Changing Home Care

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Experts agree that home can be the best setting for providing long-term health care to patients. Visiting a doctor, whether at a hospital or physician’s office, can be a stressful experience. With advancements in technology, telehealth, or the use of electronic information and telecommunication technology to support long-distance clinical health care and other health care related technology, health care can more easily be delivered in the comfort of a patient’s home.
Home health care usually consists of a licensed h​ealth care professional providing medical care in the comfort of the patient’s home. These services are typically utilized by adults that are recovering from a hospital or facility stay. It is also an option for those who need additional support to live at home safely with less risk of an accident happening. The constant advancement of telehealth gives patients the ability to receive health care at home on a day-to-day basis. As the senior population continues to increase, the demand for home care services becomes greater. Home health care is solving problems such as transportation difficulties and lack of hospital space. In addition, home health care provides a solution for those wanting to recover or continue living in the comforts of home.​

A principal aim of home care telehealth is to improve access to health care services. Telehealth enables patients to receive certain services at home that were only previously available in hospitals. Telehealth also has additional benefits such as saving patients time and travel costs. Besides the advantages of an early diagnosis a​​​​​​​​​​​nd management of chronic illnesses in the home, further potential uses of telehealth include the availability of specialist teleconsultations out of the hospital, and improvement in appropriateness of hospital admissions and referrals to the emergency department.

​​​​​​According to the publication, Home Healthcare Nurse, care can be provided less expensively in the home. Evidence suggests that home care is a key step toward achieving optimal health outcomes for many patients. If patients have a better transition between the hospital and home, the amount of falls and medication errors can be reduced. This evidence shows that home care involvement can improve quality of care and can reduce hospitalizations due to chronic conditions or adverse events.
Telemedicine, which is the use of electronic communication and information technology to provide clinical services to patients in other locations, is still being developed and eased into the home care world. With this transition we see both pros and cons of the system. The main issues are the provider and patient accepting the product and the reimbursement factor. “We’re still in the fact finding stages about how to leverage it in the home care setting. Some various degrees of telemedicine for home care are the medical alert pendants and virtual visits where a physician is able to do consultative medicine in the home,” says Craig Moore, Administrative Director at Florida Hospital Home Care Services. “At Florida Hospital we piloted home care telemedicine using devices to measure blood pressure, pulse, oxygen saturation and weight. These different devices sync with a main hub connected through a telephone jack. The primary issues around telemedicine are reimbursement and adoption. There are some patients that may not have the proper wiring to set up specific telemedicine devices, which can pose a problem. With those patients, wireless technology is brought into place, which is improving with time. Patients also need to be willing to adopt this technology, which can be done by properly educating them. The greatest success will occur when reimbursement is provided. Unfortunately, Medicare doesn’t reimburse for those services. Hopefully with time this will change,” says Moore.

​As different devices become available for chronically ill patients, hope stands that they can receive low-cost and high-quality care provided in a home visit. Some physicians aren’t adopting telemedicine because insurance companies only reimburse for face-to-face visits. Some hospitals have been able to launch telemedicine programs without charging patients, but most institutions can’t afford to pay the bill without reimbursements.​

​​A study by the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control found that 64 percent of older adults receiving home care experienced medication errors, which can be prevented in the future by telehealth services. The medication errors usually occurred within a few weeks of discharge. “Personal medication dispensers (PMD) prevent the risk of missing dosages or double dosing, which we provide to patients in our Home Care program,” says Moore. “The PMD dispenses medications directly into pill cups, providing both an audible alert and a visual alert, a flashing light, to remind patients to take their medication. The device will do that for a certain period of time. If someone doesn’t take the medication, it pulls the medication into a different compartment of the PMD, which prevents double dosing. It is also hooked up to a telephone line, so it notifies health care providers if the dose is missed. This way, we can figure out why the patient hasn’t taken their medication by calling them or, if need be, visiting their home. Besides dispensing medication, the device has different reminders that can be set up. For example, it will give an audible reminder if a medication needs to be taken with food or even if you are a diabetic and need to take your insulin at a specific time.”​

In addition to checking on patients by telephone, home telehealth services may incorporate technology such as a vital signs monitoring unit for blood pressure, pulse, blood oxygen level and weight. Personal Emergency Response Systems (PERS) are used as a method of notifying help in case of an emergency, and can be placed in the home of a patient at high risk for a fall. According to the Journal for Healthcare Quality and Journal of Hospital Medicine it is possible to achieve optimal health outcomes for the patient with telehealth. Home care providers need to collaborate frequently with hospitals, physicians, nursing homes, pharmacies and other providers. This is critical as patients transition to and from various care settings. Evidence shows that seamless communication, transitions and coordination among providers can improve patient outcomes and ultimately allow them to stay at home using telehealth services.

The National Telehealth Training Center in Florida has been working with the U.S. Department of Veterans Affairs (VA), which offers telehealth services, including home telehealth. According to the publication Veterans Health Administration, a Pew Research Study shows that 54 percent of Americans age 65 and older have access to the internet. While 33 percent of Americans age 77 and older have access to the Internet. With a low percentage of seniors that have access to the Internet, problems can occur when implementing telehealth for these seniors when they do not have technology such as the Internet to link telehealth devices. The VA is working to educate seniors on telehealth services and ways the devices can help improve their quality of life.

In 2013, several veterans agreed to try telehealth and enrolled in the home care telehealth program to help with weight loss, which in turn helped remedy other health issues such as diabetes. The home telehealth program uses interactive voice response (IVR) technology and a talking weight scale. The IVR communicates back to the physician with updates on the patient’s progress. Encouragement from an engaged staff lets participants see that technology could help better their health and improve their lives through self-management of the IVR scale. Home telehealth allows symptoms and vital signs to be checked with devices, transmitting the results to physicians and nurses who monitor the patient. This monitoring allows physicians to change medication or come up with other plans of treatment based off of the results of the devices. The VA hopes that with the education of home health care using telehealth and with time, that home health care will give seniors a chance to remain at home and live safely.

​When new technology is introduced into practice, it is often used without a clear idea of which patients will benefit most, the balance of benefits and harms, and the value for money that technology can offer. “Some private duty companies are partnering with telehealth. Besides video conferencing and medication reminders, some companies are using technology through specific videoconferencing to determine whether a patient is feeling anxious or depressed. The clinical aspect is also advancing with technology developing with remote blood sugar monitoring and remote EKG monitoring,” says Margherita Labson, executive director of the Joint Commission’s Home Care Program. “There is also a human side to the technology. Issues can include engaging the patient to safely and appropriately use the equipment. The appropriate selection of patients to be a candidate for telehealth is very important. For example, we need to understand why a patient may not be engaged and if they aren’t self-monitoring. Also, clinicians need to be involved with the use of this technology and involvement with the patients.”

In the article “Wireless Technology and Point of Care in the Home,” Dr. Richard Satava describes how home telehealth technology can be very simple to use. “Wireless systems are predicated upon a set of non-invasive, wearable monitors which can accurately measure certain critical factors, such as vital signs or blood chemicals. For fitness and for heart disease individuals, these measurements will be blood pressure, pulse rate, and electrocardiogram (EKG) that can measure the performance of the heart as a measure of total body fitness or as a warning for heart failure and irregular heartbeats. Other sensors, such as blood sugar and sweat, can determine the fatigue level of a fit person, or the dangers in persons living with diabetes or other metabolic diseases. As a stand-alone system, these monitors can notify the person about their excellent health, or alert them when an impending crisis is about to occur. In the latter situation, urgent action can be taken to avoid a serious medical emergency, thus preventing the person from a complication of their disease that would require hospitalization.” As time progresses these vital pieces of information will give people an opportunity to monitor their health and stay motivated to live a healthy life. Dr. Satava also states, “Sensors will become even smaller and less intrusive to the point of being literally invisible. An example is the Smart Tee Shirt that automatically begins monitoring vital signs when the shirt is on. Patients will receive reassurance that their health is being monitored and they will be alerted if there are problems.”

​By integrating telehealth into the daily home setting, treatment changes will emphasize self-management through communication and education. Chronic conditions such as diabetes and heart failure can be managed through regular contact with physicians. Devices such as the PMD will help decrease the amount of medication errors and PERS will allow patients immediate access to their physician in an emergency. It is also possible that hospital admissions will decrease as people use telehealth. As the role of home care evolves, telehealth will prove to be a valuable part of the recovery process and disease management. Programs based on specific and local situations, as well as specific diseases and severity will be options for reducing health care costs. With time, reimbursement may be possible, giving more people access to home care telehealth, proving to be a better option for some patients.​​​​​​​​​


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