Telehealth Services for Medically Ill Older Home Healthcare Patients: A National Survey

Background & Purpose. Despite the demonstrated effectiveness of telehealth services in screening and treating chronic disease and depression among older adults, telehealth adoption among home health care agencies has been slow. Empirical research is deficient on barriers and facilitators of telehealth adoption in the home health sector. For these reasons, this study examined the following questions: 1) how are telehealth services utilized for chronic disease and depression care among older adults in home health care (HHC)? , 2) how do HHC staff (i.e., social workers & nurses) perceive telehealth care?, and 3) what are the predictors of positive perceptions or use of telehealth services? Methods. Between June and July 2015, five-hundred-and-sixteen health professionals from the National Association for Homecare and Hospice (NAHC) were sampled. They completed an online survey based on the Unified Theory of Acceptance and Use of Technology Model and Bobni’s Innovation Culture paradigm. The survey had 33 questions, was administered using Qualtrics, and took 15-minutes to complete.  A majority of participants were female (87%), Caucasian (93.6%) and in an administrative role (86.8%). Their mean age was 53.32 (SD: 9.8). On average, they had 18.2 years (SD: 9.5) of experience in the HHC profession and 4.4 years (SD: 4.8) of experience in providing telehealth services. Descriptive statistics were calculated for all survey items. Cronbach’s alphas were estimated to check the internal consistency of survey items. Hierarchical regressions were conducted to identify predictors of telehealth perception and use. Results. Among HHC agencies that reported using telehealth, telephone (63%) and remote-monitoring devices (56%) were the most utilized technology. Various telehealth services, including monitoring of health services (64%), chronic disease management (58%), and patient health education (43%), were provided. Telehealth was the least used method for depression care (15%). Overall, there was a positive perception towards telehealth for patient care. However, HHC staff perceived telehealth as more positively for chronic disease management (90.7%) compared to depression care (53%). A majority (74%) perceived themselves as having the necessary knowledge to use telehealth for chronic disease while only 32% did for depressed patients. Innovative environmental culture, staff training for telehealth, budget, years of experience in using telehealth, and access to hospital records were identified as key predictors of a positive perception toward telehealth (R2: .33, p-value: .0***). Additionally, innovation culture, staff telehealth training, patient telehealth training, and budget were identified as key predictor variables of current agency usage of telehealth (R2: .23, p-value: .0***). Conclusions & Implications. Results suggest that although there is a positive perception towards telehealth for patient care, there may be other factors (e.g., lack of innovation culture within HHC agencies, training, and years of telehealth experience) that affect HHC agencies’ perception and use of telehealth. Thus, further education and training are needed to support telehealth use in HHC agencies, as well as pro-telehealth and reimbursement policies. Future studies may consider exploring other potential barriers and facilitators to telehealth use in HHC.