Skip to main content

SD eResidential Facilities Healthcare Services Access Project

  • Need: To bring more local health services to rural, elderly populations in long-term care facilities located in four Midwest states near a tertiary care organization.
  • Intervention: Implementation of telemedicine services to reach patients at their respective sites.
  • Results: The program increased local care evidenced by yearly avoidable provider-determined transfer data: 33%, 50%, 63% program years 1 through 3, respectively.


Promising (About evidence-level criteria)


Due to variables such as distance, weather, or lack of provider availability, rural long-term care facilities and their staff are challenged with meeting the clinical needs of their residents, most with multiple chronic health problems. Time becomes a concern for providers traveling from clinic to clinic over long distances in order to treat a resident with an urgent or complex health issue. For long-term care patients, transferring them out of their home environment to a provider causes discomfort and disorientation, further complicating their condition. To address this, Avera Sacred Heart Hospital, along with four Avera affiliates, and two consortium partners, developed the SD eResidential Facilities Healthcare Services Access Project.

This project was developed using practice models and studies of eLongTerm Care (eLTC) endorsed by the American Telemedicine Association. Avera and its partners implemented the project at 20 sites located in South Dakota, Iowa, Minnesota, and Nebraska. Participant facilities in this program where chosen by criteria which included rural status, healthcare access needs, urgent care needs, and nursing support needs. The intent of the eLTC program was to assist rural long-term care facilities with better 24-hour access to needed care, urgent care support, staff training and education, and other geriatric services.

The patient population included frail elders in long-term care, assisted living, and rehabilitation facilities since elderly residents have higher rates of mortality associated with chronic diseases, such as diabetes, heart disease, and Alzheimer's Disease. Project site residents were also older than state or the national averages.

The eLTC program was gradually and systematically implemented over three years in order to assure quality services. Through the use of two-way video, a specialized stethoscope, a camera used for closer details of patients, and other peripheral equipment, the eResidential project kept residents in their own facility with the caregivers who know them best and best able to provide their care. Also, numerous specialized medical sources of information were offered to caregivers through these services. The eLTC strategies also decreased healthcare cost by avoiding unnecessary emergency room visits and hospital re-admissions.

The consortium partners of the SD eResidential Facilities Healthcare Services Access Project include:

The program received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.

Avera Health also has a larger collection of services called Avera eCare. Through these services, Avera connects rural health care providers to specialists in more urban areas.

Services offered

  • Provided rural residential facilities and residents access to a provider 24 hours, 7 days a week, 365 days per year via two-way video
  • eConsult specialty access include Infectious Disease, Wound Care, Cardiology, and Nephrology
  • ePharmacy offering information on drug administration, side effects, and interactions
  • Evaluation of long-term care residents' complications and complaints
  • Emergency assistance if needed through eER (eEmergency Room)
  • Enhanced resources available to long-term care staff


During the original 3-year grant cycle, there were over 630 two-way video encounters in addition to almost 800 consults not requiring the patient to be on camera. By the 3rd year, 63% of potential transfers were avoided due to collaborative efforts between the teams.


  • Inconsistent primary care providers for facility residents
  • Sites' distance barrier from the eLTC Hub for training and support services
  • Differing provider credentialing requirements between sites (later solved by utilization of eEmergency physicians to cover sites while credentialing issues reconciled


  • Universal staff training
  • Full leadership support to direct how eLTC services utilized
  • Preservation of wireless mobility

Contact Information

Anthony Erickson, Vice President of Senior Services
Avera Sacred Heart Hospital

Elderly population
Long-term care
Specialty care

States served
Iowa, Minnesota, Nebraska, South Dakota

Date added
October 9, 2015

Date updated or reviewed
July 8, 2019

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.