Audrey Kinsella, MA, MS,

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Telehealth in Home Care Planning for the
Longer Term

Audrey Kinsella, MA, MS, Research Director and
Lead Writer Information For Tomorrow home
telehealth program planning services 828-252-8571
/ telehealthcare_at_lycos.com www.InformationForTom
orrow.com
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Home Telehealth What is it?

• Healthcare services and education delivered by
  nurses to patients at home using
  telecommunications-ready devices.
• Were using
• .Telephones
• . Videocameras
• . Measurement tools like blood pressure
  cuffs and glucose meters
• Were talking about improved communications
  between patients and nurses.

Kinsella, NY State Teleconference, Jan. 25,
2006 2
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Home Telehealth Tools
Audrey Kinsella
Audrey Kinsella

• A sampling.

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Home TelehealthcareWhy Use It Now?

• We all need to
• Provide needed care to our patients.
• Help patients achieve better outcomes.
• Avoid re-hospitalizations.

Kinsella, NY State Teleconference, Jan. 25,
2006 4
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Learning This New Frontier of Healthcare Delivery

• Is there a how-to guide? No.
• We have to make our own by
• 1 Designing an in-house how-to and should
  do series of guides.

Kinsella, NY State Teleconference, Jan. 25,
2006 5
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Suggested guidelines to home telehealth use.
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Five Suggested Policies for

• Home Telehealth Use- Who can deliver it
• Staff Training
• Appropriate Assignment of Patients
• Assessment of Homes as Appropriate
• Telehealth Equipment Use and Maintenance

Kinsella, NY State Teleconference, Jan. 25,
2006 .7
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Value of Implementing Suggested Policies

• Home care agencies will be starting out in
  telehealth
• with a single in-house compass
• on a surer footing
• more able to move toward routinization of
  planning and delivery, a needed next step.

Kinsella, NY State Teleconference, Jan. 25, 2006
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Paperwork Were Talking About the Need for Forms
Lots of Them!

• Why?
• To
• Provide direction for your staff.
• Allow for consistent delivery.
• Enable clear documentation of delivered care
  (tele- and/or conventional).

Kinsella, NY State Teleconference, Jan. 25,
2006 9
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Form for Home Assessment far beyond checking for
working electricity

• In home telehealth, we must ensure that there
  are
• At least one working telephone line.
• A telephone that can be unplugged from the wall
  jack.
• Adequate environmental controls for heat and
  humidity
• Nearby contact sources for just-in-case needs.

Kinsella, NY State Teleconference, Jan. 25,
2006 10
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Particulars for Home Telehealth

• A handwritten plan which notes
• Location and number of electrical outlets in the
  home.
• Location and condition of the telephone jacks.
• Possible difficulties to be expected as a result
  of distances between electrical outlets and
  between telephone jacks and electrical outlets.

Kinsella, NY State Teleconference, Jan. 25,
2006 11
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Back-up Bag for Home Assessment

• To complete the plan accurately, bring a Back-up
  Bag containing
• An electrical extension cord
• An extra phone line splitter
• A surge protector with a 10-foot-long cord
• Duct tape for taping extra wires to carpet or
  floor
• A portable lamp
• Small screwdriver
• Tape measure

Kinsella, NY State Teleconference, Jan. 25,
2006 12
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Layout of Patients Telehealth Room
  Measuring from patients usual physical
location during a visit (sofa, kitchen chair,
etc.) Measure distance of these from jacks and
from phone(s).
Kinsella, NY State Teleconference, Jan. 25,
2006 13
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Making Telehealth Work

• Key
• .Going into the home and making sure that
  ordinary people can use telehealth devices
  comfortably, routinely, and safely.

Kinsella, NY State Teleconference, Jan. 25,
2006 14
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Safety-proofing an elderly womans living
room Pinpoint her usual routes!

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Patient Assessment Form
Patients Capabilities
Good Adequate Poor Nonresponsive Ability to
See ______ _______ ____ ________ Ability
to Hear ______ _______ ____ ________
Manual Dexterity ______ _______ ____
________ Understand Directions ______ _______
____ ________ Attitude Toward
Technology ______ _______ ____ ________
Ability to Tell Time ______ _______ ____
________
Kinsella, NY State Teleconference, Jan. 25,
2006 16
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Matching Tele-Tools with Patients Capabilities
Needs

• Customization options
• Vendor partnerships in design matters

Kinsella, NY State Teleconference, Jan. 25,
2006 17
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A Brief Review of the Tools.

Kinsella, NY State Teleconference, Jan. 25,
2006 18
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Working Differently with Patients Through
TelehealthPotentially, the care will be
targeted timed Were looking at
communicating with patients on an as-needed,
when-needed, kind-of-need basis.
Kinsella, NY State Teleconference, Jan. 25,
2006 19
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Planning For Tele-Delivery

• Design and implement the Telecare Plan
• Components
• Frequency of contact (tele- and conventional)
• Frequency of telemonitoring or other telecontact
  (e.g., instructional videoclips on syringe use).
• Duration of contact per visit.
• Duration of use of telehealth equipment (per
  contact and per admission period).
• Dated checkpoints.

Kinsella, NY State Teleconference, Jan. 25,
2006 20
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Making It Work Getting In With the Right
Group.

• Key target patients who need the most contact
  and can benefit from it.
• Case of a noncompliant patient with diabetes
• Design care plan indicating
• Number of televisits and other contacts
• Number of increased educational sessions
• Assignment and instruction in using a menu
  planner.

Kinsella, NY State Teleconference, Jan. 25,
2006 21
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Kinsella, NY State Teleconference, Jan. 25,
2006 22
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Value of Telehealth Programs to Supplement
Conventional Care

• With Home Telehealth, clinicians can be
• More fluid in planning as whats working is
  tracked and assessed
• More able to get patients involved in their own
  care.
• More confident throughout the admission period
  that outcomes expectations will be reached.

Kinsella, NY State Teleconference, Jan. 25,
2006 23
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Success Stories in Home Telehealth

• Common denominators
• Chronic disease patients
• Short-term studies
• Small groups
• Chronic diseases with demonstrable results.

Kinsella, NY State Teleconference, Jan. 25,
2006 24
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Whats Missing?

• Long-term results.
• Details on projects that didnt work.
• Acknowledgement that telehealth is still a new
  and untested frontier of service delivery.

Kinsella, NY State Teleconference, Jan. 25,
2006 25
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Todays Potential for Making Your Telehealth
Programs Successful

• Replicate success stories.
• Identify new tools, new interventions to expand
  on the conventional.
• Address new conditions affecting planning in home
  care
• PPS. Nursing Shortages New and Growing
  Populations in Home Care, such as Multicultural
  Patients.

Kinsella, NY State Teleconference, Jan. 25,
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Making Home Telehealthcare Work

• We must
• Not just buy a telehealth machine
• Not just continually shop for other or more
  machines
• Tweak/customize the telecareplan
• Nurses must work with their patients and with
  tools to meet their patients needs and improve
  outcomes thats what making telehealth work is
  all about.

Kinsella, NY State Teleconference, Jan. 25,
2006 27