In a cozy living room, a baby named Charlotte snuggles with her grandparents on the carpet in front of a laptop computer. She wears a cranial orthosis and sits on a pink and white blanket with toys on it.
On the screen, her physical therapist asks the adults if they can remove a nearby couch cushion and place it next to the girl. The therapist—at home on her own floor—demonstrates how to use the pillow to form a platform for Charlotte to reach across, gently guiding the adults and demonstrating how to encourage the tiny girl to stretch just beyond her comfort zone to grab a toy. And she does—a little too quickly, so that her grandfather has to peel the plastic toy from her fingers for another rep.
This virtual therapy session caught on video is pretty typical these days for Solace Pediatric Healthcare, an in-home therapy provider based in Denver, Colorado, with offices elsewhere in Colorado and in Las Vegas as well. Solace offers pediatric nursing, family caregiver, occupational, physical, speech and feeding therapy services. At the peak of the pandemic, it went to 100% telehealth and is now running about 30% of its therapy sessions online.
“Telehealth is a great modality,” said CEO Darcie Peacock. “It’s not the perfect fit for every family, but for most, the hybrid model is the most successful long term.”
How It Started
Solace, which serves medically complex children from birth to 21 years old, actually started aiming at a telehealth program back around 2016, without having much luck getting families on board.
“We had been taking steps for three to four years trying to launch a telehealth program and we were wildly unsuccessful,” Peacock said. “We had no takers—both from patients’ standpoints and clinicians’. We really just couldn’t get any traction.”
In February of 2020, they were making a big push, pouring energy into training staff, making sure they had the technology they needed, and ensuring that their insurance contracts would cover virtual visits. Then the world stopped—and Solace moved all of its therapy visits online.
“We flipped overnight,” Peacock said. “I think we made 20 years of gains in telehealth in terms of market adaptation to it as a modality in the course of a week in 2020.” (HomeCare first checked in with Peacock in those early months of the pandemic; you can read our interview here.)
With an equally dramatic shift to online schooling for most of their clients, Solace set a new goal: to make sure none of its patients slipped backwards in their progress.
“We wanted to have them make gains here even if they’re not in school; that’s what we rallied around,” she said.
Solace’s information technology team grabbed the company’s spare iPads, loaded them up with data plans, and shipped them out to customers all over Colorado. And the organization’s philanthropic arm stepped in to deliver groceries for the first few months of the pandemic to keep their patients fed.
They also made sure they had multiple technological platforms available for visits, so if one wasn’t working or a family couldn’t sign in, they had other options.
How It’s Going
In September of 2020, when Colorado started to open up and the company had enough personal protective equipment to keep staff and clients safe, Solace slowly reinstated in-person home visits at a pace of about one visit per month.
“It was really a slow move back, much slower than I anticipated,” Peacock said. “I was kind of afraid that all of these advances to telehealth would be left in the dust.”
But even as home visits ramped up, Solace staff continued to encourage existing and new families to consider periodic telehealth sessions. It was a no-brainer for families with medically fragile children seeking to protect them from viral exposure. But many others took advantage on bad weather days or when a child was home sick, and they found the convenience appealing enough to stick with it.
“It’s just really flexible, and families are so busy, especially if they have multiple children,” Peacock said. “We have kiddos who will plug in their headphones and sit with their iPad at a sibling’s hockey practice.”
The therapists—there are about 300 on the team in Colorado—love the switch. It alleviates battles with tough Denver traffic and allows them to more easily reach school-aged children in the narrow window most have between 3:00 p.m. and 7:00 p.m. They make the same rate whether they do a visit in person or online, so they are able to boost their income by reducing travel time and fitting in more virtual visits. They can take on assigments while on vacation if they choose, or even if they relocate.
“With clinicians leaving the area, we’ve otherwise had to say goodbye, but we have kept some even as they’ve moved out of state,” said Peacock.
Suprisingly, there was another bonus. The team discovered that not being able to put hands on a child means therapists must train family members to do the work themselves, a step that improves outcomes.
“Now, instead of being in the family room with Johnny where I can see him pull up on the couch, I have to say, ‘put your left hand right above his; now give him a little support,’” Peacock said. “You’re guiding them through and it’s their hand guiding the child. It’s really about empowering the family and the caregivers to take the lead.”
What They Learned
There’s also been an upside from a business perspective, Peacock said, especially since Colorado passed a state law in July of 2020 requiring insurance payers and the state’s Medicaid program to reimburse home health and hospice providers for telehealth services. (The agency’s Nevada-based operations include private duty nursing and have not gone as fully toward telehealth.)
There’s been an advantage in terms of staffing—both offering flexible hiring and allowing Solace to retain therapists who want to work remotely—as well as a savings in the use of its approximately 200 fleet vehicles. And they’re getting more out of the team they have.
“These are highly skilled, highly educated—masters, doctorate-level staff—that any time they’re behind a windshield are not effective,” she said. “The efficiency gain of being able to see children back to back allows those therapists to serve
In addition, Peacock said, it appears that the company’s telehealth clients complete their therapy more quickly because they miss fewer appointments and maintain their continuity of care.
“Those children whose families have really embraced the telehealth model or the hybrid approach are achieving their goals faster and getting to discharge faster, opening up a spot for another child who can then get access to care,” she said.
It hasn’t always been easy, however. Therapists have had to work hard to redesign their approach to work virtually. Peacock said the company started a monthly newsletter in which team members share approaches and content ideas.
“I’m an OT myself; it’s absolutely the same amount of preparation to run a telehealth session—and often it’s just more,” Peacock said.
Nonetheless, she hopes Solace can stay at close to the current proportion of telehealth or even higher even after the public health emergency ends. And she says that, like any other major shift, telehealth has to be a company priority to make it stick.
“I think it really comes down to leaning into telehealth,” she said. “If you keep it at an arm’s distance, you’re never going to have movement in it. Keeping it at the forefront is the only way.”