Transcription:
COVID-19 and Geriatric Care: Optimizing Telehealth and Keeping Nursing Homes Safe

Melanie Cole (Host):  This is the Northwestern Medicine podcast on COVID-19 dated March 27, 2020.

Welcome. This is Better Edge, a Northwestern Medicine podcast for physicians. Joining me today, is Dr. Fernanda Heitor. She’s a Geriatrician and Instructor in the Division of Internal Medicine and Geriatrics at Northwestern Medicine. Today, we’re talking about how the Northwestern Medicine Geriatrics team is evolving to treat patients during the COVID-19 pandemic. Thank you so much Dr. Heitor for joining us today. Seniors are among the most at risk of developing severe symptoms and dying even from COVID-19. Can you tell us about some of the measures your team has taken to be able to safely and effectively treat your patients during this pandemic? Talk to us specifically about the Telehealth options you’re offering now.

Fernanda Heitor-Behdad, MD Guest):  Well needless to say these are unprecedented times. Our big goal here is to reduce as much as possible the risk of any close contact, cross-contamination with that in mind and as much as possible and appropriate. We are moving towards avoiding any face to face or in person visits transitioning to encounters using the technology, so Telemedicine. So a big game change here is that Medicare has lifted some of the limitations regarding Telehealth and we are able to provide this care independent of the site limitations. So, we can provide the services for the patients in the comfort of their homes and again, avoiding that unnecessary exposure for that vulnerable population.

Another important factor also is that at this moment, at least for now, there are also some relaxed restrictions regarding the use of the everyday communication ways that we have. For example, Facetime of Skyping. And these are easily accessible. We are trying our best to do phone calls and also video conferences with our patients and this is going with some hurdles here and there but overall, going very well that our patients do certainly appreciate that we are reaching out to them or when they reach out to us, we are able to connect with them without having them come to the office.

Host:  Dr. Heitor, what has this process been like? You mentioned a little bit about what it was like to set it up. But tell us about some of the key things you learned that other providers might want to know if they may be setting up this kind of practice for Telehealth for their patients.

Dr. Heitor:  Our process pretty much at this point, has been let’s hit the ground running. That’s the first. And that’s what we’re doing. We are adapting and learning better ways as we make this work. So, fortunately, we are a very cohesive group. Our Section Chief in Geriatrics, Dr. Lindquist, she has been ultra-supportive and has advocated for us towards taking advantage of the restrictions that have been lifted for Telehealth and giving us that in a sense, freedom to decide which works best for our patients looking to the best ways to be there for them. So, for the most part, we’ve been really using these video chats and some of the important factors we’re trying to be very cognizant is making sure that this is a process that is easy and, in a sense, satisfying for the patients who participate as well.

One important thing also, like the mundane things, looking into the battery of your device that we might not pay attention to. So, I find it helpful to have one of those extra external batteries handy, just in case the juices start running in my device. Also having some comfortable good headphones that might be something else to look into. Having a place, also that you can talk to your patient and respect their privacy as well. So, important points to keep in mind.

Host:  Now let’s talk a little bit about some of the challenges and how you and your team have worked through these. One of the ones that I would see might be something that happens is that seniors have trouble with Facetime or Skype. They can talk on the phone but maybe they have issues with the technology itself. Have you run into this and how have you overcome it?

Dr. Heitor: Definitely paying attention and being very open to your patient about their level of comfort and acceptance to use this technology. And a problem here also is that again, this happened very fast and is not that we had a chance to work with our patients, educate them. We just had to adapt and go. So, the good part is the technology we’re using now is this everyday communication technology and for the most part, full disclosure, no benefits attached but we’ve been using a lot of the Facetime and our mobile phones. I have done some visits with the nurse also between me and the nurse, we do the Facetime and the nurse is there with the patient, so we have that pretty much a multidisciplinary visit if you will. And that has worked very well. Of doing also conferences with the patients and their significant others or loved ones.

So definitely the patient level of comfort and ability to use tech is one. Bringing up to the point that moving forward, we really need to keep an eye and pay attention that the ease of use of these technologies is very important. So, I think at this point, as providers, we should be paying attention, taking notes, and having our voices out there to really let it be known what works and what doesn’t work.

One huge barrier, nonetheless, is hearing loss. That’s a big problem we encounter quite often. Many times, using the video communications app, it is better than relying just on the voice because then your patient can compensate for that, lip reading and the whole body language. So, definitely, the video conferencing, it is very helpful. Well another one also that – especially for doing a phone conference it can unravel as chaotic mess when you have a patient and a loved one, everybody is speaking on top of each other. So, as a provider, you have to work pretty much as a referee and really directing each one to take their turns speaking clearly, speaking with pauses but making sure to direct that conversation in a way that it’s going to be effective and also you have to be cognizant of the timing.

I guess one of the – in my experience, when we have that face to face in person encounter, there are those body language queues that you can use in order to transition from one part of the visit to the other and with the Telehealth, that gets a little bit perhaps truncated or maybe we are just on the learning process on how to better utilize this. But it’s important to try to keep the timing on check let’s say.

Another point I want to point out also that regarding the scheduling can be also a bit of an issue. So, very important to have a good cohesive work with your supporting staff, good communication channel with the scheduling staff because those patients that they will have their encounters converted to Telemedicine, they need to be informed and most importantly, also they need to consent to have that Tele encounter. You need to have the patient consent and have that documented as well. So, working nicely as a team is very important.

Host:  Well it certainly is. And another major concern Doctor, for Geriatricians is keeping COVID-19 out of nursing homes and assisted living facilities. Tell us about the effort and the protocols that Northwestern Medicine has implemented to keep nursing homes safe. What advice do you have for other providers and while you’re answering that, if people – older adults and seniors are showing symptoms or diagnosed as positive, when are you recommending admission to the hospital?

Dr. Heitor:  Great points. Yes, so keeping COVID out of the facilities is a huge concern. And much of this effort is directly related to containing the community spread of this virus. So, from hospital perspective, Northwestern has done a great job in being very proactive and doing the best to control this. So, Northwestern has moved forward with some quite “stern” but very important safety measures that pretty much involves visitation restrictions.

So, we have those in place already in the nursing facilities that they are in a lockdown, tough but very necessary. Communication also with the providers I think there are tons of communications and emails. This is a really fast moving situation. As providers we are trying also to minimize going to the facilities as well. And trying to do as much as possible also Tele communications.

Now, in a nursing facility, if a resident is showing any symptoms concerning for a possible COVID; we will really try to avoid admitting right away. We will monitor. We will perform some tests and we will certainly implement isolation precautions and avoiding hospitalization unless of course, it’s absolutely necessary.

Host:  Well thank you for that answer. So, importantly, aside from the physical health, there’s concern across the board for all of us but especially for seniors. They feel so isolated. How about mental health during this isolation? How are you advising your patients to stay mentally well? What are you telling them Doctor?

Dr. Heitor:  So, good point. Again, this is a joint effort working with the nursing facilities, our team there for activities, they have been very proactive and we’re working closely with them to engage patients on a one on one basis and having activities that do not need much of a communal sharing. With patients again going back to doing those phone calls or the video conferences just showing them that you are there for them. This has a huge impact. And also encouraging families to do the same to keep in touch with their close ones, with their loved ones. In the facilities, one of the facilities I staff in Uptown South Home, we have lots of tablets now that they are being given to patients exactly to facilitate this communication.

Host:  Well that’s so important. So, speaking more broadly, Dr. Heitor about actions to contain the virus. Do you think our efforts will effectively flatten the curve in the United States?

Dr. Heitor:  Definitely that’s the hope. That’s the goal. I think we are certainly in the right direction. I think that the community at large has been very collaborative.  I think as far as I can say as far as I can hope, I think doing this together we can certainly flatten this curve hopefully. I guess we still have to see how things go especially over this next two weeks, numbers are scary. But again, we should, we have to continue this effort.

Host: Please wrap up with what you’d like other providers to know about COVID-19 and the Telehealth program that you are doing there at Northwestern Medicine.

Dr. Heitor:  COVID is here to stay, unfortunately. I guess we are learning how to best deal with it. I guess again, focusing in supporting our patients as best as possible and definitely exploring this other ways that we can be there for them. Providing that care, giving them comfort, being very cognizant on how we are connecting to each other also very important to have that open communication. Yet to be seen what’s going to happen in the future, honestly, I guess there are so many moving parts in here, so many variables. We don’t know much about this virus and this is really changing the way we are providing care especially in long term and skilled nursing facilities.

But I guess, we again, we are running as we hit the ground and lastly Melanie, what I would like to say is that at Northwestern Medicine, we would like other providers to know if they are interested in learning more about our Telehealth program, we are here to help.

Host:  We certainly are and thank you so much for joining us today and telling us about the important Telehealth program with Northwestern Medicine. Such an important program at this time. Dr. Heitor, thank you so much for joining us. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on COBID-19 please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. I’m Melanie Cole.