For most of history, the ability to age in place was the norm. Multigenerational families would either live together under one roof or in close proximity. Grandparents would help take care of their grandchildren while their children looked after whatever needs their parents could not fulfill for themselves. Two significant occurrences changed this way of life: medical technology that enabled people to live longer lives and the replacement of extended families with the nuclear family.
These factors ultimately led to the need for older people to fend for themselves in their so-called golden years. If they could not, they were often placed in nursing homes, assisted living communities or other long-term care (LTC) facilities. However, this does not mean older people are ready to go willingly—or quietly. When surveyed, most would prefer to age in place, i.e., in their own homes or with family members, for as long as possible.
In prior years, achieving this goal would have been difficult. Too much can happen too fast to enable many older people—especially those who are most vulnerable to illness, chronic conditions or injury—to remain at home. However, new developments in remote patient monitoring (RPM) technology and reimbursement strategies for those technologies from government and commercial health plans, are beginning to change this calculus.
The advent of affordable, easy-to-deploy and easy-to-use telehealth and remote patient monitoring technology has been a game changer for those who want to continue living safely in their community. These technologies enable older people to create a direct connection to their healthcare professionals on-demand via voice or video plus voice. They also enable healthcare providers (especially hospitals and health systems) to collect health data from their patients each day without the logistical challenges and disruption of an office visit.
Rather than relying on static snapshots of health data such as weight, blood pressure, pulse oximetry, blood glucose level, etc., that could be days, weeks or even months old, telehealth and RPM ensure providers are always looking at the current state of their patients’ health. Artificial intelligence (AI) and machine learning (ML) can then be applied to analyze this data, spot developing trends and bring them to the attention of healthcare professionals so interventions (if needed) can be applied earlier, reducing the risk of a costly and disruptive visit to the emergency department (ED) or inpatient stay. Taking advantage of these early warning signs helps providers deliver better health outcomes while meeting Centers for Medicare and Medicaid Services (CMS) requirements for value-based care programs.
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A person with diabetes, hypertension and asthma begins to present more frequently at the ED with health issues related to one of those three conditions, but not always the same condition. An analytic review of their prescription refill history indicates they are not taking all of their medications as prescribed. A telehealth contact or automated reminder via remote patient monitoring can remind them to take their medications and then confirm that they have been taken. RPM can show when blood pressure or blood glucose levels rise or lower so a direct intervention can occur.
Similar to the previous example, some patients simply may not remember that they need to take certain medications. Conversely, they may not remember they have already taken their medications and may take a second dose. Telehealth and remote patient monitoring can provide regular reminders to build a routine and monitor their conditions to ensure those instructions are being followed.
A patient is diagnosed with chronic heart failure. His or her health is brought back under control, but there is a risk of recurrence. Rather than discharging the patient to a skilled nursing facility or recommending a permanent move to a nursing home, the patient is enrolled in a telehealth program so his or her physicians can ensure that the post-acute treatment regimen is properly managing the condition(s).
Since much of the care TRU delivers occurs in the home through nurse visits due to the severe nature of the patient’s condition, the organization realized it needed to find a different way to serve its populations. Telehealth and RPM seemed like the ideal solution. They needed a robust platform that could offer more than just a video call. It had to have an educational function, the ability to monitor patients’ conditions day-to-day and an interactive component that enables clinicians to interact with patients and discuss their needs in real time. In addition, the solution needed to use standard, off-the-shelf tablets and biometric monitoring equipment that could be acquired and deployed quickly.
The tablets make it easier for nurses to serve their patients without increasing the risk of bringing the Coronavirus in or carrying it out and spreading it to a larger area. It also reduces the need to use personal protective equipment which continues to be in short supply.
While much of the focus was placed on the use of the telehealth platform by clinicians, it also had a profound effect on patients and their attitudes during these troubling times.
“COVID-19 had a significant impact on the communities we serve,” said Chad Hartmann, director of access and palliative services at TRU Community Care. “Not just the health effects of the virus but the uncertainties and the isolation that came from the quarantining that went with it. People felt more connected to the outside world because they knew someone was keeping an eye on them all the time, and that they could reach someone if needed at the touch of a button. For some patients we were their primary connection to other people, so we were serving a higher purpose than just pure healthcare. We really helped many of them deal with the whole pandemic more effectively.”
Many of the patients on the telehealth platform do daily check-ins and pathways. Others, who have less severe needs, only use the platform once or twice per week. It all depends on their acuity, Hartmann shared.
On the hospice side, the connected care team typically checks in on the days nurses do not make home visits. Ultimately, however, the timing can be customized to whatever is needed.
In terms of specific actions, the registered nursing staff has assessed the answers to nearly 66,000 care pathway questions and responded immediately to 4,500+ patient alerts when a patient’s care pathway has fallen outside a predetermined threshold. In addition, its RN staff has conducted close to 22,500 minutes of telehealth virtual visits. When that time is added to the hours (and dollars) of travel time saved by the nursing staff, the difference is remarkable.
“In a typical day, when our RNs were going to patients’ homes, they were able to complete five visits per day maximum,” said Hartmann. “With telecare they can see eight or nine patients per day with zero loss of quality.”
Having this connected care capability is also proving to be a differentiator for TRU in a very competitive market.
Many hospitals and health systems have recognized the preference to age in place among older people. As a result, they have started their own home care programs to enable even those patients with serious conditions, whether acute or chronic, and whether singular or comorbid, to return to their homes rather than automatically be moved to a nursing home or other LTC facility.
Telehealth and remote patient monitoring can help fill those gaps between home health visits. By engaging patients, taking daily biometric readings and symptomology and assessment questions, hospitals and health systems can receive early warning that a patient’s condition may be getting worse. They can then decide how to manage the potential incident—phone or video call with the patient to gather more information, redirect a home health worker for a more in-depth risk assessment (especially if tests outside the routine are required), an in-person visit to the patient’s primary care physician or an immediate trip to an acute/urgent care clinic or ED.
No group of patients can benefit from remote care more than older people. In the U.S., they overwhelmingly account for the highest volume of chronic comorbid conditions and for more than half of the U.S. spend on healthcare. The need to monitor these conditions closely has led to many of them being placed in nursing homes and other long-term care facilities when they were otherwise capable of living on their own.
By making broader use of telehealth and RPM, hospitals and health systems can give older people the thing they desire most—the ability to age in place—for a far longer period of time.
The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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