- A national provider of behavioral healthcare services for long-term care facilities is using telemedicine to address an urgent need for mental health care.
Texas-based Deer Oaks, which works with some 1,400 LTCFs in 27 states, is using virtual care to connect residents with behavioral healthcare providers, enabling those residents to get treatment at the time and place that suits both provider and patient.
Christopher Pick, the organization’s Director of Telehealth Service Solutions, says the connected care platform erases many barriers to care that are prevalent in LTCFs and other types of skilled nursing facilities.
“The needs are high (and) providers are scarce in many counties,” he says. “There are not a lot of providers to go into the facilities, and it is not easy to take the residents to outside community-based services who may not even accept individuals with many of the conditions that people in nursing homes face - things like being not self-ambulatory, incontinent, having IV tubes and so on. Where services are available, they are often one provider instead of an integrated approach of psychiatric treatment, psychologic testing and counseling services as appropriate for each patient.”
Pick lists a number of statistics related to lack of access to mental health care in these communities:
- According to the American Journal of Preventive Medicine, some 65 percent of people living in non-metropolitan counties don’t have access to a psychiatrist, and 47 percent can’t easily see a psychologist.
- Among the senior population, more than two-thirds suffer from behavioral or mental health concerns; more than half are living with Alzheimer’s or some other form of dementia, and about 37 percent suffer from depression. Those health issues can increase the chances of developing comorbid conditions like immune system and cardiac issues, susceptibility to infection, asthma, slowed recovery time and an increase in suicidal thoughts.
- More than 30 percent of nursing homes are located in rural areas, many of which are dealing with a shortage of healthcare providers and barriers to healthcare access.
- More than 30 percent of the nation’s counties, according to the Center for Medicare & Medicaid Services, are designated as Provider Shortage Areas.
In this resource-thin landscape, Pick says, telehealth can offer a lot of benefits.
“A telehealth platform allows for the consistent delivery of integrated behavioral care,” he says. “Whether the home is too small, too distant, or the patients would benefit from additional hours, days (or) types of licensed professionals; telemedicine can add, supplement or supply these in conjunction or in place of on-site services.”
“We have locations where patients go into crisis or near crisis, and their provider can see them face-to-face on an emergent basis,” he says. “We have locations plagued by flood, snow and other weather events, where telemedicine allows patients to still be seen, week in and week out, by the provider they know and have a relationship with. Consistent care by the same provider is of immense benefit when working with people with the types of problems we see and who are admitted to a nursing facility.”
Deer Oaks is using SnapMD’s telemedicine platform for its telemental health programs
Deer Oaks uses SnapMD’s telemedicine platform for its telemental health programs. Each facility gets all the equipment and the training they need, and they’re asked to supply a facilitator, for which they can be reimbursed by CMS and many managed care plans through the originating site hosting fee.
Pick says each facility needs a reliable internet connection, preferably Wi-Fi, with 500 kbs of bandwidth. Once that’s established, the facility needs to create a list of residents who might use the service and have the necessary care providers sign off on the program.
LTCFs also have to plan carefully, he says, to make sure these platforms are sustainable.
“There are several unique challenges to providing telemedicine to an SNF,” Pick says. “A lot of the challenges go along with rural locations where infrastructure is behind what we all get used to in urban areas, with fiber optics and other high-speed internet. The people in rural homes are not as technology dependent, so correspondingly they are not as comfortable with technology. Given the average age of nursing home residents, this is probably true no matter where they are located.”
“Unfortunately, many SNFs, while quite comfortable, were built a long time ago, and there is not a lot of technology infrastructure or investment in them that we see in other kinds of facilities and businesses. The majority of places we talk to claim to have ‘poor Internet’ or ‘poor Wi-Fi’ that goes out with the first drop of rain or gust of wind. The guests and employees often strain the resources available. So far, we have been able to overcome these challenges. It takes knowing what you will need and having the right technology employed, but it does not necessarily have to cost a lot of money.”
“Also given that we treat patients … suffering from conditions like depression, anxiety and dementia; we cannot rely on the patients alone to connect through telemedicine,” Pick adds. “We must rely on … a team approach with the facility staff. This close cooperation, when formed, improves the level and quality of care for the patient as well as what is offered at the SNF overall. This benefits the patients, their families, and the staff.”
“Lastly,” he says, “many residents of nursing homes are there not only because they cannot manage a medical condition on their own, but also because of other conditions that make them less able to function independently. Many can and do benefit from behavioral services, but our clinicians have to be good at reaching across the divide to connect with them and to help them.”
So how does an organization measure whether a telehealth program is doing what it’s supposed to do? Pick says there are several benchmarks to take into consideration.
“Success is measured both for the patients and for the facilities where we can deliver our services,” he notes. “For the patients, we measure and hopefully demonstrate improved quality of Life, cognition and memory, social behavior, emotional well-being and family Interactions. We similarly try to demonstrate reduced stress and feelings of anxiety, need for antipsychotics, negative thoughts and behaviors, aggression and depression.”
“On the facility side, we demonstrate and they measure improved: quality of care, quality indicators and STAR ratings, nursing/patient interactions, non-pharmaceutical interventions and GDR results and care plan outcomes,” he says “Similarly we hope to reduce: hospitalization, polypharmacy and adverse reactions, state visits, crises caused by behaviors and liabilities and exposures.”
Pick expects that Deer Oaks will expand its telemedicine program in time, but the path to scalability isn’t always clear-cut.
“Right now we have many homes that we cannot reach, or we can’t add additional services that meet the Medicare standard (for reimbursement) of being in Non-Metropolitan Statistical Areas or HealthCare Provider Shortage Areas,” he says. “In the states we currently serve, that is more than 1,000 facilities. Eventually Medicare might open the list of approved originating sites so that we could provide across-the-board integrated behavioral health services to seniors in Assisted Living, Independent Living and Community centers. We could deliver those services whether they’re big-city locations or the most remote, and consistently, no matter what the weather or distance.”
Pick, who has spent a decade in telemedicine, says the landscape has evolved considerably over those 10 years, so that connected care technologies are becoming the norm rather than the exception.
“The surprise comes from the difference between when I first talk to facilities (and to staff) who cannot picture their residents accepting this, to those who we have trained and then are utilizing the service,” he says. “It goes from doubt – ‘I do not know if that will work here’ - to surprise – ‘That’s it?’ - to elation – ‘This is so great, the patients love it, and you can really see the difference around here.’ The joy of what we do is when we can make people’s lives better.”