The following is a guest article by Ed Mercadante is the Chief Executive Officer of MediTelecare.
With the COVID-19 cloud casting a shadow on high-risk elderly care communities, there’s another effect to make note of besides the way these facilities have been unfortunately impacted with cases. With limitations in place from seeing loved ones, elderly residents have heightened isolation like they’ve never seen before, dampening their spirits and increasing several mental and behavioral health disorders.
It has come as no surprise that the pandemic has also put up serious limitations to in-person medical care. To address the ongoing need for medical treatment during this time of physical distancing, there has been a rapid expansion of offerings for health care services by way of telehealth across all medical fields. Physicians and other health care providers supply services to their patients at remote locations, including long term skilled nursing facilities. A service that is proving to lessen the experimental over-prescribing of unnecessary medications within this elderly community. But there has always been one question detractors of telehealth ask: does it actually work?
Repairing the Patient-Provider Disconnect
A recent industry report shows there are staggering benefits of using telehealth services as it applies to behavioral health conditions in the elderly at long-term care facilities, which couldn’t have come at a timelier moment.
While most resident-patients have been quarantined behind closed doors, 1,350 resident-patients were offered the telehealth service with the same level of care they would receive with an in-person office setting. Through this video technology platform, the digital features built-in enabled clinicians to provide care via a video linkage. Psychologists would walk through a talk-therapy session to address their behavioral condition, while a medical practitioner reviewed their medical chart and dosage of their medications to see if the patient was eligible for an alternative or something less dangerous.
The team of medical experts was able to discontinue high-risk medications such as antipsychotics and hypnotics, successfully transitioning patients onto either less dangerous medications or to non-pharmacologic options altogether. This holistic care management approach of bridging the communication between not only doctor and patient but practitioner and therapist reduced the overall use of psychotropic medications by 17 percent, while anti-anxiety and hypnotic use were reduced by 15 percent.
These facilities also averaged 50 percent less use and overuse of antipsychotic medications than the national average, averaging seven percent versus a national average in skilled nursing centers of approximately 14 percent.
What was discovered is that these care facilities could safely and effectively manage behavioral health conditions through proprietary telehealth technologies. The reliable combination of greater access to behavioral health specialists, with a team that scientifically understands evidence-based treatment protocols, resulted in positive outcomes among a vulnerable resident-patient population.
Alleviating the Risks
With long-term care facilities not typically equipped with in-house clinicians, resident-patients often aren’t given the experience to look into their complicated behavioral or mental health issues. From mild depression and anxiety to pronounced Alzheimer’s Disease, there are substantial diagnoses to be explored and alternative solutions to be considered.
The overuse of antipsychotic medications in skilled nursing facilities is linked with greater medical risks for elderly resident-patients. These could include increased falls, risky side-effects, and rehospitalization adding to the excessive costs their families already incur for their care.
The recent findings show how reducing risky medications with direct access to clinicians who understand the full spectrum of options and safer alternative medicines, enhanced the trajectory of these individuals.
The Barrier of Restrictions
The barriers to consistently access this type of care within the elderly population are pronounced.
- Shortage of mental health practitioners at large. With the lack of the right doctors, there are more buildings and patients in need than there are mental health providers.
- Challenge of getting to a doctor. You can be transported, often with the assistance of a wheelchair by a family member or aid. Then there’s the rare alternative, the physician comes to the nursing home.
- Limited Contact. The parameters currently in place to come and go in skilled nursing facilities are stringent at best.
In addition to cognitive diagnoses, the emotional distress from the recent isolation results in residents seldom speaking, suffering from nightmares, and crying frequently. This leads to an experimental cocktailing of medications to settle the symptoms. In actuality, what the report is finding is that some of these may be unnecessary and the true remedy may be found in one-on-one talk therapy with experienced practitioners familiar with telehealthcare.
New Standard for the Industry
Looking to lower the overuse of high-risk medications within the elderly community is becoming something nursing facilities are watching carefully. As families entrust their cognitively impaired loved ones with well-rounded care, their hope is that they are given a holistic approach to care management that addresses the patient as a whole.
Reducing risky medications with direct access to clinicians who understand the full spectrum of options and safer alternative medicines should be at the forefront of ways to offer resident patients a better quality of life.
Looking to the Future
As the digital age advances, the post-pandemic world for the healthcare community will show telehealth as one of the first modalities to reach patients and provide follow-ups. The refinement of the right technologies will allow patients and providers to communicate much more efficiently.
This reliable combination of greater access to behavioral health specialists, with a team that scientifically understands evidence-based treatment protocols, results in positive outcomes among a vulnerable resident-patient population. Having the right team of doctors all on the same page caring for the patient as a whole is showing that you can significantly reduce the overall rate of inappropriate and unnecessary psychotropic medication use in a telehealth setting.
About Ed Mercadante
Ed Mercadante is the Chief Executive Officer of MediTelecare, industry leader in providing behavioral telehealth services to residents of skilled nursing and long term care facilities; improving access to world class clinical services and introducing new mobile telemedicine technologies to resident-patients.