Telehealth Could Offer More Care Options for Nursing Homes, But It’s Not Widely Used

There was a surge in telehealth use in nursing homes early in the COVID-19 pandemic, but it didn't last. (Image credit: ©Dragana Gordic - stock.adobe.com)

When the COVID-19 pandemic began in early 2020, far more Americans used telehealth than ever before, including residents in nursing homes.

Researchers say that in skilled nursing facilities, the use of telehealth spiked in 2020. While more nursing home residents are using telehealth now than before the pandemic, virtual visits have dropped substantially from pandemic peaks.

Fewer nursing homes were using telehealth in 2021 and 2022, according to findings published on Jama Network Open on Aug. 18.

“Taken together, these results suggest that though telemedicine could provide an opportunity to extend the temporal and physical boundaries of care in SNFs, in practice this did not happen consistently,” the authors wrote.

Researchers from Harvard University, Beth Israel Deaconess Medical Center, and Brigham and Women’s Hospital conducted the study and described it as the first extensive look at telehealth use in nursing homes in the pandemic. Ateev Mehrotra, M.D., M.P.H., a member of the Managed Healthcare Executive editorial advisory board and a professor at Harvard Medical School, is one of the authors.

To conduct the study, Mehrotra and his colleagues examined data from more than 4.4 million residents at more than 15,000 skilled nursing facilities.

In early 2020, the use of telemedicine in routine visits to skilled nursing facilities rose from 0.15% to 15%. More than a third (37%) of outpatient visits were done virtually.

By mid-2021, the numbers fell sharply. Telemedicine was used for only 2% of routine nursing home visits and 10% of outpatients visits.

In 2000, roughly 9 out of 10 skilled nursing facilities had telehealth visits, but that fell to about 6 in 10 by 2022 (91% in 2020 versus 61% in 2022).

Researchers said telehealth offered more access to psychiatry for nursing home residents. Advocates for telemedicine have said virtual care can be particularly helpful in providing mental health services to those in areas with shortages of psychiatrists.

The authors pointed to the potential for telehealth in making it easier for nursing home residents to get care, especially for those with health complications and limited mobility. They note that clinicians are rarely on site at skilled nursing facilities on evenings and weekends, and residents who develop problems end up going to the emergency department, sometimes unnecessarily.

The study found that a small percentage of physicians were using telehealth in seeing nursing home residents. Fully half (50%) of telehealth visits to nursing homes were provided by the top 7% of clinicians using virtual visits. And 80% of all virtual visits to skilled nursing facilities involved the top 13% of clinicians in their use of telehealth.

The clinicians most apt to see patients virtually served rural areas, and they noted that this likely coincides with the smaller number of providers in rural communities.

Researchers found that clinicians seeing patients via telehealth didn’t end up seeing patients more often.

“Overall, telemedicine use did not result in a substantially different volume of visits, mitigating concerns that loosening restrictions and regulations might unleash potential abuse and excessive billing,” the authors wrote.

The researchers also said that residents could potentially get better care with the continued federal reimbursement of telehealth in nursing homes

“We found preliminary evidence that telemedicine adoption might be associated with some changes in patterns of clinical care, potentially leading to improved access to specialty care,” the researchers said.

Shortly after the pandemic began, the federal government eased restrictions on telehealth, making it easier for Medicare reimbursement. Congress agreed to extend telehealth flexibilities through 2024. Telehealth advocates are continuing to push for permanent reforms so patients can easily receive care virtually.