| Just as technology must evolve to meet consumer | | | | record their own vitals, and that information was |
| needs, telemedicine has reached a pivotal point in its | | | | then sent to their physicians. |
| development that finally makes it a realistic option for | | | | "It was especially helpful around issues like blood |
| senior living providers. Telemedicine talk and try-outs | | | | sugar, where you might see a spike on one day, |
| have long been part of resident care discussions, but | | | | when the previous 30 days were stable. So you |
| only now can the technology really start making good | | | | would not make a decision based on that one |
| on its promise of providing effective virtual | | | | moment in time," Campbell Jenkins says. |
| care-bringing physicians and residents together, | | | | Then outside events intervened. The kiosk's |
| despite the miles between them. | | | | manufacturer, Virtual Medical Care, was acquired by |
| It's welcome news for senior living companies seeking | | | | Intel, which in September 2008 took back the |
| innovative ways to enhance the resident experience | | | | machine, citing safety compliance issues with the |
| by making medical care accessible in ways that are | | | | FDA. Intel refunded 75 percent of the purchase price. |
| both convenient and cost effective. Plus, as acuity | | | | And, despite the strong initial reception, Arbor has |
| continues to rise, the need for quick and easy access | | | | not replaced the machine or restarted the program. |
| to physicians and specialists grows for residents-and | | | | There's a fundamental shortcoming in these systems, |
| being able to meet that need also makes a | | | | Campbell Jenkins says. It's true that they can save a |
| community more competitive. | | | | lot of daily effort on the part of nurses by |
| Exploring Care Options | | | | accumulating helpful data, but that data still has to be |
| The term telemedicine could encompass a variety of | | | | compiled and analyzed, which can effectively erase |
| technologies, including wireless in-room monitoring | | | | the labor savings. |
| systems for residents and some emergency-call | | | | "It has great potential to help identify early signs of a |
| systems. But on the cutting edge of those | | | | change in condition," she explains. "But it has to be |
| technologies is telemedicine in its truest sense-the | | | | managed very closely, and physicians don't want to |
| use of audio, video, and other means to capture vital | | | | manage it. So then it falls back to our over-stretched |
| signs, transmit data between multiple locations, and | | | | clinical leaders to do it, and we are stretched too thin |
| facilitate virtual visits with physicians. Most | | | | already." |
| technologies specific to telemedicine "seek to | | | | Arbor is testing a similar telemedicine kiosk in a South |
| replicate remotely what happens in a clinical setting, a | | | | Carolina senior living community, where the |
| doctor's visit, or a nurse's visit," says David Stern, | | | | company's home health partner operates the machine |
| chief professional officer of Living Independently | | | | in the assisted living building, monitors the data, and |
| Group, a telemedicine technology supplier based in | | | | then alerts the director of clinical care in case of |
| New York City. | | | | changes, such as uneven blood pressure readings. |
| Traditionally, if a resident needs to see a physician, a | | | | This helps cut the workload for the nurses, but it |
| family member must provide transportation and | | | | doesn't address Campbell Jenkins' greater quandary: |
| assistance or arrange for the resident's community to | | | | Who's supposed to pay for all this? Right now Arbor |
| do so. Either option can be a logistics challenge, an | | | | is picking up the tab to have that extra pair of clinical |
| additional expense, and a stressful situation for the | | | | eyes watching over collected data, but that's not a |
| resident. | | | | winning proposition for the long term. |
| "It makes logical sense to explore the role | | | | "We have not successfully figured out how to pass |
| [telemedicine technology] could have in assisted living, | | | | the cost of that on to families," says Campbell |
| and in senior housing in general," says Elizabeth | | | | Jenkins. "That is not something they have been willing |
| Wheatley, corporate director of clinical operations for | | | | to pay for up to now." |
| Newton, Massachusetts-based Five Star Senior Living. | | | | Wheatley meanwhile worries that it might be a |
| In addition to enhancing resident care, Wheatley also | | | | burden to establish the appropriate links between |
| sees the long-term business benefits. "The bottom | | | | communities and physicians. "If we have the device |
| line is we want to help our residents stay as healthy | | | | but the physician doesn't, then who are you going to |
| as possible so they can stay with us. So I think this | | | | communicate with? I think these things need to be |
| will help us with resident retention in the long run." | | | | further developed." |
| Ideally, Wheatley envisions a telemedicine system | | | | Planning for the Future |
| that combines video communications and clinical data. | | | | Especially given the current economic environment, |
| "It could allow more frequent communication | | | | most providers are looking carefully at the options |
| between the resident, the community, and the | | | | when it comes to telemedicine technology. On one |
| provider. That means you might be able to identify | | | | hand, it can work toward enhancing resident care and |
| subtle changes in their condition a little early on," she | | | | making the senior living experience a more enjoyable |
| says. Researchers at the Texas Tech University | | | | one for residents and their family members. Plus, |
| Health Sciences Center in Lubbock have shown that | | | | such an offering can make a community more |
| such a system is possible. They have been working | | | | competitive. On the other hand, telemedicine |
| with a local assisted living community to demonstrate | | | | technology requires staff training and daily |
| a telemedicine system that incorporates a desktop | | | | monitoring-which can affect the bottom line in the |
| audio-visual system and a hand-held camera for | | | | long term. |
| diagnostics. Researchers report the ability to deliver a | | | | "We have looked at it and looked into it, but we |
| variety of primary care services remotely that will | | | | have not used [telemedicine technology] formally or |
| reduce the need for in-person visits. | | | | introduced it into our buildings as of yet," says |
| Testing the Technology | | | | Sunrise Senior Living's Suarez-Roskosh. |
| Since telemedicine technology began rolling out in | | | | Five Star Senior Living's Wheatley wants to see a |
| recent years, senior living executives have been | | | | few more tangible demonstrations of telemedicine in |
| watchful of its business benefits. More than this, | | | | assisted living settings to feel more certain about its |
| though, they're intrigued by the potential boon to | | | | efficacy. "I would like to see some kind of pilot |
| overall resident wellness. | | | | study, so that we really understand the |
| "The idea that we can do some minor diagnosing | | | | methodologies involved," she says. |
| through a [virtual consultation] versus sending | | | | While assisted living executives have not made |
| someone to the ER just to get diagnosed for a | | | | telemedicine technologies an integral part of their |
| urinary tract infection-that's what interests me," says | | | | business plans as of yet, it's clear that the wind |
| Bettina Suarez-Roskosh, national director of clinical | | | | continues to blow in that direction. Vendors say they |
| services for McLean, Virginia-based Sunrise Senior | | | | have experienced a definite progression in favor of |
| Living. | | | | telemedicine. |
| At The Arbor Company, based in Atlanta, Vice | | | | "Three years ago, the reaction was: 'What's this?'" |
| President of Quality Mary Campbell Jenkins points to | | | | says Stern of Living Independently Group. "Two |
| a variety of in-room and kiosk-based technologies | | | | years ago, it was: 'I think I heard about this last year |
| that allow residents to self-collect data and report | | | | at the conference, and I was looking for you.' There |
| various vital measurements such as weight, blood | | | | is this gradual recognition building that this kind of |
| pressure, and even blood sugar levels. The | | | | technology can help." |
| information is recorded for caregivers and sent | | | | Even without video, without self-monitoring |
| electronically to physicians. | | | | technologies, the fundamentals of telemedicine |
| This type of telemedicine technology in some ways | | | | continue to fascinate. At LogicMark, a manufacturer |
| "enforces a discipline about collecting that | | | | of personal emergency response systems based in |
| information," Campbell Jenkins says. "It heightens | | | | Fairfax Station, Virginia, President Mark Gottlieb points |
| awareness and, from a corporate perspective, it | | | | out the ability of such systems to foster a higher |
| allows for a greater degree of oversight." | | | | quality of life. |
| On the other hand, implementing telemedicine | | | | "The fact is most people in assisted living reside in |
| technology isn't as simple as buying a new gadget | | | | their own apartments and maybe the door is closed |
| and using it. As with any technology purchase, the | | | | or maybe they are in the bathroom," he says. "With |
| consumer assumes risks-and in the case of | | | | the ability to quickly communicate an issue to |
| telemedicine kiosks, an unforeseen circumstance | | | | caregivers, the better the outcome is going to be. So |
| forced The Arbor Company to discontinue the use | | | | it really allows people to live independently while still |
| of such a kiosk at its community in Decatur, Georgia. | | | | being just a push-button away from getting help if |
| The company installed the kiosk about two years | | | | they need it. |
| ago. Residents quickly learned to use the machines to | | | | |