Telecare brings doctors and residents together.

IN THE SEARCH FOR COST-SAVING ALTERNATIVES FOR ELDER CARE, telecare techniques may be the answer. By technologically connecting with other health care providers and hospitals, you can not only offer a higher level of resident care, but also drive down your operating costs. What's more, by adopting these technologies, you position your facility as having technical capabilities above and beyond that of your competitors.

Imagine a situation where a resident is short of breath. A staff member positions the resident in front of a telecare cart and dials up the health care provider at the receiving site. A physician or nurse takes a medical history and performs a virtual examination, listening to the resident's lungs and heart, and obtaining a blood pressure and electrocardiogram. The consultation is a real-time, live interaction. Each party has the ability to speak and be seen. The health care provider can then make a diagnosis, recommend treatment, arrange a specialty consultation, or advise on the timing and options for follow-up care.

Telecare also can help avert expensive medical crises. For example, information on weight, blood pressure, or pulse, entered either directly by the resident or by a member of your staff, can signal potential problems. The resident's physician can then adjust the medication regimen or order follow-up lab tests.

In addition to timely intervention and avoidance of medical crises, telecare empowers residents to participate more fully in their care. The educational and informational components that might be incorporated include prevention and wellness. With a camera, monitor, and the digital equipment needed to monitor vital signs in their very own rooms, residents can take their own vital sign readings and hold a digital display up to the screen. Their medical data, such as blood pressure, temperature, blood-sugar levels, and medication information, can then be recorded by a monitoring specialist at the base location.

All of this information could, of course, be communicated via telephone, but videoconferencing contributes additional information. Because residents can hold prescription medications up to the screen, providers can confirm medication compliance. Video also makes possible an assessment of a resident's demeanor, based on appearance and dialogue with providers. Such monitoring, conducted by nursing staff, is currently a luxury enjoyed only by residents of high-end assisted living communities. By allowing for less intensive staffing, telecare can help pave the way for a more affordable housing model.

The Internet also is expanding the range of possibilities for telecare. Last month Healinx [less than]www.healinx.com[greater than] launched a messaging system for interactive communication between patients and their physicians. The Web site allows patients to schedule appointments; request prescriptions, refills, and referrals to specialists; engage in noncritical consultations; and access their medical profiles online.

Telecare includes not only the monitoring of a resident's physical condition, but can address a resident's emotional needs as well. With the help of several technology companies, LCOR is making it possible for its residents to have "virtual visits" with families and friends. Each LCOR community will have videoconferencing rooms, and residents' families will be furnished with a PC-top camera through which they can dial in. This brings family, residents, and caregivers closer together, and appeals to tech-savvy babyboomers as a way to stay connected in spite of their busy lives.

Monitoring vital signs and attempting to ensure medication compliance through telemedicine, however, could lead to an overemphasis on data collection at the expense of human contact, shorting residents on the emotional support and coaching that is crucial to helping them achieve a healthier life. Providers who embrace this technology must learn to balance high-tech with high-touch. Telecare should be thought of as a tool to assist staff in doing their job and to allow residents greater access to health care.

As with any new technology, expect some resistance at first. But over time, staff and residents will become more accustomed to, and comfortable with, using telecare tools for a wide range of reasons. For example, the same system that residents use to enter their vital signs might also provide educational information, news stories related to their conditions, chat rooms for support, and e-mail communication with their health care professionals.

Despite imperfect technology, provider resistance, and uncertain reimbursement, the future of telecare looks bright. The innovation and enthusiasm that marks the field today will continue, driven by the demand for efficiencies and improvements in health care quality.

Daniel M. Gold is president of LCOR Senior Living in McLean, Virginia, and chair of ALFA's Future Trends in the Industry group. He is developing a new venture focused on the design and testing of telecare technologies for LCOR communities and other providers.