Programs are emerging to care for elderly patients' needs through technology.
With an aging population and a shrinking number of providers, a healthcare crisis looms on the horizon: care of the elderly.
Health systems are tackling the needs of these patients through a variety of initiatives, and experts say that telehealth could play an increasingly important role in meeting future needs.
Some are already exploring ways to make this work. A look at three novel telehealth programs for the elderly provides a glimpse into models that may work for other health systems seeking to meet needs in their own communities.
By the Numbers
According to the U.S. Census Bureau, as reported by the Centers for Disease Control:
- The number of people aged 65 or greater in the United States is estimated to reach 71 million by 2030, comprising nearly 20% of the population
- By comparison, in 2000, those 65 or older comprised 12.4% of the population, or about 35 million people
- The number aged 80 years or older is expected to increase from 9.3 million in 2000 to 19.5 million in 2030
At the same time the number of physicians is shrinking.
- The United States will face a shortage of between 40,800 and 104,900 physicians by 2030, according to a study commissioned by the American Association of Medical Colleges (AAMC) and released March 14, 2017
- According to the American Geriatrics Society's Geriatrics Workforce Policy Studies Center, "approximately 30% of the 65 plus patient population will need to be cared for by a geriatrician. Each geriatrician can care for a patient panel of 700 older adults. Based on these numbers, approximately 20,000 geriatricians are needed now to care for over 14 million older Americans. As of 2016, there were 7,293 certified geriatricians nationwide."
1. Long-Distance Dementia Care and Screenings
Due to a shortage of geriatricians in the state, patients had to travel great distances to visit specialists in Jackson, where the UMMC MIND (Memory Impairment and Neurodegenerative Dementia) Center is located. While travel can be disruptive for any patient, the hardship is often exacerbated for those with memory issues.
The MIND Center conducts research to understand the causes of Alzheimer's and related dementias, and develop new treatments. The telehealth program extends those services to patients at hospitals or clinics across the state of Mississippi, especially in rural areas.
Patients are examined by a UMMC physician in Jackson while assisted by a healthcare professional trained to facilitate the virtual exam. Services include assessment, diagnosis, and treatment for memory loss and cognitive impairment including:
- Clinical assessment
- Comprehensive memory and cognitive evaluation
- Diagnostic labs and imaging studies of the brain, such as CT scans or MRIs, conducted locally
- Continuous monitoring of disease progression
- Ongoing communication with primary care doctors
- Expert medical care, health education, and public health services for patients
- Education, support, and other resources for family members
2. Testing a Concept to Provide Skilled Nursing at Home
In the next six months, Banner Health in Mesa, Arizona, will test a new telehealth concept: skilled nursing at home. The pilot will be conducted on the heels of a somewhat similar test to determine whether a hospital at home program might be viable.
The skilled nursing model will offer in home care combined with telehealth services to patients who might otherwise be transferred to skilled nursing facilities upon discharge. "Patients might be a little bit deconditioned, but not really sick enough to stay in a nursing home for a couple of weeks," explains Natalya Faynboym, MD, CPE, executive director of Banner's innovation think tank, Imaginarium.
Healthcare professionals will conduct home visits with care supplemented through telehealth services, providing 24/7 access and monitoring. The goal is to provide care in a setting where a patient might be more comfortable, while reducing costs.
3. Enhancing Healthcare in Skilled Nursing Facilities
Use of telehealth in skilled nursing facilities is emerging as a valuable way to improve healthcare services to the elderly, says Michael Kurliand, RN, director of telehealth at West Health in La Jolla, California. The non-profit organization focuses on research, policy, and philanthropic efforts to lower healthcare costs and enable seniors to successfully age in place.
While West Health does not provide telehealth services directly, some of its partners, who operate skilled nursing facilities in California, do.
"They see this as an opportunity to potentially avoid unnecessary transfers and admissions to hospitals," says Kurliand, particularly as part of "change in condition management programs." Adding a telehealth into the continuum of care in these particular situations "has a very positive impact on patient outcomes," he says. "It's helping keeping patients out of hospitals.
We're a very mission-driven organization and if we see a model of care that we think truly has value and benefits the patient, then we want to help disseminate information about those models."
The concept is gaining traction in other areas of the country. Randy K. Hamilton, RRT, MBA, a member of HealthLeaders Population Health Exchange and system vice president, operations, Norton Medical Group, the physician practice group affiliated with Norton Healthcare in Louisville, Kentucky, explains how that health system is uses telehealth in its skilled nursing facilities to reduce readmissions.
“Between 11 p.m. and 4 a.m., when the staffing and skill sets tend to be at the lowest, is when patients are typically transferred out," says Hamilton. Once the facility has the technology infrastructure in place, our advanced practice providers can provide telehealth services by working with the bedside LPN at the facility. They can initiate orders such as fluids, breathing treatments, etc., to take appropriate actions to help prevent patients from getting transferred to the ER."
"The good news," says West Health's Kurliand, "is that more and more organizations are starting to recognize this demographic and shift resources. They are thinking of ways to use technology to help augment care and are [instituting] these new workflows and processes in their current businesses."
Mandy Roth is the innovations editor at HealthLeaders.