Barriers in telehealth access in senior living communities

ABSTRACT

Background: During the COVID-19 pandemic, older adults are missing routine care appointments despite increasing availability of telehealth video visits. We conducted a needs assessment of two Residential Care Facilities for the Elderly (RCFE) in Northern California as a first step to improving access to telehealth visits for older community dwelling individuals. Methods: We conducted voluntary surveys of the independent community dwelling adults of two RCFEs. Site A houses residents who are mostly Caucasian and middle and upper middle class. Site B provides subsidized senior housing and serves a large group of residents who are non-English speakers. Surveys ascertained residents' preferred devices as well as comfort level, support, and barriers regarding telephonic and video visits. Results: Of the 700 surveys distributed, 249 surveys were completed and returned (36%). The average age of participants was 84.6 (SD = 6.6) and 77% were female. At site A, 89% of participants had a bachelor's degree or beyond and 99% listed English as their preferred language. At Site B, 43% had a bachelor's degree or beyond, and 13% preferred English while 73% preferred Mandarin. Regarding remote visits, 37% of all participants felt comfortable connecting with their healthcare team through video visits with computer being the most preferred device (23%) followed by smartphone (19%) and iPad/tablet (11%). Regarding perceived barriers, there were substantial differences depending on the site. Participants at Site A reported not knowing how to connect to the platform (24%), not being familiar with the technology (22%), and difficulty hearing (14%) as the top three barriers, whereas for the participants at Site B, the top three barriers were not being able to speak English well (55%), lack of interest in seeing provider outside of clinic (35%), and not knowing how to connect to the platform (35%). Conclusions: Significant barriers exist for older adults in RCFEs with telehealth visits with their care team. The largest barriers include difficulty with technology or using the video visit platform, language barriers, and lack of desire to see provider outside of clinic. Due to site specific differences in reported telemedicine barriers, any intervention to improve access should be tailored to the specific needs of that site.