The Wilton Ambulance Service could receive hundreds of thousands of dollars from the federal government to launch a mobile integrated health program. It would enable first responders to provide at-home care to address the needs of high-volume callers, especially those with recurrent falls and lift assists, said Ambulance Chief Danielle Gardiner.
The need for it is great, according to a report that analyzed 911 calls in Wilton, Lyndeborough and Greenfield, but members of the Wilton Select Board said they’re hesitant to pilot a new program with no guarantee of funding past the first year. They shared concerns about the town’s role in providing this care compared to when a hospital, like Monadnock Community Hospital’s mobile integrated health (MIH) program, provides it.
Chair Tom Schultz said he’s concerned about the unreliability of federal funding.
“Then we’re going to be in a situation where we’ve established a program, established we have a need,” he said. “We’re going to start providing a care level, and then it’s going to be stripped away because this town is not going to be able to fund it.”
Gardiner argued a first-year contract will give the board more information and will not force the town to continue the program if it’s not sustainable. She also said if the program works, it would let Wilton and surrounding towns allocate resources accordingly, allowing emergency services to respond to emergencies while helping the aging population get the services they need.
“If you miss appointments and you have chronic illnesses, then you have poor chronic disease management, which leads to exacerbation of conditions, which leads to a 911 call,” Gardiner said. “So if we can stop it right where it starts … and help with that chronic disease management in their home, they get to stay home longer, they get to live a healthier life.”
‘If we can somehow intervene’
A small portion of the combined populations of Wilton, Lyndeborough and Greenfield resort to calling 911 for non-emergency care, according to the Paramedic Utilization and Local Services Evaluation (PULSE) report by the Wilton Ambulance Service.
Using 2025 calendar-year data, Wilton Ambulance screened 577 calls to find a high volume of non-urgent requests among the aging population across the three towns, straining emergency response resources. Mobility-related issues like falls and lift assists were the most common non-urgent calls in 2025.
More than 50% of all patients who called 911 had their condition initially classified as not immediately life-threatening, with only seven percent of patients classified at the highest level of emergency, including cardiac arrest or severe trauma.
The report also noted 35 high-volume callers, patients who called three or more times in 2025. These 35 patients accounted for 162 calls, with one patient calling 10 times in one year and others calling up to eight times.
Falls and lift assistance were the top reason for non-urgent calls, with breathing problems and diabetic problems following. In 2025, 88 patients reported at least one fall or lift assist, with 198 calls in total.
Of those, 20 patients accounted for 115 calls. A little over half of these calls did not result in transport.
“If we stop the fall, or if we can somehow intervene beforehand, that domino doesn’t fall and these people get to live longer and independent in their home,” Gardiner said.
How the program works
Gardiner and her team framed the first year of the proposed MIH program to address the needs of high-volume callers, especially those with recurrent falls and lift assists.
In partnership with St. Joseph Medical Resource Hospital and Medical Director Dr. Kimberly Ohman, the MIH service will offer at-home care sign-ups.
In the first year, they plan to establish “multidisciplinary education” opportunities to address the issues highlighted in the report, including medication reconciliation, chronic diseases and wound care as well as follow-up and home-based care. With the leadership of Dr. Ohman, the MIH program will develop clinical protocols, documentation standards, escalation procedures, competency requirements and continuous quality improvement processes, according to the grant application.
Additionally, the application states the first year includes a plan to establish referral options with municipal, healthcare and community partners, including the Community Volunteer Transportation Company, Meals on Wheels of Hillsborough County and the Open Cupboard Food Pantry.
Once the program is established, it will have a public-facing website and intake portal, with the goal of making initial contact within 48 hours. Fifty patients are expected to complete an intake assessment and enroll, with the goal of adding 150 residents through organized blood pressure screening events.
The program will provide 40 hours of paramedicine coverage each week during traditional business hours, since the report shows most non-urgent calls come between 10 a.m. and 1 p.m.
Who will pay?
Wilton was selected for the grant earlier this month but has no formal contract or approval from the Wilton Select Board yet. The money comes from the Rural Health Transformation Program, enacted last year in the One Big Beautiful Bill. New Hampshire was awarded $204 million, which is being managed by the governor’s office.
The proposed grant spans five years and requires one-year approval. The grant would provide $485,633 to fund the program for one year.
At a summer meeting, when the opportunity for MIH grant funding was presented on short notice, the select board approved the application while citing reservations about the funding.
Select Board Member Frank Edelblut requested numbers on expected patient volume and reimbursement rates for each.
“I had said very clearly, if I don’t have a sustainability plan, then I’m not gonna vote in favor of it,” said Edelblut.
Gardiner clarified because the MIH program does not transport, she cannot bill private insurance companies, Medicare or Medicaid directly for at-home care.
Gardiner said other, more complicated ways to pay for this service exist, but they do not always provide reliable reimbursement. She said she had set aside money in the grant application to pay an expert to explore options.
“If this cost the taxpayers a penny, we’ve failed,” Gardiner said to the select board.
While New Hampshire received the most federal funding for rural healthcare among New England states, that could change depending on how the federal government assesses first-year progress, as reported by the New Hampshire Bulletin. If the federal government finds that New Hampshire has not distributed money effectively, it will cut the funding.
Schultz described the grant for MIH programs as a “federal Band-Aid.” The federal government will cut Medicaid funding by $2.3 billion over the next decade in New Hampshire, he said, referencing a study by KFF, a national health policy non-profit.
“I don’t see the value of starting up a program like this to start providing this level of care, just to offset the fact that the hospitals are all closing or downsizing because the federal government stripped away their budget,” Schultz said.
At the Oct. 19 meeting, the board voted to let Gardiner continue the application process to gather more information, but it did not promise to sign the contracts. Board members Kermit Williams and Edelblut approved the continuation, while Schultz voted against it.
The board will take the matter up again at its Nov. 2 meeting.