Study examines benefits, challenges of telehealth in nursing homes during pandemic

by University of Missouri

Kimberly Powell. Credit: MU Sinclair School of Nursing

The COVID-19 pandemic caused nursing homes to rapidly change their policies overnight. Telehealth was instantly adopted widely in an effort to reduce stress on the health care system by keeping residents safe and avoiding unnecessary transfers to already-overwhelmed hospitals.

A new study at the University of Missouri found that the use of telehealth not only reduced stress for nursing home residents, but also increased access to convenient care. Kimberly Powell, an assistant professor in the MU Sinclair School of Nursing, interviewed nursing home clinicians and administrators from a sample of 700 nursing homes across the country to better understand the benefits and challenges of widespread telehealth adoption.

“Transporting a resident to the hospital can be a very traumatic and stressful experience,” Powell said. “Whether it’s a fall in the middle of the night or a sudden change in vitals, if a nurse can quickly hop on a Zoom call with a resident and make an assessment, perhaps an intervention plan can be developed that allows the resident to be treated in the nursing home, which saves time, money and an unnecessary transfer to the hospital.”

Still, there are other impacts to consider. While telehealth offers unprecedented convenience, it can also remove much needed socialization opportunities for older adults, and even create confusion for nursing home residents with cognitive difficulties.

“For some nursing home residents, going to a doctor’s office for a consultation or follow-up appointment can be a fun social event, as it may be their only chance each month to get fresh air and go out in the community, so taking that opportunity away can be difficult for some,” Powell said. “Or for those with cognitive impairments, they might not understand on a telehealth call why or how their doctor is talking to them through a computer screen. While telehealth can be very convenient and beneficial, it should not be viewed as a one-size-fits-all solution, and this study helped us see various nuances involved.”

Powell added the adoption of telehealth during the pandemic was quicker and smoother for nursing homes that already had experience using it before.

“The pandemic highlighted the need for more technical training toward nursing homes that up until now had never used it before,” Powell said. “Going forward, there is also the need for better data integration so that when clinicians are on a Zoom call with nursing home residents, they can quickly and easily access medical records such as blood tests or lab results.”

Powell’s interest in using information technology to improve nursing stems from her years as a doctoral student, when online patient portals were first being invented, allowing clinicians and patients unprecedented access to individualized medical data.

“As a nurse, I have always been fascinated with how information technology can be used to improve patient health outcomes,” Powell said. “Telehealth opens up so many opportunities for early interventions and allows clinicians to also take into account personal preferences and shared decision making.”

“Consequences of rapid telehealth expansion in nursing homes: Promise and pitfalls” was recently published in the Journal of Applied Clinical Informatics. Funding for the study was provided by the Agency for Healthcare Research and Quality.