Telehealth expansion has been supported by many healthcare and government leaders in the post-pandemic world, including President Biden, as a way to ensure everyone has access to coverage and essential health services.

However, adding broadband access to rural or underserved communities may not be a silver bullet that enables telehealth use in those areas, a new study shows.

This means that long-term care providers, particularly those in rural areas, need to make sure that digital literacy training and cultural factors are in place for telehealth use.

Study authors were most concerned with policymakers and whether they were viewing telehealth issues too narrowly.

While the study, which looked at 170,000 Wisconsin Medicaid beneficiaries, supported the idea that telehealth helped remove geographical barriers to important healthcare services, the researchers concluded that actual telehealth use is separated by what they termed the “digital divide.” This includes a mix of factors including age, ethnicity and tech literacy.

“Although telehealth expansion has been touted as a low threshold policy intervention to expand access to care,” the study authors wrote, “leveraging telehealth to improve access for underserved populations will require more nuanced attention to the specific mechanisms linking telehealth and health care utilization to avoid inadvertently deepening disparities for select populations.”

After the pandemic, those who adopted telehealth skewed older, urban and female, the study found. While the researchers held back on making a definitive conclusion for why this cohort would be more amenable to telehealth use, they speculated that it was broadly due to better knowledge and trust in the healthcare system. The study showed greater telehealth use for lower-income and education individuals — but only for audio-only interventions, which are only a small fraction of telehealth care.

While seniors are often slower to adopt new technology, it is not the older adults themselves who are hesitant to use telehealth, but rather clinicians who worry that telehealth visits are insufficient to address more complex medical needs, McKnight’s reported last year.

Lauren Lapointe-Shaw, MD, PhD, from University Health Network in Toronto, and colleagues investigated whether there was a difference in subsequent emergency department use between patients who had a virtual visit with their own family physician versus those who had virtual visits with an outside physician. The analysis included 5.2 million individuals with a family physician and virtual visit (April 1, 2021, to March 31, 2022).

The researchers found that when propensity score matching those with a personal versus outside physician, those who saw an outside physician were 66% more likely to visit an emergency department within seven days of the virtual visit versus those who virtually saw their own physician (3.3 versus 2.0%; risk difference, 1.3%; relative risk, 1.66). The risk was even greater for patients with definite direct-to-consumer telemedicine visits versus patients with own physician visits (risk difference, 4.1%; relative risk, 2.99).

“These findings suggest that primary care virtual visits may be best used within an existing clinical relationship,” the authors write.

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Many healthcare organizations, including skilled nursing facilities, and also senior living communities, have touted interoperability as a major goal, and now a national framework exists to help them achieve it.

The Trusted Exchange Framework and Common Agreement, or TEFCA, went live this week. It was a project seven years in the making.

The TEFCA framework, which was first mandated by the 21st Century Cures Act in 2016, is intended to help facilitate the exchange of health information between various systems. 

Five organizations were designated “qualified health information networks” that will support data exchange under the TEFCA umbrella: eHealth Exchange, Epic Nexus, Health Gorilla, KONZA and MedAllies.

For senior living and care operators, such a framework can help guide how residents’ health data are accessed, either via electronic health records or monitoring apps. 

A slate of new health technologies depend on access to these data, either because more older adults are using telemedicine or because new tools can use health metrics to help prevent falls or other health emergencies.

The Department of Health and Human Services announced TEFCA going operational on Tuesday.

“After over a decade of very hard work, today marks another major milestone in our march towards a 21st-century digital healthcare system,” HHS Secretary Xavier Becerra said in a statement. “TEFCA allows patients, providers, public health professionals, health insurers and other healthcare stakeholders to safely and securely share information critical to the health of our country and all of our people.”

Interoperability remains a challenge for skilled nursing providers, as administrators have expressed a willingness to change and innovate, but progress remains slow and there is often a frustrating communication gap between different healthcare settings, McKnight’s Long-Term Care News reported over the fall.

The two-page outline for the TEFCA agreement can be found here.

Advance-care planning, or ACP, is crucial for residents of long-term care facilities and communities, and digital technology now is a crucial element for ACP, a new report shows.

ACP is defined by the study as “the process by which individuals learn, decide and share their quality of life priorities, health goals and future medical treatment preferences.”

Senior living and care providers are looking into ways to foster more discussions about ACP with residents, as the actual number of individuals who have a plan, or have talked about one, remains low, the McKnight’s Clinical Daily recently reported.

This fact is despite evidence that ACP can help lower costs and, more importantly, lead to more comfort-based end-of-life care for diseases such as cancer. 

Using digital tools to help generate an advance-care plan, however, “reduces barriers” to fostering a discussion and makes it easier for family members and healthcare providers to access such plans, the new analysis shows.

When study participants were given access to digital tools via Koda Health’s platforms, a majority of users took some steps toward creating an ACP, and just more than 52% completed one, the study found. 

This result is compared with a 7% to 17% rate of ACP among older adults generally, study authors pointed out.

“This work indicates that digital tools like Koda Health’s platform might be effective at increasing access to ACP to populations in an equitable manner,” the study authors wrote. “Given the challenges of administering ACP in traditional healthcare settings, healthcare systems should consider the use of technology and new tools to effectively engage their patients in ACP to improve quality of care.”

Koda Health also suggested that the study bolstered the efficacy of their digital tools or other similar cloud-based platforms.

“Evidence-based, online resources can easily be introduced in the clinic, and doctors can trust that patients can make informed decisions,” study co-author R. Lynae Roberts, PhD, and a research scientist with Koda Health, said in a statement last week. “The cloud-based platform enables individuals to create detailed advance care plans.”

Almost all older adults in the United States, an astonishing 97%, had at least one telehealth appointment this year, a new survey indicates.

The data, which come from remote platform operator Independa, indicates that telehealth usage among older adults has grown 20% over the past three years, almost back up to the pandemic-era peak, when in-person options were not available. 

Experts have expected telehealth options to trend upward among older adults, although this is the first indication that telehealth use is near-universal. 

As recently as last winter, other reports were showing that both older adults and their clinicians remained skeptical of using remote options for check-ins or appointments.

The new study from Independa doesn’t indicate that older adults have switched to remote visits for all their clinical needs, but 98% of survey respondents said that the telehealth visits, which often shaved an hour or more off of their appointment times, improved their relationship with their physician(s), and a similarly high percentage of older adults said that they are ready to incorporate artificial intelligence into their healthcare, the Independa data show.

“Our findings show telehealth has indeed become a vital component of modern healthcare,” Kian Saneii, founder and CEO of Independa, said in a statement. “Convenience, ease of setup, significant time savings and ability to improve doctor-patient relationships are all powerful drivers of telehealth adoption.”

Although concerns exist about the complex health needs of older adults and whether physicians can make accurate remote judgments, it is much easier to set up those remote visits and also less likely that older adults will miss such virtual appointments, the data indicate. 

Although older adults may be turning more to telehealth visits, they are less likely to make follow-up telehealth appointments, one study showed earlier this year, although that finding may be because many telehealth appointments are for brief consultations for issues such as nutrition.

Are digital health technologies moving too fast for healthcare providers to keep up?

Although innovations for older adults, such as remote monitoring sensors and disease screeners, have appealed to the long-term care market, the rapid pace of innovation often means the research validating them is too thin or unverified, researchers warn. 

In addition, long-term care operations overall still lack the knowledge and coordination to effectively implement new software solutions, such as those with artificial intelligence capabilities, a new report warns.

The study, which details some of the challenges to adopting new technology as well as some pitfalls regarding unproven claims, concludes by strongly recommending “development of a universal evidence framework” that could guide use of technology in long-term care settings.

“The implementation of digital health technologies within long-term care is usually done in the absence of a systematic process,” the researchers write, “as well as insufficient technological support and infrastructure, and inadequate staff training. This implicates a moral duty for scientists as well as for industry and long-term care organizations.”

The researchers called out falls-reduction systems, as well as certain dementia assessments, as being widely adopted without sufficient proof or research to back manufacturers’ claims about their clinical benefit. 

The researchers recommend that any new tool for long-term care must be:

• Sufficiently validated.
• Compatible with the current digital system or workflow of the organization.
• Aligned with the end-user’s knowledge and digital abilities.

Despite those concerns, many long-term care operators have adopted a guiding principle that tools provide interoperability and make sure all their health systems are integrated and working seamlessly. 

In addition, although some experts believe that initial adoption of electronic health records were not user-friendly and caused problems for staff members unfamiliar with the tools, newer software often addresses this problem. Although there is no universal program in the United States or elsewhere for senior tech literacy, many operators do provide training and courses to help residents. 

The call for digital health guidance was published earlier this month in the journal Age and Ageing, the official publication for the British Geriatrics Society. 

Digital health tools — either in the form of apps or other online healthcare services — won’t be useful for older adults unless they are designed to be easy to use and are available at any time of day, a new analysis shows.

The study adds to the growing body of research analyzing what possible barriers or limitations remain for seniors’ using tech tools, even as their use has proliferated since the pandemic. 

The study’s recommendations could benefit senior living and care providers looking to establish increased use of digital communications between residents, caregivers and clinicians.

Although the study includes both clinical consultations and more generic health information under the broad “telehealth” umbrella, the scoping study is aimed squarely at the latter: how older adults can use digital tools to improve their own health outcomes and lead a healthier lifestyle.

“Even though telehealth interventions for preventive and health promotion purposes have the potential to assist older adults in managing and improving their health, studies have shown that their adoption and actual use is low and inconsistent,” the study authors wrote.

The researchers recommend including older adults themselves in co-designing apps and other telehealth tools, to avoid learning after the fact that a tablet or app is too complicated or complex to use. 

The idea that older adults need specialized digital interfaces, either because of physical or cognitive challenges, is not a new concept. Many clinicians themselves have expressed concerns that some telehealth tools are difficult to use, to the point of being dangerous.

One more unique suggestion from the review, however, is for digital tools to include a more social element, such as peer-to-peer interaction on a platform and the ability for family members to interact with their loved ones.

The scoping review on telehealth used data from Australia; whereas the use of telehealth also is down in the United States from its peak during the pandemic, its use in long-term care settings remains high, and Congress is considering permanently extending telehealth options for Medicare beneficiaries.

Several years ago, I published an article addressing the long-term care industry’s need to focus on developing relationships to enhance care. The impetus of the article was that employers must be relational in their leadership approach to sustain a positive workplace culture. When frontline staff members are satisfied and engaged, they, in turn, are more likely to provide even better care to aging residents on senior living campuses.

Fast forward to present day, and this still remains true. We also now are attempting to sustain loyal resident and family relationships amid the larger challenge of a shrinking workforce caused by the swell of baby boomers and severely reduced numbers of next-generation workers.

Select labor markets have managed to rebound post pandemic, whereas others remain challenged by an environment of increasing wage costs, inflationary expenses that outpace reimbursement and a shortage of uniquely qualified workers, particularly caregivers.

Those challenges are driving many senior living and care providers to implement innovative ideas to bridge the gap. Choosing between the competing demands on our staff members’ time while also promoting the personal touches necessary to sustain relationships between residents and families can be daunting, to say the least.

In search of a solution, CHI Living Communities has embraced innovation to meet the needs of a growing segment of savvy older adults, connecting them with their families and our care team through the use of smart home devices.

In partnership with Amazon Alexa for Senior Living and Serenity Connect, for instance, we have piloted Engage devices for approximately 20% of our senior living residents, with plans to expand because of popular demand and satisfied users. We see a world where aging service providers, older adults and their loved ones collaboratively provide care together. Why?

With a 91% utilization rate among residents at our Gardens at St. Elizabeth independent living, assisted living and memory care campus in Denver, we have seen numerous benefits, such as:

• A 40% reduction in staff turnover, minimally equivalent to a $54,000 savings annually;
• Improved care, with three providers per communication channel;
• A savings of three to five work hours per week per employee, including freeing up clinical leaders by five to 10 hours weekly; and
• Increased communication among 565 family members with their residents and our staff members.

Thanks in part to the interoperability of a variety of new smart home devices such as Serenity Connect, current trends suggest that older adults increasingly will seek to age in place. Moreover, those technologic advances will enable them to work with any number of community-based organizations for remote patient-monitoring and virtual care provided in their own homes.

Although some individuals still may have the misperception that technology impedes interpersonal relationships, CHI Living Communities leaders and frontline staff have witnessed the opposite, firsthand. Based on the successful use of telehealth medicine during the pandemic and beyond, some of our residents have remarked that this technology is reminiscent of physician house calls!

My current duties include implementing the American Hospital Association’s Age-Friendly framework across CHI Living Communities’ parent company, CommonSpirit Health. As a co-leader of this massive undertaking and someone who has been a long-term care leader for nearly 30 years, I realize the crucial importance of its “4 M’s” when providing evidence-based healthcare to aging adults: what matters, medication, mentation and mobility.

What matters most to older adults is staying connected to family, friends and caregivers, because socialization has such significant psychosocial benefits while maintaining health, as well as throughout the healing process.

We are quite pleased to offer Serenity Connect to our Gardens of St. Elizabeth residents, their families and our caregivers, and we look forward to implementing it at our other senior living campuses throughout the United States. Not only does this technology give us marketplace advantage, but — much more importantly — it positions us to provide even better care to seniors.

Prentice O. Lipsey is president and CEO of CHI Living Communities.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

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When it comes to the importance of telehealth, for older adults and anyone else, the Senate Subcommittee on Health Care and healthcare organizations appear to be on the same page.

Both subcommittee members and outside experts weighed in on the value of telehealth during a hearing Tuesday afternoon, including the value of options for conditions that predominantly affect older adults, such as stroke and heart failure. 

Congress is considering making pandemic-era telehealth coverage permanent via the CONNECT for Health Act of 2023; currently, Medicare coverage of certain telehealth options is set to expire at the end of 2024.

“I’ve seen firsthand what telehealth means [for patients],” Committee Chairman Ben Cardin (D-MD) said to open the hearing. “It’s less costly for the consumer, that’s for sure. We have to underscore the importance of permanency: if you are a provider, you need to know a health plan won’t be disrupted because Congress is late in extending these rules.” 

Cardin offered an anecdote that he’d recently seen a veteran in western Maryland get “timely, quality telehealth care” from a clinician in Baltimore, 150 miles away.

Among those who submitted written testimony for the hearing were leaders with the American Hospital Association, which urged the committee to make the telehealth access permanent. 

“We strongly support the provision in the legislation which would permanently remove the geographic restrictions that currently limit where patients can access telehealth services,” AHA Executive Vice President Stacey Hughes said in a statement.  “We would encourage consideration of simply eliminating originating site restrictions altogether. Doing so would ensure that all Medicare beneficiaries can access services regardless of where they and their providers are physically located.”

Because the bill was reintroduced over the summer, there has been bipartisan support for its passing, with 60 senators and six bipartisan sponsors endorsing the legislation. 

President Biden also has made recent remarks about the importance of increasing healthcare access in underserved communities and training new healthcare workers. 

A telehealth care team can offer a “slight comparative advantage” for older adults with end-stage Parkinson’s, including those in senior living communities, a new study shows.

The study, which evaluated the feasibility of improving palliative care for people living with Parkinson’s, tackled two separate concerns: training neurologists to better understand palliative care needs, and providing people with late-stage Parkinson’s with a telehealth care team.

“Persons with Parkinson’s have high palliative care needs that are underrecognized and undertreated in standard models of care,” the study authors write, adding that staffing shortages, or the lack of available palliative or Parkinson’s specialists in general, have created barriers to care. 

Approximately one-fourth of all older adults with Parkinson’s live in assisted living communities or nursing homes, and cases in the United States continue to increase by approximately 90,000 each year, data show.

The dual concepts of training more clinicians to assist in palliative care, as well as expanding access via telehealth, showed a small but meaningful change to patients’ quality of life, the study authors said. The participants in the study who received telehealth care revealed slightly decreased signs of depression and, more importantly, showed more “advance directive completion” over six months, the study results indicated.

Despite hundreds of older adults and clinicians taking part in the study, the authors concluded that “more research” is needed to establish when an in-person care team needs to be supplemented with telehealth options. 

The report did not discuss the Parkinson’s patients’ perceptions of the care offered, although 20 participants discontinued the care model before six months, and another 13 died.

A separate recent study concluded that, more broadly, any technology introduced into palliative care must maintain a humanistic or “warm” approach to be effective.

Although training more neurologists could help accomplish this goal, another emerging option to train nurses in palliative care is by using virtual reality platforms, as the McKnight’s Tech Daily noted earlier this week.