Problems With Telehealth and Seniors
Dan Makevich, a Bay Area, California resident, visits his doctor’s office in person for treatment of diabetes and respiratory problems. When the coronavirus disease 2019 (COVID-19) hit the country earlier this year, Makevich said his doctor’s office canceled in-person visits and began scheduling appointments on Zoom, a platform for video and audio conferencing, chat, and webinars.
Makevich, 67, said he couldn’t schedule the online appointments because he did not have a computer and cannot afford to buy one because he lives on a fixed income. If it’s one thing that COVID-19 did, it exposed the digital divide among older adults.
While some older adults subscribe to the Internet, own computers and digital devices, and know how to use them, there are many who do not.
The digital gap is clearly seen when it comes to health care now that doctors are using telehealth as a safe and effective means to care for their patients.
Like Makevich, many seniors live on a fixed income, so paying for internet is not in their budget, especially if they do not have a computer or computer skills in the first place. Unless healthcare providers offer home visits or in-person visits to the doctor’s office, some older adults may not receive medical treatment.
Health insurers have taken notice of the disparities during the pandemic. For instance, SCAN Health Plan, a 215,000-member Medicare Advantage plan in California, took a survey of its most vulnerable members after the COVID-19 outbreak. The survey results showed that:
- About one-third of the members did not have access to the technology needed for a telehealth appointment.
- Nearly 40 percent of the members have vision issues that interfere with their ability to use digital devices
- 28 percent of the members have a clinically significant hearing impairment.
Eve Gelb, SCAN’s senior vice president of health care services, said the company is considering sending community health workers into homes of vulnerable members to help them with telehealth visits. In addition, Gelb said the company may give members easy-to-use devices, with essential functions already set up, to keep at home.
One device, GrandPad, is gaining traction among seniors because the tablet makes it easy for seniors to arrange telehealth visits. In July, GrandPad, the first purpose-built tablet for people over 75, announced that it was partnering with the National PACE Association, which provides primary, acute, and long-term care services for seniors at 263 locations in 31 states. PACE organizations nationwide will use GrandPad to help seniors with their telehealth visits.
Challenges Involved With Telehealth Visits
Seniors may have computers or smartphones but that doesn’t mean that they are adept at using the devices. In addition, the physical conditions of older adults, such as vision or hearing impairments, can interfere with their use of technology.
For example, doctors, volunteers who teach digital literacy, and family members say seniors face several challenges when using devices for telehealth purposes, such as:
- Installing telemedicine apps that connect patients with their doctors to provide secure video chats or eVisits
- Registering their doctor’s appointments online
- Sending and receiving text messages or emails to receive prescription updates and appointment reminders
Dr. Charlotte Yeh, chief medical officer for AARP Services, learned firsthand about the difficulties seniors face with technology. Yeh, who lives in Boston, was trying to remotely teach her 92-year-old father, who lives in Pittsburgh, how to use an iPhone to talk to his 90-year-old wife, who was in a nursing home which was closed to visitors because of COVID-19. Yeh said her father had challenges using the phone because he is blind in one eye, has severe hearing loss, and a cochlear implant. As a result, he had trouble hearing conversations over the phone.
Yeh said when her mother came home in April, her doctor wanted to arrange telehealth visits to treat her for metastatic lung cancer. But, her mother could not use her smartphone or her computer. Yeh said the smartphone screen was too small and the computer was too hard to move around. So, her mother used a tablet held at a certain angle with the phone’s flashlight aimed at it so that the doctors could examine lesions around her mouth.
Yeh said the telehealth visits were “like a three-ring circus.” But, while her family had the resources to handle the problems, many families and older adults do not.
Study Shows Seniors’ Difficulties With Telehealth Visits
A study conducted by researchers at the University of California-San Francisco found that an estimated 38 percent (13 million) of all U.S. seniors were not ready to handle a telehealth visit, due primarily to inexperience with technology and physical disabilities. The number climbed to 72 percent for seniors over 85 years old.
Researchers found that even though another person was with the older adult to help them get connected, 32 percent (10.8 million people) were not prepared to use telemedicine, which included setting up a video visit.
When it came to using the telephone to visit with their doctor, 20 percent could not handle the phone call because of difficulty hearing, difficulty communicating, or dementia.
The study’s authors recommend that telecommunication devices should be covered as a “medical necessity,” and the devices should have “accessibility accommodations,” such as closed caption for people with a hearing impairment.
The authors concluded that many older adults are willing and able to learn how to use telemedicine. However, an “equitable health system” should recognize that it’s already difficult for some people, like those with dementia and those who are socially isolated, to visit a health care provider in person. So, for these patients, it’s essential to have home visits and other models of geriatric care.