Video fills the gap in rural nursing homes for mental health care

KNOXVILLE (Iowa) — Bette Helm was happy to talk to someone about her insomnia.

Helm lives in a central Iowa nursing home with approximately 7,500 residents. There are few mental health services. Helm had an appointment with a Texas psychiatric nurse practitioner, 800 miles from her home, on a recent morning. Helm used an iPad that she placed on her lap and spoke to Helm via video.

Residents of small-town nursing homes have found video visits to be an increasingly popular way to access mental health care. Patients don’t need to travel to the clinic. Patients don’t have to leave their homes or get dressed, which can be a daunting task for those with anxiety and depression. Online care providers are less likely to cancel appointments and can often work remotely. Although the use of other telehealth services might decrease as the covid-19 pandemic ends, providers expect that rural nursing homes will continue to have a high demand for remote mental healthcare services.

Are you worried about falling asleep? Ayesha Macon, a nurse practitioner, asked Ayesha Macon: “Is your mind racing?”

Helm stated, “Yeah that’s kind of my time to think.” She said that her thoughts keep her awake past three a.m.

They talked about the anxiety Helm experiences during the day, as well as her routine of watching the TV news at 10:00 p.m. Macon suggested that the news could cause Helm to feel agitated and asked if she could reduce stress by skipping the news before heading to bed.

Helm replied, “No.” It’s interesting to me. It’s interesting to me. I have always been a bit obsessed with news.

Macon smiled and stated that she understood. They discussed other methods, such as online meditation and reading the many novels Helm has stored in her bedroom. Macon agreed with her, saying, “If I couldn’t read, I believe I would go absolutely crazy.”

Telemedicine visits were more common in the American health system after the pandemic. This was because guidelines on “social distance” reduced the number of in-person appointments, and insurance companies relaxed restrictions on what they covered. Medicare paid for a large number of telehealth visits. The number of people who voted for the campaign jumped tenfold Comparing the same period one year ago, the nine-months ended 2020 with a lower rate.

Online treatment is a popular choice for those who are unable to access in-person care. Supporters say that it can be a great match for mental health care. As an example, they cite small-town nursing home as a prime example. Encounter Telehealth, which arranged Helm’s appointment, has more than 200 assisted living centers and nursing homes, most of them in the Midwest. Jen Amis (President of Encounter Telehealth), said that 95% of these facilities are located in rural areas. She is based in Omaha.

Encounter Telehealth employs about 20 mental health professionals. Many of them are psychiatric nurses practitioners who live in cities. They access patients’ electronic medical records via a secure computer system and review their symptoms and medications before they schedule appointments. They can complete as many as 2,000 visits per month.

Amis stated that it is important for seniors to receive expert support when they are dealing with stress and uncertainty as they age. She said, “We all will be there at one point.” “Wouldn’t it be nice for that last chapter to be peaceful?”

When the pandemic struck, the company saw a surge in demand for its services. While the coronavirus caused thousands to become ill and died, nursing homes were closed to visitors for several months. It could prove to be too much stress for all involved. Amis stated, “Oh my gosh! The isolation and fear.”

Amis stated that her company’s services are possible because of several technological developments. Video systems and electronic medical records are essential. She also stated that many states have granted more autonomy to nurse practitioners and other non-physicians. It is now easier to bill private and public insurance plans for mental healthcare treatment.

As the pandemic subsides, the federal government may tighten regulations for certain types of telehealth care. Amis believes that Medicare will continue to pay for remote mental health visits in rural areas.

Jonathan Neufeld, program director of Great Plains Telehealth Resource and Assistance Center, at the University of Minnesota, stated that in-person mental healthcare can be difficult to arrange in rural facilities.

Neufeld, a federal grant-funded psychologist who runs Neufeld’s center, said that “You have a double or even triple whammy going now.”

He pointed out that the national number of mental health professionals has been low for many years, even prior to the pandemic. All types of rural employers. including nursing homesStaffing shortages are a serious problem in many areas.

Neufeld stated that telehealth visits can prove difficult for some residents of care facilities, especially those with dementia. They might not be familiar with how a video feed works. However, he also said that it can be difficult for people with dementia to be treated in person. A relative or staff member should accompany the patient to appointments. The mental health professional will generally consult with the facility staff regarding a patient’s treatment.

Telemedicine wasn’t available before rural residents had to travel to another clinic to see a mental healthcare professional. This could take up time and cause stress for patients.

Seleta Stewart is a certified nursing assistant at Accura HealthCare nursing facility where Helm resides. She said that the facility’s demand for telehealth services is growing partly because it is home to many younger residents with mental illness. She said that in the past, many of these Iowans would have been treated by specialized facilities such as two state mental hospital. 2015 – Closed. More people are now living in nursing homes.

Stewart stated that Iowa is not a good state for mental health.

Photo of a nurse home worker talking to a mental worker via video conference.
Ayesha Macon (psychiatric nurse practitioner) meets with Shaina Frost (right), a certified nursing assistant at Accura HealthCare in Knoxville, Iowa, before visiting patients in their rooms. They discuss the health of residents at the nursing home and their medications.(Tony Leys / KHN)

Neufeld stated that even with the efficiency of telemedicine, it can still be difficult to find staff for nursing home companies. Many mental health professionals have too many patients to handle and may not be able to find the time to volunteer online. He also said that Medicare, which covers most seniors, has lower rates than either private insurers or patients who pay on their own.

Encounter Telehealth president Amis stated that Medicare pays $172 for an initial appointment, and $107 for a follow up appointment. Care providers get roughly 30% to 75% more for patients who have private insurance or pay their bills themselves, she added. Encounter Telehealth charges a fee for nursing homes to have mental health professionals visit them via video.

Many patients and caregivers said that the transition to video appointments was usually seamless, despite seniors’ reluctance to use new technology.

Since 2002, Dr. Terry Rabinowitz has provided telemedicine services for a rural nursing home in upstate New York. He is a psychiatrist and professor at University of Vermont. He stated that many patients are able to adjust quickly to video visits even if they don’t prefer it.

He said, “I believe most people, if their druthers were around, would prefer to see me in person.” He said, “And if they had my druthers I’d prefer to see them in person.” However, online visits can present special challenges for patients with impaired vision or hearing. These complications can be overcome.

Nancy Bennett, another resident at Helm’s Iowa nursing facility, can attest that the benefits are real. Bennett was able to have a video conference with Macon this morning. The nurse practitioner heard that Bennett was feeling stressed. She said, “I’m 72 years old, I live in a nursing facility, and I don’t have any family nearby, so yeah, it’s a bit depressed.” “I get sad sometimes.”

Macon assured her that it was normal.

Bennett stated that she doesn’t like taking too many pills. Macon suggested that Bennett could be tapered.

Bennett later revealed that she had been to a mental health clinic in the past. Bennett said that she had been to a clinic for mental health care before being forced into the nursing home. She now spends most of her time in a blue recliner in their room.

She said that if she had been required to dress and travel for her Macon appointment, she would probably have cancelled. She said, “There are days when it’s not worth the effort.”

Bennett felt a bit better when the mental health professional came by Bennett’s house on an iPad.

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