The 2020 to 2030 decade will have several notable firsts for the United States. For the first time in US history, individuals age 65 and older will represent 20% of the population^[1]. It is anticipated that this surge in the older adult population will see approximately a million more residents in senior living communities such as nursing homes and assisted living. As the healthcare landscape evolves and the senior population grows, post-acute and long-term care (PALTC) organizations have emerged as a lower cost site for complex care. Alternative care delivery models such as telehealth provide a value-based care option to address resident needs by virtually evaluating and treating patients at a distance.

Changes to healthcare will demand more from PALTC organizations today and in the future. By 2030, the projected physician shortage will be somewhere between 40,800 and 104,900^[2]; including both primary and specialty care, with specialty shortages projected to be particularly high. The lack of primary care providers will have an impact on preventive healthcare services which will become more crucial as the risk for health problems increases with an aging population. Additionally, several states in the south and west regions of the United States are expected to have Registered Nurse (RN) shortages between 2,200 and 44,500^[3]. Complicating matters, the shortage of specialists and nursing staff will leave patients with heart failure, Alzheimer’s, strokes, cancer, arthritis, and other ailments with less access to timely care. The decreasing number of unpaid caregivers will further complicate the situation. In 2010, for every person that needed a caregiver, there was an estimated seven caregivers; that number has dramatically decreased to four caregivers for every one person^[4],[5],[6]. Meeting the clinical needs of the 65 and older segment of the population is already a challenge without considering the reduction in medical providers and caregivers.

Today’s healthcare providers, buckling under the pressures of shrinking margins, are already seeing more senior patients with more complex physical and psychological needs, dominating the available resources. One of the biggest challenges of today is the demand on resources caused in obtaining timely care, particularly for residents and patients in long-term care communities. These patients are typically older, some of the frailest and some of the most vulnerable. To add to the complex patient population, PALTC organizations are now increasingly measured on their ability to avoid hospital readmissions and safely care for acutely ill patients onsite^[7]. Poor performance is addressed by exclusion from preferred partnerships and ACO's including financial penalties for transfers back to the ED and hospital.

Recognition that the U.S. healthcare system is facing an undisputable demographic shift, clinician resource constraints and skyrocketing costs are the first steps in realizing that healthcare delivery models must change. This is where telehealth can help.

Telehealth can help to improve provider efficiency and can reduce the need for transportation time and its associated costs. This benefits not just the providers, but especially the patients and their families or caregivers. Telehealth provides a solution and a means to improving patient education and monitoring patients virtually to address and manage chronic disease.

Telehealth-enabled care models provide an opportunity to address the timeliness of care delivery. Rather than moving the patient, telehealth moves the site of care to where the patient is located, such as their home or living community. Telehealth also brings specialty care and other health services that were previously inaccessible to seniors into long-term care settings. Ultimately, it offers a pathway to more comprehensive, patient-centered and accessible care that better serves our communities and protects our most vulnerable citizens. Telehealth programs have the potential to completely change the game—but they need to be scaled, structured, fully-deployed and disseminated. 

Despite the many benefits of incorporating telehealth into practice, the uptake of telehealth by Post-Acute and Long-Term Care (PALTC) providers has been limited. Challenges in understanding how telehealth can be used and lack of specific guidance has contributed to the slow proliferation of telehealth models. To increase telehealth adoption for older adults in PALTC settings, West Health, a mission driven non-profit, non-partisan organization focused on decreasing the cost of care and successful aging, convened leading organizations to create a first-of-its kind practical guide on best practices and lessons learned.The guide highlights a range of topics for a successful implementation of a telehealth program in PALTC organizations, many of which may be translated to other settings. 

Every healthcare organization that treats patients in PALTC communities must begin planning for a future that implements telehealth using practices to improve patient outcomes. Seniors deserve effective, low-cost care, and with technology advances, every healthcare organization can provide it.  

West Health is dedicated to exploring how telehealth and connected care can improve how seniors age in place and lower healthcare costs. For more information, visit: https://www.westhealth.org/telehealth/.

If your organization is interested in understanding more about implementing telehealth services, West Health will be hosting a free, interactive workshop that will provide administrators and professionals an opportunity to learn about best practices in bringing telehealth to post-acute and long-term communities (PALTCs). Led by a multidisciplinary team, attendees will have a unique experience interacting and learning from leading experts in a non-vendor driven environment. In addition, all attendees will receive a free copy of West Health’s new guidebook, “A Practical Guide: Implementing Telehealth in Post-Acute & Long-Term Care.” 

To join the interest list, visit: www.westhealth.org/event/paltctelehealthworkshop/

Event:

References: 

[1] Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014, May). An Aging Nation: The Older Population in the United States [PDF]. The United States Census Bureau

[2] GME Funding and Its Role in Addressing the Physician Shortage. (2016, September 08). Retrieved from https://news.aamc.org/for-the-media/article/gme-funding-doctor-shortage

[3] U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2017. National and Regional Supply and Demand Projections of the Nursing Workforce: 2014-2030. Rockville, Maryland

[4] R. W. Johnson, D. Toohey, and J. M. Weiner, Meeting the Long-Term Care Needs of the Baby Boomers: How Changing Families Will Affect Paid Helpers and Institutions (Washington, DC: The Urban Institute, May 2007).

[5] J. R. Knickman and E. K. Snell, “The 2030 Problem: Care for Aging Baby Boomers,” Health Services Research 37(4) (2002), pp. 849–884

[6] Redfoot, D., Feinburg, L., & Houser, A. (2013, August). The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers [PDF]. Washington, D.C.: AARP Public Policy Institute