Better healthcare access for older adults in facilities—a COVID-19 silver lining?

The COVID-19 pandemic, though truly tragic,has proven to be a great accelerator of how healthcare is received.

Two years ago, San Diego’s West Health, in partnership with the University of California San Diego Health launched a pilot study to better understand the challenges and opportunities in bringing telehealth to nursing homes and assisted living facilities. The aim was to connect residents with health system providers to proactively address their needs and help reduce“panic transfers” to the emergency room (ER).

While the rationale for telehealth in nursing homes and assisted living facilities has been touted for years, exactly how to best implement these programs has always been a barrier.As a result West Health,in partnership with other national leaders in telehealth for older adults put together a practical implementation manual on incorporating telehealth into nursing homes and assisted living facilities and made it publicly available. However, in spite of all these efforts, telehealth uptake remained slow.

Then came COVID-19. “When COVID hit,all the issues [with residents landing in the ER] resurfaced quickly,” said Zia Agha, West Health’s chief medical officer and executive vice president.

But, nursing homes and assisted living facilities couldn’t quickly launch a comprehensive telehealth program and needed to address the needs of residents right away. In response West Health saw the need for resources that could be used immediately: “We took a look at the broader manual, as well as our own experiences and realized facilities needed guidance on how to launch a program in a matter of weeks, not months” said Agha.

This past March, Agha and Kelly Ko, director of research with the West Health Institute, developed a rapid implementation toolkit that includes checklists, pre-visit questionnaires, post-visit summaries and example workflows.In mid-April West Health made the toolkit publicly available.

Dubbed the Post-Acute and long-term Care Telehealth program (PACT), the model works like this: When medical directors in nursing homes or assisted living facilities recognize a change in a resident’s condition they complete the pre-visit questionnaire, it is emailed or faxed to the health system and a video visit is scheduled.

In the West Health model, facilities are able to initiate a video consultation with a health system provider in what is referred to as a “provider-to-provider”consultation,says Agha. “Or it can be a three-party exam, including the patient.”

During the visit, if it is determined the older adult needs treatment, they can either be treated on site, transferred to another facility such as urgent care, or, when circumstances indicate a more dire situation, the resident would be taken to the ER.

Though it is early in the program’s implementation, West Health,in partnership with local health systems and two facilities,are busy streamlining it on the fly. Staff training takes less than 30 minutes; and nursing home and assisted living facility staff appreciate PACT’s simplicity—as they are already being overwhelmed with new local and federal protocols for COVID-19, including infection control and more.

Due to increased pressure on facilities’ staff during the pandemic, ongoing high staff turnover rates in these residential settings, plus a fear of infection and even a fear of being in close proximity to these older adults, there is a heightened need for support and training in infection control, isolation, and even PPE (personal protective equipment) use, says Agha.

“Telehealth, as much as it is a tool to help put out fires, is more valuable than that. It will create a connection between the larger healthcare system and local nursing home and assisted living facilities, including peer-to-peer support, guidance and someone to get on the phone or video-conference with and ask questions, plus training. he says.

Although COVID-19 has brought forth a host of questions from residents, their families, staff and providers, such as who needs testing and the necessary follow-ups, another ongoing issue has surfaced because of the pandemic.

“People are not accessing their routine care and their physical and mental health are being neglected,” said Agha. The PACT platform can enable providers to connect with patients who live in facilities, to maintain their routine healthcare needs, deal with chronic care conditions and ensure these residents’ health concerns are not being ignored just because they can no longer visit a doctor’s office.

In the near term, West Health is open to all potential partners across San Diego County, including the local ER health system and long-term-care facilities. Agha wants AgeBlog readers to understand that West realizes it is not alone in using such telehealth programming, and welcomes the opportunity to learn from others launching or working with similar programs,to identify common challenges as well as potential solutions.West is providing all available resources (comprehensive guide, toolkit, checklists, relevant research articles), plus hosting webinars to share lessons learned with providers and nursing homes (see resource links below).

“In this crisis,there is one silver lining, which is more awareness of the need to take care of[older people]—no matter where they are,” said Agha. “And the focus is no longer just on reimbursement, which is now less of an issue given temporary changes in federal policy, instead we can focus on ensuring access to quality care.”

Agha is hoping telehealth programming like PACT might finally break the revolving door cycle where in older adults repeatedly go to the hospital, come home, get sick again and return.

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