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By Lisa Romano RN, MSN
As COVID-19 continues to strain hospitals, pushing them to – or beyond – capacity, we’ll see more and more patients recover from COVID-19 at home this winter, either declining admission themselves, or unable to meet more stringent admission requirements. The increasing demand for hospital-level care at home allows patients to recover with the support of family and in a comfortable environment, but it also presents challenges, particularly in treating patients experiencing adverse downstream effects of social determinants of health.
According to the CDC, during the first quarter of 2020, the number of telehealth visits increased by 50 percent, compared with the same period in 2019, with a 154 percent increase in visits noted in surveillance week 13 in 2020, compared with the same period in 2019. Last January, telehealth was seen as a nice-to-have by hospitals and providers. Now, it’s a requirement, especially as more and more patients recover at home. The shift to in-home care has given a rise to another new phenomenon: the informal caregiver. More and more often, family members or friends are overseeing care regimens for at-home patients, becoming a new central element to the patient care circle.
The new dynamic demands new tools and integrations. Patients and their families need to be provided with the tools to track health at home, the means to communicate seamlessly with providers on the medium that makes the most sense, and the contextual information to play a meaningful role in their care. Here are the key crucial elements needed for successful in-home care:
- Access to telehealth: Telehealth gives patients and their in-home care team the ability to video chat, asynchronous messaging, or both with the medical care team for healthcare guidance and support. It is also important because it allows the patient to stay in the comfort of their home, remain connected to their family, and reduce additional exposure. Hospitals need to facilitate telehealth activities and provide a seamless patient experience that includes engagement tools like appointment reminders, post-appointment follow-up, and more.
- Ability to monitor vital signs: Monitoring vital signs begins with the basics, a diary to track symptoms and medications. Thermometers, pulse oximeters, and blood pressure monitoring devices are needed for tracking temperatures, oxygen saturation levels, heart rate, and blood pressure levels. The combination of symptoms and vitals need to be communicated on a agreed-upon basis with the medical care team to guide care recommendations. We’ll also see consumer-grade wearables, like smartwatches and other IoT devices, become increasingly incorporated in remote care, offering real-time vital health data to predict or identify issues before they become serious.
- Supportive home environments: Family members need to be able to pick up and administer prescription medications as needed and take other measures to ensure that the patient sticks to their care plan. Most importantly, they need to be the patient’s healthcare advocate with their medical care team ensuring they get the healthcare attention needed. To facilitate this, hospitals and providers need to be aware of environmental and social factors in the home – does the patient or their family have the physical space, for example, to be able to isolate sick family members? Is the patient able to get medications filled? Do they understand how to take those medications and any side-effects? Are informal caregivers shift workers who may not be able to remain available for the patient creating potential gaps in care? Are there childcare needs in the home to consider? Through outreach and rounding, hospitals should consider the presence of social determinants of health and other factors when considering or designing at-home care regimens.
As hospitals and ICUs reach capacity for COVID-19, we’ll continue to see a ramp-up in virtual and remote care, at least until the current wave of cases subsides. As they are adapting, healthcare providers also need to think about the future. They need to take inventory and look at the approaches they used, what worked, what did not work, and where there is room for improvement — for the patients, caregivers, and providers. As we move past COVID-19, we need to constantly be thinking about how to improve remote care, digital engagement is no longer a nice-to-have but a prerequisite. Many experts believe, It is no longer a matter of if there will be another pandemic but when. While we all hope that there will never be another pandemic, we have learned much from this devastating year and realize that incorporating those learnings into future emergency planning is essential.
Lisa Romano RN, MSN, is chief nursing officer of CipherHealth.