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Ann Oldenburg | May 4, 2022
For those inclined to look for silver linings, one particularly powerful one has emerged for caregivers as a result of the coronavirus pandemic: a huge acceleration in both innovation and receptiveness to in-home medical care.
“We’re seeing just a wonderful explosion, a huge number of innovations and devices that can treat conditions or take vitals in new ways,” says Todd Haedrich, CEO of Optimize Health, a Seattle-based company that bills itself as being devoted to simplifying remote care. “A lot of those devices that required a stand in a hospital and had to be plugged in a certain way are all moving into the home.”
This can have a big impact on family caregivers. Transportation is their most common duty, with 80 percent of caregivers taking on this task, according to a 2020 report from AARP and the National Alliance of Caregiving. Many of these trips can include doctor appointments and other health care needs.
The shift toward allowing doctors and patients to meet via teleconference rather than in person is well underway as a result of the pandemic. The number of U.S. telehealth visits in 2020 was 63 times higher than in 2019, according to a study by the Department of Health and Human Services. But the changes that Haedrich and others talk about go far beyond just communications. Medical technology placed in the home can allow patients and caregivers to run tests, such as blood pressure and glucose-level readings, and even perform kidney dialysis and take X-rays.
Health care delivery further shifted in late 2020, when the Centers for Medicare & Medicaid Services (CMS) issued a statement that “more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD), can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.” Now more than 200 hospitals in 34 states offer CMS-approved Acute Hospital Care at Home programs that allow patients to go from the ER to home for recovery, although funding would need to be extended beyond the current COVID-19 emergency.
One booming area is remote patient monitoring (RPM), in which devices connected to health professionals and electronic health records make care more cost-efficient and easier to manage. Globally, RPM is expected to become a $3.4 billion market by 2030, with products that can track blood pressure, oxygen, glucose, weight, dehydration, abnormal heart rhythm, shortness of breath and more already making their way into patients’ homes. At Mass General Brigham Home Care, for example, the Connected Cardiac Care Program allows for a physician to remotely monitor and manage a patient who is being treated after heart failure.
Other ways RPM is being used or tested: wearable devices that also measure vitals, bioingestible sensor capsules that measure patient data, “smart” pill bottles with sensors to audit intake, and electronic “tattoos” that track pneumonia progression. All these high-tech innovations help not only the patient but also family caregivers.
RPM also allows doctors to have a depth of knowledge about their patients they just can’t get in a teleconference. In Lexington, Kentucky, before implementing RPM, patients at Kentucky Cardiology were writing down their blood pressure and bringing pieces of paper to the office to discuss with the doctor during appointments. After switching to RPM, Optimize Health expanded the number of hypertensive patients being treated through Kentucky Cardiology by 500 percent in the first three months. Monitoring, Haedrich says, means patients have “an ongoing conversation with a doctor.”
Procedures at home
To see how more intensive medical care can happen at home, a great place to start is kidney dialysis. Nieltje Gedney, executive director of Home Dialyzors United, says the move from clinic to home care is all “back to the future.” In 1930, 40 percent of health care was delivered in the home. Over time, it moved to hospitals, clinics, physicians’ offices and emergency departments.
Hemodialysis and peritoneal dialysis began as a form of treatment for kidney disease in the 1940s. “At first, treatment in the home [by doctors] was the only method that was permitted,” Gedney says. Clinics started popping up in the ’80s, and dialysis moved to those settings. In 2005, a consumer home dialysis machine, made by NxStage, was cleared for the market by the FDA. But, Gedney says, “it was slow to take off.” Today, despite widespread home-dialysis capability, more than 85 percent of Medicare-covered patients in the U.S. with end-stage renal disease travel to a dialysis center for treatment three times a week, according to CMS.
Gedney says she is tracking “eight new devices” in the pipeline that will provide even better home dialysis, but adds that one problem is a lack of infrastructure — trained personnel, transportation and willing patients.
The Human Touch
While special devices, remote monitoring and telehealth are becoming a routine part of care, many patients still don’t think talking to a screen (or a voice assistant) is a satisfying experience. According to one October 2021 study — spearheaded by NPR, the Harvard T.H. Chan School of Public Health and the Robert Wood Johnson Foundation — 64 percent of households using telehealth said they would have preferred an in-person visit.
They may be in luck. Part of the trend in at-home care includes medical professionals on your doorstep. Since 2013, Landmark Health, based in Huntington Beach, California, has been sending medical teams to make house calls. Landmark contracts with health insurance plans —mostly Medicare Advantage plans, says Carissa Foley, a nurse practitioner and advanced practice clinician supervisor. “For most people, it is a free program; we’re an adjunct to primary care with seven-day-a-week urgent visits, if a person needs it. There’s nothing like seeing patients at home.”
With all these efforts, a key goal is to keep people out of the hospital. “With our aging baby boomers, we’re going to run out of space, so this has to happen. And people want it to happen,” says Michael Maniaci, M.D., physician leader for Mayo Clinic’s Advanced Care at Home program. “If we can do it safely, and with high quality to provide the best experience, it’s how the medical community and the future of health care survive in this country.”