Telehealth Programs Allow More Rural Seniors to Live at Home

by Candi Helseth

Revolutionary telehealth approaches across the United States are helping senior citizens continue to live independently in their own homes. In five Midwest states, a research project underway uses advanced telehealth capabilities and motion sensors to track and electronically report residents’ daily vitals and changes in trends. In Kansas, integrating telehealth with home nursing care and social service supports has decreased hospital and nursing home admissions. In New York State, short-term home telehealth intervention is helping seniors with chronic diseases manage flare-ups that jeopardize their ability to remain at home.

“Throughout the nation, telehealth technology is transforming health care and bringing advanced technologies into homes,” says Dr. Ron Poropatich, University of Pittsburgh School of Health Sciences executive director of the Center for Military Medicine Research and associate editor of Telemedicine and e-Health Journal. “Telehealth is key to the delivery and growth of services in the future, particularly in rural areas.”

Technology transforms homes

Phyllis Consoer and Warren Consoer

Phyllis Consoer, 88, and Warren Consoer, 91, are able to maintain a “fierce independence” through the LivingWell@Home program. (Here they are celebrating her 88th birthday.)

When chronic medical conditions threatened Warren and Phyllis Consoer’s resolve to remain in their farm home of 55 years near the Iowa-Minnesota border, they found their solution in the LivingWell@Home program. The Consoers are among 1,200 seniors enrolled in the five-year telehealth research project that the Good Samaritan Society (GSS) is conducting throughout 40 communities in South Dakota, Minnesota, Iowa, North Dakota and Nebraska.

The Consoers are still fiercely independent. Warren, 91, operates the tractor and loader to remove snow in the winter. Phyllis, 88, enjoys cooking and baking. “But now we always have someone right here if we need help and that lets us stay in our home,” Phyllis adds.

That “someone” is LivingWell@Home’s advanced technology. Phyllis and Warren both wear a personal emergency response system (PERS) that will automatically summon help if they are unable to do so. Their daily morning ritual includes a reminder from their telehealth unit to take their vital signs. The unit visually directs them through checks of blood pressure, heartbeat, oxygen, pulse rate and weight. Nearly invisible motion sensors installed in the home monitor their movement and sleep quality 24 hours a day. Data is transmitted via a secure Internet site to GSS’s corporate location in Sioux Falls, S.D., where nurses analyze the reports and alert the designated care provider of changes in trends.

“By integrating all this health information, we know what is normal and what is changing for these individuals,” explained LivingWell@Home Director Sherrie Petersen. “For instance, if they begin going to the bathroom many times during the night and haven’t previously, that change in pattern will initiate looking into whether or not this person has a change in health, such as a possible urinary tract infection.”

The Consoers have given their son, Jim, permission to access their care plan from his personal computer at his home 70 miles away. It gives him peace of mind and opportunity to assist with needs that arise.

“The timing for the Good Sam technology was a godsend,” Jim said. “The daily monitoring has saved my parents more than once from having to make an emergency trip to their doctor’s office.”

Coordination of services improves outcomes

Aimee Roberts

Aimee Roberts, a client enrolled in the Windsor Place At-Home Care telehealth program, monitors her own blood pressure.

Since it opened in 1997, Windsor Place At-Home Care (WPAHC) in Coffeyville, Kan., has provided both long-term nursing care and human service supports in the home. In 2007, WPAHC added home telehealth. Executive Director Monte Coffman says the integrated program improves continuity of care and reduces hospitalizations. Because keeping seniors healthy longer at home is less labor intensive, Coffman added, the service stretches limited human resources.

WPAHC is the only reason Para Lea and Ray Bilyeau are able to remain in their country home near Neodesha, Kan., according to Para Lea. Ray, 82, can move only with the aid of a walker and suffers from congestive heart failure and sleep apnea. Para Lea, 75, has limited mobility due to back problems and her need for a third joint replacement. She says she is on “a lot of medication for all the different things wrong with me.”

Using a telehealth monitor in their home that electronically reports results to a nurse at WPAHC’s office, the couple takes their daily blood pressures, oxygen levels and weight. WPAHC caregivers also go into the Bilyeaus’ home to provide personal care assistance, and do cleaning and laundry five days a week, for two to three hours (a schedule that can change, depending on the needs of the patient—each patient is evaluated by a nurse and an individual plan is set up). Caregivers also do the couple’s grocery shopping and run errands for them.

“When I had my hip replacement, I couldn’t even get in and out of bed so they gave me baths and helped with everything we needed,” Para Lea said. “We’re pretty thankful. We couldn’t do it without them.”

The addition of telehealth, which began as a one-year grant approved by the Kansas Department of Aging (KDOA), evolved into a three-year pilot project that confirmed its value. The University of Kansas Medical Center (KUMC) collected data on pilot patients, who averaged 3.2 chronic disease states. Final data demonstrated reductions of 38 percent in hospitalizations, 67 percent in emergency room visits and 20 percent in nursing home admissions. Participants admitted to a nursing home had stays that were 58 percent shorter than the Medicaid average.

“When we serve the needs of the whole person, our chance of success becomes much greater,” Coffman said.

Intervention fills the gap

Sometimes, all an individual needs to remain at home is short-term help. The Geriatric Assessment Program (GAP) in New York’s Wayne County combines home and telehealth services under the direction of a geriatric team to treat patients whose chronic conditions are out of control. Denise Washburn, a longtime Wayne County resident who is a Certified Geriatric Care Manager, goes to the home to assess the patient and environment. She reports her findings to the geriatrician, who then sees the patient via a telehealth appointment at the local hospital. The geriatrician develops a care plan to manage the patient’s syndrome, and Washburn continues to monitor the patient. Once the patient’s condition is again under control, the geriatrician refers the patient back to his or her primary physician.

Wayne County has no geriatric specialist so telehealth fills a critical need, Washburn said. Home visits strengthen the service, she added, because they build patient-provider trust and often reveal problems not apparent during a telehealth consultation.

A patient with a history of frequent falls was labeled non-compliant after failing to keep appointments for referrals to outpatient physical therapy. Outside the patient’s home, Washburn observed 20 steps the nearly immobile patient couldn’t maneuver to go in and out of her home. When GAP arranged PT in the home, the patient began improving. Symptoms related to medication mismanagement account for approximately one-half of patient referrals, Washburn said. She examines all prescription bottles, confirms that they contain the prescribed drug and ensures that the dosage being consumed conforms to the prescribed dates. Then she helps the patient establish a plan to take medications properly.

“Most of my patients are very frail elders,” said Washburn, whose patients have included her mother. “The people I work with are generally not part of any other program and they have no one to help them at home. I don’t think we should be measuring success solely by how we avoid hospital readmissions and nursing home placements. Success is helping these people live better and healthier.”

GAP is funded by a HRSA Rural Health Care Services Outreach Grant, which was awarded to the Wayne County Rural Health Network (WCRHN).

Successes expand services

Patient wearing a PERS

A patient enrolled in the LivingWell@Home program wears a PERS (personal emergency response system) that will summon help if needed.

“We know that chronic condition management, medication compliance and social interaction improve and that the family caregiver burden, and health care related travel decrease when seniors receive care in the home,” Petersen said. “Most importantly, these services support seniors’ desire for independence and allow them to live as they wish.”

GSS’s LivingWell@Home, which began in 2010, is funded with an $8.1 million grant from the Leona M. and Harry B. Helmsley Charitable Trust. Currently, University of Minnesota researchers are evaluating its effectiveness. Petersen said the next step will be developing a sustainable business model that demonstrates the program’s efficacy. Ultimately, the intent is to convince lawmakers that supporting home telehealth technologies is a cost effective means of improving health care nationwide. Telehealth technologies in GSS facilities are being expanded into 24 states throughout 2014.

WPAHC is further proving the value of its integrated model by collaborating with PACE (Program of All-inclusive Care for the Elderly) and three hospitals on two separate projects. WPAHC served 17 PACE patients with advanced chronic conditions for 13 months. Coffman said PACE was very pleased with outcomes: patients had a total of 13 hospital days and no nursing home placements. Six months into a pilot project with three hospitals trying to reduce their 30-day readmissions, the WPAHC patient base has had no readmissions. (As of Oct. 1, hospitals are financially penalized if too many of their patients with certain conditions are readmitted within 30 days of a prior hospitalization.)

WPAHC’s service area has grown from about 400 patients in Montgomery County where Coffeyville is located to 1,500 patients throughout Kansas. Coffman said WPAHC is partnering with several managed care organizations to expand telehealth services in 2013.

Lack of broadband or fast Internet access still limits telehealth expansion into some rural areas. According to the 2012 CRS report, Broadband Internet Access and the Digital Divide, 23.7 percent of the 61 million people living in rural areas had no fast Internet service offered for their homes. Yet, rapid growth of cellular communications and the 4G network is going to help propel services into even the most rural areas, Poropatich predicted. The most recent telehealth leap is termed m-Health (mobile) where providers and patients can instantly access information wherever they are using mobile devices such as cell phones and tablet computers.

“As telehealth technology becomes more and more pervasive across rural America, I believe we’ll see improved care with frequent proactive health care treatment for patients via mobile devices as opposed to treatment of episodic events,” Poropatich said. “Telehealth’s possibilities for rural America are endless!”

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