Telehealth refers to a home based health monitoring system which monitors an individual's clinical data daily; such as heart rate, blood pressure, oxygen saturation, temperature, weight and can be a medication reminder depending on the unit available.
Some systems may not have all of these components available; others may have additional components that may be added as needed per the individual’s diagnosis and available through the provider.
The data is automatically transmitted to the provider agency office via a computer program, through a phone line, where staff will clinically review the information and respond as needed to the individual, family member, physician, and/or the Adult Services and Aging Specialist as appropriate. Clinical monitoring most often occurs daily, but some providers may be able to offer more frequent monitoring depending on the needs of the individual.
Telehealth includes equipment rental and set up and the availability of nurse time to monitor and provide feedback to the individual, their family, and/or consultation to the individual’s physician and the Adult Services and Aging Specialist. In addition, monthly clinical reports may be computer generated for the Adult Services and Aging Specialist at their request.
In addition to meeting other eligibility criteria, program specific eligibility for this service includes:
- Either the individual’s inability to complete two activities of daily living without personal assistance, standby assistance, supervision/cues and/or assistive devices;
- Or the individual’s behavior poses a serious health or safety hazard to self and requires substantial supervision due to a cognitive impairment; AND
- The individual may have frequent hospitalizations or emergency room visits, difficulty getting to a medical facility, medical condition(s) which requires frequent monitoring and those who may live alone in a rural setting where it is difficult to receive prompt medical care.
Program eligibility and individual need must be determined utilizing the South Dakota Assessment prior to the authorization of services. Staff determine if Telehealth can be accessed through other resources, such as Medicare, etc. and is not available through any other funding source.
Once eligibility and need have been determined, Telehealth may be authorized for an individual subject to the following guidelines:
- Telehealth becomes a part of the $750 per month maximum care plan.
- The Monitoring Unit* required by individual
- Initial set up fee;
- BASIC or Advanced Unit*; *Discuss with the provider the type of unit available. Some providers may include the oximeter as a part of the Basic unit. An Advanced Unit may include a glucometer or other such monitoring devices.
- Nurse Visit -- if required by client as a result of Telehealth monitoring.
- Household’s resources may not exceed $40,000 for an individual and $45,000 for a married couple.
- Individual will participate in the cost of the program through the cost share process whether offered as a single service or provided in combination with other ASA services.
Individuals must be cognitively alert to manage the system and their ability to operate the system should be required as a result of the monitoring device. Disease management and improving client outcomes is the goal of the service.
Individuals with the following health conditions are the most appropriate for Telehealth:
- Congestive Heart Failure or other heart conditions
- Chronic Obstructive Pulmonary Disease
- Other precarious health conditions that can be monitored safely through the system.
If Telehealth is provided in combination with any other ASA services, the individual will be informed of the total cost of the services and asked to cost share towards the total amount.
Services NOT available with Telehealth:
- Purchase price of the equipment.
- Equipment available through other state or federal programs.
- Liability for equipment damage while in individual’s home.
- Clinical data to be reviewed daily by a licensed nurse.
- Monitoring system set up in eligible individual’s home by provider or trained technician.
- Training video may be available for identified staff, ASA or Provider, on how to set up equipment or check it during a home visit.
- Follow up calls to identified resources/professionals by provider.
- Home visits by provider to reprogram the device or change the settings of the monitor as required by the individual’s health status.
- Optional Nurse assessment if monitoring warrants a visit. If a nurse assessment is warranted, the provider will:
- Assess the individual’s health status and document findings as an official part of the case file;
- Make recommendations to the ASA Specialist regarding the individual’s ability to remain at home and the need for services;
- Identify nursing problems and establish a tentative nursing plan of care;
- Assist in the development of the “Individual Care Plan” with the ASA Specialist and individual, after the individual has been determined to be eligible;
- Review all prescription and over-the-counter medication (dosage, route, and frequency) taken by the individual and any other nursing care needed by the client which can be verified by the individual’s physician;
- Obtain a signed copy of the “Individual Care Plan” from the ASA Specialist;
- Complete documentation each time the client is provided nursing tasks;
- Provide nursing services in accordance with the individual’s needs and scope of nursing license of the nurse providing care.
- Depending on Provider system used, there might be a website link that ASA Specialist and authorized family and physician can access the clinical information.
- ASA Specialist may be provided with a monthly progress report of how the individual is doing. Routinely an individual is not provided with a report unless there are clinical issues identified. The Provider Nurse may be requested to call or send information in writing to the individual, or a family member, on a routine schedule to provide an update. ASA Specialist should work closely with the Telehealth provider to request this report as needed.
If the individual exhibits any abnormal signs and symptoms during the routine daily monitoring or if there are concerns about continuation of the Telehealth program, the nurse will notify the physician, ASA Specialist and any other appropriate individuals. Needs beyond the scope of the program may be provided by the nurse with the approval of the ASA Specialist after all other resources have been exhausted, including Skilled Medicaid or Medicare. It is the responsibility of the nurse to obtain physician’s orders for any additional services.
The individual’s responsibility includes:
- Responding daily or as frequently as needed to the monitoring system.
- Ability to call physician should they be directed by the Nurse based on information identified through the Telehealth system.
- Locate equipment in the home where it is easily accessible and away from any potential damaging elements such as water.
The nursing service identified above, may be a separate nurse visit from the routine nurse visit as a part of the Individual Care Plan. Not all Telehealth providers have a nursing contract with the Division of Adult Services and Aging, therefore it is possible that two different providers are assisting an individual with their health care needs.
The Telehealth nurse visit would only be needed as a result of issues related to the daily Telehealth monitoring. If the individual needs a routine nurse visit this should be under the regular Nursing services program and provided by a contract provider. A Telehealth nurse visit would be paid at the same contracted nursing rate.