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Rx REPORT: Caring for seniors during the pandemic

The Centers for Disease Control and Prevention states eight of 10 deaths in the U.S. due to COVID-19 are adults 65 older. The pandemic has highlighted the cracks in the health care system, from systemic racism to the lack of quality care for our aging population.

Alignment Healthcare’s Chief Medical Information Officer Dr. Arta Bakshandeh is an integral part of a medical team in the development and implementation of the clinical care model, data analytics platform and home monitoring programs for patients with a variety of chronic diseases. The platform was developed to create the experience of having a “doctor in the family” — filling in critical gaps in care and member data no matter where the member is.

He is an assistant clinical professor of internal medicine at the Keck School of Medicine of the University of Southern California, where he lectures physician assistant students in the USC Physician Assistant Program. Bakshandeh continues to work on the front lines treating patients statewide both in the hospital and virtual settings.

ML: What is the home monitoring program for patients with a variety of chronic diseases?

AB: When it comes to senior care, health care can and should happen anywhere, and not just in a doctor’s office or care center. My team and I can remotely monitor our patient’s health status in real-time every 30 minutes, as well as identify and predict issues to empower our care team to provide the best care daily. We monitor things like identifying drops in oxygen levels and missed prescription pickups. We can act on this data — reaching out to check on members and provide solutions, such as transportation to pick up missed prescription refills. To date, thousands of members have had access to this at-home monitoring.

ML: How are you assisting seniors?

AB: Seniors in America are our focus. Amidst the pandemic, they are the most vulnerable population. Our facilities are constructed for the comfort of seniors. Our reception counters are lower, the floors have non-static carpet, so it does not interfere with or cause sparking in their hearing aids, wheelchair-accessible doorways are standard and we offer same-day appointments.

We quickly mobilized to address our seniors during the COVID-19 through several steps:

We make proactive calls to our most at-risk populations to check in on them and offer added support. We contacted the husband of a hospitalized patient; he was so happy that we called not only to check on his wife but him as well. He shared that he had been very depressed because he was not able to see his wife. He felt that he didn’t know everything that is going on with her. He was grateful to us for reaching out.

We deliver meals to help members who live alone, live below the poverty line, and those who are unable to go to the grocery store. We assembled a team of 50 volunteers to deliver more than 22,000 meals to our members in need in California and North Carolina.

We host a series of virtual town halls to answer questions, break down myths and share vital information related to COVID-19, loneliness and fitness at home. To date, more than 53,000 members have participated in our town halls.

ML: What is your advice for older people dealing with depression, anxiety, or loneliness as they are alone at home especially while their spouses are in the hospital due to COVID-19?

AB: Before COVID-19, the risk for social isolation and loneliness was already high among older adults. Per guidance from the CDC, I continue to urge the elderly population to continue staying at home and practice physical distancing for their safety. Still, I understand the emotional toll that this can take on them. Social connection through FaceTime, Zoom, or even a phone call is more important than ever for all of us, and especially older adults, to engage at a safe distance with our families and friends. Also, having hobbies or learning is an excellent way for seniors to stay enthusiastic and excited about something to stay occupied.

Spouses are at a unique risk. We made an extra effort to provide support to the spouses of members who are in the hospital due to COVID-19. There have been instances where my patients, both husband and wife, have been hospitalized at the same time due to the disease, which is why it is so crucial to realize that one person’s decisions can directly impact someone important to you. 

If you need to see your healthcare provider during the pandemic, it is wise to call the provider’s office and see if they provide virtual visits via a computer or mobile device. Much of non-urgent health care can be done simply through an appointment with your doctor through an application like FaceTime or Zoom. Telemedicine allows you to access the care you need without the risks of encountering COVID-positive patients in a doctor’s office or emergency room.

ML: Tell me more about some of the patients you assisted during the pandemic.

AB: We had an elderly couple in which the husband was admitted to the ICU due to COVID-19. His wife didn’t drive and was left home alone, worrying about her husband in the ICU. We identified her as a risk for running out of food and delivered groceries until her husband recovered and returned home. We then provided them both with cooked meals for a month so she could focus on helping him in his recovery.

In the hospital setting, I make sure to spend a lot of time speaking with the family about our patients before and after I go into the isolation room. I do this because COVID-19 patients are alone, with no contact with the outside world. I send messages to the patient from family members and remind them that they are not forgotten. I also help our patients FaceTime with the family when possible.

With those whom we don’t FaceTime, I call the family again to let them know how the patient is doing and their reaction to the messages. My goal is to make sure that the patient and family know they are never alone.

ML: What do you think is the future for senior care?

AB: We believe telehealth will take center stage going forward. But, for us, this isn’t just about using technology to make an in-person experience online. We’re working hard to ensure seniors have ongoing relationships with the primary care doctor of their choice, and that their data is connected for all health care professionals to see and act on to provide the very best care. Telehealth will not just be a matter of safety for vulnerable seniors in the future but as a matter of comfort and easy accessibility to quality care from where they reside.

In a time when we hear so much conflicting information about COVID-19, one thing remains true: the elderly population suffers disproportionately from more complications due to COVID-19 and has a higher rate of hospitalization than other age demographics. It remains vital for all of us to continue practicing social distancing and wash our hands with soap for at least 20 seconds before touching our faces and after touching surfaces. 

ML: What is “Grandkids On-Demand?”

AB: According to the National Institute of Aging, social isolation and loneliness are linked to higher risks of heart disease, cognitive decline, and other chronic illnesses. We focus on supporting our patients with emotional and physical well-being and have introduced several benefits that support “social determinants of health” such as food security, transportation and loneliness. We partnered with Papa, Inc. to provide members on certain plans who qualify with a “grandkids on-demand” benefit. The program provides seniors with companionship, along with support with technology needs and everyday tasks. Anyone with a verifiable background can join the Papa program if they are looking to help seniors in their community. During the COVID-19 pandemic, our qualifying members have been able to enjoy this companionship from the comfort of their home virtually by phone or video.

The “grandkids on-demand” are available to meet with qualified members for up to two hours per day, 12 hours per quarter, and 48 hours per year. Medical records are used to establish qualifications and, once qualified, the member will be eligible for the remainder of the plan year.

ML: What are some general tips or recommendations on how seniors can take care of their physical and mental well-being as they self-quarantine.

AB: Staying active can improve mental health by reducing anxiety, depression, and negative mood. Even as seniors are encouraged to practice physical distancing, there are many ways for them to stay active and safe. I encourage seniors to sit less and to get up often, to do an active chore or march in place. If possible, take a short walk outside your neighborhood. Also, many safe low-impact exercises are available on the web. Seniors can also contact their health insurance provider to see what at-home fitness programs are available to them.

Have a question to ask a medical professional? Contact Marie Y. Lemelle at RxReport2020@gmail.com.

Marie Y. Lemelle, MBA, is the founder of www.platinumstarpr.com and a film producer. You can contact her at MarieLemelle@platinumstarpr.com. Follow her on Instagram @platinumstarpr.