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Implementation Considerations for Telehealth Programs Serving Older Adults

Telehealth can be an important tool for ensuring that older adults living in rural communities can age in place while still meeting their healthcare needs. For example, telehealth can facilitate the ability of older adults to receive care in their homes, help older adults adhere to their medication regimen, and connect caregivers of older adults to support and advice.

Many rural communities are implementing telehealth programs for older adults in skilled nursing facilities in order to decrease hospitalizations and increase access to care for older adults with complex healthcare needs. Successful implementation of telehealth programs in skilled nursing facilities requires ensuring that facility leadership support the telehealth program, training clinical staff to use telehealth equipment, and integrating telehealth into existing policies and workflows. One approach to facilitating implementation is to pilot new telehealth programs with a few high-utilizers of healthcare services. These individuals can provide feedback on the process and allow clinical staff to put their training into practice.

Engaging caregivers can be critical to the success of telehealth programs for older adults. Rural telehealth programs may need to allocate funds to train both caregivers and patients about telehealth technologies. For example, remote patient monitoring programs may need to engage caregivers to ensure that devices are working correctly and transmitting the necessary data to telehealth program staff. Rural communities may also consider using telehealth to ease caregiver burden. For example, the evidence-based STAR-Caregiver training program in Oregon uses telehealth in order to increase engagement of rural caregivers of patients with dementia.

When creating telehealth programs for older adults, rural communities may need to assess their target population in order to understand and address concerns about telehealth. For example, while program planners may assume that older adults will have reservations about using new technology, participants may actually be most concerned about the privacy and security of their health information.

Resources to Learn More

Impact of After-Hours Telemedicine on Hospitalizations in a Skilled Nursing Facility
Document
Describes the impacts of an after-hours physician coverage via telehealth in a skilled nursing facility.
Author(s): Chess, D., Whitman, J., Croll, D., & Stefanacci, R.
Citation: American Journal of Managed Care, 24(8), 385-388
Date: 8/2018

Integrated Telehealth and Telecare for Monitoring Frail Elderly with Chronic Disease
Document
Presents the findings of a telemonitoring program that collects the vital signs and activity-level information of elderly individuals living alone with chronic disease. Includes discussion on integrated care monitoring technologies to improve timely care for elderly populations.
Author(s): Gokalp, H., de Folter, J., Verma, V., et al.
Citation: Telemedicine Journal and e-Health, 24(12), 940-657
Date: 12/2018

Telehealth in Skilled Nursing Facilities: Opportunities to Improve Quality, Health, and Costs of Care
Document
Describes the increased clinical and financial pressures faced by skilled nursing facilities. Discusses how telehealth can help improve access to care and financial outcomes in skilled nursing facilities. Includes policy opportunities and recommendations to expanding telehealth to skilled nursing facilities.
Author(s): Broderick, A., Redington, L., Steinmetz, V., & Lindeman, D.
Organization(s): Center for Connected Health Policy: The National Telehealth Policy Resource Center
Date: 2012

Use of Telemedicine Can Reduce Hospitalizations of Nursing Home Residents and Generate Savings for Medicare
Document
Examines if nursing home residents who received off-hours telemedicine physician coverage experienced lower hospitalization rates compared to nursing home residents who did not. Conducts analysis to determine if nursing homes with telemedicine coverages experience lower hospitalization rates for residents and if it resulted in financial savings.
Author(s): Grabowski, D.C. & O'Malley, A.J.
Citation: Health Affairs, 33(2), 244-250
Date: 2/2014