Learn how continuous remote patient monitoring can improve nursing home care plans in this free ebook!

Excerpt

Residents living in long-term care facilities such as nursing homes face significant medical and emotional challenges that need the attention and care of skilled, experienced nurses, sometimes around the clock.

Nurses, aides, and other staff strive to keep residents stable, safe, and comfortable, while also serving as sentinels for the warning signs that certain residents may need higher levels of care from either their primary care doctors or other physicians and specialists at a hospital.

Unfortunately, standards can vary across nursing homes, and in a time of constrained resources, it’s harder for nursing home staff to give patients the individualized attention that they may need.

However, emerging concepts in technology-driven patient monitoring offer the potential for improving nursing home care plans for residents across the nation.

These alternative approaches revolve around patient-wearable, smartwatch-like devices that enable patients to be monitored continuously, twenty-four hours a day, seven days a week. The devices provide reliable, hospital-quality data of patient vital signs, which medical teams can use to forecast potential problems and take action before they become emergencies.

A single device to check all parameters is a powerful tool in the struggle to improve nursing home care at all stages, from planning to execution. The information provided by continuous patient remote monitoring (CRPM) supports faster and more informed decision-making on treatment, leading to better outcomes for patients and peace of mind for families.

CRPM systems also present opportunities for improving operations and the financial condition of nursing homes by tackling one of their most enduring and costly problems: hospital readmissions.

Studies show that nursing home residents return to hospitals at a high rate. By some estimates, one in four residents faces a second stay within thirty days after returning to their nursing home beds. There are many complex reasons for this. But by offering enhanced data-based surveillance, CRPM can identify and even predict problems before they escalate into longer-lasting issues, taking action before they become crises or emergencies.

By helping facilitate improved nursing home care plans, this new system could have a vast impact, providing a better quality of life for the patient, reassurance for families, and a technology force-multiplier for overworked and overstressed nurses and staff.

Caring for Aging Residents in Nursing Homes

The United States has an estimated 15,600 nursing homes operating across the country. In 2015, these homes cared for 1.3 million people. Ensuring that these residents get the attention and care that they deserve is a herculean task that falls to the efforts of skilled nurses and other professional support staff in the home.

Most, if not all, nursing home residents struggle with the effects of various chronic conditions, including asthma, diabetes, and high blood pressure. Others may be showing signs of early-onset dementia. Many residents need help in carrying out the major tasks of managing their daily lives, including some or all of the following:

• Preparing meals
• Eating
• Bathing and dressing
• Performing personal hygiene tasks
• Managing medical care
• Administering and tracking medications

Nursing home workers can provide much of this basic care with the assistance of various support staff, responding to resident needs and various complaints. Part of their role involves recognizing when a resident’s condition has begun to worsen. These intensifying conditions often flare up without warning, in ways that may be life-threatening.

In such instances, residents need a level of care that goes beyond what can be provided within the nursing home. They will need the attention of attending physicians or if physicians practice in the nursing home, their private doctors. As situations worsen, doctors may need to adjust treatment plans or in more severe cases, arrange for residents to go to the hospital.

Much of this decision-making is based on imperfect information. It may come from vital signs captured hours or even days ago or from subjective reports about how the patient is feeling. It may be a condition downturn that happens without any warning at all.

Though nursing homes nationwide employ about 1.5 million people, only a fraction are engaged in skilled care and have the necessary experience and training to recognize problems and sound the alarm when cases become more troublesome. The suddenness with which chronic conditions can turn into emergencies makes it hard for nurses and staff to keep up with each patient. Conditions can change at a moment’s notice.

But with the right systems, these deviations can be spotted by real-time data provided by CRPM. The pressing need is for a broader deployment of this system to provide data to nurses, attending physicians, primary care physicians, specialists, and others engaged in a patient’s care.

The global pandemic has further highlighted the need for such a system. COVID-19 hit health care facilities hard, especially nursing homes. Hospitals and doctors’ offices were challenged to find ways to continue to deliver care without exposing others to the risk posed by the deadly virus. In adjusting to the pandemic, health care providers had two goals: to keep those with the virus from spreading it inside the home and to keep staff and others inside the home from carrying it to the broader population. CRPM systems have been effectively deployed to help triage patients—to keep those with low levels of symptoms of the virus isolated or at home—while addressing the most severe cases in the hospital, where advanced measures are most widely available. In nursing homes in many states, residents became casualties from COVID and died of it at a higher rate than the general population.

Think of CRPM as a system for digital surveillance of vital signs, designed to recognize someone’s problems before they even know that they are in danger. According to Neil Charness et al. of Telemedicine Journal and eHealth, some people in the system have described this as “automated hovering.” Put simply, in an automated hovering system, patients are “watched over not just at an occasional doctor’s visit, but also daily as outpatients via mobile devices and real-time wireless data transmission and analysis technologies.” Charness et al. also looked at studies of the efficacy of the use of patient remote monitoring systems. They found compliance among patients to be at a high rate: “Proactively detecting symptom changes earlier with healthcare provider intervention is intuitively better than reactively treating patients who may wait too long and become seriously ill before seeking treatment. Recent meta-analyses support this proactive model of care, showing improvement in quality of life and reduced healthcare costs when key symptom tracking for chronic conditions was used with early intervention.”

Though focused on ways of remotely monitoring patients to keep them safe at home, the findings of the study extend broadly to nursing homes. CRPM is an effective conduit for better nursing home care plans. 

Using Technology to Improve Nursing Home Care

Smartly deployed with the right hardware and software, along with institutional support and training, CRPM has the potential to help improve health care across the board, including nursing home care and other long-term care facilities.

The use of machines to aid in care isn’t just a US phenomenon. For instance, a recent review of the future of healthcare in the United Kingdom referred to various projects aimed at automating care to free up staff to concentrate on those who are most in need. The report envisions an interconnected network of robots, sensors, and software to facilitate better all-around communication and coordination of care: “For inpatients, ‘bedside robots’ may become a reality, assisting patients with meals, transportation, and mobilisation. Digital systems will enhance communication with friends and family, and biosensors will allow the remote monitoring and alerting responses to clinical observations (as in sepsis.) One area with significant potential is diagnostics, where there is evidence to suggest that AI-based systems including machine-learning algorithms can be used to improve the accuracy of diagnosing diseases from radiological images.”

Also, according to the study, the use of robotics and automation could free nursing home staff from repetitive tasks—not only hygiene ones but also tasks such as taking blood glucose measurements or blood pressure—and increase the amount of time available to devote to patient care by almost 25%.

The image of robots roaming around nursing homes may seem startling to some. But machines and automation can play a role in improving nursing home care plans in less obtrusive ways, such as through wearing devices that capture vital signs and wirelessly transmit them to doctors and nurses.

Governments are waking up to this possibility. The United Kingdom, for instance, is looking at ways of deploying robots and other technology to assist in administering healthcare. Yet in allocating money for research, the country notes some of the inherent challenges, such as the need for data privacy and security and making the devices easy, reliable, and comfortable.

Remote Monitoring: An Idea Whose Time Has Come

Remote patient monitoring is not a new concept in healthcare and has been discussed for years as a way of adding efficiency and improving care while lowering costs. For example, early remote transmissions of ECGs took place in the mid-1960s. One of the first major projects in remote health monitoring involved a system designed to monitor members of a remote Native American tribe in Arizona.

The urgency of the discussion has increased in light of the COVID-19 pandemic, which created significant disruptions at doctor’s offices and hospitals out of fear of spreading the virus further to workers and other patients.

As the pandemic has progressed, so have the number of projects aimed at implementing remote health monitoring more widely. For example, the US military has gotten excellent results from a nationwide pilot of remote health monitoring of service personnel. The goal of the program was to reduce risks to patients and staff while maximizing limited and increasingly stressed staff resources and impact ninety-eight patients at seven facilities.

The Defense Department reported initial results in February 2021. These included:

• Improvements in outcomes. The pilot programs helped eliminate 180 patient bed days overall and saved almost $1 million by lowering overhead in the first three months.
• Value-added personnel deployment. By keeping patients with mild symptoms at home, doctors and nurses could focus on patients in more severe conditions.
• Expanded knowledge. The program had a high rate of patients who asked to be re-enrolled in remote monitoring.
• Less burdened staff. Providers felt more comfortable discharging patients knowing that they would be remotely monitored.

Hospitals also took up the challenge. At the University of Iowa Healthcare in Iowa City and OSF Healthcare in Illinois, patients with milder symptoms were given remote monitoring kits that included blood pressure cuffs and other devices. They were advised to record their results and symptoms and communicate them to doctors via video or telephone visits. In the event that symptoms worsened, doctors could then decide whether the patient needed to come into the hospital for more advanced treatment.

The same potential for utilizing CRPM exists for nursing homes or other long-term care facilities as a way of using technology to recognize when someone needs more immediate help. 

CRPM in Nursing Homes

Given the speed with which medical conditions can change, especially for those struggling with chronic illness, it’s not always possible for doctors or families to react and respond in the most timely fashion as problems develop.

CRPM can help close that information gap by capturing and transmitting real-time data to doctors about their patients. The data consists of physiological parameters, such as blood pressure, blood oxygen levels, blood sugar levels, and activity sensors.

Increasingly, medical professionals are viewing CRPM as an “untapped resource” in caring for residents in long-term care facilities, as an article in Today’s Geriatric Medicine describes it. The continuous nature of the monitoring means that primary care teams can have a direct and immediate glimpse into how their patient is doing at a particular time. The information flow is dynamic and current rather than static, based on readings from hours previously. The availability of real-time data history with CRPM also opens the doors to next-level care that is more anticipatory. The system can catch when certain readings fall off the baseline, suggesting that a situation is changing to a point that might require hospital admission. In some instances, patients can then schedule telehealth sessions with providers, which enables providers “to treat patients where they are, rather than having to admit, or, in some cases, readmit them to a hospital.”

One area where remote patient monitoring could directly impact nursing home care is with pressure ulcers. Nursing home residents spend excessive amounts of time sitting or lying down, which can create pressure wounds. Monitoring systems combined with clinical observations can help focus staff time on the residents most susceptible to pressure ulcers, helping them avoid these painful situations.

CRPM is particularly well suited to help nursing homes limit hospital readmissions, which remains a significant challenge for long-term care facilities. An estimated one in four nursing home patients is readmitted to the hospital within thirty days after a stay. CPRM can help identify condition changes early enough to avoid that second stay. This eases stress on the patient and provides families with the peace of mind of knowing that their loved one is being watched continuously.

Reducing readmissions also provides benefits for the operation of the nursing home. By enabling patients to be treated in place, the homes avoid a potential loss of revenue from the resident being in the hospital. By signaling problems early and avoiding readmission, homes can also avoid fines or other penalties from the Centers for Medicaid Services. 

How CRPM Works

In CRPM, data is captured through the use of a wearable—a smartwatch-like device worn continuously on a patient’s wrist. It captures physiological data and transmits it wirelessly to digital patient records or other hospital information systems for review by primary care doctors or specialists if needed.

Devices such as Oxitone’s 1000M gather data at hospital-grade standards for accuracy, reliability, and privacy. The 1000M is designed to be worn comfortably as a lightweight device, made with materials that will not irritate a patient’s wrist. It utilizes patented technology that avoids requiring patients to attach bulky fingertip sensors for readings. Studies of remote patient monitoring programs suggest that making devices easy to wear or use is crucial to compliance.

The Oxitone 1000M is the first device to be cleared by the FDA for remote patient monitoring. It provides data on various parameters:

• Respiratory rate
• Skin temperature
• Motion/activity
• Sleep patterns
• Blood oxygen
• Pulse rate
• Heart-rate variability

The Oxitone 1000M provides enormous benefits when monitoring chronic conditions, which are common in nursing homes. For instance, chronic obstructive pulmonary disease, or COPD, has warning signs that can be recognized from data provided by the 1000M. Recognizing the signs early can help residents avoid serious complications, including airway collapse, memory loss, and depression.

When doctors can monitor oxygen saturation in real time, it can speed the response to problems before they happen by predicting complications, with an increased chance of reducing unnecessary hospitalizations. COPD and other cardiovascular conditions can increase a person’s risk profile for COVID-19.

Remote monitoring has also been shown to provide early warnings of problems from chronic heart failure, diabetes, and chronic kidney disease, according to a research report from the University of California at San Francisco. The university researchers conducted a literature review and examined a range of case studies, looking at applications of remote patient monitoring systems. Noting the need for additional research work to be done, the UCSF team concluded that “patient-centered monitoring technologies have the potential to improve the efficiency, cost, and accountability of chronic health care delivery.” But they did caution that success depends on engagement with and support from medical professionals, appropriate training, and clearly designed roles and responsibilities. “Nurses must rely on critical thinking skills and their ability to verbally assess patients, ask the right questions, and make clinical judgments.”

Artificial Intelligence in CRPM to Improve Nursing Care Treatment Plans

CRPM systems provide data that tells what is happening right now with patients. But what if it could also tell you what is about to happen? That capability is the real key for improving nursing home care plans.

By integrating artificial-intelligence (AI) tools into CRPM systems, that capability is now well within reach. AI deployed in these systems is helping doctors see the future and act sooner, saving residents from complications and unneeded hospitalizations.

AI-integrated CRPM systems capture and report data and analyze patterns to help make predictions. In doing so, the system helps health care providers “anticipate/identify illness exacerbations, and avoid unnecessary treatment, including emergency room visits, rehospitalizations and excess costs to the health care system.”

This is particularly important for conditions such as COPD, which is incurable but can be managed with the right information in the hands of doctors. The system helps spot when a patient moves off their baseline results, giving doctors precious time to prescribe solutions that can keep patients stable and out of the hospital.

In a nursing home context, this ability to get involved earlier and in a way that care is coordinated can keep patients healthier, their families more at ease, and the homes more financially successful.

Revolution in Care for Chronic Conditions

Oxitone is focused on developing tools that lead to improved health care and quality of life at reduced costs. We do this through comfortable, easy-to-wear, and easy-to-use wrist-worn devices that capture data on patient conditions. When integrated with AI, our devices deliver reports on specific diseases for better decision-making and faster treatment of complications.

Here at Oxitone, we boost value-based healthcare by delivering extraordinary patient, clinical, and economical outcomes at reduced medical utilization and cost. Patients need a prompt response to emergencies. Physicians need an easy and timely follow-up with patients. Our mission is to transform chronic disease management and help save lives worldwide.Let’s save lives together! To see how we help remote patient monitoring companies and physicians improve the management and care of high-risk patients, contact us today!