Elder Health in Rural America, Research Paper Example

Introduction

Technology has advanced rapidly in ways that allow professionals as well as other people throughout the world to do things better. In the healthcare field, technology is also rapidly changing in ways that help nursing and other medical professionals to respond quickly to the needs and wants of patients, in addition to allowing for better quality care, and improving the nursing practice. Web-based programs have been influential in a number of ways that have helped nurses be better at their duties, including allowing for furthering education, monitoring patients, and utilizing limited resources. Where these applications are lacking is in both the field of home health care, and in allowing rural patients to access medical services.

As the older population has continued to increase, the socioeconomic and demographic impacts of the baby boomer generation are magnified significantly in rural communities in which the elderly are represented disproportionately. (Young, Weinert, and Spring, 2012) In proposing a web based intervention that can be beneficial for patients and the nursing practice, the PICOT question is asked: For patients that live in home health centers that are situated in rural communities, how can implementing a web based intervention provide better accessibility and care improve health delivery services within the first year? In answering this PICOT question, this paper will propose a web based intervention targeted to home health nurses that have to provide health care services in rural communities.

PICOT Question

Potentially, telehealth services are considered a great resource that is able to increase quality and access to healthcare in rural communities. According to the National Rural Health Association (NRHA), “Individuals 65 years and over constitute approximately 13.1% of the American population; however, 20% of the elderly live in non-metropolitan designated areas” (NRHA, 2013, pg. 1). In addition to these staggering numbers, is baby boomers over the age of 65 in 2011 were estimated to be 75 million, and are projected to boom to 72 million by 2030, which will constitute over 20 percent of the US population. (Young, Wienert, and Young, 2012) For rural and small town-settings, the baby boomer migration patterns are projected to rapidly increase, as they will provide dramatic demographic changes that will create challenges to the socioeconomic domains of society. This includes health-care cost containment, health-care access, long-term care, housing, and Social Security. In rural areas, the elderly population are presented with a history of limited access to preventative services and healthcare, a higher incidence of chronic health conditions, and being in poorer health. (NRHA, 2008) The closure of hospitals and other market changes have adversely affected rural areas leaving many of the home health facilities with concerns about access to health care. There has been in the past decade an increase for the need for providing new approaches to health care delivery services in rural areas where home health nurses are left with limited resources.

The proposal for a web-based intervention is imperative for nurses and home health centers to be able to provide quality health care delivery services to the millions of elderly and disabled people that live in rural communities. Implementing a telehealth or telenursing services are able to be used in conducting nursing practice and delivering nursing care to patients. With this web-based intervention, nurses will be able to engage in evaluating, intervening, planning, and accessing the outcomes of nursing care. They will be able to do this through telemonitoring equipment, digital assessment tools, telephones, computers, and through the internet. According to research, “the delivery of telehealth care is not limited to physicians and nurses; it includes other health disciplines such as radiology, pharmacy, and psychology” (Schlachta-Fairchild, Elfrink, and Deickman, 2008, pg. 4).

In comparison, for nurses that work in home health care there are met with widespread job dissatisfaction that has contributed to risk to patients, turnover, and costly labor disputes. (McHugh, Kutney-Lee, Cimiotti, Sloane, Aiken, and Fagin, 2011) Nurses in home health care work alone with just the support of resources from the central office, supplying a limited contact with physicians, which can be necessary when needing to communicate findings and make assessments.  The goals of home health care services are to help patients avoid hospitalization or admission to long-term care institutions, assist patients in remaining at home, promote the patient’s optimal level of well-being, live with greater independence and improve function. According to the Centers for Medicare and Medicaid Services (CMS) estimates that within the United States annually there are 8,090 home health care agencies that provide care for 2.4 million disabled and elderly people. (CMS, 2006) From these thousands of home health centers, only a small percentage of rural communities were served by skilled nurses and home health services, with a majority only being served by one agency. “A total of 107 countries, 103 of them rural, lacked medical social services, while 84 (80 rural) lacked speech pathology services, and 75 (71 rural) lacked occupational therapy” (South Carolina Rural Health Research Center, 2014, pg. 2).

The outcome of implementing a web-based intervention for nurses in home health services in rural communities would effectively provide millions of elderly and disabled patients with access to quality health care, improve life expectancy, preventative services, detect and treat illnesses, and improve the overall mental, social, and physical health status of patients. In addition, telehealth programs could potentially provide more funding opportunities and more resources to nurses that permits local providers to take advantage of distant expertise. While there is no definite period, if a web based intervention such as Telenursing or Telehealth were implemented in rural communities, the status of patients, and delivery of health services would greatly improve in elderly and disabled patients, as well as improve the nursing practice.

HIT Perspective

In looking from a Health Information Technology (HIT) perspective, the increase in web-based technology to increase collaboration, communication, and other benefits has been rapidly adopted by many online educational services and health-related professionals. This is mainly due to their ease of use, ease of collaboration and powerful information sharing, and rapidity of deployment. HIT provides the utilization of using information and communication technology in health care to transfer, retrieve, protect, store, and record medical information within the healthcare field. HIT allows for the bridging of several professional disciplines that includes research, project management, business, computer science, informatics, law, allied health professions, and medicine. The implementation of a web based intervention that promotes the use of Telehealth or Telenursing, or other programs are aligned with the definition and the goals of Health-IT. According to Effren and Abott (2013), “A team-based approach involving community members, technology providers, policy makers, funding agencies and health care professionals is critical to achieving the vision of IT-enabled, improved health care delivery in underserved rural communities” (pg. 441). Home care agencies are already in the process of seeing the benefits of adopting tele-home care technologies that help in managing and monitoring patients in their homes, and these provides exceptional opportunities for rural locations, in the management of chronic diseases, and other issues. By implementing these web based intervention, it typically reduces travel expenses for providers and patients, lowering patient’s use of acute care services by decreasing the length of stay and health care costs, reduce re-hospitalizations, and improve self-management.

Conclusion

For patients that live in home health centers that are situated in rural communities, how can implementing a web based intervention provide better accessibility and care improve health delivery services within the first year? This PICOT was answered by providing evidence-based resources that cite not only the problems of limited health care delivery for rural communities, but highlights the challenges that home health nurses must face in trying to care for the increasing elderly and disabled population in these rural locales. Looking from a HIT perspective, the implementation of a web based intervention such as Telehealth, Telenursing, or Tele-home could effectively and efficiently bridge the gap in providing adequate health care delivery services. As well as numerous benefits that could provide nurses and other local providers with expertise, funds, and support for the improvement and transformation of healthcare in home health agencies in rural communities.

References

Centers for Medicare & Medicaid Services. (2006). Home health quality initiative overview. CMS. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/index.html?redirect=/HomeHealthQualityInits

Effken, J. A., & Abbott, P. (2009). Health IT-enabled care for underserved rural populations: The role of nursing. Journal of the American Medical Informatics Association, 16(4), 439-445.

McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses’ Widespread Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care. Health Affairs (Project Hope), 30(2), 202–210. doi:10.1377/hlthaff.2010.0100

National Rural Health Association. (2013). Elder Health in Rural America. National Rural Health Association Policy Brief.

Probost, Janice, Towne, Samuel, Mitchell, Jordan, Bennett, Kevin, and Chen, Robert. (2014). Home Health Care Agency Availability in Rural Counties. South Carolina Rural Health Research Center. Retrieved from http://rhr.sph.sc.edu/report/%2811-2%29HHC_Agency_2014.pdf

Schlachta-Fairchild, L., Elfrink, V., Deickman, A. (2008). “Chapter 48 Patient Safety, Telenursing, and Telehealth”.  From Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality. Rockville.

Young, D., Weinert, C., & Spring, A. (2012). Home on the range: Health literacy, rural elderly, well-being. Journal of Extension, 50(3), 3FEA2.