An estimated 10,000 Americans turn 65 every day, representing a significant challenge to the national health care system. Meanwhile, the COVID-19 pandemic has dramatically accelerated adoption of one of our primary tools to meet that challenge: telehealth.
In a recent column for McKnight’s Senior Living, Ed Mercadante called telehealth “the great equalizer, disrupting the existing paradigm barriers of geography, travel, weather conditions and other impediments that contribute to accessibility difficulties and inefficiencies of care.”
To be sure, telehealth technology does help alleviate long-standing challenges to delivering healthcare. But telehealth also comes with its own, different set of barriers. This post will explain what those barriers are, what strategies healthcare providers are employing to overcome them, and how telehealth is rising to meet the challenge of an aging population.
Seniors Are Increasing Interested and Participating in Telehealth
Across the board, seniors used more telehealth in 2020 than ever before. The percentage of adults aged 50 to 80 who had ever participated in a telehealth visit rose from 4% in May 2019 to 30% in June 2020, according to research from the National Poll on Healthy Aging.
During that same time, the number of older adults who said they were very or somewhat comfortable with video conference technology rose from 53 percent to 64 percent. The number who said they were interested in using telehealth to connect with their doctor rose from 58 percent to 72 percent. Before the pandemic, nearly half (49%) of seniors said they had concerns about the privacy of telehealth—after, that number had fallen to less than 1 in 4.
Clearly, there is a huge opportunity for care providers and health systems to reach older adults through telehealth technology. But that isn’t to say that there still aren’t barriers.
Barriers to Providing Telehealth to Seniors
The barriers in providing telehealth to older adults generally fall into two categories.
The first group of challenges generally relates to seniors themselves: Their own mental and physical capacities, plus their comfort (or lack thereof) with telemedicine technology.
As we age, most adults experience at least some mental or physical decline, both of which need to be taken into account when delivering care via teleconferencing or video conferencing. This decline can include reductions in sensory or motor function, such that they have trouble seeing, holding, or hearing devices. It can also include a decline in cognitive function impacting memory, reasoning, and multitasking.
Delivering a platform which provides true ease of use is absolutely critical to ensuring that care delivered to older adults via telemedicine is successful.
The second group of challenges generally relate to the country’s IT infrastructure, namely broadband internet access to poorer areas and rural areas. The Center for Healthcare Strategies estimated last year that 90 percent of urban areas have access to broadband, while 75 percent of non-urban areas do. That’s a good start, but unfortunately it is usually the poor and rural areas where lack of broadband and chronic, long-term care management intersect the most.
Fortunately, billions in pandemic-era federal dollars are on their way toward alleviating this problem, including money specifically earmarked to strengthen internet access for healthcare organizations looking to expand telehealth programs for underserved populations.
In order to address the first set of challenges, however, healthcare organizations are deploying a number of strategies.
Making Telehealth Work for All Adults
In 2020, researchers Umar Ikram, Susanna Gallani, Jose F. Figueroa, and Thomas W. Feeley called up four healthcare groups to ask them about the strategies they used to transition care delivery to telehealth during the COVID-19 pandemic. All four organizations predominantly served older populations, and, notably, all four organizations participated in Medicare Advantage, a capitation, value-based care payment system.
As the four researchers wrote in Harvard Business Review, the value-based payment system gave these care providers “both the flexibility and the incentive” to experiment with telehealth delivery, “including pivoting to telehealth with their challenging populations.” Of course, not all care providers need to transition to value-based care, but still, the flexibility these organizations had to experiment with different strategies can provide lessons for all healthcare providers.
Ikram, Gallania, Figueroa and Feeley identified four main challenges:
1. Lack of internet access or appropriate devices
One healthcare group surveyed its patients and found 40 percent of them either did not own a smartphone or tablet that was appropriate or didn’t have a data plan that would have allowed for video visits. Another organization reported 60-70% of its patients lacked such basic internet capability.
The solution was two-fold. In cases where patients lacked internet devices, healthcare groups either mailed or hand-delivered tablets directly to their patients. For those who lacked sufficient internet access, the solution was to send “mobile medical assistants” with personal protective equipment. These assistants would then conduct an in-person intake at the patient’s home, and coach them through the video consult with the doctor.
2. Medical conditions that impede the use of telehealth
If you predominantly serve older patients, chances are that a large percentage of them will have cognitive or physical impairment. For one of the organization’s surveyed, 40% of their patients had a hearing impairment, 15% had a vision impairment, and 10% had dementia.
Response strategies for these patients rely on actively engaging in-home caregivers, usually a family member, to help conduct the visit. “In one example, a nurse practitioner coached the spouse of a patient with lung disease on how to appropriately use a nebulizer,” the researchers wrote.
3. Patients with limited digital literacy
“Most of my video visits are spent looking at the ceiling fan,” reported one clinician, noting that a lot of patients lack the basic digital literacy to have a videoconference. And in many cases, being able to actually see the patient on screen is a critical tool for clinical assessment.
Healthcare organizations reported varied onboarding and training strategies to respond to this challenge, from using administrative staff to conduct “practice visits” to deploying “healthcare ambassadors” who visit patients at home and walk them through downloading, setting up, and using whatever telehealth platform has been chosen.
Employing these strategies can dramatically reduce both lost time due to technical difficulties and the number of missed appointments.
4. High-risk patients who need regular monitoring
All four healthcare groups interviewed reported sending or dropping off monitoring devices for their most at-risk patients, from blood pressure cuffs and pulse oximeters to weight scales. They then coached patients and in-home caregivers on how to take vital signs, identify irregularities, and call for help if needed. Many Caregility partners now provide such services.
In short, telehealth is an invaluable tool for providing healthcare to seniors all over the country. However, we must work to not only understand the unique needs of America’s aging population, but also build bridges to overcome the barriers and challenges many older adults face when it comes to taking full advantage of telehealth technology.
Learn more about expanding telehealth access to underserved rural populations.