Telemedicine in Senior Living Centers

Telemedicine in Senior Living Centers 

Telemedicine is the practice of providing patient care remotely. This is typically done through phone consultation or video conferencing.  Numerous advances in technology allow telemedicine to be conducted following HIPPA guidelines.   Currently, many platforms are available.  These range from simple video-conferencing platforms to those that combine video-conferencing and remote monitoring technologies.  In addition to patient and provider uses, telemedicine is also being used to provide communication among providers at different levels of care, such as a PCP to a hospital or a specialist.  

This technology can bridge gaps in care for those patients in senior living communities.   Typically, these older adults seek care for illness and related medical concerns more often than seniors residing in their home settings. Research indicates that older adults use medical services four times more frequently than do younger adults. However, there are many barriers in obtaining this care.   One hurdle is the lack of same day appointments with primary care physicians (PCPs).  This may be the result of a shortage of PCPs and Geriatricians.   Another barrier is transportation.  Many of these adults do not drive and/or are not able to navigate the public transit system.  For some, the cost of public transit is prohibitive, while others may have impairments which prevent them from being able to use public transportation.  These may be cognitive or physical (Shah, McDermott, Gillespie, Philbrick and Nelson, 2013).  

High-intensity telemedicine is a way to provide older adults with the services they need in a timely manner.  These systems allow providers to perform complete exams remotely and have been successfully used for pediatric populations.  Telemedicine has proven to be a feasible, acceptable, and effective treatment option.  This approach has also been effective in nursing home situations (Shah, McDermott, Gillespie, Philbrick and Nelson, 2013). 

 Veterans Affairs / Oklahoma conducted an informative pilot study using high-intensity telemedicine with rural residents suffering complex medical histories and mental illness. The program allowed the VA to provide care to Veterans who would not have otherwise qualified for home-based care since they lived outside the service area.  Participants in this VA study showed improvements in physical strength, improvements in occupational therapy evaluations, improved social function, as well as increased compliance with their treatment plans. One participant showed marked improvement in his A1C measurements.  In addition, he reported feeling more accountable for his own care as a result of daily monitoring and data transmission. Findings also indicated decreased caregiver burnout.  Telemedicine not only provides opportunities for access to care, but it can also allow older adults more control in managing their own health (Sorocco, Qureshi, Bratkovich, Wingo, and Mason, 2013). 

Cost-Benefit

The average cost of a telemedicine visit is estimated to be $40 - $50 per visit, while the average cost of an office visit is about $136 - $176. Research indicates that the patient’s issue can be successfully treated via telehealth 83% of the time.  It is estimated that telemedicine visits save an average of $126 for commercial insurance carriers.  Interestingly, Medicare programs reimburse telehealth visits at the same rate as in-person visits, but have been shown to still provide a $45/visit saving for Medicare overall.  

Telemedicine also allows better access to care beyond traditional office hours.   For example, many practitioners offer this service on weekends and after hours.  It has also positively impacted the use of alternative sites of care.  One study indicated that for every 100 patients using telehealth:

●      5.6% would have gone to an emergency room;

●       45.85% would have visited urgent care;

●       30.9% would have gone to their PCP office,

●       5.4% would have visited other clinics,

●        12.3% would have done nothing to treat their acute problem.

Using telehealth services instead of alternate care sites such as the ER and Urgent care has been shown to provide cost saving.  Estimated saving per visit by site, depending on type of insurance, include the following:

Site of Care                             Commercial                Medicare

ER                                            $1595                          $943

Urgent Care                               116                              98

PCP                                                98                              83

Other Clinics                                 57                              83

While “doing nothing” did not have an associated cost, it could lead to the subsequent need of reaching out to one of the alternative care sites as a result of a worsening condition.  Potentially, this could lead to needing a higher level of care or extended hospitalization.  (Yamamoto, 2014). 

Concluding Comments

Telemedicine visits remove many barriers to care, such as lack of transportation.  It also decreases Caregiver stress in trying to get patients to appointments.  Telemedicine may also improve overall care, especially when patients would otherwise seek care in emergency rooms or urgent care centers. Typically, emergency/urgent care providers do not have access to patients’ health histories, medications and baseline status (Shah, McDermott, Gillespie, Philbrick and Nelson, 2013). This could lead to inadvertently prescribing medications or treatment that may have an adverse effect on the patient.  

The initial cost of equipment and software is of concern and varies significantly depending upon what vendor is used.  However, studies suggest that start-up costs could be made up in four years of implementation.  There are also some administrative costs involved, such as program managers and schedulers.  Another concern, as noted in the VA study was lack of integration between the technology and the EMR.   However, it is becoming more common for telemedicine to be integrated into EMRs.

References

Shah, M. N., McDermott, R., Gillespie, S. M., Phillbrick, E. B., & Nelson, D. (2013). Potential of telemedicine to provide acute medical care for adults in senior living communities. Society for Academic Emergency Medicine, 20(2), 162-168. https//doi.org/10.111/acem.12075

Sorocco, K. H., Qureshi, S. M., Bratkovich, K. L., & Mason, P. J. (2013). Integrating care coordination home telehealth and home-based primary care in rural Oklahoma: A pilot study. Psychological Services, 10(3), 350-352. https://doi.org/10.1037/a0032785

Yamamoto, D. H. (2014, December). Assessment of the feasibility and cost of replacing in-person care with acute care telehealth services.

About the Author

Chandra Garcia, RN, BSN, CEN is an Emergency Room nurse with 25 years’ nursing experience – 20 years of which were served in the ER.  Currently, she is Director of a Level 1 Trauma Center Emergency Department in Northern Virginia. In addition, she is completing her M.H.A. degree at Saint Joseph’s College / Maine.