Long Term Care Tele health visits – The new normal?

Older adults who live in nursing homes or long-term care (LTC) facilities are at the greatest direct risk of contracting the new coronavirus and having severe symptoms. To combat this threat, LTCs have enforced extreme social distancing measures, such as banning or limiting visitors and eliminating group recreational activities and congregate dining.

With the onset of COVID-19,  CMS policy changes during the COVID-19 pandemic have reduced barriers to telehealth access and have promoted the use of telehealth to deliver acute, chronic, primary and specialty care including as a way to provide non-emergent care to residents in long-term care facilities.

The goal of Tele health is to make healthcare accessible to people as well as maintaining COVID distancing best practices.  While Tele health is beneficial to many, there is question of using it for physician visits with nursing home residents.

EXPANSION OF TELEHEALTH WITH 1135 WAIVER:  Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, are able to offer telehealth to their patients using common and easy-to-use videoconferencing platforms (such as Zoom Video, Skype and Facetime), via the client’s own computer or smartphone or a facility-provided device for physician visits. 

While I applaud the effort to expand Tele health to the LTC elderly population, this will be extremely challenging as most residents do not have their own personal devices such as a computer or smartphone or know how to use these devices. They will be more dependent upon staff for assistance in facilitating services and by managing the technology onsite at the nursing home.

Facility visits will require the input of facility nurses on a facility-provided device for appropriate facts to the evaluating medical staff as well.  In my experience, when accompanying my parent to a physician appointment,  my elderly dad would forget important details or downplay symptoms or issues to the doctor when seen. This may lead to missed diagnoses or care.

While telehealth has the potential for better-coordinated care, it also runs the risk of fragmenting health care. What does this mean for the accuracy of healthcare assessments for nursing home residents?

https://www.cms.gov/files/document/covid-19-nursing-home-telehealth-toolkit.pdf

https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html

            Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic

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