Video mental health care fills the gap in rural nursing homes

KNOXVILLE, Iowa ― Bette Helm is happy to have someone to talk to about her 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 had an appointment with a psychiatric nurse practitioner about 800 miles away in Austin, Texas. They talk via video, in which Helm uses an iPad that she rests on her lap while sitting in bed.

Video visits are an increasingly popular way for residents of small-town nursing homes to receive mental health care. Patients do not have to go to the clinic. They don’t even need to clean up and leave the bedroom, which can be difficult for people with depression or anxiety. Online care providers are less likely to cancel appointments, and they can often work from home. While use of some other telehealth services may decline as the covid-19 pandemic subsides, providers anticipate demand for telemedicine mental health services. will continue to increase in rural nursing homes.

“Are you nervous trying to fall asleep? Is your mind racing? asked nurse Ayesha Macon.

“Yeah, it was a time for me to think,” said Helm. She says her thoughts can keep her awake until well past 3am.

They discussed the anxiety that Helm sometimes feels during the day and Mrs. Macon’s 10pm TV news habits, suggesting that the news could upset Helm and wondering if the 71-year-old patient could can relieve stress by skipping the news before going or not. go to bed.

“No,” said Helm. “I find it interesting. I want to know what’s going on in the world. I’ve always been a bit of a newshound.

Macon smiled and said she understood. So they talked about other approaches, including using online meditation programs and taking quiet time to read the dozens of novels that Helm piled up in her room. “If I couldn’t read, I think I would go completely crazy,” she tells Macon, who agrees it’s a good habit.

Telemedicine visits have become much more common in the US health care system during the pandemic, as “social distancing” guidelines have limited in-person appointments and Insurers loosen restrictions on what they will cover. Medicare-covered telemedicine visits jump ten times The last 9 months of 2020 compared to the same period last year.

Advocates of online treatment say it is a good match for mental health care, especially in places where it is difficult to arrange in-person services. They cite small-town nursing homes as prime examples. Helm’s recent appointment company, Encounter Telehealth, serves more than 200 nursing homes and assisted living centers, primarily in the Midwest. Jen Amis, president of the Omaha, Nebraska-based company, says about 95 percent of those facilities are in rural areas.

Encounter Telehealth employs about 20 mental health professionals, many of whom are psychiatric nurses living in cities. Practitioners read patients’ electronic medical records through a secure computer system, and they review symptoms and medications with nursing home staff before each appointment. They complete up to 2,000 visits per month.

It’s important for seniors to have expert support as they face the stress and uncertainty of aging, says Amis. “We will all be there at some point,” she said. “Don’t you want the final chapter to be peaceful?”

The company saw a spike in demand for its services in care facilities during the pandemic. Nursing homes have been closed for months while the coronavirus has caused thousands of illnesses and deaths for residents and staff. The tension can be overwhelming for everyone involved. “Oh my god, isolation and fear,” Amis said.

Amis says a number of developments have made her company’s services possible. Electronic medical records and video systems are critical. In addition, she said, many states have given more independence to nurses and other non-physicians, and the billing of public and private insurance plans for mental health treatment god becomes easier.

The federal government may tighten regulations for some forms of telehealth once the pandemic is over. But Medicare already paid for many telehealth visits to rural areas before covid, and Amis expects support to continue.

Jonathan Neufeld, program director of the Great Plains Telehealth Resource and Support Center at the University of Minnesota, says in-person mental health care can be difficult to arrange in care facilities. in contryside.

“Right now, you’re having a double or even tripled problem,” says Neufeld, a psychologist whose center is backed by federal grants.

He noted that the number of mental health professionals nationwide had been inadequate for many years, even before the pandemic. And all kinds of rural employers, including nursing homesfacing a serious staff shortage.

Neufeld said telemedicine visits can be a challenge for some care facility residents, including those with dementia, who may not understand how it works. of the video feed. But he says it can also be difficult to directly treat people with dementia. Either way, a staff member or loved one needs to accompany them to appointments, and mental health professionals often consult with facility staff about the patient’s treatment.

Before telehealth, many residents of rural nursing homes needed to be taken to another town clinic to see a mental health professional. That can eat up staff hours and add stress to patients’ lives.

Seleta Stewart, a certified nursing assistant at the Accura HealthCare nursing home where Helm lives, said demand for the facility’s telehealth services is growing, in part because the facility is home to residence of some young patients with mental illness. In the past, she said, many such Iowans would have been served by specialized facilities, such as the state’s two psychiatric hospitals. closed in 2015. But more now live in nursing homes.

“Iowa is not a great state for mental health,” says Stewart.

Photo of nursing home staff talking to mental health staff over video call.
Before visiting patients in their rooms, psychiatric nurse practitioner Ayesha Macon, on a video monitor, consults with Shaina Flesher (right), a certified nursing assistant at Accura nursing home HealthCare in Knoxville, Iowa. The two discussed the condition of the nursing home residents and the medications they were taking.(Tony Leys/KHN)

Neufeld says that, even with the effectiveness of telemedicine, staffing can be a challenge for companies providing services in nursing homes. Many mental health professionals already have more patients than they can handle, and they may not have the time to advertise online. He added that Medicare, which covers most seniors, pays lower rates than private insurers or patients pay out of pocket.

Amis, president of Encounter Telehealth, said Medicare pays about $172 for the first appointment and about $107 for the follow-up appointment; She said care providers collect about 30% to 75% more from patients who use private insurance or pay the bills themselves. She added that nursing homes pay a fee to Encounter for the convenience of video visits by mental health professionals.

Some patients and care providers say the transition to video appointments is generally smooth, although older adults are notoriously uncomfortable with new technology.

Dr. Terry Rabinowitz, a psychiatrist and professor at the University of Vermont, has provided telemedicine services to a rural nursing home in upstate New York since 2002. Many patients, he said, quickly adapt to video visits, even if it’s not their initial preference.

“I think most people, if they had a drill, would rather see me in person,” he said. “And if I had drills, I’d like to see them more directly.” “Online visits can present special challenges, even for patients who cannot hear or see well,” he said. But these complications can be resolved.

Nancy Bennett, another resident of Helm’s Iowa nursing home, can attest to these benefits. Bennett had a video date with Macon one recent morning. She told the nurse that she felt stressed. “I am 72 years old, in a nursing home, with no family around, so I am a bit depressed,” she said. “Sometimes I feel sad.”

“It’s normal,” Macon reassured her.

Bennett said she doesn’t like taking a lot of drugs. Macon says she can reduce some of Bennett’s medication.

In a later interview, Bennett said she had previously visited a clinic for mental health care. That was before physical problems forced her into a nursing home, where she spent most of her time sitting in a blue recliner in her room.

She said, if she had to get dressed and go to her date with Macon, she would probably have canceled. “There are days when I don’t want to be bothered,” she says.

But on this day, a mental health professional came to see her on an iPad ― and helped Bennett feel a little better.


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