Leslie “Red” Butler was reclining in her basement’s blue sofa bed, so her Yorkshire terrier named Whiskey was the first to greet the firefighter and paramedic.
For years, Colin McCann from Chesterfield County’s Fire and EMS department has visited Butler’s home in Bon Air. But Whiskey still barks at him every time.
“Traitor,” he said to the dog while bribing him with a treat to stay outside. Then McCann scurried inside, passing a hole at the bottom of the basement stairs where Butler’s head barreled through the wood panels several years ago. She had fallen down the stairs drunk.
That was back when Butler weighed about 300 pounds — and in the span of a year, called Chesterfield police and Fire and EMS dozens of times. It would take five or six firefighters or police officers to lift her off the ground, or get her to the restroom, or back into her bed.
“We would get her situated, pet Whiskey on our way out, and be gone,” McCann said.
Butler, 68, is part of an age wave in the county. Seniors, currently one-quarter of Chesterfield’s population, are projected to be one-third by 2030.
Butler is also one of many seniors who now prefer to age in the homes where they have typically lived for decades and raised their families, rather than move into an assisted living facility or downsize.
Two-thirds of the county’s households are now without schoolchildren.
By the time her head crashed through the basement wood panel, Butler’s second husband was gone. So was her government job and the U.S. Air Force, which she joined when she was 18 to rebel against her mother, who wanted to marry her off to a Philadelphia doctor. So were the motorcycle gatherings where her flaming red hair would fly from beneath her helmet.
“The louder I got, the redder it got,” she said.
She hadn’t talked to her son in 12 years after she “made a fool of herself” at his wedding, McCann said, though her son still lived in Chesterfield with his family. Once first responders picked her up from the floor, the brick house was quiet again. There was only Whiskey, and Gentleman Jack whiskey.
For many seniors aging in place, there are overburdened relatives, or none at all. There’s a lack of community and limited access to health care. The quiet homes fuel mental or physical ailments, and the 911 calls in Chesterfield have increased.
Emergency responders were facing unsustainable growth in call rates, officials said. Last year alone, the EMS calls increased by 2.82 percent, which is a decrease from previous rates.
Four years ago, Chesterfield Fire and EMS officials tried something new. They shifted four veteran firefighter/paramedics into a mobile integrated health unit that is focused on prevention, capitalizing on a push on the state level to drive down hospital readmission rates and make emergency services more proactive.
For about $120,000 from the Fire and EMS budget, people like McCann tend to the department’s repeat users, whose average age hovers in the late 60s.
“It disrupts the conventional way of how we look at the EMS system to make it more efficient,” said Dr. Allen Yee, the operational medical director for Chesterfield’s EMS division. “To our knowledge, this was the first one in Virginia with this focus. There are others across the country.”
A year after the unit was established, calls related to falls, abuse, resource needs, re-referrals and chronic disease management declined about 50 percent or more, compared with the previous year. Calls for hospice needs decreased 100 percent.
On any given week, three paramedics handle an average of 21 cases, though there are 104 cases active now.
McCann has sat through dental surgeries of a talented medical illustrator with dementia while in the process of reconnecting him with relatives in California. Along with adult protective services, he helped a woman let go of her late husband in a house brimming with mice and her husband’s things from the 1940s.
Within one day, the unit found a team of physicians for the elderly mother and aunt of a woman who paid $10,000 to have the women travel from Puerto Rico last year after Hurricane Maria.
Fire and EMS used to lift a man in his 40s with multiple sclerosis from the toilet daily, until McCann connected him with home care through Medicaid coverage that he didn’t realize he had.
When firefighters went to clean the last of the blood stains from an elderly woman’s carpet after her daughter had shot herself, they noticed she was showing signs of serious depression and anxiety. They contacted the integrated health unit, which helped place her in an assisted living facility.
For a month, the woman locked herself in her room. Firefighters hung up a motivational poster in her room encouraging her to get out of bed. She eventually left her room, and became known for shopping with friends along Midlothian Turnpike before passing away about a year ago.
Almost half of the people who are referred to the unit refuse services, but McCann tries to at least strike up a conversation while he’s checking their smoke detectors. He also checks to see if they need a shower rod or medical equipment that he can get through the unit’s connections to Goodwill or dozens of other agencies.
“We’re not dealing with a 20-minute fix. We can’t fix 30 years’ worth of problems in 20 minutes,” Yee said. “A social worker may have 20 or 30 people to see in a day. Colin can stay at a house for three hours.”
The unit is now expanding to respond to another troubling trend: the rise in opioid addictions, and deaths. A trained peer counselor who can connect with addicts with her own story of recovery rides with the unit 20 hours a week, now handling 45 cases of her own. The average age of those helped by this arm of the unit is 30.
“At first, we considered getting 5 percent of our addicts into rehab a success,” Yee said. But out of the overdoses, “we’ve been able to contact almost half. Of the half we contact, two-thirds have gone toward rehab services. We are usually connecting with people the day after they leave the hospital.”
They recently held a health fair in a community where overdose rates were high, and Fire and EMS Lt. Daniel Stamp and the peer counselor showed up at a local school to talk to a student whom paramedics had revived from an overdose not long before. The student agreed to keep talking with the peer counselor.
As Stamp and the peer counselor were leaving the meeting, the school guidance counselor ran after them, asking: “Who are you people?”
“I’m a fireman,” Stamp replied.
The guidance counselor pleaded with him to stay, saying there were three more students she wanted them to see. He said they would be back as soon as they could.
In the four years since its inception, the unit has handled 1,217 total cases. Butler was case No. 15.
“The irony is I’ve never had a DUI. I would have two or three drinks and stop, but then I’d go to the liquor store. And come home, and just drink, drink, drink,” she said. If she didn’t show up to the local ABC store after a couple of days, the manager would call emergency services worried about her.
“I finally figured out that I was a functional alcoholic,” she said.
McCann chimes in: “I told you that.”
“You told me that? Well, I don’t know,” Butler shouts. “Don’t ask me what I had for breakfast today.” Then she adds: “If it were not for him, I would still be drunk and on the floor.”
She once asked McCann: What would it matter if she died? No one would bat an eye.
McCann told her he would, that he wouldn’t want his mother living this way. She grumbled back at him, and would usually flick him a middle finger.
But he kept coming back. He showed her pictures from his days in the U.S. Marine Corps, his new wife, and his four kids. She talked about her father’s hospitalization when she was a teenager and how she found the keys to the liquor closet. About the tattoo of a bass on her arm because her second husband was a bass fisherman, and her first husband whom she refers to only as “A.H.”
McCann called her son, asking him for any advice he could give. McCann told Butler’s son that his mother hadn’t had a drink in 30 days, something the son said never happened during his childhood.
Now, Butler is two years sober, and her son has stopped drinking as well. She goes to the gym three or four days a week with her personal trainer, who has helped her lose more than 100 pounds. He has introduced her to all of his girlfriends when they go out for dinner, she said.
This past week she dropped off sidewalk chalk for her grandchildren, and she occasionally goes to brunch with her son and his wife. She has called 911 just twice in the past two years.
“I intend to wear out, not rust out. I can very easily become very sedentary. And I thought, ‘No, that isn’t going to work,’” she said.
One day last week, Stamp, the Fire and EMS lieutenant, broke off from McCann to drive up and down Turner Road in search of a 73-year-old homeless Vietnam veteran who has a beard like Santa Claus.
Using the name and birth date that firefighters managed to get from the man a week earlier, Stamp learned that he is qualified for a number of benefits from the Veterans Administration that would give him more than enough for rent and food. The man used to attend church every Sunday, and have a job, and go by a different name. Something happened to him, something has happened in his mind, Stamp kept repeating.
Standing at her gate, Stamp asked Butler to keep a lookout for the man. She promised to call if she saw him. Then she walked with her cane back into the basement, telling McCann she’d see him tomorrow.