Disclaimer: The views presented here are of the authors and do not necessarily reflect the views of United Hospital Fund, its staff, or its board of directors.
For health care, and long-term care in particular, the COVID-19 pandemic has been devastating. From the loss of so many of our seniors, to the unprecedented financial insecurity the industry faces, to steep new regulatory staffing requirements, to the exacerbated shortage of health care workers—the heartache and challenge persist. Yet there are many bright spots and lessons learned that will make life better for our seniors and for our industry moving forward. One opportunity is leveraging technology to put our residents first, through an innovative telemedicine/telehealth program born from necessity just a year ago.
When COVID-19 struck early last year, seniors became afraid to leave their homes to seek the care that was essential to maintaining their health. A hospital colleague approached us, asking for our help in reaching these essentially home-bound individuals and providing them access to the medical care they needed to stay healthy and safe at home until the pandemic eased or a vaccine was developed. As a provider of a full continuum of care, Gurwin Healthcare System operates a certified home health agency; we quickly mobilized to train our staff and launched our collaborative telehealth/telemedicine program with the hospital and their physician practices.
Key to our success was working closely with hospital and physician partners to identify at-risk seniors who were COVID-positive, experiencing signs of COVID, or had worsening symptoms of their chronic illness—and then using technology to connect them with their health care team from the safety of their homes. The program provided physicians with real-time health information via state-of-the-art, Bluetooth-enabled technology. This enabled the transmission of critical medical information—including heart and lung sounds, ECG recordings, daily clinical alerts, and virtual physician and nursing visits—which enabled virtual medical care to be successfully provided at home.
Our telehealth and telemedicine program paid off. Many seniors were able to continue living at home, avoiding emergency room care and hospitalization. During the height of COVID, our home care census doubled, we expanded to reach seniors in need, we were recognized for our ability to leverage technology to meet the health care needs of our seniors when it mattered most, and we were able to add new service to our home care program offerings. It was a win, not only for us and our hospital partner and physician practices, but also, most importantly, for our seniors.
VIRTUAL SENIOR CENTER
Restructuring our foundation team to focus on grant opportunities to fund innovative telemedicine/telehealth programs was critical to our strategic success. Early on when COVID hit, our adult day care programs were shut down by the New York State Department of Health. These seniors, many with dementia, were essentially cut off from the programming that kept them socially engaged and safe during the day. In addition, our own nursing and rehabilitation center and assisted living community residents were feeling isolated and lonely, unable to see family and often confined to their rooms due to social distancing protocols.
To meet this challenge, we pursued a bi-annual grant from the Alzheimer’s Foundation of America to implement the Virtual Senior Center Program for Dementia/Alzheimer’s for individuals with memory loss, both in our nursing and rehabilitation center as well as those living in the community. Our certified therapeutic recreation specialist with memory care training facilitates the program, which is geared for those who need assistance to participate and benefit from the wide range of dementia-specific programing. We offer the program in small increments of time to involve and connect seniors with one another and activities they enjoy. To the delight of caregivers and family members, formerly agitated residents are now engaged, calm, and smiling. The grant covers the minimal cost of running the program and the technology—and the benefits are priceless.
Seeing how this worked with the dementia population, we applied for a Mother Cabrini Health Foundation grant through the New York State Home Care Association to extend the program to non-dementia participants both in our assisted living facility as well as those at home in the community. The program allows participants to engage with other seniors in virtual classes and discussions as well as health and wellness programming. It also offers them the opportunity to go on virtual tours of museums and gardens, attend art and music shows, and much more. Residents in our facilities were assisted by our recreation staff; residents at home in the community were assisted by specially trained home health aides who learned best practices for engaging patients in the virtual platform. It didn’t take long for individuals experiencing loneliness and depression due to social isolation to again feel connected and social—this made all the difference for their health, emotional outlook, and quality of life.
EXPANDING FOR THE FUTURE OF CARE
Clinical experience became hard to come by for nursing and other students during the pandemic. For years, many students completed their geriatric rotation at our nursing and rehabilitation center, but the pandemic essentially put a halt to this necessary training for our future health care professionals. With some creative thinking, our clinical innovation team leveraged a grant from United Hospital Fund for improving care transitions for patients and families to create a partnership with a local nursing school, using the telehealth knowledge we gained through our other programs to extend a virtual clinical rotation for students earning their Bachelor of Science in Nursing.
Students provided virtual education to our short-term residents via Zoom and met with them weekly to discuss their health concerns and diagnoses, as well as to provide health education on their chronic illnesses and medications. In addition, they began to help the residents prepare for discharge and to educate them on self-management skills for diabetes, stroke, high blood pressure, congestive heart failure, and other conditions. Students in this pilot program conducted 60 individual sessions with more than 25 individuals and then facilitated more than 70 follow-up calls post-discharge, assuring a safe transition from the rehabilitation center back home. Because of this intervention and the coordinated care the nursing students provided, our residents reported that they felt more prepared and confident to take care of their health needs and expressed high satisfaction in the program. The nursing students collaborated with our certified home care agency’s clinical team to support the residents’ education on their chronic health conditions, medications, and home safety, and were able to follow up with the home care team to report health care concerns. This was not only a win for our residents, but also for our future health care professionals, who gained the clinical experience needed to provide best-practice transitional care to our seniors.
By looking for simple solutions and identifying ways to leverage technology, we were able to turn a few small grants into an opportunity to expand our reach, keep seniors safe, and cultivate a new and innovative academic collaborative during the COVID-19 pandemic. This additional funding made the outreach possible and will continue to help us evolve our transitional care models going forward.
Stuart B. Almer is the president and CEO of Gurwin Healthcare System.
United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from Stuart B. Almer spotlights some innovative long-term care programs launched during the pandemic. – UHF President Tony Shih