Vol. 16 •Issue 6 • Page 12
Geriatric Care
Telehealth Keeps Seniors at Home—Where Care Is Less Costly
Health care costs climb annually; the labor pool of caregivers continually shrinks. The double whammy spells danger ahead for the growing number of elderly who need quality medical care should the problems continue unabated.
Because inpatient care is so expensive today, third-party payers spend big bucks each year trying to devise ways to keep older patients out of acute care hospitals, diverting them to outpatient care, home care and alternative care facilities where care is far less costly. Efforts in this direction are paying off, thanks to advances in electronic equipment like pagers and computers.
These modern marvels, coupled with new monitoring systems, have led to a steady growth in the telehealth industry. And with each advance, the number of patients who can be served from afar increases.
Home care, of course, is nothing new. Mothers have spooned chicken soup to their sick children for thousands of years, and family members have tended to the needs of feeble elderly for just as long. But there is little doubt oxygen tanks and portable ventilators truly ushered in a new era of high-tech care in non-traditional settings over the past half century.
Today, in-home aids like TV monitors linked to telephones and medical devices all play a major role in keeping the elderly at home without sacrificing their care. And it is no longer a new-kid-on-the-block technology. State-of-the-art technology offered by telehealth firms like American TeleCare® Inc. have been instrumental in helping seniors stay at home since 1993.
Such technology is especially beneficial for elderly patients in remote areas and for those who lack transport to a hospital, especially those who can have their underlying disease deteriorate in the days spent in obtaining care.
CASE STUDY
Although various telehealth provider models are in operation across the country, it is helpful to look at what American TeleCare (ATI) offers as a mirror reflecting the type of technology currently available. As a basic starting point, ATI features a self-contained home-based health care station.
The link, carried via telephone lines, allows health care providers and patients to have direct audio and video access. Caregivers use the patient’s in-home system to monitor the patient’s heart beat, breath sounds, blood pressure, glucose levels, blood oxygen levels from pulse oximeter and weight. Caregivers can use enhanced video and snapshot capabilities which offer more thorough examinations.
Peripheral equipment connected to the patient station allows data to be downloaded to the clinician’s remote computer system, allowing the caregiver to track patient progress, assesses the individual’s condition and make recommendations for changes in care.
“The goal is to keep people out of the hospital and the ER and allow them to live more comfortably at home,” said Randall S. Moore, MD, MBA, president, chairman and CEO of ATI.
Studies back him up. Data from a recent study by a California Veterans Health Administration hospital showed it takes 2.9 days from the time an individual begins to feel ill and schedules a clinic appoint before he will actually see the physician. As an alternative, sicker patients, such as those in heart failure who begin deteriorating fast, typically go to an emergency room where they are seen and then sent home or admitted to inpatient care. The key to reversing reliance on ER care is to treat patients before they are seriously ill.
Telehealth has the ability of offer extremely fast service. One ATI client found its nurses “could see someone within 20 minutes of their phone call,” Moore said. Twenty minutes using telehealth products versus nearly three days for an office visit makes a big difference in patient care.
There is a rather unexpected bonus to the care too. Because the technology is so portable, caregivers can evaluate and monitor patients from the comfort of their homes as well. In the next wave of care, an RT in pajamas and slippers might well sit at the kitchen table watching a patient afar use an incentive spirometer.
The ATI system, although expensive at about $150 per month, still is cost effective. “With chronic illness patients, the cost of care can be reduced between 50 and 70 percent,” Moore said. A Veterans Health Administration study showed the program saved the VA system $23 million, driven by greater than 10 percent reductions in ER use , hospitalizations and nursing home placements.
The switch to telehealth, however, involves major changes in the way procedures are typically performed in health care. This leads to concerns about the level of care patients will receive at home, miles away from the hospital in many cases.
However, recent studies suggest elderly patients are fairly comfortable with the system, knowing they have a caregiver at the other end of the TV monitor. As a bonus, “the patients become more engaged” in their own care, Moore said. “There has been an overwhelming response to this technology.”
PATIENTS RESPONDING
One physician involved in the initial ATI program told Moore the program was destined to be a great success after he talked with the first patient who used the ATI technology. The physician visited in the home of an 84-year-old diabetic woman who wore Coke-bottle glasses and had never before touched a computer.
What he encountered pleasantly surprised him. “She had her system on a special table which she dusted every day,” Moore said. She had even named her system, giving it a humanized quality.
Audiovisual equipment allows caregivers to make patient assessments on a real time basis. “And when the assessment is done earlier, before the patient deteriorates, the intervention is much simpler,” he said.
By providing the care on a real-time basis and doing a complete assessment, the caregiver can determine whether the patient needs a clinic or hospital visit or just an adjustment to the level of home care.
In most illness, especially in those of seniors, there is an anxiety component that must be configured into care since clinicians are asking patients to put medical faith in a box on the coffee table. Still, with systems like those provided by ATI, the patient connects with the provider through live video, and the exchange of information puts patients at ease in their own home, not in an impersonal ICU.
TO THE FUTURE
“I think we are just in the process of moving beyond the early-adopter mode where people want to have the latest and greatest things with mainstream health care providers now being the main purchasers,” he said. ATI has proven itself in terms of patient outcomes and health care economics, he said. Also as the technology grows, it will improve and the price will go down.
“I think the system will become a mainstream medical device that will be a part of our society,” he said.
Moore expects telehealth will evolve to the point where different levels of technology can be afforded for different acute levels of patients. “We are introducing a monitoring unit that can ask questions, check on symptoms and give additional information back,” Moore explained. “We are also expanding beyond technology to clinical management programs for diabetes, COPD and heart failure.”
Moore characterized telehealth as “exciting,” an area that is finally beginning to grow rapidly and provide better care at a reduced cost.
You can reach Caroline Crispino at [email protected].
Hospitals Go High-Tech Internally Too
Telemedicine is not confined to linking a home care patient to a far-off medical site. Telemedicine is also increasingly becoming a part of the in-house patient care experience. And hospitals are investing big bucks in the process as they link their patients to nurses stations.
For example, the Electromedical Systems Division of Siemens Medical Solutions recently began the installation of a $1 million INFINITY Patient Monitoring Solution™ system at East Jefferson General Hospital in Metairie, La.
That installation is the hospital’s second system. The monitors, which are networked to each other and to the nurses’ station, are currently installed in the coronary care unit, the neonatal intensive care unit and the emergency department. Additional monitors are being installed in the intensive care unit. The hospital had already installed two telemetry units previously.
When a patient is in critical condition, it is important for caregivers to have the ability to monitor that patient at all times, whether the clinician is at the bedside or in a room down the hall, said Bill Isenberg, group vice president of Siemens Electromedical Systems Division.
The patient monitors being added at East Jefferson General Hospital will provide continuous quality health care to the community, he added.
Various companies offer hospital monitoring packages of varying capabilities and designs. Siemens’ package is called PICK AND GO™ and was designed so the monitors can be moved with a patient throughout the hospital stay. It has add and subtract features, allowing capabilities to expand or contract on demand for varying patient types, acuity levels and care environments.
There is no need to change monitors and cables every time a patient is moved. This eliminates the need for separate transport monitors and in.creases the time clinicians can spend with their patients while reducing the time needed to move a patient from Point A to Point B. Since the monitors are networked to the central station, clinicians have access to the vital sign data from all patients at all times, even while they are being moved.
