‘Reflexive’ Telehealth Adoption Evolves As Senior Living Providers Learn Lessons

Covid-19 opened the telehealth floodgates in senior living and all signs point to the technology being here to stay.

Providers found telehealth platforms to be an important tool in their clinical programs. As the industry gradually brings the pandemic to heel, determining how and where to utilize telehealth in a “new normal” will require deliberation and strategy.

Most providers reflexively embraced telehealth in 2020 and created hybrid care models in the process. But results varied, depending on care acuity, and the lessons learned over the past year will inform future decisions on what to expect in telehealth implementation.

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These are among the main takeaways of a webinar Thursday hosted by the National Investment Center for Seniors Housing & Care (NIC), featuring leaders from Seacrest Village, Avera eCare and West Health.

Cost of health care grows

The long-term outlook for telehealth adoption in senior housing is much rosier than it was a year ago due to a confluence of trends, said Michael Kurliand, director of telehealth at West Health. The La Jolla, California-based nonprofit collective is dedicated to finding ways to lower health care costs and enable successful aging.

He noted that baby boomers are turning 65 at a rate of 10,000 per day through 2030, and the oldest boomers are turning 75 and that people are living longer, however with multiple chronic conditions that will need regular care in a long-term care setting. 

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The boomer demographic in need of more health care coincides with a shortage of clinicians, through the same time frame. The U.S. is expected to see a shortage of over 43,000 primary care physicians by 2030. Additionally, between 33,500 and 61,800 care specialists will be needed, as well as an unknown number of nurses. The ratio of unpaid caregivers is also decreasing, from seven for every one senior today, to four for every senior by 2030.

Moreover, Covid-19 added pressure to already growing health care bills. The U.S. has the most expensive health system in the world, and the average household is expected to spend $14,000 per year on health care by 2030. And half of households fear that a medical event can bankrupt them.

“Something’s got to give,” Kurliand said. “You have to look at alternatives.”

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Purpose-driven decisions

Telehealth can save senior housing providers money and man hours by reducing the need for emergency room visits, hospitalizations and re-hospitalizations, reduce lengths of stay in acute care settings, and be used to treat seniors in place, said Josh Hofmeyer, senior care officer with Avera eCare. The Sioux Falls, South Dakota-based company specializes in telehealth solutions for senior care, emergency care and intensive care units.

Telehealth can be used to fill gaps in care, allowing physicians and specialists to diagnose and treat patients, conduct psychiatry sessions, and prescribe and manage medications, for example.

But providers need to resist the temptation to bring in a telehealth system simply to have one. Hofmeyer stressed that telehealth platforms are not universal — even Avera eCare has various services that provide different benefits for clients. 

Providers strengthening their telehealth models need to identify gaps in care, then determine where telehealth can serve as a bridge. This is a lesson learned by Seacrest Village, a continuing care retirement community in Encinitas, California. 

Early in the pandemic, Seacrest relied on tablets to facilitate virtual communications between residents and their families, scheduling as many as 35 calls daily and hiring extra staff to handle requests, President and CEO Pam Ferris said.

Seacrest providers added telehealth visits a few months later, with varying degrees of success depending on care level. Seacrest Village’s memory care unit adapted quickly to telehealth visits, because it offered quick access to a doctor or nurse practitioner, the cohort is small at around 25 units, and residents did not have to wait for an appointment.

Telehealth visits in Seacrest Village’s health care center, by contrast, were marked by miscommunication regarding appointments and medication management, and physicians creating unscheduled visits, which took nurses and other staff away from their regular duties.

Telepsychiatry visits shared similar trends. Memory care residents seemed to respond well to the visits, while assisted living and skilled nursing residents did not take to the platform as well as they preferred face-to-face sessions.

Still, the positives outweighed the negatives. Ferris believes telehealth will have a future at Seacrest Village, and the community will look at where to implement it after it has stabilized in a post-pandemic environment.

“We want to evaluate how it worked in various operations, and what would be the best way to go forward,” she said.

Providers will find plenty of options to partner and collaborate with telehealth companies. Venture capital is flowing to the space: $1.7 billion in venture capital was earmarked for health-tech startups in 2018, Kurliand said. And restrictions on telehealth services relaxed last year by the Centers for Medicare & Medicaid Services (CMS) are expected to evolve this year, making it easier for rural communities, in particular, to leverage platforms in their care strategies. 

Covid-19 shattered the ceiling on Medicare telehealth usage. Pre-pandemic, only 0.1% of Medicare beneficiaries used telehealth. From mid-March through mid-October of 2020, that percentage skyrocketed to 39%.

Kurliand believes that providers and telehealth partners can capture even more reimbursements through new and creative partnerships.

“It’s time to rethink how you deliver care, because if we’ve seen anything this last year, it is better to be prepared and be reflexive,” he said.

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