Virtual home care appointments might be high-tech, but the patient-nurse relationship enabled by telehealth is surprisingly human.
Sandy Legg-Forgiel, RN, telehealth coordinator for HopeHealth Community VNA, should know. She launched the telehealth and remote patient monitoring program in 2005 and still manages it today.
“There’s something immediate and almost anonymous about talking to a health care provider over the phone,” Sandy explains. “My patients can tell me about their needs and symptoms in real time. Some even share personal things they wouldn’t tell a nurse who is sitting there face to face.”
Candid conversations are especially important for patients living with a chronic illness, such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) or diabetes. Telehealth and remote monitoring help these patients manage their health and steer clear of the hospital.
Only 7% of HopeHealth Community VNA telehealth enrollees were readmitted to the hospital during a 2021 study period.
The idea behind telehealth in home care is simple. Patients use special equipment to measure their vital signs every day. The data are transmitted automatically to a nurse for remote monitoring and follow-up.
“Telehealth equipment is very easy to use,” Sandy says.
Telehealth is an additional support and does not replace visits from a home care nurse. “You will still see a nurse, even if you need a visit every day, but remote monitoring helps us better direct your care and discover problems,” Sandy says.
What vital signs show about health
Vital signs are an important measure of overall health, and an irregular reading could signal trouble ahead.
- A diabetes patient with a high blood sugar reading might have eaten a sugary snack the night before, or they could be fighting infection.
- A congestive heart failure patient who reports sudden weight gain might have missed a dose of their diuretic medication (known as water pills), or their heart failure could be worsening.
It is the telehealth nurse’s job to spot potential problems, contact the patient and decide whether to loop in other members of the patient’s health care team.
Sandy educates patients on the connection between their behaviors and their vital signs. “How they take their medications, when they take their medications, how they eat, what they eat — all play a big factor in how well they’re able to manage their health at home and stay at home,” she says.
If Sandy is uncertain of the trigger after speaking with the patient, she will reach out to a physician for guidance. The doctor might decide to adjust a medication, send a nurse to the home, order lab work or schedule an in-person appointment.
Telehealth nurses offer compassion and address health care inequities
Managing a chronic illness can be hard on patients and their families for many reasons. Some medications have side effects. Nobody loves “eat this, not that” dietary rules. Prescriptions and supplies can be costly.
Sandy says it is normal for patients to make mistakes or get frustrated. She gives advice and pep talks with compassion, free of judgment.
“I tell patients, ‘Don’t worry. I’m not your mother, and this isn’t confession. I’m trying to understand the big picture. Is this issue with your heart due to a dietary choice or is something bigger going on that’s going to put you in the hospital?’” she says.
She also hears about risk factors that have nothing to do with free choice, such as financial hardship. Some patients reveal they cannot afford their medications or are eating poorly because they rely on food pantries. Sandy might refer these patients to a social worker or other community resources, or she asks the doctor to prescribe a more cost-effective medication.
One of Sandy’s favorite roles is trusted advisor. “A lot of my patients love knowing they can call me and ask me anything. They know I’m going to pick up the phone and answer their questions, and if I don’t have the answer, I’m going to get it for them,” she says.
What to expect when starting telehealth home care
STEP 1: SETUP AND TRAINING
Once you qualify, a technician will visit your home to set up equipment and train you or your caregiver. We will provide you with:
A tablet computer for recording vital signs (either with or without a video camera)
A scale to measure weight
A pulse oximeter to measure pulse and blood oxygen level
A blood pressure cuff
A glucometer to measure blood glucose level (for diabetes patients)
STEP 2: DAILY MEASUREMENT
Every day, you will use the tablet to answer a short health-check survey and then measure your vital signs. Data is sent automatically to the telehealth nurse for immediate review.
STEP 3: COMMUNICATIONS AND TRIAGE
If any of your vital signs are abnormal, you’ll hear from your telehealth nurse right away. Some patients prefer phone conversations, while others opt for video. After speaking with you, the nurse will decide if further action is needed.
Telehealth and remote monitoring are available to qualifying Medicare beneficiaries and private-pay patients. To learn about our telehealth program in Massachusetts, call (508) 222-0118. For telehealth care in Rhode Island, call (800) 696-7991.
Above photos: Sandy Legg-Forgiel has witnessed the evolution of telemedicine in home care since she launched a telehealth and remote monitoring program for HopeHealth Community VNA in 2005.