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Well Haven

Well Haven Blog Post:

Most of us can relate to the desire to create the most comfortable conditions for our loved ones as they age. For most Americans surveyed, this would entail aging in place, remaining within the comfort of their homes and communities. However, sometimes it can feel as if there are myriad barriers preventing us from cultivating a suitable environment required for aging-in-place. These limitations feel particularly pronounced in areas of rural Alaska where resources for elderly care are scarce and physically far away. Well Haven, a business founded by Emily Byl focuses on implementing changes and practices that make it possible for Alaskans to remain in their homes and in their communities as they age.

By modifying living spaces, delivering virtual and in-home rehabilitative care and educating caregivers, Well Haven strives to provide the resources to promote effective long-term solutions for aging-in-place. Telehealth occupational therapy is not only billable through Medicaid, it has been shown to produce comparable results to in-person care delivery. In this way, Well Haven is allowing us to rethink where we grow old, especially in rural Alaska.

Relocating our loved ones hundreds of miles away to receive care does not have to be our only option, and Well Haven is here to help change that reality. If you want to see how you can support your loved one’s desire to age-in-place, join the Health TIE Open Innovation on March 24th.

Here are my notes from talking with my dad!

I asked about his thoughts on Telehealth:

“I think it is here to stay and a very good way of increasing access and keeping patients connected. I think it can be used effectively to help monitor people who may not have been able to be as frequently monitored if you were trying to set up an in-person visit. I think the potential for telehealth is huge, but we are just really opening the door to the possibilities. I would like to see it used appropriately and in a balanced way. If you are able to set up a video telehealth you can see where people live and how people are living. A lot of times people will not be putting insulin in their fridge like they should or putting medications in the wrong places but those are the things that could be most helpful considering the social determinants of health. If you have someone who is a fall risk and you see that it is cluttered, you can tell that you need to send a visiting nurse. It can be used as a monitoring and health upkeep. We are still at the nidus of the telehealth movement.

This is the backside of it – I can foresee it causing further disparity for people who don’t have broadband connectivity or a computer that allows appropriate care. I’ve had issues with my telehealth just In rural places of Vermont and new Hampshire. I’ve been on many video or phone telehealth appointments that have disconnected.

It can also be overused and taken for granted. You can’t only do telehealth. You have to be able to look at the patient. I’ve had patients send me pictures saying “look at this does this look normal” but you can’t tell the difference for so many reasons (lighting, photo, camera) whether it is a normal pink after surgery or pre-infection. That’s the critical issue of needing to see the patient and know what it feels like for a physical exam – need to feel what a ligament stretch feels like or minuscule tear, exams you can’t do over the phone or over video. It is a great adjunct, but you can’t just do telehealth.

Are there things that have changed in healthcare delivery that are permanent for the better or worse?

“I think that COVID really spurred the universal use of telehealth out of necessity and is here to stay in its expanded and expanding presence. I think that that’s again very good because it is increasing access to every aspect of healthcare. It’s not just healthcare providers like physicians, nurses and PAs but also social workers, physical therapists, occupational therapists. So the very good part is that prior to COVID it was not being reimbursed barely at all and because of COVID it was pushed through not only Medicare but all insurance types reimburse telehealth. And it’s become an ingrained part of our electronic records and our patient’s records. Every telehealth visit is recorded and becomes part of the patients records that can be accessed. I think one limitation right now is that now we have been living with COVID for two years and living with expanded telehealth, and they are not reimbursing and not accepting cross-state telehealth visits. So, if your patient is in FL for the winter and NH for the summer, I can’t have an official telehealth visit with them because of the cross-state lines. My hope is that those barriers would be alleviated.”

On electronic records – “this is a jaded old surgeon talking”

“Ostensibly electronic records were supposed to help us synchronize information but there was no guidance or oversight. It was said 15-20 years ago that you had to have electronic records, but it wasn’t specified that there should be one electronic record or need for them to connect to other records, so every company did a mad dash of a capitalistic free-for-all where all these different companies made different propriety systems that don’t speak to each other. The biggest to come out of this was EPIC but they are not going to allow interconnectivity of record sharing and they have a ton of power. When smaller hospitals get absorbed by bigger hospitals, they are required to change electronic records and pay a ton of money. Electronic records were supposed to make life easier but really it just made things incredibly fragmented.

Electronic records have unfortunately become basically tools to make coding more efficient to fulfill the insurance companies mandate on getting paid. You want easy access to your patient’s information, but electronic records have become catered also to fulfill insurance payments. The electronic records have become a click box of insurance requirements which take away time from a patient. I fall asleep every night doing my notes because it takes 1000 inefficient clicks”

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