Telehealth for seniors in need of wound care during COVID-19 pandemic
By Benjamin Roussey
Telehealth plays a key role in bringing healthcare services to people in remote corners of the United States. Seniors use telehealth and telemedicine for wound care, as many of them happen to be frail and immobile to a large extent due to age, underlying health conditions and the nature of their wounds.
The need for telemedicine services has never been greater, as healthcare facilities across the country are overwhelmed with patients suffering from COVID-19 infection.
Why access to wound care is important for the elderly
Wound healing generally tends to be slower in the elderly due to reduced skin elasticity, delayed inflammatory response, poor circulation and a number of other factors. The presence of health conditions, like diabetes, can also slow down the healing process considerably. Particularly, complex, non-healing wounds, like surgical wounds, stasis ulcers, radiation sores and pressure sores, need to be treated with great care, as they can lead to complications like infections and gangrene. This is why proper wound care is extremely important for seniors.
The problem, however, is that many elderly people – especially those who live in rural areas – do not have access to wound care specialists. Their primary care providers, in most cases, are not capable of treating complex wounds, especially for patients with underlying health conditions, like diabetes, high blood pressure or heart disease. With telemedicine, these patients can receive wound care from home irrespective of their geographic location.
Telemedicine for wound care
Telehealth connects patients with wound care specialists through technology. For instance, a nurse at an assisted living facility can take pictures of a patient’s wound and transmit it – along with the patient’s medical history – to a wound care specialist. The specialist can look at the patient’s medical history and the images of the wound and recommend the right treatment to the nurse.
A telehealth consultation can be synchronous (the specialist interacts with the nurse, assesses the patient’s condition and recommends treatment in real time) or asynchronous (the nurse forwards the patient’s information to the specialist, who later reviews the information, develops an appropriate plan of care and relays it to the facility).
The need for telemedicine during the coronavirus pandemic
The U.S. is currently the epicenter of the COVID-19 pandemic, with over 1,417,889 confirmed cases. Thousands of people are getting tested on a daily basis in healthcare facilities across the country. In such a scenario, telemedicine might be the only way for elderly patients with non-healing wounds to receive the care they need.
In fact, many physicians in the country have embraced telemedicine in the wake of the coronavirus outbreak, as it allows them to diagnose and treat their patients without visiting them, which greatly reduces the risk of contracting the virus from someone. Also, a telemedicine consultation takes less time than an in-person consultation, which allows physicians to serve more patients than they normally do.
The government has also rightly recognized the need for telehealth services at a time when hospitals across the country are filled to their capacity. A series of measures have been taken at federal and state levels to expand telehealth programs in healthcare facilities all over the country.
Measures taken by the government to expand telemedicine services
Grant for telehealth:
The Health and Human Services (HHS) Department has stated that it will be providing a grant of $100 million to more than 1,000 healthcare facilities in different parts of the country to expand their telemedicine capacity.
Telehealth covered under Medicare:
The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare will now cover the cost of telehealth services so that patients can receive the care they need without having to visit a physician in person.
The site limitations for providing telehealth services have also been temporarily removed. So, any physician can provide telehealth services to any patient – irrespective of their geographic location.
Telehealth-related provisions in the coronavirus stimulus package:
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, which is designed to promote economic stability and boost the capabilities of hospitals and community healthcare centers to fight and contain the coronavirus epidemic, has provisions to make telemedicine services more accessible and affordable to patients across the country.
One of the most notable provisions in the stimulus package is the waiver of face-to-face requirements for telemedicine services. So, in the absence of visual aids, elderly people can receive wound care over the phone, and it will still qualify as a telehealth consultation.
HIPAA requirements for telehealth services:
The Office for Civil Rights (OCR), which is responsible for enforcing the regulations under the Health Insurance Portability and Accountability Act (HIPAA), has stated that it will not be imposing penalties on healthcare providers who fail to comply with HIPAA rules while providing telehealth services to patients during the COVID-19 emergency.
The important thing to be noted here is that the OCR will not impose penalties on healthcare providers for non-compliance of HIPAA rules, even if their telemedicine services are not related to the diagnosis or management of coronavirus infection. In other words, physicians can provide telehealth services to any patient for any medical condition – including chronic or non-healing wounds – without worrying about HIPAA compliance requirements, as long as they are acting in good faith.
The OCR, however, has stated that telehealth services should not be provided using Twitch, TikTok or Facebook Live, as they come under the category of ‘public facing remote communication applications’. They are free to use non-public facing applications, such as Apple FaceTime, Google Hangouts, Skype, Facebook Messenger and Zoom.
The American Medical Association (AMA) has also issued a set of guidelines for physicians who provide telehealth services to their patients:
• Set up audio/video technology to connect with patients and their caretakers from different locations.
• Use wearable devices that can transmit the biometric data of patients for review.
• Let all your patients know that you are offering telehealth services to avoid in-person visits to the extent possible.
• Let all your patients know when your telehealth services will be available (at a specific time or all through the day).
• Document each telehealth visit just as carefully as you would document an in-person visit.
On the whole, seniors who are in need of wound care need not worry, as they can continue to receive the care they need – despite the COVID-19 pandemic – through telehealth services.
