Joseph Shega, M.D.

Out of the challenging conditions COVID-19 has posed to healthcare providers and patients, solutions have arisen that could reshape the nation’s healthcare system into a more flexible, inclusive model — if they are permitted to be fully explored and implemented.

Chief among these is telehealth.

Once dedicated mainly to extenuating circumstances or remote, underserved locations, care delivery over virtual channels now has become commonplace, thanks in part to the temporary easing of telehealth guidelines by the Centers for Medicare & Medicaid Services, with applications that span disciplines and demographics.

An all-encompassing approach

Dying residents in skilled nursing and assisted living facilities around the country —many of whom are isolated from their loved ones by COVID-related facility restrictions—make an emotionally arresting case for expanded telehealth. VITAS Healthcare has found both clinical success and improved family satisfaction in these patients’ care by using telehealth for a variety of purposes:

∙      Head-to-toe patient examinations via videoconference enable admissions nurses to evaluate and determine hospice eligibility remotely in minutes, with caring participation from the patient’s loved one or facility caregiver.

∙      Virtual tours of the resident’s living area help hospice nurses determine what durable medical equipment should be delivered to the facility without setting foot in the room.

∙      Goals-of-care conversations and advance care planning can occur over video, enabling physicians, patients and loved ones to establish needs and goals and make difficult decisions about ventilation, do-not-resuscitate orders and preferences for patient-centered care in a supportive environment.

∙      Virtual support groups led by bereavement specialists can support anyone facing grief over the loss of a loved one without the limitations or risks of in-person gatherings.

Telehealth is a modern modality to meet individual care needs. In general, the convenience and accessibility of telehealth improve the continuity of care by eliminating factors that lead to care delays, such as limited office hours, lack of access to transportation or inability to leave a facility. 

A swift solution for gaps in care  

The landfall of Hurricane Laura along the Texas-Louisiana border in September 2020 offers a more extreme example of using telehealth to overcome barriers to access.

When a Houston nursing facility resident showed signs of hospice eligibility just after the storm had passed, flooding and storm damage made an in-person evaluation impossible. Instead, a VITAS admissions nurse used telehealth to assess the resident’s needs and seamlessly transition her onto service.

Telehealth also enables hospice representatives to connect with patients and providers earlier in the care journey, reducing gaps in care. This additional venue for connection instills confidence in end-of-life care and may lead to earlier identification of hospice-eligible patients.

Plus, with reduced physical contact comes a reduced reliance on personal protective equipment, helping to preserve critical resources. In some high-risk cases, virtual care may be the only way to safely reach a patient or family in need.

A critical case for expansion 

Under expanded telehealth guidelines, patients’ families can stay involved, updated, educated and connected without risking in-person visits. Even loved ones who live great distances from the patient can be involved in their care through telehealth. Family participation creates understanding and more accurate expectations regarding the patient’s decline, which in turn encourage the pursuit of goal-concordant care.

For residents of skilled nursing facilities (where 37% of all hospice care was provided in 2018, according to the National Hospice and Palliative Care Organization), earlier adoption of hospice services can elevate quality of life, support aging in place and enable better allocation of supplies, medication and equipment. Hospice also helps minimize risks of hospitalization or emergency service utilization for symptom exacerbations.

While the current administration has expressed interest in making relaxed telehealth guidelines permanent, there’s no guarantee this benefit will remain available or affordable to patients near the end of life once COVID-19 ceases to be an immediate threat. Establishing telehealth as a permanent, accessible option for patients throughout the care continuum will facilitate improved access, reduce burdens of care for facility staff and residents and improve quality of life and overall satisfaction for patients and their families.

Joseph Shega, M.D. is chief medical officer for VITAS Healthcare