Many nursing homes across the country were hit hard by COVID-19. Clusters of infections popped up in almost all states, often leading to serious illness and deaths, according to state health department data compiled by AARP. Not all states have reported COVID-19 deaths in long-term care facilities. The reporting variations are large, but available data show more than 38,000 nursing home residents and staff died from the disease through May 31. (Find out more at: https://www.aarp.org/caregiving/health/info-2020/coronavirus-nursing-home-cases-deaths.html.)
These stark facts meant case managers and other healthcare professionals needed to be careful about how and when they would facilitate patients moving to and from long-term care facilities.
“We were concerned with COVID-19 that we were not going to be able to access our potential participants [of a telehealth pilot study] because many of our research participants were in nursing homes, which were very hard hit,” says Steve Davis, PhD, associate professor in the department of health policy, management, and leadership at West Virginia University (WVU) School of Public Health. Davis is leading a pilot telehealth study that monitors patients’ vital signs.
Because of the additional concerns and risks of transferring patients to nursing homes from hospitals, more people were sent home after a hospital stay. That meant they would need remote case management and in-home care services.
“Going home can be seen as a good thing to avoid some of the community spread of the disease,” says Davis, adjunct professor in the department of emergency medicine at WVU School of Medicine. “We have six folks home, so far, who are transmitting [remote monitoring] data. We’ve had a couple of success stories early on.”
One story involves a patient with a medical history of hypertension. The patient’s blood pressure spiked during the weekend. The telehealth technology company’s nurse monitored the patient’s daily vital signs through a remote device and caught the blood pressure reading when it was out of the normal range.
“They notified our nurse on a Sunday, and we got in touch with the research participant and took measures to ensure the person’s blood pressure was brought back into a safe range,” Davis says. “We saw the benefit of remote patient monitoring, and that was one of our goals.”
Seamless Transition to Remote Tech
Some healthcare organizations turned to telehealth solutions seamlessly because of options built into their electronic medical records (EMRs). For example, providers and patients at NYU Langone Health can use its EMR to schedule a video visit, says Devin Mann, MD, associate professor in the departments of population health and medicine, and senior director for informatics innovation and medical center information technology.
“Patients can use the patient portal to click on the icon for a video visit, starting the visit in a matter of minutes,” Mann says. “It’s a great experience, and patients love it.”
When patients log in to the virtual visit, they are placed in a virtual waiting room. As soon as their provider is ready, the virtual visit begins. “It’s similar and different from a regular patient visit,” Mann says.
For one, healthcare professionals need to get used to a video medium when communicating with patients. Also, they might have to ask patients to adjust their phone or tablet so the camera angle works, he adds.
Technology issues usually are on the patient’s end: “Occasionally, their connection is a little weak, and their image quality is lower. But in terms of work — both clinical and research and meetings — there are no problems,” Mann says.
Find the New Normal
As in-person medical care is phased in nationwide, healthcare providers will need to identify their new normal, he notes.
“There is a need for in-person care because we need to see, touch people,” Mann says. “But there are things that we were doing that could be done equally well in video now that we know it can work effectively.”
Things have evolved and changed during the pandemic, and every situation is different, says Cynthia Bourbeau, RN, CRRN, CCM, CNLCP, rehabilitation nurse case manager, life care planner, and president and owner of Medical and Life Care Consulting Services, Inc. of Belchertown, MA.
The case management nursing team holds daily, remote discussions on challenges and issues. They meet once a week through a virtual meeting service, Bourbeau says.
Patients also can meet with physicians via virtual conferences. “We’ve tried as case managers to continue to do our jobs, but we just do it differently,” Bourbeau says. “We keep people in the home, safe.”
Therapists wear masks and gloves for patients who are comfortable with in-person therapy. “For people who can’t go out of their home, whether because of comorbidities or a higher risk, we have set up video therapy sessions,” Bourbeau says. “The therapist is [virtually] taking the patient through the exercises.”
Case managers have even gone to COVID-19 patients’ homes, stood outside their glass door or window, and held up a computer screen with the therapist showing the patient the exercises. This is a solution for when the patient does not have the internet or technology capabilities to perform the remote therapy on their own.
“When they are symptom-free and COVID-negative, the case manager goes in with protective clothing, wearing a mask and gloves. She puts the computer on a protected surface, like a plastic sheet, so the patient can follow the exercise program remotely,” Bourbeau explains. “It’s been working very well. All our patients have continued with their treatment, which is our goal.” After the visit, the case manager disinfects the equipment.
Soon, case managers and other healthcare professionals will see a whole ecosystem start to grow around virtual health, video visits, in-home monitoring, and e-care, Mann predicts. Virtual healthcare visits and encounters will continue to evolve as the pandemic continues.
“Let’s reimagine in-person visits now that we know so much can be done with video,” Mann says. “The reality is these tools are no longer kind of interesting and a one-off. These are going to become bread-and-butter medicine, and we should embrace it and learn how to use it.”