Clinicians must be careful not to stereotype older adults as being unable or unwilling to use technology. A study in JAMA, Internal Medicine, which included 4,500 participants, age 65 years and older, reported that up to 38% of older adults in America had little experience with technology at the time COVID-19 arrived, while 20% may have hearing loss or dementia that could negatively affect the use of telephone visits. However, there are multiple levels of skill and access to technology in this population. Knowing a client’s skill, comfort level, and access to/with technology before engaging in telehealth for seniors can help clinicians make effective suggestions and back-up plans. Having someone available to help in case of technical difficulties is a useful strategy when delivering telehealth for older adults.
Benefits for Telehealth for Seniors
A benefit of having access to telehealth for older clients in their homes are several:
- Gives clinicians an inside view of how the client/patient lives and any problems that might exist in their living conditions. Seniors with good social skills may be able to carry on a comfortable conversation but can have difficulty managing their daily lives and lack the ability to fully engage in daily living skills (DLS).
- Video visits with clinicians also allow for face-to-face visible cues to be seen that currently would be prevented by the use of face masks during an in-person visit.
- Further, telehealth allows older adults with mobility issues a convenient way to receive care without having to leave their home or having to arrange special handicapped-accessible transportation which may be limited or costly.
Treatment Tips for Using Telehealth with Seniors and Older Adults
Carrie Nieman, MD, MPH, and Esther S. OH, MD Ph.D. of the John Hopkins Bloomberg School of Public Health reported that they have successfully treated patients age 90 plus via telehealth visits. In fact, they have developed some key points to remember when conducting telehealth for older adults:
- Two-thirds of adults 70 years older and up have some hearing loss. It, therefore, is helpful to request that they wear headphones/headsets while using their hearing aids if available.
- Microphone/speaker combination devices can be purchased for older adults who know how to use the telephone but may be confused by video setups. One such device is the “Phoenix Audio DUET MT202-PCO USB Speakerphone,” which allows the user to hold the device to their ear much as they would a telephone handset. The user simply speaks as they would when using a telephone. One device then serves as a speaker and microphone, which helps the older adult understand what’s happening and how to proceed. The speaker’s sound can be turned up through the computer to be heard by hard-of-hearing clients and patients.
- Clinicians using video conferencing should consider wearing a headset and make sure their face is in full view for the client or patient to see their lips move. Exaggerating mouth movements may also be helpful in some circumstances.
- For clients with severe hearing loss, using a landline along with their hearing aids for the auto audio portion of the visit can also work if a video channel is not essential.
- Provide a written summary of the call and any instructions for both the client or patient and caregiver.
- Routinely involve a loved one or caretaker in the visit when possible if the client is unable to participate fully. Loved ones can help with the treatment plan set up, such as helping the client/patient be comfortably seated, and clearly seeing or hearing the practitioner. They can also help to assure that the older adult can be clearly seen and heard by the clinician. They can help both with the implementation of agreed-up behavioral changes, medication regimes, and reminders.
- In some cases, private sessions with caregivers are warranted.
- CPT codes exist for practitioner reimbursement when using telehealth with either the patient or caregiver without the patient present (see below).
Telehealth CPT Codes for Older Adults
Telehealth billing codes (CPT codes) exist to offer older adult greater access to care from the convenience of their homes while allowing clinicians a more holistic view of the client’s situation, thereby allowing them to provide more informed care. A skilled telepractitioner can easily ask various family and friends to participate in sessions with a loved one, even if they are in a distant area. Whether billing for telehealth during COVID or billing for telehealth after COVID, or specifically for remote patient monitoring (RPM), a wide variety of codes exist to help the clinician deliver a full range of services via telehealth for older adults.