Telehealth as a Bridge for Palliative and End‐of‐Life Care in Nursing Homes
Rachael Alexander, Rebekah Perkins, Amy Powell‐Versteeg, Pamela Barrientos, Laura Block, Rebecca M. Goodwin, Megan McClure, Rebecca Utz, Paige Patterson, Theresa A. Allison, Lynn Flint, Caroline StephensABSTRACT
Background
Older adults living in nursing homes experience high rates of serious illness, hospitalization, and death, yet access to specialty palliative care remains limited. The COVID‐19 pandemic rapidly expanded telehealth use in nursing homes, creating new opportunities to remotely deliver palliative and end‐of‐life care. Understanding how telehealth supported or complicated palliative care during this period is critical to informing sustainable post‐pandemic clinical and payment models.
Methods
We conducted a qualitative descriptive study using semi‐structured interviews with 29 multidisciplinary nursing home staff from 22 facilities, including 14 rural, across the United States from June 2021 to July 2022. Interviews explored experiences using telehealth during the pandemic, with attention to symptom management, goals‐of‐care communication, family involvement, and end‐of‐life care. Data were analyzed using reflexive thematic analysis.
Results
Three themes in relation to telehealth use in palliative and end‐of‐life care were identified: (1) Adoption of Telehealth : Staff described how the pandemic forced telehealth into nursing home culture. Multiple platform use, family involvement, and provider engagement expanded care access and reduced transportation burdens during this time of crisis with emphasis on improved communication and inclusion of geographically distant family members; (2) Difficult Experiences with Telehealth Implementation : Participants reported technical challenges, workflow strain, and digital literacy gaps along with its limitations for assessment, rapport, and personable end‐of‐life conversations; (3) The role of Telehealth as a Bridge for Palliative and End‐of‐Life Care : Telehealth facilitated goals‐of‐care discussions, supported comfort‐focused decision‐making, and enabled virtual presence during dying.
Conclusions
Telehealth played a critical role in maintaining connection, coordination, and compassionate palliative care for nursing home residents during the pandemic. Findings highlight telehealth's potential as a sustainable strategy to expand access to palliative and end‐of‐life care in nursing homes, especially in resource‐limited settings. Telehealth policy and practice should focus on sustaining telehealth infrastructure, workforce training, payment systems, and ethical guidance for serious illness communication.