On the 30th of September 2020, the Royal Commission into Aged Care Quality and Safety (Royal Commission) published a Special Report into Aged Care and COVID-191. To quote the report, “When the Prime Minister announced this Royal Commission in 2018, nobody could have foreseen that the aged care sector would find itself in the grips of a pandemic”. Due to the high mortality rate of the elderly as a result of contracting COVID-19, the Aged Care sector was subject to strict lockdowns and restrictions early in the Australian response.
The result from a resident’s perspective was an increased sense of isolation, with people often confined to their rooms. From a community perspective, people developed a sense of fear for the wellbeing of elderly family members, fed by a lack of access to up-to-date and timely health information relating to both residential aged care facilities and specific residents, along with a lack of regular interaction with family members in residential aged care. The report notes that “The understandable restriction of visits between older people and their friends and families has had tragic, irreparable and lasting effects which must immediately be addressed as much as possible.”
In addition to the benefits that telehealth technology can have on the mental wellbeing of the elderly, the final report identifies that “Telehealth is [also] a means of avoiding the potential harm and distress for frail older people caused by travel to receive medical care”. The use of telehealth has become widespread as a result of the COVID-19 pandemic in 2020. Whilst the medical industry as-a-whole has adopted telehealth as a mechanism for overcoming restrictions on face to face consultations resulting from the COVID-19 pandemic, the aged care sector had struggled to give residents regular access to phone based consultations with GPs and phone check-ins with family members.
The future of telehealth in aged care
| Recommendation 63: Access to specialist telehealth services, states: |
“that the Australian Government should expand access to subsidised specialist telehealth services to older people receiving personal care at home, and require aged care providers to have the necessary equipment and capable staff to support telehealth services”.
According to the Aged Care Industry Information Technology Council2
“The extent to which telehealth services are used to support people living in residential aged care is not known”.
Technology provides an immediate opportunity to reduce the workload of the staff of a residential aged care facility by automating low value tasks, reducing the need to do checks on residents, facilitating family visits and clinical consultations, and by maintaining a higher level of health and care for residents, reducing the incidences of acute episodes and interventions.
There is an immediate opportunity to leverage off both the funding and investments being made by the Federal Government and the broader healthcare sector in regard to the adoption of telehealth.
Nicole Gillespie, the KPMG Chair in Organisational Trust and Professor of Management at the University of Queensland Business School, says:
“One of those barriers was the funding model which gave little incentive for doctors and health practitioners to use telehealth. That has changed with temporary MBS telehealth items available for a wide range of consultations and health practitioners such as GPs, medical practitioners, nurses, midwives, and allied health”3.
| Recommendation 109: ICT Architecture and investment in technology and infrastructure covers: |
“systems that are designed to enable better services for older people”, “pre-certified assistive technologies and smart technology”, and “pre-certified assistive technologies and smart technology”, underpinned by a technology strategy to be developed in consultation with older people.
The introduction of technology extends across retirement living, care at home and residential care. Using a framework from KPMG’s Delivering healthcare services closer to home report (and detailed below), there are a range of technologies that can be applied across different settings. Retirement living lends itself to remote monitoring to ensure early intervention in the event of an accident or acute episode.
Care at home also lends itself to remote monitoring, but with the addition of artificial intelligence to identify the incidence of falls or other predictable events, along with the tracking of key health indicators such as blood pressure through connected medical devices. Residential aged care and care at home lend themselves to remote telemedicine. Emerging technologies include home health robots and care guidance platforms, while some technologies such as wearables and embedded vital monitors are more suited to chronic disease management.
Aged care technology landscape to support quality care
| New technologies can help support quality care in the following ways: |
Care guidance
Platforms that arm patients with relevant information and reminders at key points in their interaction with the healthcare system.
Connected medical devices
Wearable technologies that help patients track and manage existing conditions and enable preventative techniques.
Remote telemedicine (telehealth)
Diagnosis and treatment of patients using video-conferencing via a digital device, allowing them to access doctors from their home.
Home health robots
Machines programmed to provide 24-hour home care, especially to aged and older patients.
Artificial intelligence (AI)
A platform that analyses multiple data points, including home environment, behaviours and biometric readings, and highlights changes in an individual's health.
Patient networks
Health networks that help patients find new treatments, connect with others and take action to improve their health outcomes and general wellbeing.
Remote monitoring
Continuous, automatic and remote monitoring of patients via sensors, enabling them to continue living in their own home.
Embedded vital monitors
Small and flexible wearable sensors to collect and stream biometric data to doctors and nurses.
So, what are the next steps? Once the Government presents their response to the recommendations of the Royal Commission, it needs to kick off the development of the Aged Care Information and Communications Technology Strategy. For aged care providers to effectively participate in the development of the Strategy, they will need to familiarise themselves with the remote monitoring solutions available in the market, investigating new models of care that enable the effective use of these technologies. Providers then need to begin the process of aligning their work practices, standards and systems with the capabilities of the technology platforms to be deployed. Starting this journey now, will best position the industry to take incorporate the recommendations of the Royal Commission.
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Further reading
Footnotes:
1. Royal Commission into Aged Care Quality and Safety - Aged care and COVID-19: a special report – 30 September 2020
2. Aged Care Industry Information Technology Council’s CARE IT research report published in October 2020
3. Trust and the future of telehealth services in Australia by KPMG, published on Friday July 17, 2020