Traditionally, hospice and palliative care agencies have been slow to implement health-technology services. However, in recent years, telehealth had been increasingly applied to hospice and palliative care to extend the full spectrum of care services to patients’ homes. As remote patient monitoring expands beyond home health, there has been a major push for telemonitoring across the care continuum. Organizations are creating telemonitoring programs for hospice care, palliative care, private duty, chronic care management, and more, with the goal of providing telemonitoring services at every step in the disease process.
In the hospice care setting, there are many unique benefits presented by telemonitoring that can improve patient care and reduce cost of care. Telehealth services incorporate patient data and virtual visits to evaluate patients better, enhance specialty care services, incorporate caregivers into the care continuum, improve clinical outcomes, and reduce ED visits and hospitalizations.
Many hospice patients will call 911 when they feel they are becoming symptomatic or their symptoms are aggravated. In many cases, a virtual visit or call with their provider can alleviate the patient’s anxiety, and keep them safely at home, avoiding the associated cost of an unnecessary ED visit and/or readmission. Additionally, symptom surveys and medication reminders can warn providers of escalating symptoms prior to an emergency occurring.
Patient Data Improves Care Coordination and Pain Management
Pain management and symptom control are critical to hospice care to reduce suffering for patients and family members, as well as reduce ED visits and hospitalizations. Hospice patients often experience severe symptoms such as shortness of breath, pain, and nausea that greatly impact their quality of life. Telemonitoring platforms offer symptom surveys and medication reminders that inform clinicians when a patient’s symptoms are exacerbated and allow them to rapidly adjust a patient’s medication regimen to ease their worsening symptoms.
Virtual Visits Extend Specialty Services
In addition to preventing ED visits and hospital readmissions, virtual visits can be integrated into hospice care to augment in-home nursing visits.
Of the two million Americans enrolled in hospice annually, over 65% receive home-hospice care services. Traditional home-hospice services rely on home visits from the patient’s hospice provider. There are also many hospice patients who live in rural areas or have impaired mobility and are unable to travel to hospice care-centers, or do not have access to home-hospice services that they require.
Research utilizing data from the Center for Medicare and Medicaid Services found that over 30% of hospice patients did not have any contact with a care provider during their final week of hospice care, indicating that in-home visits and clinician outreach often do not occur as frequently as is necessary or do not occur quickly enough when a patient’s health status is exacerbated.
Via video visits, hospice providers can perform additional patient evaluations to augment in-home nursing visits. Real-time video conferencing allows clinicians to read patient reactions and analyze patient responses to determine their understanding of instructions and their emotional state. Virtual visits between patients, caregivers, and one or more members of their care team improve access to specialty advice regarding symptom control, pain relief, coping with emotional distress, and more.
Engaging Caregivers in the Care Continuum
Caregivers are essential to providing hospice services, specifically, informal caregivers such as family members, spouses, children, and friends. Since 2000, the hospice industry has more than quadrupled, with 65% of Americans spending their final stages of life in hospice care. The rapidly increasing utilization of hospice care services, combined with staffing shortage affecting the entire healthcare industry, is driving the need for improved engagement of informal caregivers. Telemedicine is an effective tool in engaging caregivers in their loved one's care.
Medicare Conditions of Participation mandates interdisciplinary team (IDT) meetings to coordinate care across the multiple services offered in hospice care. Participation of caregivers (and patients) into IDT calls is encouraged but often impossible due to geographic obstacles or the delicate condition of patients. Video conferencing eases the burden placed on caregivers, allowing them to participate in these important meetings with clinicians and their loved one’s care team.
Virtual visits are not the only telehealth resource that can be made available to caregivers in order to improve care. In a recent article published in Progress in Palliative Care, Phongtankuel et al. suggest that as an indispensable member of a hospice care team, the mental and emotional health of caregivers should play an influential role in determining a patient’s need for support services and in-home visits. Recommend in the paper is the collection of clinical data from caregivers, in addition to patients, to prioritize care requirements and build data analytics to predict patient needs and outcomes based on both patient and caregiver health status.
Phongtankuel, Veerawat, et al. “Mobile Health Technology and Home Hospice Care: Promise and Pitfalls.” Progress in Palliative Care, U.S. National Library of Medicine, 26 Apr. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6261422/.
Hallman, Ben. “How Dying Became A Multibillion-Dollar Industry” The Huffington Post, TheHuffingtonPost.com, 19 June 2014, projects.huffingtonpost.com/hospice-inc.
Doolittle, Gary C., et al. “TeleHospice: A Community-Engaged Model for Utilizing Mobile Tablets to Enhance Rural Hospice Care - Gary C. Doolittle, Eve-Lynn Nelson, Ashley O. Spaulding, Adam F. Lomenick, Hope M. Krebill, Natasia J. Adams, Sandy J. Kuhlman, Joe L. Barnes, 2019.” SAGE Journals, 25 Feb. 2019, journals.sagepub.com/doi/abs/10.1177/1049909119829458.