Being homebound puts patients at risk, particularly those with respiratory symptoms either related to COVID-19 or as a result of reactions to treatment.
This article was originally published November 22, 2021 on PSQH by Matt Phillion.
According to a new study from JAMA Internal Medicine, an estimated 4.2 million adults over 70 were homebound in 2020. This number was twice what it was in 2019, impacted by the pandemic and the aging baby boomer generation. Healthcare organizations and providers need to encourage an evolving ecosystem of care for these patients, with a focus on home-based solutions.
“I think social isolation has always been something of a challenge for seniors at home,” says Rosemary Kennedy, PhD, RN, MBA, FAAN, chief health informatics officer with Connect America. This social isolation doesn’t just have an emotional cost—it accounts for an estimated $7 billion in additional Medicare spending as a combination of loneliness and medical conditions bring these patients to the ED.
“COVID put a big spotlight on this and increased it,” says Kennedy. “Seniors didn’t want to leave their homes, didn’t want to go into nursing homes. We saw a reduction in nursing home admissions.”
Being homebound puts these patients at risk, particularly those with respiratory symptoms either related to COVID-19 or as a result of reactions to treatment.
“With the increase in respiratory symptoms in 2020, technology has a role to play,” says Kennedy. “Through technology, we can pick up symptoms and intervene sooner so they’re not deteriorating in the home.”
The use of personal emergency response systems emerged as a way of identifying COVID-related symptoms early on, enabling providers to intervene before conditions deteriorated and these seniors were forced into the ED or ICU. These systems could take some of the pressure off the healthcare delivery model as well as the labor from hospitals and doctor’s offices in those early stages of monitoring.
These systems also have a social benefit for the seniors using them, Kennedy notes. Connect America provides one such service, and the stats show interesting results beyond respiratory intervention. “We saw an increase in seniors who just want to talk to someone,” she says. “They call a response center, hear a human voice, have a conversation, which provides a human element and a human touch to care.”
With physician’s offices overwhelmed and, as a matter of safety, keeping in-office care limited to those who most need it, remote monitoring solutions can pick up signs and symptoms, track blood pressures, and more in the home—and often treat patients in the home as well.
Remote monitoring after treatment
Technology can also play a role even if the patient is admitted, treated, and released. With continued hesitancy to go to a nursing home, some method of tracking progress in the home is pivotal.
“When they leave the hospital and want to go home, not to a nursing home, there’s a tremendous opportunity for remote response to keep an eye on these patients,” says Kennedy. “Home is a big black box. We know what’s going on in the hospital; the physicians and nurses can see what’s going on. But any technology that can give us a window of what’s happening at home—signs and symptoms, conditions—can help connect delivery of care.”
Post-care and monitoring is particularly helpful for seniors as 85% of seniors have at least one chronic condition, and 60% have two. More chronic conditions means more doctor visits, which became even more challenging during the pandemic. “Getting these individuals to the physician’s office can be burdensome,” says Kennedy. “It’s not so much the cost as it’s upsetting to the patient.”
Remote technology isn’t just a matter of convenience of care, Kennedy notes. It’s also a steady stream of data about the patient that allows for more extensive monitoring. “In terms of the broader healthcare ecosystem, think of the physiological data points that can be captured,” she says. “Blood pressure, blood sugar. Those data points can feed dashboards, and those dashboards can go to a clinic or a physician’s office, enabling nurses to see what’s going on with the patient.”
Nurses can review the information within minutes and reach out to the patient or move them up the chain to a higher level of care. “Escalate it to a physician or nurse practitioner and say: ‘The patient seems to be having trouble today.’ The providers can then move the intervention upstream.”
It also allows for assessing emergent situations before they become full-on emergencies. “The patient can push a button to a call center. Maybe they’re having pain, but it may not require EMS intervention,” says Kennedy.
This enables a level of transparency with the patient to not only give them a voice to speak with, but go through their health information—for example, if they’re taking their meds or not—and get that information into a health information exchange, allowing for a continuum of communication throughout the intervention.
“For instance, in an emergency, if EMS shows up at your home and brings you to the ER, the family may not know what ER [you] went to, but the health information exchange knows,” says Kennedy.
A changing attitude toward technology
In many ways, the challenges of COVID-19 prompted technological advancements out of necessity, and at-home monitoring is no exception. “As we’re connecting all the dots with disparate systems, we have a tremendous opportunity to connect in the home as well,” says Kennedy. “There’s a momentum now for all of those systems to collaborate.”
Older patients, too, have grown more positive about the use of technology. Previous hesitation toward using new technology fell away as need for better communication during the pandemic took precedence.
“I think seniors are ready for it,” says Kennedy. “They see the value of it, and I think if we develop a solution so they don’t necessarily need to have a smartphone or be extremely tech-savvy, we can make it easy for them to reach out to the external world.”
But as life begins to return to “normal,” will this new attitude stick?
“Working with groups of seniors, interacting with them, learning what they want from technology and what their experiences were like, I think it forced them to adopt some of the technology” they had previously avoided, says Kennedy. “They learned to use Zoom® and other technologies and saw the positive side and the value of it.”
New levels of comfort and technology don’t just help with healthcare or emergency situations for these isolated patients. They permit patients to stay connected with family and friends.
“Many of them can’t get out, so this concept of interacting with care circles, using technology to stay connected” is a powerful step forward, Kennedy explains. “It might be interacting with a nurse’s aide, with the clinic to help with their medications, or it could be their daughter or friend.”
Healthcare isn’t just connecting with the doctor’s office or clinic, Kennedy notes. Patients stay healthier if they stay connected to the things that they enjoy, like sharing photos, virtual bird-watching, or listening to music. “This connection is so critical,” she says.
Healthcare will need to be vigilant about the segment of isolated patients who may struggle with marshaling even the fundamentals of connective technology, Kennedy says. Dual-eligible patients often do not have access to a smartphone or Wi-Fi. This means involving the payers and broader healthcare community to help build better access.
“There’s a model where to care for this population, we need to involve the payers and the care managers who want to help keep these patients out of the ED. There are significant needs around social determinants of health,” says Kennedy. “We will hear from these patients that their homes are cold or they ran out of medication. If technology can give us insights into those social determinants of health and move that knowledge upstream, we can help those patients stay safe.”
Taking care of these patients in the home can lead to benefits for payers and healthcare organizations as well. Many of the trackable elements at home, such as hypertension and blood sugar, contribute to performance measures. Subscriber engagement is a big initiative as well, and keeping these patients connected and engaged in their health can help them stay healthier and adherent to their plans of care.
Remote monitoring can also help with the growing worker shortage, notes Kennedy. “Anything we can do to help providers be more efficient with their time frees them up to care for the patients most in need of attention,” she says.
Caring for these isolated patients from afar is just part of what Kennedy sees as a growing connectivity between all areas in healthcare. “We’re seeing an explosion of emerging, creative technology, and investment in this technology,” says Kennedy. “I think we’ll be using them in a combined fashion where the sum is greater than the individual parts.”
“Going back to social isolation and loneliness, these patients will often call in just to hear a voice. We see a lot of positive correlation between social interaction and general well-being,” she says. “It keeps them at a higher level. And simply put, as we age, we need each other.”
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