The future of health care in a post-pandemic world

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PORTSMOUTH – Health care workers have had to make significant changes to the way they deliver services in light of COVID-19 and many of those changes will become the new normal going forward.

While infection control and disinfection have always been mainstays of any health care facility, COVID-19 forced a ramping up of sanitary practices and also resulted in the isolation of patients, both for their own safety, and to keep them from infecting others.

Nursing homes and assisted living facilities have been hard hit because of the proximity of patients to each other. Visitors were quickly banned, except in some end-of-life cases at some facilities.

“I can’t imagine nursing homes and assisted living communities going back to normal any time soon,” said Tom Argue, president and director of Webster at Rye. “As long as COVID-19 is still in the greater community and there are community-acquired infections, seniors with co-morbidities in health care facilities will continue to be at much greater risk. This no doubt means Centers for Disease Control and Centers for Medicare and Medicaid Services will continue to require that residents not dine together or have group activities without social distancing, visitors will continue to be restricted, employees will continue to be screened each time they enter and wear personal protective equipment, and residents and staff will continue to have rolling testing.”

“For assisted living communities where people have more options on whether to move in or wait, people are hesitant to move in knowing they are essentially severing any direct visits with their loved ones other than window visits or meetings via Skype or Zoom for the foreseeable future until such time as the visitation restrictions are lifted,” Argue said. “If this continues for another year or so, and it probably will for senior health care communities, assisted living communities will be significantly hurt by fewer admissions.”

Argue said every admission must be treated as a presumptive positive COVID-19, which requires isolation in a private room for 14 days.

“For most nursing homes set up with primarily semi-private rooms, this creates a bottleneck for admissions and much like assisted living communities, lower census,” he said. “Despite staff’s best efforts, the longer this continues the great potential for feelings of isolation and depression for residents and the more difficulty families will have accepting the restrictions.”

Olivia Korpi, marketing director at Wentworth Senior Living, said they will likely continue using telehealth where appropriate.

“We traditionally had a primary care doctor come in a couple of times a week,” Korpi said. “They are using telehealth and it is working. Obviously, there are times we need a doctor in, but we found not always, and I think that will continue.”

Korpi said the residents isolated to their rooms are actually expanding their circle of friends. The facility handed out a telephone directory of residents and she said patients are using it to call and talk with each other. She said they are taking advantage of things they might not have before, like book club, arts and crafts, and hallway exercise class.

“We are doing activities in small groups, socially distanced,” Korpi said. “We are using headphones with a Bluetooth microphone. They can be sanitized, and our residents can hear what we are doing while staying safely apart. I think that for at least the next 12 to 18 months, this is what things will look like.”

Dr. Joann Buonomano is chief medical officer for Greater Seacoast Community Health, which includes Goodwin Community Health in Somersworth, Families First Health & Support Center in Portsmouth, and Lilac City Pediatrics in Rochester. Buonomano said televisits by phone or video will be one enduring benefit of this pandemic.

“At Greater Seacoast, we now offer telehealth for medical care, behavioral health counseling and even dental care,” she said. “Telemedicine has been on the cutting edge for the past five years. This pandemic has turned it into a mainstay reality. Until recently, health care providers could rarely bill for phone or video visits. As of March, telehealth visits are now covered by Medicare, Medicaid and commercial insurance.”

Buonomano said patients and providers expect telehealth services will continue and Greater Seacoast is making changes in its offices to accommodate it for years to come.

“For patients, telemedicine offers greater convenience, allowing them to maintain a relationship with their primary care provider in their own home, where they are more comfortable,” she said. “It also breaks down transportation barriers and reduces the amount of time the patient has to take from their busy schedule for the visit.”

Buonomano said phone and video visits put the provider and patient on a more equal level, which supports an enduring relationship and more relaxed, open communication. Telemedicine, including tele-behavioral health counseling, can also help patients and their families overcome obstacles to receiving care related to severe social phobias, trauma and anxiety.

“These health problems can often be triggered when entering into a medical office,” she said.

Buonomano said GSCH now offers drive-by pharmacy pickup and an organized respiratory clinic. She said it plans to offer drive-by nursing assessments to assist with quick point-of-care rapid blood testing needed for following the progress of diabetic patients, following a televisit.

Exeter Health Resources’ operating affiliates, Exeter Hospital, Core Physicians and Rockingham VNA & Hospice, have provided care throughout the COVID-19 crisis and adapted programs and services to ensure the safety of patients and staff, said Deb Vasapolli, communications director at Exeter Hospital.

“We will continue to adhere to our social distancing and universal mask policies,” Vasapolli said. “We will ensure we have adequate supplies, including personal protective equipment; clear processes for screening and/or testing patients for the virus; enough space in clinical areas to adhere to social distancing guidelines; and procedures for thorough cleaning and disinfection.

“Telehealth appointments will continue to be offered when appropriate for a patient’s care but as our offices re-open, we are ensuring we are ready and safe to care for patients when they come in.”

Dawn Fernald, director of communications at Wentworth-Douglass, said they are focusing on a new experience for patients and staff as they enter their facilities.

“We are still in the midst of re-opening services, but patients should expect a change with respect to safety and infection prevention protocols,” Fernald said. “This is a new normal for all of us and is ever-evolving. We are adapting services and processes to include infection prevention parameters in both public areas and behind the scenes.”

Dr. Travis Harker, chief medical officer for the Appledore Medical Group, with offices in Portsmouth, Rochester and Derry, said telehealth will likely remain as a patient option when appropriate.

“We need to actively demonstrate to patients that our offices are safe to come to,” Harker said. “We started precautions in August, in anticipation of flu season so we had a jump up when the coronavirus appeared. We were already requiring patients to wear a mask when they came in. We were already diligently wiping down surfaces.”

When COVID-19 emerged, about 80% of patient visits were through telehealth. Harker said once people became more comfortable with the message that the doctors’ offices were safe, that percentage swung the other way.

“Now 80% of visits are in the office, with 20% done through phone or video calls,” he said. “We definitely see a use for it and so do our patients. My only concern with using it in the future is that insurance companies need to maintain reimbursements. If providers lose money, they may not be able to keep using telemedicine.”

Dr. Thomas Wold, chief medical officer at Portsmouth Regional Hospital, said COVID-19 will change things forever.

“The constant unknowns we saw and the constant new information made us all struggle to keep adapting,” Wold said. “In the end, a lot of basic things we already do like good hand hygiene and cleaning common surfaces like doorknobs and counters proved to be most important, for basic infection control.”

Wold said the task moving forward is assuring patients they are coming into a welcoming and safe environment as more services reopen.

Wold said the threat of COVID-19 is not going away anytime soon so universal precautions like screening patients and wearing masks are here to stay.

“We have redesigned the wait room,” he said. “High-touch risks, like vending machines, magazines and toys in the wait rooms are gone. We will continue to do our service desks differently, with barriers between people.”

Wold said telemedicine is here to stay for several reasons.

“We have learned that many visits can be done this way,” he said. “The other perk is that it reduces our need for PPE. My only lament is the loss of patient contact, something we need to balance going forward.”

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