Introduction

Due to COVID, Inspira LIFE had to close their day center and switch to telehealth and virtual platforms for Participant support. This closure led to social isolation among Participants, compounded by challenges in phone-only visits and challenges in adapting to tools like Microsoft Teams for video visits. Participants lacked suitable devices or data plans, hindering tasks such as logging vitals or attending virtual visits or activities. A 2020 study by Lam, Lu, & Shi highlighted that older adults, particularly minorities and those in poor health, were unready for the shift to telehealth. These findings mirrored Inspira's situation, as a diverse PACE program per DataPACE3. Thus, finding an accessible virtual platform became crucial for maintaining engagement, combating loneliness, and catering to Participants' needs.

Project Overview

Inspira LIFE explored various senior-oriented in-home devices in English and Spanish. They identified effective options for video visits and games but faced challenges in finding a platform that provided psychosocial support similar to that of in-center interactions. Seeking to replicate the conversational and empathetic atmosphere, they chose care.coach. This platform, managed by trained Health Advocates, offers touchless navigation, auto-answer video visits, health escalation protocols, entertainment, companionship, and coaching.

The successful integration of care.coach by the IDT during the pandemic unveiled unexpected insights into technology-enabled healthcare, showcasing its potential to enhance equity, quality of care, and program expansion.

Advancing Health Equity

The choice of languages and user-friendly interface minimized access disparities. Unbiased health protocols ensured uniform, top-notch care, irrespective of socioeconomic factors, location, or tech skills. This fosters fair healthcare distribution. One example is a participant with limited mobile minutes used to ration calls with loved ones and his care team. Now that he has care.coach, he is able to receive video calls from his care team and loved ones without time constraints.

Program Growth

When the pandemic closed the day center, the Behavioral Wellness department shifted to remote operations for psychiatry and counseling via phone or video visits. They saw efficiency, capacity, and utilization gains, leading to a hybrid model upon reopening. The psychiatrist still uses care.coach for all initial consultations and is fully remote, while counselors blend face-to-face, phone, and video visits. Time savings are now channeled into documentation and case consultation. With a second site opening earlier this year, the program has continued to employ the hybrid model to serve both locations and meet the growing demand for psychiatry services.

Case Study: Improving Care and Health Equity While Lowering Cost

In August 2020 a Hispanic Participant, living alone, and with no phone joined Inspira LIFE. When aided in obtaining a phone he was unable to use it and would repeatedly use his Personal Emergency Response System (PERS) button and be taken to the ED. He was assessed by the Behavioral Wellness Department and revealed that he was “afraid” of going to the hospital for fear of “catching COVID” but felt as though he had no choice for communicating but to “press the [PERS] button.” The IDT felt powerless to help without a way to connect so they implemented care.coach on November 20, 2020. He worked with his counselor to have his favorite meditations and relaxation techniques added and this helped to manage panic. He worked with his nurse, provider, and psychiatrist to add medication/appointment reminders along with health coaching for his chronic conditions. His social worker used video visits for complex case management, and he started relaying his needs via his Avatar as opposed to using his PERS. Following these changes, he began attending more appointments, his medication compliance improved and as a result, he significantly reduced his hospital admission and ED visits.