confused elderly woman with connection cables
Helping seniors connect
by Tammy Ross

Before the term telehealth was even coined, many envisioned the practice. A 1925 cover of Science and Invention magazine featured a patient being diagnosed over the radio, as well as an imagined device that would provide patients with long-distance video examinations.   

Now, after hundreds of thousands of people have died from COVID-19 in the United States and many more have been locked in, discussions have moved past what is possible to what is necessary. Complications from the virus have disproportionately affected older communities, and many homecare providers have struggled as fear from patients and staff continues to limit in-person visits. Telehealth offers affordable and efficient care for older populations, and, according to the Centers for Disease Control and Prevention (CDC), it can also support infection mitigation strategies.

As many providers continue to find utility in telehealth and remote care monitoring—a subset of telehealth that allows for the direct transmission of patient data from a distance—it is becoming more evident that the many barriers to these technologies’ adoption are beginning to break down.

Let’s take a look at them.

1. The Technophobia Barrier

Telehealth’s success depends on end-user adoption. Yet technophobia, or a fear of technology, has long been a barrier to implementation.

Introducing older generations to telehealth can be difficult, and, according to the United States Census Bureau, about 10,000 Americans a day have turned 65 since the 2010 census. However, many have aged with a familiarity with technology and the internet since at least their early 40s, and, as technological solutions continue to advance and become more intuitive, many people—including seniors—are becoming increasingly comfortable participating in telehealth services.

But to best combat any remaining unease, communicating the beneficial nature of telehealth as is crucial. A 2016 study that analyzed older users’ home telehealth service acceptance behaviors found that a telehealth service’s perceived ease of use, functionality and security are leading predictors in how well older users will accept the technology. Therefore, when offering telehealth to patients, it is crucial that homecare professionals clearly convey the technology’s security and utility.

2. The Broadband Access Barrier

But before one may achieve buy-in, it is key to first achieve accessibility—and those who most require home-based care are often the hardest to reach.

Through telehealth services and remote care monitoring, organizations can provide care to communities with limited access to needed services. However, these communities frequently include rural areas where broadband connectivity is scarce and where access to other technologies needed for telehealth, such as smartphones, may be minimal. This has historically presented one of the greatest barriers to telehealth.

In 2016, the Federal Communications Commission (FCC) found that many rural areas were behind in mobile broadband rollout. At the time, approximately 14 million rural Americans lacked mobile
LTE broadband at speeds required for telehealth services.

However, the digital divide is closing. In a 2020 FCC report, it was found that the number of Americans without fixed broadband access dropped 30% over the course of 2017 and 2018.

Additionally, many who do not have access to smartphones, computers or reliable broadband connectivity can use a landline to consult with their provider.

“We talk about telehealth, and we assume we’re looking at computers and smartphones, but you can also perform telehealth through just a regular telephone, replacing … virtual business with landline communication,” said Arlene Maxim, a clinical consultant and home health expert.

3. The Financial Barrier

Beside broadband access, there is a financial barrier that has slowed telehealth adoption amongst homecare organizations. Despite physicians’ ability to earn revenue from these technologies under Medicare Part B, the homecare industry has yet to be acknowledged as one to which payments should be made in a broad way.

Some agencies are afraid the dearth of reimbursement will create Low Utilization Payment Adjustments (LUPAs) and lose money for their organizations.

“I believe that agencies are looking at this backwards,” Maxim said. “There are ways that telehealth can avoid LUPAs, because you can provide reminders to patients and identify times when the patient needs to be seen.”

As a matter of fact, these benefits to telehealth, as well the sheer amount of data gained during the pandemic, means that “CMS cannot ignore telehealth,” said Maxim. And the Centers for Medicare & Medicaid Service (CMS) has not. CMS leaders have indicated that they see value in telehealth and related technology.

“I believe Medicare is on the cusp of providing telehealth reimbursement for us, and agencies need to know that there’s potential for this to become a reality and that we’re actually going to be able to bill for it,” said Maxim. “When it does, agencies are going to have to decide what kind of remote care monitoring they are going to provide—if any—and what type of telehealth service they are going to choose.”

Maxim explained that, with telehealth and remote care monitoring, there comes an extra expense for the agency, exacerbating the financial barrier.

“I think sometimes agencies don’t understand the expense of using telehealth,” Maxim said. “It can be very expensive because, depending on the size of your staff and the type of program you implement, you’ll have to hire new employees.”

However, if organizations “choose to contract out with a third-party vendor, then it typically is less expensive,” she added.

The Future of Care Is in the Home

The COVID-19 pandemic has shown the importance of in-home care and proven to be a strong catalyst for telehealth adoption. By getting accessible services to vulnerable populations and maintaining patient-provider relationships over distance, providers proved to the CDC that telehealth has become an essential element in maintaining continuity of care.

In fact, according to a recent study observing telehealth in the context of COVID-19, telehealth may see itself further established in health care after the pandemic ends. And though many of the changes experienced during this health crisis may not last forever, telehealth will undoubtedly find its place within the care-at-home industry once it is over.

As the many different barriers to telehealth break and the industry sees rising acceptance and adoption, one thing has never been clearer: The future of health care is in the home.

Tammy Ross is the senior vice president of professional services at Axxess, where she oversees the company’s professional services division with a focus on practical operational solutions for the home health, homecare and hospice sectors of the post-acute care industry using technology. Visit