KNOXVILLE, Iowa — Bette Helm was happy to have someone to talk to about his insomnia.
Helm lives in a nursing home in this central Iowa town of about 7,500 people, where mental health services are sparse. On a recent morning, she met with a psychiatric nurse practitioner in Austin, Texas, about 800 miles away. They spoke via video, with Helm using the iPad she was holding on her lap while sitting on the bed.
Video visits are an increasingly popular way for small town nursing home residents to receive mental health care. Patients do not need to go to the clinic. You don’t even have to clean up and leave your bedroom, which is great for people with depression and anxiety. Online care providers face fewer canceled appointments and can often work from home.
While the use of other telemedicine services is likely to decline as the pandemic subsides, health care providers expect demand for telepsychiatric services in rural nursing homes to continue to grow.
“Are you anxious when you try to sleep? Is your mind racing?” asked nurse practitioner Aisha Macon.
“Yeah, it’s kind of time for me to think,” Helm said. Her thoughts can keep her going past 3am, she said.
They discussed Helm’s occasional anxiety during the day and his routine of watching the news on television at 10 p.m. Macon suggested the news might involve Helm, and she said that before the 71-year-old patient went I wondered if skipping the news could relieve stress…to bed.
“No,” Helm said. “I think it’s interesting. I want to know what’s going on in the world. I’ve always been sensitive to tidbits of information.”
Macon smiled and said okay. So we discussed other approaches, such as using online meditation programs and quietly reading the dozens of novels Helm had piled up in his room. I think,” she told Macon.
During the COVID-19 pandemic, as “social distancing” guidelines reduced in-person appointments and insurers eased coverage restrictions, telemedicine visits became more common across the U.S. healthcare system. rice field.number of telemedicine visits paid for by Medicare jumped tenfold Comparison of the last nine months of 2020 with the same period of the previous year.
Proponents of online therapy say online therapy is well suited for mental health care, especially in situations where it is difficult to arrange in-person services. . The company that arranged Helm’s most recent appointment, his Encounter Telehealth, serves her more than 200 nursing homes and assisted living centers, primarily in the Midwest. About 95 percent of these facilities are in rural areas, said Jenn Amis, president of the Omaha, Nebraska-based company.
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Encounter Telehealth uses about 20 mental health professionals, many of whom are urban psychiatric nurses. The practitioner reads the patient’s electronic medical record through her secure computer system and reviews symptoms and medications with her members of the nursing home staff prior to each appointment. Complete up to 2,000 visits per month.
As older adults face the stress and uncertainty of aging, it’s important to get professional support, Amis said. “We’re all going to be there at some point,” she said. “Don’t you want that final chapter to be peaceful?”
The company has seen a spike in demand for its services at nursing homes when the pandemic hit. Nursing homes have been closed to visitors for months at a time while the coronavirus has caused thousands of illnesses and deaths among residents and employees. may become. “Oh my God, isolation and fear,” said Amis.
Amis said several developments made her company’s services possible. Electronic medical records and video systems are very important. Many states have also given independent powers to nurse practitioners and other non-physicians, making it easier to claim public and private insurance plans for mental health care.
The federal government may tighten rules for certain types of telemedicine as the pandemic abates. But Medicare had covered the cost of many remote mental health visits to rural areas before his COVID, and Amis hopes the support will continue.
Jonathan Neufeld, program director of the University of Minnesota Great Plains Telemedicine Assistance Center, says it can be difficult to arrange in-person mental health care in rural care facilities.
“You’re being hit double or triple right now,” said Neufeld, a psychologist whose center is supported by federal grants.
He noted that the number of national mental health professionals had been inadequate for many years, even before the pandemic. including nursing homesfacing a serious staff shortage.
Neufeld said telehealth visits can be a challenge for some nursing home residents, including those with dementia who may not understand how video feeds work. But treating people with dementia directly can also be difficult, he said. In any event, staff or relatives must be present at the time of booking, and mental health professionals typically consult with facility staff regarding the patient’s treatment.
Before telemedicine became available, many rural nursing home residents had to drive to a clinic in another town to see a mental health professional. It can waste hours of staff time and add stress to a patient’s life.
Seleta Stewart, a certified nursing assistant at the Accura HealthCare nursing home where Helm lives, says the facility has several young residents with mental illness, and the need for telemedicine services has increased. says that In the past, many such Iowans have been served in specialized facilities, including two state mental hospitals that closed in 2015, she said.
“Iowa is not a great state for mental health,” Stewart said.
Even with telemedicine’s efficiency gains, Neufeld said staffing could be a challenge for companies that provide services in nursing homes. Many mental health professionals already have more patients than they can handle and may not have time to voice their opinions online. He added that Medicare, which insures most seniors, pays a lower rate than private insurers or patients pay themselves.
Encounter Telehealth president Amis said Medicare will pay about $172 for the first appointment and about $107 for follow-up appointments. Health care providers collect about 30% to 75% more from patients who use private insurance or pay their own bills, she said. She added that nursing homes pay for Encounters to allow mental health professionals to visit them on video.
Several patients and health care workers say the transition to video appointments is usually smooth, despite the reputation of seniors being uncomfortable with new technology.
Dr. Terry Rabinowitz, a psychiatrist and professor at the University of Vermont, has provided telemedicine services to rural nursing homes in upstate New York since 2002. He said many patients get used to video visits quickly, even if they don’t like them at first.
“Most people would rather see me in person if Drutter were around,” he said. “And if I have my own Drucker, I’d rather meet them in person.” he said. However, these complications can be addressed.
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Nancy Bennett, another resident of Helm’s Iowa Nursing Home, can attest to the benefits. Bennett made a video appointment with Macon on a recent morning. She told her nurse practitioner that she was stressed. “I’m her 72-year-old, in a nursing home, with no family around, so I’m a little depressed,” she said. “I get sad sometimes.”
“It’s normal,” Macon assured her.
Bennett said he didn’t like taking a lot of medicine.Macon said he could reduce some of Bennett’s medicines.
In a subsequent interview, Bennett said she had been to a clinic for mental health care in the past. I spent a lot of time sitting in a recliner.
Had she had to change and travel for an appointment with Macon, she probably would have canceled.
But on this day, a mental health professional came to her on an iPad and made Bennett feel a little better.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), along with policy analysis and polls. KFF is a donated non-profit organization that provides information on health issues to the public.
