The devastating impact of the pandemic on nursing home residents has also drawn attention to programs to help patients with complex medical needs in the community. Many have had to get creative and rely on technology to find new ways to care for their patients.

The Program for Integrated Care for the Elderly (PACE) is an evidence-based model of care for seniors who receive nursing home-level care but live primarily in community settings. About 260 PACE organizations in 31 states serve about 54,000 people. On average, each works with about 400 applicants. This is a high-cost, high-need population with significant disabilities. On average, participants have six chronic conditions and 46 percent have dementia. Ninety percent are dually eligible for Medicare and Medicaid. PACE organizations receive per capita payments and are responsible for all services, including medical, behavioral and long-term services and supports. Teams have funding flexibility and can consider social determinants or use the funding to provide services such as air conditioning for someone with a respiratory illness.

Although all PACE participants must have a nursing home certificate of need for nursing home care to enroll in PACE, only about 7 percent of PACE participants nationwide live in nursing homes. If a PACE participant needs nursing home care, the PACE program pays for it and continues to coordinate their care. When the pandemic struck, these programs took pioneering steps to move many of their services from PACE day centers to home settings.

Element Care, a nonprofit organization founded in 1994, was created as a joint venture between Lynn Community Health Center and Greater Lynn Senior Services to bring an all-inclusive program to seniors in their Massachusetts community. Today, Element Care has eight PACE adult day health centers and two alternative care facilities covering the North Shore, Merrimack Valley and the northeast region of Middlesex County.

Joanna Duby, M.D., medical director of Element Care, said each center employs between 120 and 200 seniors. “We usually have a day center there. People come in during the day, have breakfast, have lunch, we have activities, and we also have medical care for them. We have nursing staff, physical therapist, social workers, nutritionists and doctors, nurse practitioners and our own behavioral health staff. We are a very flexible model. If someone needs to be seen at home, they will be seen at home.”

That all changed when the pandemic hit and seniors in the program couldn’t get together. “Element Care didn’t pay much attention to telehealth before because they felt it didn’t meet the needs and capabilities of the population,” Dabi said. “When the pandemic hit, we took another look at telemedicine visits to see if they could be friendly to our elders because we didn’t know how long it would last.”

They ended up partnering with GrandPad, which has its own tablet computer designed for seniors. “It’s a very simple interface. They can do very limited things with it,” Dabi explained. Users can only call people who are on their list. With the click of a button, they can contact a nurse. “We quickly implemented them, and the behavioral health team started using them, the physical therapy team started using them either for individual therapy sessions or even for group sessions,” Dabi added.

Gradually, PACE participants used it for missed events as well. They had coffee hours with other friends from the center they hadn’t seen in a year. “We also saw a nurse and/or nutritionist. Within six months we had 300 to 400 users, and I don’t think they’re leaving,” Dabi said. “I think the people who have them like them and want to keep using them. They can video chat with their families and friends. As a program, we’ve always appreciated that someone’s family life and lack of loneliness and connection to them is just as important as the medication they take, what they eat, and that they have something to eat and a roof over their head.”

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The COVID-19 pandemic put a lot of pressure on the entire health care ecosystem, and one of the biggest early challenges for patient care organization leaders was navigating the new landscape of transitioning a large number of in-person visits to telemedicine. While the pandemic has certainly impacted many health care institutions, hospitals have been disproportionately burdened; the American Hospital Association estimates that hospitals have suffered a financial loss of $202.6 billion, or an average of $50.7 billion per month, from March 1 to June 30, 2020. Part of that group in great financial difficulty were children’s hospitals, of which there are more than 250 In a May 2020 letter to then U.S. Department of Health and Human Services (HHS) Secretary Alex Azar, executives from more than 75 children’s hospitals were explained that their revenues had dropped by more than 40 percent and were suffering losses of about $2 billion a month. One of the largest pediatric health systems in the United States, located in North Texas, sees about 75,000 patients each year as part of one of the largest pediatric health systems in the United States.

However, like most organizations across the country, the typical patient experience at Children’s Health began to change rapidly as COVID-19 became more prevalent in the Dallas metro area. Suddenly, patients became hesitant to attend their in-person appointments, make new appointments, or receive medical care in general for fear of contracting the virus. About 15 percent of pediatric patients nationwide are classified as children with special health care needs, and about 3 million U.S. families have more than one child with such needs, as indicated by the Special Needs Financial Planning Organization. At Children’s Health, in particular, the organization’s behavioral health team, which offers its patients a variety of behavioral health services, treatments and therapies, recognized that their core work would become even more important in these unprecedented times, prompting team members to change their existing strategies and operations to ensure comfort and safety for both patients and their families.

When the behavioral health team assessed the patient population at the beginning of the pandemic, three key groups came to the fore: general patients with various medical conditions; patients recovering from substance abuse; and people with developmental disabilities. With this key audience information, the behavioral health team set out to create strong alternatives to traditional face-to-face care, and the efforts of the integrated behavioral health team and the health system’s virtual health program led to it being named a third person.

School-based mental health moves into the home As part of a common cohort of patients with a variety of conditions, Children’s Health’s school-based remote behavioral health program virtually connects students in 178 North Texas schools with licensed mental health professionals. addressing common behavioral health issues, including depression, anxiety, self-esteem and coping skills. Usually in this program, the school will identify a student with a potential behavioral health need and then, if deemed necessary, refer the student to Children’s Health. If such a referral occurs, a licensed health care provider will conduct family outreach, conduct a behavioral health assessment, provide supportive telephone case management and, when clinically appropriate, offer telehealth behavioral health therapy sessions at the student’s school. at the school and with a physician at another location.

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