Virtual Care in the Home Setting - A Better Solution to Caring for Older Adults

Original Article by Kurt M. Tamaru, MD, FAAFP

As a primary care physician with an older surviving mother, I found myself in territory similar to millions of families across America. Concerns around an aging mother and her changing health care status, as well as more immediate needs for her to remain independent but safe at home, became a regular conversation with my siblings. While the children of our aging mother were spread across the country, much of the physical burden had rested on one child who happens to live one city away. Daily visits and help with activities of daily living engulfed my brother and his wife's time and attention.

Despite the loving help provided by my brother, he was not a physician or health care worker and his observations and concerns around daily health-related issues weighed heavily on him and the need for regular guidance. While my mother had an established primary care relationship with a close-by office location, the challenges of making and getting to an appointment due to extreme difficulty with walking, only made regular office-based care nearly impossible. As time went on, small issues and changes went unnoticed or were hopelessly attributed to part of the aging process. However, when my mother began to seek acute medical care, we realized that daily issues that could have been addressed earlier would have easily prevented visits to the emergency room and subsequent hospital admissions. 

Based upon such personal experience and a sense of failure to recognize and intervene sooner in many of my mother’s issues occurring at home, I began to explore options of how one might better manage older adults in the home setting short of a 24/7 caregiver on site. As a physician distanced from my mother’s care, I began to explore the options available for older adults and the family. Aside from the usual home care agencies, home health companies, and some visiting house-call doctor programs, I was unable to find affordable continuous care options in the market today. The limitations and cost of these in-home services were only a mild improvement to office-based solutions which made me dig further into more technology-driven solutions. I was surprised by the limited use of digital, mobile, and other sensor technologies in providing accessible and knowledgeable care for patients year-round. While remote monitoring companies that provided a technology platform existed, no comprehensive clinical and interventional component existed. The fallback to the office-based doctor solution was all that existed.

Often as with my brother, caregivers are unclear on what may be a true health condition versus emerging risks that if not addressed could result in greater health issues. Adding other points of care solutions like an occasional home visit or phone and video call seemed like a band-aid approach to a broader problem of “how do you better understand the life of a patient while aging in place at home?” Hence, why I developed a virtual primary care program for older adults.

How can you use technology solutions in an easy to deploy fashion with simple solutions to provide daily information seamlessly and without overwhelming patients and caregivers? How can data beyond vital signs and other biometric information be used to understand emerging risks and barriers to care? How can one engage a patient and their caregivers in a meaningful and trusting relationship? What interventions and capabilities would be required?

As with any new concept, we built a prototype and tested our model and approach. Using live patients and existing technologies, we set out to build the platform of care that best serves the aging population. Through rapid prototyping, testing, and yes - failure points, we began to see a model of care and approach that could have helped my own mother in her journey to remain independent and safe at home.

As we looked to launch our unique program to the market, no one could have predicted a global pandemic. While tragic in its impact, the awareness of deploying digital and other technologies in providing care in the home setting has emerged out of the darkness of just concept and theory. As we emerge from the pandemic, we foresee greater emergence of our model of care and adoption for those millions of older adults and their caregivers who face similar challenges that my own mother and I faced.

About the Author- Kurt M. Tamaru is a board-certified family physician & innovator with over 25 years of experience in creating or managing integrated health care service companies with the goal of better care and quality for all. With an extensive background in value-based care delivery, Dr. Tamaru is looking to create the next generation of health care services to better meet the growing needs of older adults.