By Michelle Seitzer
Telehealth. What is it all about? What does it really mean and how can it help older adults and caregivers?
The Center for Connected Health Policy defines it as “a broad variety of technologies and tactics to deliver virtual medical, health, and education services."
Preserving independence is one of the hallmarks of successful aging, and telehealth (also referred to as telemedicine) certainly fosters the ability to manage healthcare at home. This is a victory for older adults and their caregivers, easing the burden on those providing long-distance and even day-to-day support. Let's learn more about this evolving branch of medicine from several in-the-field experts:
Reaching Rural Populations
One of the most underserved and hard-to-reach senior populations are those with a rural address, especially when driving becomes difficult or even impossible. Public transport options are limited, and because of their distance from healthcare providers, a family member who offers to drive will have to devote a greater portion of their day to account for longer travel times to and from the doctor's office.
Travel time is only part of the commitment.
“Older adults are higher users of healthcare in general, so they tend to spend more time traveling and waiting to see their doctor," says Brandon Welch, PhD from Doxy.me, a free, HIPAA compliant telemedicine platform. “Telemedicine is useful because it reduces the amount of travel and waiting in clinics to see their doctor. Now for many visits, it can be done from the convenience of their own home."
While ride sharing apps like Lyft and Uber have become a popular option for older adults no longer able to drive, it just hasn't reached rural areas, says Dr. Laura Walker, Executive Director of the Envision Research Institute (ERI) in Wichita. Walker has been involved in groundbreaking work at ERI—with telerehabilitation, particularly focused on serving patients with low-vision in their homes, among her projects.
Telehealth Services: What's Out There?
Generally, there are two types of telemedicine companies, according to Brandon Welch. Some provide patients with direct access to doctors (e.g. a service from GreatCall called Urgent Care). "These doctors generally don't know the patient's health history and are best suited for episodic care," he says. "Then there are telemedicine technology companies [like Doxy.me, mentioned above] that provide technology for traditional doctors to add telemedicine capabilities to their practice for their patients."
In rural northern California—a remote area bounded by redwood forests, the ocean, rivers, and mountains—Dr. Michael Fratkin is doing innovative work around palliative care. As many with life-altering illnesses from this region would have to travel two hours or more (one way) to seek medical attention, ResolutionCare was created—using video conferencing and a home-based care approach to bring palliative care to rural residents.
Though Dr. Laura Walker's work on telerehabilitation is still emerging, much of her ERI team's research is demonstrating the importance of follow-up and further support for discharged patients who are given visual aids, like a magnifier, to use at home. Also effective: home visits from COTAs (certified occupational therapy assistants) to assess the safety of the home and to facilitate profound changes, like better lighting, and simpler ones, like tactile cues or moving the stove to a more visible location.
Breaking Down the Telehealth Barriers
In a feasibility study conducted by the Envision Research Institute, Dr. Laura Walker and her colleagues were surprised to discover how many seniors did not have WiFi at home—a major roadblock on the path to providing more telehealth services.
Another obstacle? Walker has heard colleagues in the field talk about challenges in billing. In many cases, insurance providers require human-to-human contact in order to bill for services. While telehealth offers a live connection—say, via a real-time, face-to-face conversation on Skype or FaceTime—it does not offer that contact. And when a functional assessment is required, that in-person home visit with an occupational therapist, for example, is critical. Developing the capacity to deliver hands-on services—as part of a telehealth care plan—is yet another barrier.
"Currently, relatively few healthcare providers have embraced telemedicine," says Brandon Welch. "Because it's relatively new, doctors are still dealing with government mandated electronic health records (EHR) updates. Also, a lot of telemedicine technology can be complicated and expensive to use, which can scare people away."
Dr. Mark Seraly has seen one area of telemedicine taking off, especially among older, rural patients: teledermatology. "Many practices offer it because photos taken on cell phones or through computers are the best quality they've ever been, and because dermatologists are trained using photographs," he says. "Patients are willing to pay because of the time savings and the route to faster care—and insurers seeing cost benefits of telemedicine are beginning to cover it."
While there are still barriers to using it fully, the future of telehealth is bright.
Dig deeper: Read about exciting developments in rehabilitation using today's technology.
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