“Good morning, how are you feeling today?” It’s a simple question, but the answer can speak volumes about a patient’s health, particularly their mental health.

 

That question is one frequently voiced by the central station nurses at United HomeCare when calling on patients participating in the TeleHealth program. For some homebound clients, it may be the only interaction they have with another person all day. It’s also an important connection that can detect early warning signs of medical conditions, help stave off depression and improve quality of life.

 

Nurses like United HomeCare’s Vanessa Ruiz, R.N., are at the forefront of the telehealth trend that is using rapidly evolving technology to address health care cost and access issues in new ways.

 

In 2005, United HomeCare launched TeleHealth Monitoring Services, a program designed to monitor patients with chronic health conditions, such as cardiac diseases, high blood pressure, pulmonary disease, diabetic diseases, and complex medical problems. The system uses hospital-grade wireless remote monitoring devices to track vital signs of patients on a daily basis. This information is transmitted to a central station nurse who reviews the data, identifies appropriate action, provides at home visits if needed, and communicates with the client’s physician or caregiver.

 

TeleHealth monitoring helps prevent acute exacerbations of disease that lead to costly hospitalizations or ER visits and mitigates rehospitalizations. It also facilitates more customized nurse visit schedules, based on monitored findings. In this technology-enhanced continuum of care, nurses are able to play a crucial role as disease managers and provide for a smooth care transition experience upon patient hospital discharge to home.

Because of the success of TeleHealth Monitoring Services, United HomeCare was invited to partner with the Warren Alpert Medical School of Brown University and the Weill Cornell Medical College Homecare Research Partnership to pilot a geriatric depression care management program using TeleHealth technology. UHC was one of three U.S. home health agencies to participate in the pilot. 

 

This project tested the feasibility of providing patients better access to care by linking them to a depression care manager using the agency’s TeleHealth system. The UHC TeleHealth nurse received specialized training in depression care management and was responsible for reviewing patient home monitor responses to depression-related questions. The TeleHealth devices prompted patient responses about involvement in enjoyable activities and interests, general feelings about depression, and medication compliance and side effects. The TeleHealth nurse also had regular phone contact with the patient to follow-up on monitor responses and to coordinate care with the patient’s primary care physician and mental health professionals, when needed.

 

"At the start of the study, 19 of these patients met full diagnostic criteria for Major Depression, with a mean depression severity score in the ‘Markedly Severe’ range,” noted Thomas Sheeran, PhD, ME, a clinical psychiatrist and lead researcher for the study. “We were very pleased to find that at follow-up, the average depression severity scores were in the ‘Mild’ range, indicating significant improvement in depression severity through the use of this protocol."

 

Depression among the elderly is common but that doesn’t make it normal. It is currently estimated that one in seven home care patients are depressed, though many believe it is an under-diagnosed condition.

 

What the Depression Telehealth Pilot has taught us is that by embracing telehealth and expanding the role of home care nurses it is possible to turn back the tide of late-life depression and improve the quality of life of homebound seniors.