Home-Based Video Telehealth for Veterans With Dementia
This family enthusiastically embraced the opportunity to participate in the home video telehealth program and had multiple telehealth visits. During these video encounters, the veteran, his wife, and his son and daughter-in-law were present. The clinician, communicating via computer from the Bedford VAMC, was able to hear from all the caregivers, observe the veteran as he interacted with each person, and watch as he walked within the comfort and familiarity of his home.
Based on these observations, the veteran was clearly at risk for falls. The clinician ordered a home safety consultation as a result. Thus the home video telehealth program allowed this veteran’s mobility-impaired wife to participate directly in his dementia care. It gave the clinician an opportunity to spot potential fall risks within the veteran’s home before a disabling fall and provided the entire family with additional, convenient dementia-related care beyond the standard in-person VAMC visits.
Establishing Home Video Links
Veterans must already have broadband Internet access and a home computer or laptop to participate in the program. To assess the connectivity status and computer comfort level of the family, a Bedford VAMC telehealth technician calls the caregiver to assess their computer, operating system, presence of a webcam, and Internet service provider.
In addition to assessing the equipment necessary for the telehealth visit, the Bedford VAMC telehealth team also determines whether or not the caregiver has had experience with videoconferencing. Based on this information, the proper level of support is given to the family for both the initial software and, when necessary, VA-provided webcam installation.
On a few occasions, program staff have visited the veteran’s home to install the software and camera. Thus the telehealth program is fit to the family needs and resources to ensure a successful visit. The Bedford VAMC telehealth team provides enrolled families with live phone-based support for download and installation of the VA-approved videoconferencing software and webcam. For each scheduled video telehealth visit, a telehealth technician is available via phone to assist the caregiver with initiating the video call to the clinician.
Next Steps
GRECC neurologist Lauren Moo, MD, is leading this telehealth initiative as a clinical demonstration project and is studying implementation of the service. Dr. Moo is collecting data on whether IMACC veterans/caregivers accept or decline enrollment and their reasons for declining. The goal is to empirically determine the degree to which age, Internet access, and other variables are barriers to wider adoption.
Dr. Moo predicts that the improved access to clinical care offered by home video telehealth will translate into reduced hotline calls, emergency department visits, and delay in community living center placement. Easier access should facilitate earlier intervention for common dementia-related issues, such as fall risk, behavioral symptoms, and disruption of circadian rhythm, thereby improving quality of life and reducing overall health care utilization for this growing population of veterans.
There is the perception that geriatric veterans are not “wired” for Internet-based communications or lack the technical proficiency to use current and evolving technologies. However, a recent national survey suggests that while only 34% of those aged > 75 years use the Internet, there has been a significant jump in the percentage of Americans aged ≥ 65 years that use the Internet or e-mail: from 40% in 2010 to 53% in 2012.5
Once online, 70% of adults aged ≥ 65 years use the Internet on a typical day, suggesting that when given the necessary tools and training, seniors are enthusiastic technology adopters.5 Thus, it is anticipated that the number of geriatric veterans interested in and able to take advantage of the in-home video visit format will grow rapidly in the near future. The initial enrollment rate at Bedford of 30% is expected to grow as families and providers become more familiar with this modality.
The Bedford VAMC is in an urban/suburban region with multiple Internet service providers, a relatively educated population, and comparatively low levels of poverty. As such, the Bedford VAMC veterans with dementia and their caregivers are likely a best-case scenario population in which to pilot this dementia home telehealth program. If the preliminary success of this pilot program is sustained, expansion to a broader range of home telehealth services, such as social work and home safety assessments, to more rural settings would be the logical next steps.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
