Telehealth Technology is Underused in Nursing Homes Despite Pandemic

Telehealth is severally underused in nursing homes, however the current coronavirus disease 2019 (COVID-19) pandemic can open doors for its proliferation, according to a study published in the Journal of the American Medical Informatics Association.¹

The COVID-19 pandemic has caused more than 1.84 million deaths and there have been more than 84.4 million confirmed cases worldwide, according to the World Health Organization.² In the United States, nursing homes account for 27% of deaths from COVID-19. The virus has left many nursing home residents isolated from family and health care providers. According to the study, in response to the pandemic, Medicare relaxed its rules and regulations surrounding telehealth services in order broaden access, allowing residences to receive care without having to risk travel to a health care facility.

“Before the COVID-19 pandemic, before March 6th and the telehealth waiver, nursing homes were not reimbursed unless they were in rural areas. They were not reimbursed for their use of telehealth. So, they weren’t really reimbursed for telehealth visits. So, many homes did not use telehealth until COVID-19 happened. Then, all of the sudden, there was not only this waiver, the 1135 waiver which allows them to use telehealth but there was also a relaxation of regulations around HIPPA,” said lead study author Gregory Alexander, PhD of the Columbia School of Nursing.

The study sample was made up of 664 nursing homes randomly selected from Nursing Home Compare. In total, 13,858 residents were included. According to the study, the sample was representative of location but not bed size or ownership. The sample had a greater proportion of smaller (fewer than 60 beds) and medium (between 60 and 120 beds) sized nursing homes than large (more than 120 beds) sized nursing homes compared with the national sample. Nursing homes were given score between 0 and 42 to rate telehealth use. Higher scores correlated with a higher use of telehealth technology.¹

Only 5% of the nursing homes samples achieved the maximum telehealth use score while 16% had a score of 0. Investigators found that as bed size increased, so did mean telehealth use scores. Additionally, while the sample size was made up of mostly not-for-profit nursing homes, mean telehealth scores did not vary much between ownership types. However, mean telehealth scores were lower for nursing homes in rural locations compared to those in areas with a larger population size.¹

According to the study, the COVID-19 has further isolated nursing home patients. The study, which was published prior to the FDA’s authorization of vaccines for emergency use and subsequent rollout, says that nursing home residents who do not have an electronic connection could go months or even years without communication outside the facility’s staff and residents. In the long run, lack of outside communication may worsen patient outcomes, including higher rates of depression and mobility. Study authors suggest that the Medicare regulation relaxation on telehealth services should continue in order to reduce isolation and preserve limited resources.¹

“The concern, I think, going forward is what will happen to these regulations now once we get the vaccine out there and people get vaccinated…Will we go backwards?” Alexander said. “Will there be more restrictions placed on telehealth or will they continue to be expanded? And I think it will be hard for facilities who have implemented and taken on new forms of communicating and connectivity to go back to where they were before.”

REFERENCES

1. Alexander, G. Powell, K. Deroche, C. An evaluation of telehealth expansion in U.S. nursing homes [Journal Article] September 2020; Journal of the American Medical Informatics Association. Accessed January 6, 2021. doi: 10.1093/jamia/ocaa253
2. WHO Coronavirus Disease (COVID-19) Dashboard. The World Health Organization website. Accessed January 6, 2021. https://covid19.who.int