Telehealth – helping Australians age at home.

This year will see a trend towards older Australians choosing to age in their own homes, and telehealth technology will help them achieve this goal.

This is the prediction from LiveBetter Acting Head of Operations, Mr Ben Chiarella. Based in Orange, New South Wales, LiveBetter is a not-for-profit community-care organisation providing home-care services to people across regional NSW and Queensland.

For the past two years, LiveBetter has been using telehealth technology to support elderly people – many of whom have chronic health conditions – to stay in their own homes for longer. The service, which is delivered by registered nurses, includes remote monitoring of vital signs, early escalation, and health coaching.

In remote and regional Australia, where access to residential aged care facilities (RACFs) can be limited, ageing in place is an important option.

According to Mr Chiarella one of the main drivers for people choosing to age at home – in addition to the devastating COVID-19 outbreaks in RACFs at the start of the pandemic – will be next month’s release of the Final Report from the Royal Commission into Aged Care Quality and Safety. (FEB 2021 release)

“What we are seeing during COVID-19 is the stress that exists in the residential aged care space,” said Mr Chiarella, who manages LiveBetter’s business development and delivery of telehealth services.

“There has been an awareness of this in the industry for a long time, and this year it has escalated and potentially, with the Royal Commission, we will see a catalyst for an increase in people choosing to age in their own home.

“I think the [Royal Commission] report will most definitely identify opportunities for telehealth. The Royal Commission’s Interim Report has already mentioned technology as being a part of the future [of aged care].

“COVID-19 has shown that we can achieve great outcomes through remote monitoring, virtual care, and telehealth. I really believe we are in the infancy of what’s possible in the future.”

Concerns about the level of care in aged care

The Royal Commission’s Interim Report – titled Neglect – was released in October 2019. It found that “the aged care system fails to meet the needs of its older, vulnerable citizens”; that it “does not deliver uniformly safe and quality care”; it is “unkind and uncaring” to older people, and “in too many instances, it neglects them”.

The report says most people entering RACFs do so “with great trepidation”; while those choosing to age in place experience unacceptable delays in accessing Home Care Packages.

Mr Chiarella says while there are many excellent operators in the RACF sector, all too often there is a disconnect between the level of care residents require, and what is provided.

He says elderly people in these facilities typically have complex and chronic comorbidities requiring a high level of care. However, it is common for RACFs to have one registered nurse covering up to 80-150 patients at a time, with enrolled nurses and support staff with a Certificate II in Introduction to Aged Care delivering the majority of care.

“There are very passionate and very caring, wonderful people working in the industry in a very difficult situation,” said Mr Chiarella. “But my belief is it’s like Swiss cheese – it’s got holes all over it … and an underpaid and undervalued workforce looking after these people.”

In Mr Chiarella’s opinion, ageing at home with a combination of remote monitoring, virtual care and telehealth is a viable solution.

The future of telehealth

In the future, says Mr Chiarella, telehealth technology will be used to transform the primary healthcare model from one that treats sickness, to one that focuses on wellness and health coaching.

Fundamental to this will be an increased emphasis on the role of registered nurses in providing care to elderly people choosing to age in their own home.

In this future model, GPs are still the primary source of care of elderly patients, but registered nurses play a greater role in coordinating care and escalating cases when required, providing quality patient data that has been collected over time via remote monitoring. The network will also link with community service organisations, allied health professionals, and tertiary healthcare providers.

“This can be done cost effectively through a telehealth platform,” said Mr Chiarella.

“The registered nurse, who has been monitoring and case managing the person, can send all this up-to-date data to the GP about how their prescription medications have impacted their blood pressure, or their heart, or their weight; how their blood glucose has been tracking.

“It means we can actually have a meaningful conversation about their health…It is true continuity of care.”

This new model will also require a collaborative approach: “GPs can’t do this alone, and neither can aged-care providers or allied healthcare providers,” said Mr Chiarella.

“We all need to come to the table together and create integrated models of care that support people to age in the community, manage their chronic disease in the community and … over time, improve their resilience so they’re not so reliant on the emergency department when they get sick.”

Using telehealth, registered nurses can also connect with clients to help them set health goals and outcomes, and guide them through the journey, involving them in decisions about their own health such as managing their diabetes, losing weight, exercising, and how to quit smoking.

“Helping them make those decisions is really powerful and that’s when you will get a really great outcome,” said Mr Chiarella.

He anticipates that the future will also see greater emphasis on the use of telehealth to promote social connection and quality of life for people choosing to age in place.

Using telehealth to deliver remote health monitoring and social connection to elderly Australians

Since 2015, LiveBetter’s team of registered nurses has been using telehealth technology to connect weekly, daily – or multiple times per day if required – with aged clients living in their own homes.

In 2020, LiveBetter also partnered with the Western NSW Local Health District in the Orange area to support post-hospital discharge and in-home monitoring for patients.

As part of its telehealth service, LiveBetter’s registered nurses use a smart tablet and peripheral devices to conduct remote vital signs monitoring such as blood pressure, blood-sugar and oxygen-saturation levels, temperature, heart rate, weight. They also use telehealth for pharmacological management and regular customer surveys to identify other concerns such as mental health issues.

The nurse receives the patient data in real time, and shares it with physicians and allied health professionals, as required.

LiveBetter is also using telehealth technology to provide social connection.

“Essentially, the vital-signs monitoring allows us to have a conversation with our client,” said Mr Chiarella.

“We get great connection with our registered nurses who become a health coach for our clients; they become their support, their advocate – this is especially important as when people age in their own home, they can become very isolated and telehealth can create a connection.”

Telehealth, says Mr Chiarella, is also economically viable: it reduces travel costs and appointment cancellations. It also reduces patient costs associated with acute care and tertiary care, by promoting early intervention and escalation.

“Telehealth,” said Mr Chiarella, “is one of the pillars that will allow us to touch base with people with chronic disease and monitor these people in a low-cost way.”

Baby boomers – a catalyst for change

Another factor feeding the shift away from residential aged care, says Mr Chiarella, will be the ageing ‘baby boomer’ generation.

Born between1946 to 1966, this demographic cohort accounts for 53 percent of Australia’s wealth and only one-quarter of its population1. Two-thirds of baby boomers also own their own home outright2.

Additionally, a 2017 report by the Australian Government’s Productivity Commission found that 70 percent of Australians would prefer to die at home, but less than 10 percent do.

Together, says Mr Chiarella, these facts indicate that baby boomers want to, and can afford to, age and die in their own homes – and telehealth can deliver the care and connectivity required to achieve this.

“It ‘takes a village’ to have a really great ageing process and to die in your own home,” said Mr Chiarella.

“If someone can die from old age in their own home, and have their complex, chronic conditions managed in their own community, what a great outcome for them, and what a great outcome for the healthcare system as well.”

Telehealth technology will continue to evolve

As telehealth continues to evolve and more solutions enter the market, the technology will become more commonplace and more affordable, says Mr Chiarella.

LiveBetter is currently reviewing the use of its hospital-grade telehealth system and will replace it with an app-based, Bluetooth-connected solution that is more user-friendly, cheaper and, as most people have a smart device at home, more convenient.

“With telehealth, we’ve got to make it accessible for more people,” said Mr Chiarella.

“I feel really passionate about this and I feel that the more conversations we can have, the more it will help move things in the right direction. It is so needed, and it is a focus on where we need to take our models of care. Telehealth is such an important piece of the puzzle.”