Just as technology must evolve to meet consumer needs, telemedicine has reached a pivotal point in its development that finally makes it a realistic option for senior living providers. Telemedicine talk and try-outs have long been part of resident care discussions, but only now can the technology really start making good on its promise of providing effective virtual care-bringing physicians and residents together, despite the miles between them.
It's welcome news for senior living companies seeking innovative ways to enhance the resident experience by making medical care accessible in ways that are both convenient and cost effective. Plus, as acuity continues to rise, the need for quick and easy access to physicians and specialists grows for residents-and being able to meet that need also makes a community more competitive.
Exploring Care Options
The term telemedicine could encompass a variety of technologies, including wireless in-room monitoring systems for residents and some emergency-call systems. But on the cutting edge of those technologies is telemedicine in its truest sense-the use of audio, video, and other means to capture vital signs, transmit data between multiple locations, and facilitate virtual visits with physicians. Most technologies specific to telemedicine "seek to replicate remotely what happens in a clinical setting, a doctor's visit, or a nurse's visit," says David Stern, chief professional officer of Living Independently Group, a telemedicine technology supplier based in New York City.
Traditionally, if a resident needs to see a physician, a family member must provide transportation and assistance or arrange for the resident's community to do so. Either option can be a logistics challenge, an additional expense, and a stressful situation for the resident.
"It makes logical sense to explore the role [telemedicine technology] could have in assisted living, and in senior housing in general," says Elizabeth Wheatley, corporate director of clinical operations for Newton, Massachusetts-based Five Star Senior Living. In addition to enhancing resident care, Wheatley also sees the long-term business benefits. "The bottom line is we want to help our residents stay as healthy as possible so they can stay with us. So I think this will help us with resident retention in the long run." Ideally, Wheatley envisions a telemedicine system that combines video communications and clinical data. "It could allow more frequent communication between the resident, the community, and the provider. That means you might be able to identify subtle changes in their condition a little early on," she says. Researchers at the Texas Tech University Health Sciences Center in Lubbock have shown that such a system is possible. They have been working with a local assisted living community to demonstrate a telemedicine system that incorporates a desktop audio-visual system and a hand-held camera for diagnostics. Researchers report the ability to deliver a variety of primary care services remotely that will reduce the need for in-person visits.
Testing the Technology
Since telemedicine technology began rolling out in recent years, senior living executives have been watchful of its business benefits. More than this, though, they're intrigued by the potential boon to overall resident wellness.
"The idea that we can do some minor diagnosing through a [virtual consultation] versus sending someone to the ER just to get diagnosed for a urinary tract infection-that's what interests me," says Bettina Suarez-Roskosh, national director of clinical services for McLean, Virginia-based Sunrise Senior Living.
At The Arbor Company, based in Atlanta, Vice President of Quality Mary Campbell Jenkins points to a variety of in-room and kiosk-based technologies that allow residents to self-collect data and report various vital measurements such as weight, blood pressure, and even blood sugar levels. The information is recorded for caregivers and sent electronically to physicians.
This type of telemedicine technology in some ways "enforces a discipline about collecting that information," Campbell Jenkins says. "It heightens awareness and, from a corporate perspective, it allows for a greater degree of oversight."
On the other hand, implementing telemedicine technology isn't as simple as buying a new gadget and using it. As with any technology purchase, the consumer assumes risks-and in the case of telemedicine kiosks, an unforeseen circumstance forced The Arbor Company to discontinue the use of such a kiosk at its community in Decatur, Georgia.
The company installed the kiosk about two years ago. Residents quickly learned to use the machines to record their own vitals, and that information was then sent to their physicians.
"It was especially helpful around issues like blood sugar, where you might see a spike on one day, when the previous 30 days were stable. So you would not make a decision based on that one moment in time," Campbell Jenkins says.
Then outside events intervened. The kiosk's manufacturer, Virtual Medical Care, was acquired by Intel, which in September 2008 took back the machine, citing safety compliance issues with the FDA. Intel refunded 75 percent of the purchase price. And, despite the strong initial reception, Arbor has not replaced the machine or restarted the program.
There's a fundamental shortcoming in these systems, Campbell Jenkins says. It's true that they can save a lot of daily effort on the part of nurses by accumulating helpful data, but that data still has to be compiled and analyzed, which can effectively erase the labor savings.
"It has great potential to help identify early signs of a change in condition," she explains. "But it has to be managed very closely, and physicians don't want to manage it. So then it falls back to our over-stretched clinical leaders to do it, and we are stretched too thin already."
Arbor is testing a similar telemedicine kiosk in a South Carolina senior living community, where the company's home health partner operates the machine in the assisted living building, monitors the data, and then alerts the director of clinical care in case of changes, such as uneven blood pressure readings. This helps cut the workload for the nurses, but it doesn't address Campbell Jenkins' greater quandary: Who's supposed to pay for all this? Right now Arbor is picking up the tab to have that extra pair of clinical eyes watching over collected data, but that's not a winning proposition for the long term.
"We have not successfully figured out how to pass the cost of that on to families," says Campbell Jenkins. "That is not something they have been willing to pay for up to now."
Wheatley meanwhile worries that it might be a burden to establish the appropriate links between communities and physicians. "If we have the device but the physician doesn't, then who are you going to communicate with? I think these things need to be further developed."
Planning for the Future
Especially given the current economic environment, most providers are looking carefully at the options when it comes to telemedicine technology. On one hand, it can work toward enhancing resident care and making the senior living experience a more enjoyable one for residents and their family members. Plus, such an offering can make a community more competitive. On the other hand, telemedicine technology requires staff training and daily monitoring-which can affect the bottom line in the long term.
"We have looked at it and looked into it, but we have not used [telemedicine technology] formally or introduced it into our buildings as of yet," says Sunrise Senior Living's Suarez-Roskosh.
Five Star Senior Living's Wheatley wants to see a few more tangible demonstrations of telemedicine in assisted living settings to feel more certain about its efficacy. "I would like to see some kind of pilot study, so that we really understand the methodologies involved," she says.
While assisted living executives have not made telemedicine technologies an integral part of their business plans as of yet, it's clear that the wind continues to blow in that direction. Vendors say they have experienced a definite progression in favor of telemedicine.
"Three years ago, the reaction was: 'What's this?'" says Stern of Living Independently Group. "Two years ago, it was: 'I think I heard about this last year at the conference, and I was looking for you.' There is this gradual recognition building that this kind of technology can help."
Even without video, without self-monitoring technologies, the fundamentals of telemedicine continue to fascinate. At LogicMark, a manufacturer of personal emergency response systems based in Fairfax Station, Virginia, President Mark Gottlieb points out the ability of such systems to foster a higher quality of life.
"The fact is most people in assisted living reside in their own apartments and maybe the door is closed or maybe they are in the bathroom," he says. "With the ability to quickly communicate an issue to caregivers, the better the outcome is going to be. So it really allows people to live independently while still being just a push-button away from getting help if they need it."
