“Now I see your face!” and Other Benefits of Telemedicine

The benefits of telemedicine, even before the pandemic, are well documented and almost unanimously accepted. As the Centers for Medicare & Medicaid Services (CMS) expanded access to telemedicine, the number of patients receiving these services surged. Before the pandemic, approximately 13,000 Medicare beneficiaries participated in telemedicine in a week. During the last week of April, nearly 1.7 million beneficiaries received telemedicine services; 28% of these were over age 85.

For those practitioners, providers, or other stakeholders who are still hesitant to embrace telemedicine, there are numerous benefits worth emphasizing. For our most frail nursing home residents, especially those with cognitive impairment, and for their families, telemedicine has become an essential tool that enables care, communication, and safety to merge and thrive: 

  • Seeing the clinician (minus a mask) is important for those cognitively impaired.
  • The sense of one-on-one, undivided attention, from the clinician is satisfying to residents and families alike.
  • Sudden and significant declines, common in frailty, can be easily assessed and treated earlier. 
  • Access to interdisciplinary team members (e.g., pharmacist, psychologist) can be provided in real-time.
  • Telemedicine decreases hospitalizations and ER visits with “treat in place” care.
  • It affords a venue to hold advance care planning discussions that is more personal and interactive than a phone call.  

Clinicians and facility staff are hoping telemedicine in long-term care is here to stay!

Contact us to learn more about bedside tools that can enable more efficient, productive telemedicine visits.

For more information: 

Telemedicine: Not New but Never More Useful by Joanne Kaldy. Caring For The Ages, August-September, 2020

Simplifying telemedicine use in long-term care facilities by J. Wiesen, M.D. McKnight’s Long-Term Care News, May 26, 2020.

“Telemedicine has become the go-to tool of choice during the COVID-19 pandemic to keep individuals, healthcare providers and staff safe.” Dr. J Weisen, May 26, 2020. 

Stories from the field

At 94 Annie, still wanted to participate in her health care decisions even though it was difficult for her to hear and see. Most days she is mentally clear although last night and this morning the staff noted periods of inattentiveness during care and periods of sleep alternating with being alert. She did not have a fever or cough or other obvious physical changes but during the pandemic, every change in a resident was taken seriously and assessed as quickly as possible. No other residents on the unit had COVID-19.

The Nurse Practitioner was contacted, and a teleconference was arranged. Annie’s initial diagnosis was delirium and the NP acted quickly to assess the possible causes. While waiting for results of diagnostic studies, a time was set for the family to participate in a second teleconference to review the results and to confirm decisions made in the past and documented in Advance Care Directives. 

 

The teleconference took place with Annie in her bed, along with the family and the Unit Manager. Annie’s blood work indicated mild dehydration and a UTI; and so with reconfirmed “treat-in-place” orders, she was started on IV hydration and an antibiotic. The family’s COVID concerns were addressed and they, along with Annie, were happy for her to be treated in-house and to have had treatment started within a few hours of the first signs of delirium.

 

For the frail nursing home resident, an early assessment and treatment often prevent a catastrophic outcome, a hospitalization, or an ED visit for a work-up. Telemedicine is making this possible.

“A frail person represents a complex system at the edge of failure.” (Rockwood, 2009)