Using telehealth to improve access to older people living in residential aged care: Benefits, challenges, case studies

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It’s no secret that the number of general practitioner (GP) telehealth consultations to residents of aged care homes (RACH) has substantially increased in the last five years. This has been out of necessity (COVID-19 restrictions on visitations); due to government, industry and PHN investment in telehealth funding and equipment; and due to workforce challenges. 

The Australian government has been proactive in expanding Medicare coverage for telehealth services, recognising its potential to provide timely and effective care. Despite this, adoption across aged care facilities remains uneven, with some fully integrating telehealth into their care practices, and others still in the preliminary stages of implementation. The shift toward telehealth is, however, undeniable.

Real-time video consultations between patients and healthcare providers are increasingly common, allowing for immediate assessments and care plan adjustments. Professionals can diagnose and provide self-care guidance for patients and for nursing staff to support face-to-face patient care. Remote patient monitoring is available for some, allowing healthcare professionals to track and analyse a patient’s vital signs and health conditions from a distance, which can empower residents (supported by staff) to be more proactive in managing their health.

In 2020, telehealth represented 17% of GP consultations in RACHs during the COVID-19 surge, dropping to 11% as COVID eased. For every one GP RACH telehealth consultation conducted by video, around eight were conducted by telephone. Clear evidence is lacking on whether phone-based telehealth or video-based telehealth is better, and for what conditions and under what circumstances. GPs also make a substantial amount of phone calls directly to facilities that cannot be billed through Medicare without the patient present.

Larter’s work enhancing access to care through after-hours initiatives and aged care initiatives has given us insights into the benefits and challenges of telehealth in residential aged care.

What’s working? Benefits of telehealth in residential aged care

  • Increased accessibility: Telehealth can help overcome geographic barriers, reduce time to access health care, and reduce the number of times residents need to leave their residential home. A key example is access to specialists for residents in rural and remote areas. We see instances in which telehealth has saved the need for residents to travel from rural Victoria to Melbourne, and the need for family / carers to travel as well. It can enable more family members to loop into clinical discussions. 
  • Improved efficiency / Faster care: On top of the efficiencies due to reduced travel, telehealth can also enable providers to make clinical decisions in real time (particularly important at end-of-life or after sudden deterioration), and often with increased access to medical records in the convenience of their own offices. Telehealth can also enable a number of providers (e.g. GP, specialist, allied) to collaborate and provide same-time care that is usually not possible face-to-face; and it also enables immediate medication assessment and prescription. 
  • More funding and training: One GP said to us “funding has given us the opportunity to think outside the square”. A benefit of COVID-19 was to prompt the federal government to fund MBS telehealth services and these remain available (MBS Online – MBS Telehealth Services – from 1 January 2024), PHNs and state governments have also been funding equipment and training to support telehealth models. 
  • Enhanced collaboration: Telehealth can open doors to a broader health care team delivering services into facilities including geriatricians, neurologists, allied health and palliative care teams leading to more personalised care plans. Again, this can also support enhanced family understanding and prompt their engagement in care plans.  
  • Resident-centred and personalised care: It also offers a remarkable opportunity for enhanced personalisation in healthcare. Through offsite access to real-time health data, telehealth platforms can help provide more timely responses to need. Whether it’s adjusting medication regimes, providing personalised exercise routines or helping residential care staff respond to emergencies more quickly, telehealth can empower healthcare professionals to deliver timely and customised experiences. 
  • Care in place: There is now good evidence that telehealth reduces emergency department transfers for residents, which can reduce older persons’ distress and reduce demand issues in hospitals. 

Challenges of using telehealth in residential aged care

  • Technological literacy: Aside from equipment and internet limitations, care providers may face challenges with technological literacy, especially in an aged care workforce where many workers are 45+. We know from research that technological literacy decreases with age. This can make setting up and troubleshooting video consultations difficult and time-consuming, disrupting clinical care during rounds. The same problems exist for many GPs, particularly when consulting after hours when they may not have technological support. However, with adequate training, support, and reliable technology infrastructure, these hurdles can be overcome.
  • More difficult to undertake video consultations in rural and remote Australia: Residents in rural areas are far more likely to receive a telehealth service by telephone, than by video conferencing. If staff lose confidence in telehealth due to lack of training or poor internet connectivity, we have seen instances in which they simply give up when it is too hard. A lack of connectivity at either end will lead to poor experiences. 
  • Exclusion of vulnerable residents due to device inadequacy: Clinicians and facilities talk of the need for improved devices and technologies that are specifically designed to address the needs of residents with visual, hearing, or cognitive impairments. Without this, certain residents face digital exclusion. Facilities should consider the need for big clear displays, adjustable settings, and noise cancelling (headphone) technology. Also physical, cognitive or sensory impairment may be so severe that telehealth is not appropriate. 
  • Lack of personal interaction (fit-for-purpose concerns): A 2021 Australian survey found that among all age groups, respondents aged 65 and over had the lowest comfort level with telehealth (56%). This age group also showed the strongest preference for in-person consultations (84%). It is of course important to prioritise face-to-face care to build rapport and in certain clinical circumstances. Physical presence allows healthcare professionals to observe non-verbal cues and body language that can reveal important information about a patient’s emotional state, comfort level, and cognitive function. Also, in situations where complex procedures or physical examinations are required, direct contact becomes essential for accurate diagnosis and treatment. Telehealth is best suited to remain an adjunct service delivery mode, complementing traditional in-person care.
  • Privacy concerns: One concern is the transmission and storage of sensitive patient data during virtual consultations. It is imperative in this age that secure communication channels and encrypted platforms are used to protect patient information from unauthorised access. Additionally, healthcare providers need robust authentication measures to verify patient identities and prevent fraudulent activities. Another concern is software vulnerabilities. It is vital to regularly update software and maintain firewalls. Stringent privacy protocols and compliance with industry standards can build trust in digital health.
  • Lack of evidence-based standards and guidelines: The lack of clear guidelines in Australia is a barrier, with much research in early stages. Those who are not early adopters will be cautious. The Aged Care Industry Technology Council has released an industry roadmap. The Royal Australian College of General Practitioners has released significant guidance on using telehealth in general practice, however guidelines for telehealth use in the ‘Silver Book’ (the key guide for GPs in aged care) are currently limited.

Case studies / enablers

  • Extending internet connectivity –  Better connectivity improves user telehealth experiences and builds confidence in telehealth systems. Primary Health Networks across Australia have been providing infrastructure grants to residential aged care homes for this purpose. 
  • Medical practitioners on call – Telehealth MBS funding has enabled the private sector to innovate and offer solutions – some better than others. One company we’ve been impressed with is My Emergency Doctor (MED) who have shown a willingness to partner with PHNs and consultants and broker models whereby emergency physicians provide care to help meet local need. For example, Nepean Blue Mountains PHN in New South Wales engaged MED to offer after hours medical care via telehealth for 12 months with the aim to reduce ED presentations, reduce hospital admissions, and reduce local GP after hours workload. Research reported:
    • 179/209 calls to MED were resolved with in-house treatment
    • NSW Ambulance data showed a reduction in after hours ED transfers during the 12 month trial period
    • Technology, training and easy access to MED were important for RACH staff adoption; once RACH staff were trained they were motivated to continue to use it, however refresher training in RACHs was crucial, particularly where there was staff turnover
    • GPs were satisfied with the way MED communicated with them and integrated care records
    • Some GPs preferred to maintain their own care models, commenting on the importance of a good understanding of the patient, family needs and facility and questioning the utility of a remote emergency physician model.
  • State health services: State governments are increasingly embracing telehealth solutions for residents, partially to reduce unnecessary hospital transfer. For example the South Australian Virtual Care Service (SAVCS) began in 2021, providing clinical assessment of residents via video link in partnership with SA Ambulance, hospitals and community care teams. It is available 8am-10pm every day of the year. The facilities and GPs we spoke to find the service very useful, though again, staff shortages in RACHs can mean that taking a nurse ‘off the floor’ to participate can cause issues in facilities.  

Where to next?

Telehealth in residential aged care in Australia holds immense potential, though there are significant challenges that any intervention needs to consider including staff shortages in facilities and the need for training; internet connectivity; the appropriateness of devices for persons with impairment; complementarity with the approaches of local providers; and the need for more research and evidence-based guidelines. With no end to workforce challenges in sight, particularly in rural and remote areas of Australia, we need to work together to pave the way for a future where telehealth becomes an integral component of residential aged care as long as it is personalised, accepted, easy to use and complementary to face-to-face care.

Continued investment in education, infrastructure, and evaluation of these models will ensure the investments are taken up in facilities and are resident-centred and value-based, contributing to improved healthcare outcomes among aged care residents in Australia.

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