Navigating older adults’ discomfort with telehealth in skilled nursing facilities has created certain challenges for healthcare providers and patients alike, but the opportunities for expanding access under the right circumstances have proven to be beneficial.
In March 2022, the Consolidated Appropriations Act extended telehealth coverage until December 2023. The Act implemented several significant changes to further facilitate Medicare reimbursement for telehealth use that was previously limited by administrative hurdles. One setting in which this is important is SNFs.
Under the Biden administration, more than $19 million dollars have been allotted for the expansion of this “high tech” care; however, many older adults with complex needs are not comfortable with telehealth, and SNFs are not equipped to aid older adults in adopting this technology.
While telehealth can be convenient for older adults and can lead to cost savings, many older adults still prefer an in-person visit. Reasons include a concern of being misdiagnosed due to lack of in-person assessment, patient hesitancy to inquire about multiple health problems, a perceived lack of emotional connection, and increased provider mistrust. Compounding this issue is a lack of comfort in navigating this technology: 32% of older adults feel they are not ready for video visits.
To ensure the successful implementation of telehealth in SNFs, facilities need a plan that both addresses older adults’ concerns and aligns with their preferences. Two tactics can be used to creatively incorporate telehealth while considering older adults’ preferences, feelings of unreadiness and logistical barriers while elucidating areas for creative problem-solving and where adaptations of this technology are most helpful for older adults.
One is the administration of a telehealth satisfaction survey — for example, the Telemedicine Satisfaction Questionnaire (TSQ) — to gauge receptivity to telehealth. SNFs could administer the TSQ on admission and/or prior to an appointment. In conjunction with the TSQ, a designated staff member could serve as a “telehealth champion” to mitigate telehealth discomfort.
Champion models are often used within healthcare organizations, including SNFs, when trying to adopt quality improvement interventions. The individual appointed would serve as a resource for both the resident and staff and be responsible for detailed trainings and building methods to incorporate telehealth that flow intuitively with current processes. For this model to work, SNFs need to recognize the value and likely be incentivized through the ACC to create positions such as these. A telehealth champion also ensures that the staff member responsible for connecting the older adult with their appointment has the necessary support.
As healthcare strives to enhance equity and access for all members of the community, SNFs should assess telehealth acceptance and bolster in-house resources to support telehealth visits. Rather than foisting telehealth on uneasy patients, workflow processes need to be implemented to aid older adults with their virtual visits use so they can receive maximum benefit from this technology.
Laura Tycon Moreines, MSN, FNP-BC, is a graduate student at the Rory Meyers College of Nursing. Her research interests include palliative care for older adults with advanced cardiopulmonary disease.
Daniel David, Ph.D., MS, RN, is an assistant professor at NYU Rory Meyers College of Nursing and affiliated faculty of the Hartford Institute for Geriatric Nursing.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.