readmissions into hospitals, and all those other kinds of things, so I’m really glad that you brought up the social determinants of health.

Ariella Bak  10:12

It’s so interesting, Tony, because when we first developed this program, we were ecstatic, we were so excited to put it into practice. And we knocked on the doors of the emergency room. And we said, this is going to save you so much money, we’re so excited, let’s partner and they weren’t excited, you know. I mean, we were going to a department that operated off of volume, you know, they get paid for volume. And we said, we’re gonna take some of your volume away, because it’s best for people and they weren’t so excited about that. And it really wasn’t until we found our home within primary care where it wasn’t, you know, it, it took more than just the fire department noticing that there was a problem. And the primary care physicians, while they knew there was a problem, they didn’t know how to solve it, because they were, you know, set in the clinical walls. And it took them opening their minds and their doors to this partnership. And I attribute a lot of our success to the partnerships with the primary care physicians.

Tony Delisle  11:15

And that seems to be a shift that has gone over the last decade is that if 80% of all health outcomes occur outside the clinic, how do we get people in the clinics, primary care, or even these emergency operate, you know, emergency rooms, to be connected to community based organizations or resources like yours, to address the 80% because most of the people I know that do work in clinics are interested unless it’s like a fee for service business model are interested in addressing those health outcomes that are outside their clinic but don’t know how to do it. They weren’t trained on, you know how to address poverty, or housing, or transportation or access to certain equipment or home mods, or these other kind of things that would impact the patients that they see. So how can we better facilitate this education that could be needed for people that are in clinics that might not see this yet, that they might be stuck in a fee for service business model, or just unaware? Because most people, I think, think 90% of health outcomes happen inside the clinic? That’s where we put all our resources and money and attention.

Ariella Bak  12:20

Right? Well, I think there are a couple of different facets to your question. And first and foremost, you know, when we’re talking about systemic problems, like poverty, and homelessness, those feel heavy, and they feel big. And, you know, in the beginning, we couldn’t focus on those things, I couldn’t focus on mental health, it was too big. So we focus on people focus on their stories. And for a long time, we operated off of a one patient at a time, where I would not take on a new referral until I closed out a case. And I know that that might not be realistic for a lot of people, especially those that are clinic based. But you know, find that patient who you’re connecting with, and start there. And I have to say it is more than handing someone a piece of paper with resources on it. Because I think, in today’s society, I’ve seen a lot of different clinics to no fault of their own, you know, they have those resources by the door in a brochure, and they’re handing them 10 without even asking if this person is literate. And we’re throwing solutions at problems before we even know what the problem is. So it takes that deep diving that take 10 steps outside of checking a box for a provider and go into figuring out what the problem is before you’re you’re throwing solutions at it.

Tony Delisle  13:44

And that’s such the expert driven model, right? Like we know what’s best. Here’s the answer for your problems. Versus Oh, let’s get to know you, you know your issues, you know who you are better than we do. You’re the expert, let’s put you in the driver’s seat, lets us be the student and learn from you. And then through that learning, hopefully, we can line up the resources that we have to meet your needs. So you’re pointing to something that is a service that Centers for Independent Living, all Centers for Independent Living do which we call information and referral services, which often bleeds into another service, which is advocacy, and advocating for people or teaching them how to advocate for themselves. And so I understand that you’re doing something very similar, where you’re getting to meet people understand them understand their needs, and then you’re whether CRP directly has those services, or you know people in the community that has the services, you’re trying to be that link there. Tell me what you’ve learned about that process that can help perhaps other centers understand it better so that they can do their process of information, referral and advocacy better?

Ariella Bak  14:50

Sure. Yeah. And I think there are, again, different components to this. First and foremost, your people need to be trained. Our program has expanded beyond just me. I’m not actually the one going into patients homes at this point anymore, we have a team of about to be four, two full time and two part time employees. And they’re managing these cohorts of patients. And it all starts internally with the culture that I set for my team, which is people first, we’re patient centric, and we respond when people say, help me, that’s when we go in. And we don’t say, Oh, we only operate on Tuesdays and Wednesdays. And our goal is to never be the solution. Our goal is to always connect people to solutions. Because we’re not sustainable. We’re not the answer. And we know that a ton of other organizations are doing the work already. So we’re not trying to reinvent the wheel. And I think a big lesson that I had to learn was not to take no for an answer. You know, if if I was looking for a bedrail, for example, and I called I called 10 different organizations, and they all told me, no, we don’t have one in stock. Okay, let’s get creative. Let’s, you know, can we go on Facebook marketplace, can we reach out beyond our city, beyond our county, a lot of times we’ve had to transport things that don’t fit in our own vehicles. And we’re taking a firefighters, personal pickup truck, I mean, there’s just different ways we’ve gone to university scholarship houses to get beds for patients. It’s not just about the the medical equipment, it’s about focusing on these patients qualities of life.

Tony Delisle  16:29

I was gonna say what really striking me that really ties into with independent living, is that you’re saying patient centered, and we now refer to the people we serve as consumers, but same thing, they’re people, and putting the people in the middle is a huge driver of this. And kind of what we try to do here with independent living is, we’re not going to be necessarily the answer for you, but we’re gonna teach you, we’re not just going to give you a fish, we’re going to teach you how to fish. And we’re going to connect you to the person that sells the fishing pole. And the person that sells the bait tackle or you know, the person that can teach you how to cast and we’re going to connect all these pieces together in doing that. When you put someone into this process that you’re trying to connect with resources and navigate perhaps systems, what are some of the things that you’ve learned in order to help facilitate that to the best way possible, so that they can get to that place of independently doing that on their own?

Ariella Bak  17:25

Well, I think the first thing is, it’s important to recognize that the patients that we’re serving and I know is different depending on your population, they’re vulnerable. I like to say that they have medical PTSD, because they’ve been falling through the cracks of the healthcare system, and sometimes to no fault of their own. And first things first is we need to arm them with tools to trust themselves, and then hold their hand as they navigate the system on their own. I mean, we believe in warm handoffs, so we’re never going to throw a piece of paper at someone and say, call these 10 places, We have a system, where when we first start working with a patient, we’re trying to build their capacity. And a lot of times they’re really resistant to even calling their doctor to make a doctor’s appointment. So what we do is we have this, I call it like a social contract. And on the left hand side of this piece of paper, it says “I will” written five times over and on the right hand side of the paper, it says “Gainesville Fire Rescue will” written five times over. And at first, we fill one of those I will slots and we say I will call my doctor’s appointment and schedule an appointment. That’s their homework, quote, unquote. And then on the other hand of the paper for Gainesville Fire Rescue, we fill that whole piece of paper all the way down with tasks that we’re going to do on their behalf. And over time, they’re working with that patient, it flips where we’re giving them more to do, we’re building their capacity, and we take less off of our plate. So that’s one of our tactics, and people love it because people innately like to be led. But they have to know that there’s a fallback and we’re their fallback so we hold their hand through that process. We advocate for them. And then secondly, because you know, we’re a healthcare based organization where we’re dealing with wanting to build capacity, but also shared knowledge on managing chronic disease processes, we have individualized binders, I call them health binders. For you know, if you’re a diabetic or if you have COPD or if you just fall a lot, we’re going to build you a binder and fill it with information on how to navigate what you’re dealing with. A lot of times the center of our visits because we’ll say you know what, let’s work on recognizing triggers for you. And we’ll flip to the red flag page and we’ll go through all red flags and what they have to look out for their condition or, let’s learn the physiology behind your disease process if that’s where that person is, but it’s tailored to their health literacy level and their literacy level, because those are two very different things. We really just rely on the patient and have them guide us. And you know, if they’re asking questions, and they’re engaged, then we’re going to do more, and if they don’t want to learn, you know that, then we go off of that. So it’s again, very patient centered.

Tony Delisle  20:26

I wanted to note some of the things that you said there, that it’s sometimes takes 10 times when working with a person to be able to get them to a place perhaps where they’re independent, and unable to navigate these resources on their own, like you said, the first time, people are hesitant to even make a phone call. And so perhaps that as you put it, the warm handoff is needed. So perhaps you walk with them, with them on the call, maybe maybe you go with them, if there’s an application or person that you potentially know in that other agency that you can communicate with them ahead of time, hey, I’m going to be bringing some buying and you know, this, that and the other this progressiveness towards independence, I really like built into your system, as do I with this, what I would call I guess, a compact, a joint compact, where the person that you’re working with is going to agree to these things, you’re going to agree to these things. This is a relationship, a collaboration, and we’re going to come together and here’s the responsibility. Here’s that responsibility, some accountability, I would imagine, you know, baked into that could be natural?

Ariella Bak  21:31

We always ask on, you know, the the first one or two visits, what do you see coming out of this? Because I think it is so easy as a health care provider to have this vision of health. You know, I know what being healthy looks like for you. But what does it mean for them? And I want to have that established in the beginning. And that’s going to allow us to set some clear boundaries and have a conversation on expectations.

Tony Delisle  21:59

And that’s, that right there, I think helps to ground the clarity and what’s going on, because the most important definition of health is the person that we’re working with to try and promote the health and, you know, how do they see it and having a common shared understanding and definition is huge. I’m really glad you brought up health literacy, the ability to understand and act on health related information that’s being communicated. And so to that end, I would ask you, as you’re saying, you’re providing people resources or even written materials, what do you do to address this health literacy? Perhaps if you’re working with somebody that isn’t particularly fluid, or literate, and some have written materials, or may have a disability and can’t see the size font or those other kinds of things? What have you found to be helpful in communicating with people on your end, to enhance the health literacy of people who you’re trying to communicate health related information?

Ariella Bak  23:19

Its such a good question. And I think we’re still evolving our tools. And we’re still learning. So you know, we rely heavily on visuals. And a lot of times, we can’t find the visuals for what we’re looking to explain. So sometimes we’ll create some things in house to better communicate with our population. We also rely heavily on organizations like yourself and blind services to help provide literature that or information that we need to share. But I would say, even in doing so, as a community, we can do better. You know, one thing that we’re improving on right now is working with people who don’t speak English. So how are we going to communicate with a Spanish speaker, I mean, I’m almost embarrassed to say but right now, our main resource is our students. So we had an undergraduate student who’s actually left us at this point, she’s, she’s, uh, getting into medical school, she’s picking what school she’s going to, but she was fluent in Spanish, and start to finish, she graduated that person from our program, because she was the translator between our paramedic and the patient. And this was someone who she got housed, a homeless family that she got housed. So there was a lot of communication that needed to go into that. And we didn’t have the resource, it became our student. So we’re building systems around identifying those problems. You know, we’re always learning and we’re always evolving.

Tony Delisle  24:47

Well, I’m grateful that you have an academic community to rely on that has that diversity to help you and I find those community academic partnerships to be just very important in terms of meeting those needs. So I see that collaboration that you have with an academic institution to provide you the students to be able to help you do that. You’re talking about a lot of different organizations that you work with. So we’re talking collaboration at many different levels. And a lot of times especially, we can talk about now is these public private nonprofit partnerships, and how to go about doing them. And it’s so important to do them. And even when people want to collaborate, it’s often difficult. What are some of the challenges in terms of collaboration that you have run up against? And what are some of the ways that you’ve have worked around them to collaborate better with all the different layers of collaborations that you have going on?

Ariella Bak  25:46

This is a heavy question. I would say, the first thing that came to mind as far as challenges is something logistical, which is a lot of times organizations have these legal forms that we need to sign in order to work together and that working for the city that has been a huge barrier in the past.

Tony Delisle  26:07

Is that to share identifiable information. So if you have…

Ariella Bak  26:10

No, not even not even. I mean, you know, hit we can get around HIPAA with HIPAA forms and consent forms. And that’s been fairly easy. I would say in the beginning of launching our program, that was something we came across all the time can’t talk to you because HIPAA, can’t talk to you because HIPAA. And we really don’t get that objection much anymore. Because we’re familiar with the programs. And we’ve we’ve worked together at this point. But you know, we’ll have even different departments within the academic community wanting memorandums of understanding and you know, the food banks and this organization over here, so we have to navigate that carefully, because there are processes in place to protect both agencies. And we are fortunate to be able to get our legal department involved and review forms. And I also think that the organizations understand that we have this shared goal of helping people, and what can we get done before or while we’re working through those legal problems. So we’ve had that come up where there were some legal paperwork that needed to get done. But while that was in the process, we were still able to collaborate on some levels, to not just put a pause on everything. So that’s, that’s first and then I think people are really quick to say, like, Oh, yeah, let’s collaborate, let’s collaborate. But tangibly, what does that mean? And having a system, so actually having a conversation with your partners and your stakeholders and, and to say, Okay, this is how you and I are going to work together, whether it’s going to be a referral based service, or whether it’s going to be someone that we ask for supplies when we need it for patients, or whether it’s going to be someone of a higher influence, a stakeholder with a higher influence that we need to share progressive information or budgetary information to, you know, we have to get a system down. Are we talking monthly? Are we talking weekly? Is this on Zoom? Is this a person? I mean, those small details are really important, because tangibly, that’s how you’re going to build the relationship. I think saying that we collaborate is nice and all, but that doesn’t mean anything operationally.

Tony Delisle  28:18

I’m so glad you’re saying that. Because when collaboration is put out there, it does sound wonderful, but it’s very vague. And in putting it into practice, again, even when people are wanting to collaborate and come together, what I hear you saying is time, time is that commodity to once we spend it, we don’t get it back, and how to allocate our time and prioritize our time. And the most of the time, if we’re saying yes to something, we’re saying no to other things. How do you best? Because I know you’re so busy. How do you navigate that resource of time allocation in order to collaborate?

Ariella Bak  29:00

I’m still learning I think, you know, I’m a yes person. We rarely say no. And in fact, I sent a no email this morning, we were asked to participate in a grant. And funding is always something that we’re looking for. But I have to always ask myself, you know, going back to our core mission, our core why, why we’re doing what we’re doing, is this opportunity, taking away from that or adding to it. And it’s more important than the people behind who’s asking that question. You have to put your organization first and the integrity of your organization what you stand for first. So those noes don’t feel good, but they’re necessary for moving forward and doing the good work that we’re doing. So I would say, I really just asked myself that, you know, what will this be taking away from and if we can afford to do it we certainly will and I think long term implications You know, are really important to consider as well.

Tony Delisle  30:03

I love how you bring it back to the mission and staying mission focused. And that’s why we have missions and visions to be able to keep our eye on the path and to, you know, have a North Star that’s going to take us there, because there’s so many other things that can distract us. And even if it’s on the path, there’s many things that can fast forward that walk along the path and which one is going to amplify that walk the best, and being able to balance that it’s an art, it really is. So you see many people in the community who are in need, and like you said, vulnerable, you know, from an anecdotal or even if you all are quantifying this and taking any kind of data, what would you say the percentage of people that have either a physical or mental impairment or whether it’s temporary or acute disability that they have, that they’re also navigating in terms of their daily lives?

Ariella Bak  30:57

Well, I mean, it depends how you want to justify that problem. If you’re including medical problems in that, then it’s everyone that we serve, everyone that we serve has some sort of physical impairment, mental, sometimes developmental, so everyone that we’re touching has some sort of barrier to their ability to function as productive members of society in some way. And we serve everyone from the homeless community, to it tenured University of Florida professor, because aging, you know, no one is immune to aging, and our homes tend to not age with us. So we have solutions for the gamut of problems that you come across, I would say the most difficult in working with that we have only recently begun to tackle is a substance abuse, and mental health, mental and behavioral health issues as well as the homeless community.

Tony Delisle  32:04

Given that you’re most of the people that you work with have a physical or mental diagnosis, disorder, disability, whatever it may be, what is the biggest, I would say challenge in keeping the people that you’re working with in a place that they can be independent in the community. So you’re working with people that are currently living in the community that and that’s what we want here, as Centers for Independent Living is for people with disabilities to live in the community in the least restrictive environment possible. What do you find to be one of the more pressing common or biggest issues related to keeping people living in the community independently?

Ariella Bak  32:46

That’s a really good question. I can’t say that I’ve ever been asked that before I, you know, about 20% of the needs that we see come from falls. And falls are an interesting topic, because they can physically impair someone to the point where they need to be put in some sort of assisted living facility or, or nursing home or rehab or something like that. So I would say that’s an issue that we take very seriously where we have systems in place and trainings in place to make sure that our staff are skilled in recognizing that as an issue and also able to come up with comprehensive solutions for that. And then I would say, beyond that it’s really been the mental health side as far as the challenge to keeping people safely in their homes. And firstly, we have to figure out and understand what is that person’s capacity for functioning? And does it allow for someone to just come in and assist, and if we can facilitate that, fantastic. And if you know, we need to go beyond that and get them some outpatient help, we can facilitate that. So there are some steps that go into it. And I would say, lastly, we’re looking at some long term solutions to get people help in facility type places. But it is rare where we see that happening. I think it’s happened probably three times in the six years that I’ve, almost six years that I’ve been with the city where we had to get someone into long term like skilled nursing facility type place.

Tony Delisle  34:27

And I bet it would be a whole lot more than that if you weren’t existing. And if you weren’t there to provide some of the resources to people that they would probably have to go into more restrictive, or institutionalized facilities, which, you know, from a humanistic perspective is less desirable. And from an economics perspective, it is many more times expensive to put someone in an institutionalized facility than it is to keep them in the community.

Ariella Bak  34:54

I do think though, that every individual is so different and we really have to weigh out is it possible to bring in resources and there’s a balance, right? Like if we’re bringing every resource possible to just keep someone in their home? Is it really worth it? Or do they need to start looking at those long-term options? And we’ve seen both sides.

Tony Delisle  35:16

Yeah. And and I agree there is a, you know, I want to say that I do believe there’s a need for assisted living facilities and skilled nursing homes, that they certainly have their place. And to whatever extent possible, if we can keep people in the community, that’s usually the more desirable humanistic economic kind of thing. But I think you’re absolutely right. What does that look like, you know, for for the individual, because some individuals may need a group home settings, some individuals may need, you know, home care workers that come in and out to keep them in the semi-community based setting. So I definitely see that overlap. And one of the biggest topics in issue areas that we have now is the COVID pandemic, is the fact that right now, as we speak, the statistics tell us that one out of three people that are dying from COVID come from institutionalized care facilities, that one in seven people that are in institutionalized care facilities have passed away due to COVID. That’s like 15% of the people in institutionalized care facilities have passed away from COVID. And that, you know, someone in an institutionalized care facility, every 69 seconds at this point, is passing away from COVID. So we see the impact that it’s having in this setting, and people that are not in institutionalized care facilities that have disabilities, and that right now today as the vaccines are being rolled out, are really wanting the vaccine and have to have a lot of barriers to it. So for example, we work with people that you know, have to go online to say register that don’t have screen readers and are legally blind like myself and can’t even register because the website isn’t accessible. Or if you know, it is accessible, I can’t get down there and register. Well, you know, I don’t have adequate transportation to get there, I might not have the social support or network that I would need in order to go there and be able to, you know, have someone, a patient advocate with me, so make sure that the communication of health related information is good, nor the accommodations requested, perhaps in place that would be needed in order to facilitate the vaccination, etc. So you are leading with others, a program that is going into the community to vaccinate people that have access issues, a homebound vaccination program. Currently, I haven’t heard of a lot of home based vaccination programs. I’m very interested to learn more about this one, because it seems to get around a lot of the issues related to access and functional needs that people with disabilities and others may have in terms of getting this vaccination. So please tell us more about what this home based vaccination program that you’re working with is all about.

Ariella Bak  38:09

Absolutely. And I will say, you know, the home based vaccines solve a component of the problem. But there are still barriers that we need to work on as a community to recognize that we need more comprehensive avenues to get people what they need. But so this is being done in partnership with the Department of Health. So they’re spearheading all of the vaccine dissemination in the county. And what we’re doing is once people have registered through their system, which is an online registry, they have nurses, I believe, or or some level of staffing, calling that people who have registered to make their appointments. And one of the questions that they ask them is, are you able to come to a physical location a clinic spot and get your vaccine? And if the answer is no, they get put on a separate list. That list then comes to me and to the other Fire Department locally. You know, we’re doing the homebound vaccines. So what we do then is we call and set a date for their vaccine. We’re also tracking their boosters. So we’ll go out and do their second one as well. We’ll do all of their paperwork while on the phone with them so that by the time that we get there, all the paramedic is doing is giving them the vaccine, waiting 15 minutes to ensure that there’s no adverse reaction, and then they’re going on their merry way. So the feedback that we’ve gotten from our community has been phenomenal. I mean, just last week, we vaccinated we fully vaccinated a 98 year old woman here in Gainesville. She was just amazing, but I think the stories that are coming out from this type of work I got a call last week from a UPS mail carrier. Who is talking about local hero? I mean, she is advocating for everybody on her route all of the elders on her route, saying, I need to register my whole route. How do I go about doing that? Well, and you know, we’re working with those connectors too, those community connectors to ensure that the people that she looks after are being cared for. And this is for those 65 and up, and their caretakers as well.

Tony Delisle  40:24

That’s fantastic. And so, you know, imagine you need some folks to be able to, to help do this program, who’s actually going into the homes doing these vaccinations as you’re going out and about, and what does that look like? Like, how are you able to, like, do what you’re doing?

Ariella Bak  40:40

So to get into the nitty gritty logistics, we have, it varies per day. So our minimum staffing is a one paramedic and one EMT. So it’s a two man team, they’re going out in a regular vehicle. So an SUV most of the time, a lot of times, it’s through our community paramedicine program. So they’re going in our CRP vehicle, like I said, we have those pre determined appointments, they just go and and do what they need to do. It’s usually myself, or one of my students, or one of my resource technicians calling to actually do the scheduling of the vaccine and filling out the paperwork necessary. And like I said, and we’re getting all of our supplies from the health department, we’re so grateful for their coordination, they’ve been really, really wonderful to work with. And that’s pretty much the team right there. Now, I will say it is a rotating group of paramedics. So I don’t have one paramedic doing the vaccines, it’s a group of them. So we’re giving them, they’ve been trained by the health department, we’re giving them internal training. And one team does 10 vaccines per day. So we can only get 10 doses out of one vial. And each vial has to be used within a certain amount of time when you open it. So that’s been the tricky part is my assumption prior to starting this was oh, well, you know, we can just take a paramedic and an EMT and work them from, you know, eight o’clock in the morning to six o’clock at night and get as many people as possible, well, then you factor in the waiting time and then you factor in the drive time and then you factor in, okay, you have to use all 10 doses. So it’s either we’re doing 10, or we’re doing 20. But we really can’t do anywhere in between logistically. So today, we have a really big day, we have three teams, so six people total, going out and giving the vaccine so we’re vaccinating 30 today, and I would consider that a really big day.

Tony Delisle  42:38

That’s huge. And when you look at each individual case, again, is a case where significant barriers exist to getting the vaccination likely or people that need it the most. And you’re going right there to them. And to this is a national issue. So as we’re speaking now, I think it was in this past week that I’m hearing big private entities getting together to address this issue. So I’ve heard of Walmart, partnering with Uber, to be able to get vaccinations to people who have transportation barriers, and I think it was, I believe it was CVS and Lyft, doing the same thing. So we have these multibillion dollar private entities coming together to address this issue, because it is so common and what you’re talking about, again, I haven’t heard of other entities doing what you’re doing. And partnering up, I’m sure there are. But I find this to be a very grass roots, again, public-private partnership, you know, that’s going on to be able to address this at this level. But again, these national billion dollar private businesses that are really trying to come together to address this, because so many people are addressing these access issues, I think underscores how widespread and rampid many people are facing the barriers to getting the vaccine are.

Ariella Bak  43:58

Well also, I mean, if you look at the evolution of the fire department, it only makes sense that we take on this role. And I can’t speak for fire departments everywhere. But I know certainly in the state of Florida, and even on a national level. There’s this understanding that paramedics and EMTs are going to be used for this this issue we otherwise in the past really haven’t been a part of this mass vaccination campaign. So we’re not unique in the fact that other fire departments are stepping up to fill the this need. But I haven’t seen so many departments doing this homebound mobility impaired program so.

Tony Delisle  44:40

Well on the outside looking in. I like your method versus say the corporate way of coming together to do it, which I support because it’s going to I think it’s on a scalability wide be able to perhaps reach more people. But I also know with Uber and Lyft, many of those drivers don’t receive the training necessary to work with vulnerable populations to communicate with them, especially with different types of disabilities. I’m also aware that many of the vehicles with Uber and Lyft aren’t accessible for people that might have wheelchairs need walkers and other kinds of things, I think most people would probably prefer a home based vaccination versus having to take transportation from an Uber or Lyft, which may or may not be accessible. And you don’t know if the person driving has been trained to work necessarily with you or can understand or have any other kind of barriers to communicating, and then even go into a place where Walmart and CVS might have very competent staff to be able to do that. But I certainly would rather turn to somebody that’s got more paramedic EMT training in their background to throw a shot in my arm. And again, you know, I’d rather have it at home than going out into a CVS to perhaps get it if I had the choice.

Ariella Bak  45:53

Yeah, I mean, I think there are pros and cons to each, you know, with us. Sometimes we’re only able to do 10 per day, and you’re talking about maybe even delaying the time that you would get it because of that and we’re relying on the supply from the state. So we have some pros and cons as well. And I think the most important thing coming out of this is the conversation about barriers to care. And it’s making companies, private companies rethink the way that they’re servicing their, their customers and their community. And that’s what’s important. We will all get this vaccine. And I know that there’s a lot of impatience, and you know, a lot of struggle before that happens. But the important thing is everybody is rethinking access and barriers to care.

Tony Delisle  46:43

And I guess that could be the silver lining to come out of this is that it really amplifies a lot of the issues before COVID that were out there. So yes, transportation was a barrier before COVID. And this just amplifies the issues, the access to Uber and Lyft seem to be a very big barrier before COVID. And so we saw Wow, we can maybe disrupt, you know, the transport disruption going on in transportation, which is a good disruption, right. So instead of flagging down a taxi on the sidewalk, you can just call and within a few minutes, have someone showing up. And that’s awesome. But for people that again, have wheelchairs or access issues, that’s not available, you know, to many people.

Ariella Bak  47:19

Or people who don’t have smartphones. Yeah, we work with, you know, the older adult population who don’t know how to work those technologies, nor are they willing to learn sometimes. And we work with the homeless community who doesn’t have the smartphone capabilities as well, or, you know, some people who just don’t even have the credit or the debit cards to put into able to pay that kind of system. And it’s so interesting that because I’ve seen these conversations evolve from, you know, working with systems like MV transport where you need cash. And it was so crazy to me, because in order to get the cash to pay that service, you have to go and find you have to be able to get the cash somewhere. So you need to be able to get to an ATM. From there, you had the Uber and Lyft concept. And we’re still not done, we’re still not done innovating in this space. But to me when you ask me about access to care, and what that means, it’s reshaping that conversation, where instead of people have to access us and our services here, we access them, we bring services to them. That is what access to care means, in my opinion, in today’s world.

Tony Delisle  48:34

Yeah, I like being playspace go to where the people are, where their needs are getting around most of those things. And yes, I hope this crisis, this pandemic, pushes us further down, breaking down those barriers, so maybe Uber and Lyft will look into, you know, how can we get our cars more accessible? How can we make sure that people themselves have the access to the technology or the finances, to be able to get around those barriers to get the transportation that they might need. I’m really glad you brought up.. yeah, go ahead.

Ariella Bak  49:02

Even things like incentivizing their drivers to take additional training. I mean, some people drive Uber as their primary job so just like a regular jobs, you know, a desk nine to five job or you’re incentivizing trainings and you’re always talking about professional development. How is that any different?

Tony Delisle  49:19

Right? Yeah, absolutely. So as you’re doing all of this, and you’re going out into the community, and you’re serving people that have all these access and barriers and functional needs, what are you seeing in terms of the response for people when you’re able to you know, get around those barriers you get around those access to get them actually the vaccine to them. What has it meant to them?

Ariella Bak  50:02

Oh my gosh, I mean, we’ve had people cry. We’ve had people try to donate money to the CRP program, which we don’t want them doing. I mean, the responses have been just incredible. And, again, it’s all about appealing to those hearts and minds. So we just collect those stories and, and hold them safe. Because that’s why we do what we do. I mean, sometimes, I’m kept on the phone by people while while I’m just trying to get their paperwork filled out for an extra 15 or 20 minutes, as they’re explaining how, how much that means and, and why they have so many barriers. And, you know, some people haven’t been able to see any family members in months. Yeah, yeah, since last March. And this vaccine is the first dose of freedom.

Tony Delisle  50:47

Wow, that’s priceless. So you’re, like, super inspired. You’re doing so much, you’re working so hard. Why? Why are you so driven to help people?

Ariella Bak  51:03

You’re gonna make me cry, um…

Tony Delisle  51:04

Lay it on me.

Ariella Bak  51:07

You know, I think that hard days always come. And it just comes down to like the community members that we’re serving individually. And these are people’s lives, that we’re able to change. You know, one of the first patients I ever worked with, we walked into her house. And a lot of the times I’m looking for some rapport building capability to be able to leverage. And I said, what do you want out of this? And her answer was, I want to see my daughter play basketball. And I said, boom, that’s what we’re going to hone in on. That’s what we’re going to lock in and work towards. It wasn’t to get you to the doctor’s appointment, it wasn’t to get you surgery, so you can walk again, she didn’t care. It was just to see her daughter play basketball. And my paramedic fought me. He said, and this is a good person, this is a good paramedic, one of our finest. He’s one of my close friends, but he fought me. And he said, that’s not what we’re here to do. We’re not here to get people to watch basketball tournaments. And, you know, in the moment, I didn’t really fight him. And what he saw was the evolution of a relationship where this person bought into a process, because she understood that we had this this common outcome. And she was able to see her daughter play in a basketball game. And, and this is, you know, we’re talking about uniting families, we’re talking about providing safe roofs over people’s head, we’re talking about getting them vaccine, so they can just go to the grocery store and get some sort of normalcy after a year of isolation. So yes, the hard days come, you know, in my position, right now, I work with a lot of bureaucracy. We’re doing contract negotiations for software systems and contract negotiations to expand the scope of what we’re able to do. And, you know, I personally have had a little bit of a life changing moment as I took on, essentially a patient’s kids that I’m now fostering, and there’s definitely bad days. And I think there’s always a silver lining, which is the lives that we change and holding on to those stories, you know, we have a running list of our success stories that we can look at at any time and say, Oh, my gosh, you know, this was a person who was sober for four months because of the care that we got them. So focusing on the positives is something that we we like to do, but you know, personally, for me, the system, the healthcare system that we have doesn’t work. We know that, right? The fee for service model, does not work. We have people using ERs in place of primary care, we have families who can’t afford to feed themselves can’t afford to feed their their babies. And it just goes, I want to change the system. I want to be a part of what is to come, I want to be a part of the innovation. I want to build a team that can do that. And more so, I mean, the personal development side is so important. So I’m constantly growing, I have to grow myself in order to grow my team in order to grow our patients. And it’s cyclical.

Tony Delisle  54:30

What is it that you’re working on yourself to grow so that you can be a better person to serve better?

Ariella Bak  54:35

Oh my gosh, so many different things. I think right now, my personal word for the year is perspective. I think that there’s always a silver lining I mean, this morning was honestly one of those days where everything that went wrong could have gone wrong. 

Tony Delisle  54:50

Monday is when we’re recording.

Ariella Bak  54:54

I mean, down to me spilling my drink on my computer this morning, which is ever happened. So I mean, I didn’t get my boys to school till 10 this morning, it was just one of those days.

Tony Delisle  55:04

Your boys being the two that you’re fostering because you went to a patient who wasn’t able to take care of them. They’re two one year old boys. Correct? Twins. Correct. They’re twins. You’re a saint. Alright, Ariella. Go ahead, go ahead. I don’t mean to interrupt you, go ahead.

Ariella Bak  55:19

It was one of those. It was one of those days where everything went wrong, that could go wrong, was going wrong. And I just asked myself, or I just told myself, it could have been worse. Could have been worse, right? I didn’t get into car accident. You know, I still got them to school, we’re still here at work. And, you know, holding that gratitude at the center of everything, because it’s something that I’m putting into practice. But yeah, perspective, focus is another big one of mine, I think, you know, going into being able to say no, and having to say no, that is something that’s been challenging in the past six months is there’s so much going on, you know, vaccines are just a quarter of what we’re doing right now. We have our telemedicine program, we just launched a recovery pilot, and just our normal, individualized chronic disease management program. So being able to focus and having that vision and being able to have a target and move towards it. So I mean, a lot goes into that between time management, giving myself grace, focusing on gratitude, and being a leader rather than, you know, just just someone who is a manager, I think is something that is always at the center of my day, you know, asking myself am I am I putting into practice what good leadership means.

Tony Delisle  56:41

And what I’m hearing for you is that good leadership means personal development as well. And in doing that personal development, it sounds like perspective and gratitudes. And focus and grace are some of those attributes that you’re really working to galvanize and, and how…

Ariella Bak  56:57

Yeah and to give you a tangible. I mean, when I was, I got involved with Gainesville Fire Rescue, and I was a sophomore in college, so I was about maybe 19 years old. And I knew that I wanted more. I was the only person in my friend group who was, you know, reading the David Goggins and listening to the podcasts, and I wanted so much more of it, but I didn’t have any mentors until I got to Gainesville Fire Rescue, and this department is full of leadership and full of wisdom. And when, when I started to lean into that, you know, what you focus on you find, I found a whole world of personal development that I didn’t have before. And it’s only now six years later, where we’re starting a, you know, a physical academy, Alexis is a part of that, your wife. And it’s been huge. So what I’ve implemented here, probably the past three years now is every single day, our team takes an hour out of our day, where we come together as a group, you know, there’s probably about six of us on an everyday basis. And we either pick a topic that is, you know, a topic for the week, that holds true to, or hold some relevance to the period of time that we’re going through, or I just pick a topic that, you know, I think the team could could benefit from. This is everything from looking into Tim Ferris’ streamlining activity from the four hour workweek, to, you know, we were just talking about consumption, and what is a mental diet and what are some, you know, restrictions are barriers that we should put to that and there’s always an activity in there. So you know, I challenged them to find a mentor and ask someone to be their mentor and produce more than they consume on social media, or whatever it may be for them. So I try to practice what I preach it be that mentor to the students that I so wish I had back when I was 19.

Tony Delisle  58:59

I really enjoy how you’re bringing up the David Goggins navy seal, who wrote it can’t hurt me who himself has a learning disability, and how he really worked overcome it and those kinds of things. Tim Ferriss is obviously a leader in the entrepreneurial, stoic kind of realm, the four hour workweek, and etc. And so I really appreciate how you’re sharing that you rely on those resources to sharpen your saw, and to go inward and see how you can develop better so that you can be a better leader and to share that with other people that come together and do those kinds of things. So I just wanted to call that out as I think we all need that type of resources in our lives. So always think about how we can be better just 1% better every day growing and there’s so much out there nowadays that we have access to as people that want to improve, that weren’t out there and is accessible 1020 years ago. And so, you know, for you, I’m really glad to hear that you’re doing that for the department and the Leadership Academy that you all have started over there, and it’s something that I really see as important for the Independent Living network to do as well is where can we find those resources that are out there that really teach us how to be a better version of ourselves. So we can help lift other people up that we work with. And then organizationally we can be better as well. So I just feel like all those layers stack on to one another.

Ariella Bak  1:00:21

Yeah. Well, you can’t give from an empty cup. Right, so so and that’s always a challenge that I posed to my my team is, how are you filling your cup today? And, you know, that is why personal development, that’s why we take an hour out of our day for personal development as a team because we place such a heavy importance on it.

Tony Delisle  1:00:43

And I love how that bucks that traditional model of just grind through it and you know, suck it up and these kinds of things. And it almost seems it’s counterintuitive, but if we take your just a moment to step back to ground ourselves come together, learn a little bit review, reflect, iterate, it almost like you become more productive by taking that time away to step away and reflect, is that what you’ve seen yourself? 

Ariella Bak  1:01:07

Oh, absolutely, absolutely. 

Tony Delisle  1:01:10

And someone like you who’s already booking and have limited time, and now you know, foster children that you’re working with, to take that time away, I think really calls to attention, why we should consider that as well. Again, time is such a finite resource and to box that time out, it’d be very difficult for us to do, but I think if we really prioritize that time it can get down we’ll find a way to be able to..

Ariella Bak  1:01:35

And there’s always there’s always a mechanism to do it. I mean, an hour a day might not work for every organization. But you know, something that we’re doing internally with the Leadership Academy is everyone reads a book, we’re all reading the same book depending on the level that you fall under, in in the organization. And Alexis who is running our leadership academy sends out weekly emails with takeaways and points for thought. And you know, we will host workshops I don’t know that the frequency but you know, it might be once a year might be every six months, whatever it may be, there’s always a mechanism even if it’s online.

Tony Delisle  1:02:16

Yeah, I found even the accessibility for me, legally blind. So I listened to a lot of auditory, you know, kind of things and whether it’s doing chores around the house, or there’s other kinds of things, I find myself I there’s ways to integrate things into our daily activities, even when we are box at a time, it just takes a little bit of creativity.

Ariella Bak  1:02:34

Everyone gets in the car every day, or you know, has headphones that they can put in or, you know, I took the boys on a on a walk yesterday for just 20 minutes to get out of the house and put in my air pods. And that was my personal development time while I was taking them on a walk.

Tony Delisle  1:02:52

So you said that you want to change systems, perhaps change the world? If you had the Ariella magic wand, and you got to wave it? What would that utopian world look like? What do you What are you working towards? What’s your vision?

Ariella Bak  1:03:06

I think, you know, we’re so far from complete equity. And that’s what I think what it would look like I mean, I think about my personal life, and even just what these kids have gone through, you know, I want safe homes where we don’t need foster systems, you know, you know, so everything, I think it comes down to education. Once we fix our education system, the health care system will will directly be impacted but when we shift the focus to this is what we’re doing because this is what we’ve always done to this is what we need to do because it’s good, it’s good for people. That’s where we’re going to see massive changes and and our health impact in our you know what comes out of our educational system in the economy. That’s where we’re going to see some worldwide changes.

Tony Delisle  1:04:03

Well Ariella, I really appreciate you taking your time out of your very busy schedule to talk to us about the importance in reaching people where they are, how to work with them, how to come together as organizations, how to address a lot of the access and functional needs specifically related to the biggest challenge that we face today, access to the COVID vaccination for some of our most vulnerable populations. And those key elements and attributes that are needed in order to be a better person. Thank you for sharing the ones that you’re embracing right now and that you’re working on and seeking to do better in and and thank you for your vision and and thank you for your just the fact that you you are taking on two one year old boys who you had no plan on taking them on, but then all of a sudden you come across a situation where they have nowhere to go and you take them on it just says so much about you. And I just wanted to acknowledge that, you know, with that inspiration that you have, the willingness to do the hard work, to have the perspective, to have the gratitude, to have the focus, to have the grace, we need more of Ariella, and I just want to acknowledge you I’m so glad that they you know, Gainesville Fire and Rescue being an innovative department has carved out a position for someone like you to be able to do the things that you’ve that you’ve expanded the program, that you’re so networked into this community that you’ve reached out for Centers for Independent Living, to collaborate, to bring resources in, and to really promote independent living within our community. Hats off to you, salute you. Thank you much so much, Ariella for coming on here and sharing your perspectives. And and how you do what you do. I think this can just benefit anyone who’s listening.

Ariella Bak  1:05:48

I hope so. And thank you so much, Tony, for having me. I mean, I personally on behalf of the program, it’s so grateful for your partnership. One thing I can say honestly, on air is we have never received a no from you and your organization. So you you lead an organization with a will to serve that is unlike many others that I’ve seen. So thank you for that.

Tony Delisle  1:06:11

Well, thank you for that statement. And I couldn’t do that without the staff who really.. I’m here to serve them. And so the fact that you haven’t got a no from us is a testament to them and their capacity to be able to do the things that they do. And so I appreciate you acknowledging them and everything that they’re doing. Just so phenomenal. They make me look good, I’m not doing anything. Well Ariella, I’ve tied up enough of your time you got to go put on your cape and go save the world. I look forward to having you back on again and checking in because I know you have some more wisdom and insights that can really help all of us to be the better person that we seek to be so that the community itself can be better. So.. 

Ariella Bak  1:06:59

I look forward to talking again.

Tony Delisle  1:07:01

We’re gonna do this we’ll continue the conversation and until that time, onward and upward.

Amy Feutz  1:07:28

Thanks for listening to the independent life podcast brought to you by the Center for Independent Living of North Central Florida. If you like what you hear, please rate review and subscribe. And if you know anyone who might benefit from listening, share this podcast and invite them to subscribe to for questions, suggestions, or if you have a story you’d like to share, please email us at or call us at 352-378-7474. Thanks for joining us. Until next time, support, advocate and empower each other to live the independent life.