Hospice care is a benefit offered by Medicare for terminally ill patients. A less familiar but related service known as palliative care, benefits patients by providing pain and symptom control, coordination between support team members, emotional support and relief for family/caregivers. The difference between the two is that the former is for anyone of any age at any stage of a serious illness and can be provided along with curative treatment. Meanwhile, hospice patients are no longer receiving curative treatment and may only have months to live. Telemedicine just happens to be something they have in common.
What is telehospice?
The term used for telemedicine in hospice care is telehospice, and is the new frontier of telehealthcare delivery. Even if it only involves an I-Pad with Skype installed so that an on-call nurse or doctor can communicate remotely with a caregiver, it is a telehealth application. In the case of hospice, the patient is suffering and so time and communication are both of the essence. “Hands-on” visits are by no means replaced. Customary communication and comfort provided in person are merely assisted by the immediate remote visualization provided by telehealth. That care is even more greatly enhance during an on-call crisis.
In order to fully grasp where telehealth fits in, it should help to review just what the benefit of hospice care entails. Service under the Medicare Hospice Benefit include:
- Physician services
- Home visits by nurses
- Home health aide assistance with activities of daily living
- Social work and counseling
- Physical, Speech, and Occupational therapy
- Dietary counseling
- Medical equipment and medical supplies
- Drugs for symptom control and pain relief
How does telehospice provide comfort?
Remember that on-call crisis referred to earlier? Unfortunately, these are likely to occur with serious illnesses. A caregiver may be called upon to reposition a catheter. That caregiver should be a nurse or ideally, someone with expertise will be at least present to infuse the situation with some measure of calm and guide the procedure. In reality, none of this may be possible in a moment of crisis. However, even a family member can be talked through simple procedures using a videophone. Support staff at a nursing home can use the same technology to reach an on-call doctor. The worst-case scenario facing our healthcare system, staffing shortages, only makes the necessity of telemedicine more urgent, especially when it comes to meeting the needs of hospice patients.
What are the tools of telehospice?
The tools of telehospice are the same telecommunication devices used by other telehealth practitioners. The range of equipment includes but is not limited to:
- Individual measurement devices Telehospice utilizes blood pressure cuffs, blood glucose meters, and other peripheral devices for tracking patients' individual measurements. However, these devices all have telecommunication capabilities which allows the measurements to occur more frequently between in-person visits.
- Telehealth workstations These full-scale workstations can transmit a full work-up of the patient’s physiologic parameters to a central nursing station. This can be done with live video, for face-to-face interventions or it can be done with no video. Only physical data is collected and transmitted. A digital camera accessory is available to send pictures.
- Videophones No list of telehealth gadgets is complete without videophones. They are precisely what they sound like. These telephones have visual capabilities that allow patients/caregivers and clinicians to see each other and speak directly to one another. Those aforementioned crises can be avoided with just one videophone-assisted demonstration from one of those clinicians.
- Pre-programmed devices Pain medication, hydration and nutrition can now be managed by something called an ambulatory infusion pump. What used to be a matter of complex infusion delivery now may not even require an in-person professional visit.
Again, this list is hardly comprehensive or exclusive, barely an introduction. It is more important to note are the improvements that they can add to hospice. Patients will be assessed quicker. Interventions will be timelier. Caregivers will be able to benefit from educational opportunities, “show and tell” demonstrations that spread valuable knowledge more evenly throughout the support team. Additional comfort and stress relief will be offered via music and visualization therapies. Most importantly, hospice providers will be able to generate crucial feedback for the engineers and designers of this technology that will allow telemedicine to be more specifically tailor-made for hospice patients.