Long-term care facilities have been some of the hardest hit during the COVID pandemic. According to the Foundation for Research on Equal Opportunity as of May 2020, 42% of the nation’s known coronavirus deaths are long-term care residents and staff. To date, the Centers for Medicare and Medicaid Services has reported over 38,000 coronavirus deaths in their 15,400 Medicare and Medicaid homes.
When we think of long-term care, we tend to first think about nursing homes or assisted living facilities where residents receive 24-hour care. They are among the frailest and most susceptible to the deadliest of COVID symptoms. Yet nursing homes also provide care for younger adults who may need temporary respite care after a surgery or injury, and people who need constant care such as those with a severe developmental disability. It is estimated this population makes up approximately 15% of the nursing home population of a total nursing home and assisted living population of 2.1 million people.
Care Delivery Challenges
Even before COVID ravaged nursing homes, they were faced with care delivery challenges. Patients in long-term care facilities often have chronic health conditions and many have co-occurring disorders that need complex treatment plans and advanced care coordination. There are also challenges of access to care, limited mobility for some elderly and disabled residents, low patient-to-provider ratios, and miscommunication between care providers working together to meet the high acuity needs of this vulnerable population.
When the coronavirus arrived, even the most skilled and well-staffed nursing homes weren’t prepared. Many residents became infected by staff members who were out in the community or from family members who experienced asymptomatic presentation of the illness, visiting their loved ones before the practice of banning visits took hold. The ability to optimize resources and prevent the spreading of infection in an already challenging care environment proved to be a key contributor to high nursing home death rates. Patients who died from COVID in 2020 were almost 12 times more likely to die in a medical facility than patients who died from any cause in 2018, including 22.7% who died in nursing homes.
The results have been devastating including family members saying their final goodbyes to a loved one via video and many who died alone because of visitor restrictions. Those who have recovered or were spared getting sick continue to be isolated from their loved ones for the foreseeable future.
Protecting and Caring for a Vulnerable Population
Virtual care is an important consideration for delivering care and connecting families in long term care facilities. It can support care teams no matter where they are located and connect family members with their loved ones and their providers. This continuity of care is critical to avoid negative consequences.
During a pandemic, telehealth can expand access to more care providers to quickly and more frequently screen patients with symptoms and refer critical cases to the nearest hospital before symptoms progress too far. Virtual care can also reduce staff exposure, protect credentialed physicians, and make it possible to treat patients at a distance.
Even when the coronavirus is under control and families can once again visit their loved ones, telehealth can provide non-emergent care to nursing home residents, monitor the clinical signs of chronic medical conditions, support case management for patients with special needs such as those with limited mobility and help reach more patients in rural facilities with limited access to care specialists. Consider also the opportunities for earlier intervention and more frequent care visits that can contribute to better health outcomes for the patient and a significantly reduced cost of care delivery.
The Future of Long-Term Care
The population of Americans over 65 grew by over a third from 2010 to 2020 to reach approximately 53 million. It is estimated that 52% of this population will need some type of long-term care services in their lifetimes. We need to ask ourselves how our health system will scale to manage this increasing level of need for chronic care treatment, non-emergent care, and future public health emergencies.
A little over a year ago, we predicted that virtual care was the future of healthcare. One prediction we couldn’t make was that a pandemic would propel the adoption of telehealth like never before. The future has arrived.
Virtual care may not be the only solution for long-term care facilities, but it is a long-term solution. As advanced telehealth technologies are here and continue to emerge, they will be equipped to future proof any virtual health practice. Now is the time for all healthcare providers and care facilities to invest in a telehealth program for today and the next generation of patients.