How 3 health systems are using telemedicine for dementia care
Telemedicine for dementia care can help increase access, especially for rural and elderly patients, but it faces challenges such as technology barriers and sustainability.
Dementia, a blanket term for multiple disorders that impair cognition and memory, impacts millions of Americans directly and indirectly. According to recent research, nearly 1 million Americans are expected to develop dementia by 2060.
While there is no known cure for dementia, these figures highlight the urgent need for accessible and effective dementia management. Enter telehealth.
The significant uptick in virtual care access during the COVID-19 pandemic has enhanced care delivery and access in numerous clinical areas, including dementia care. One study published in 2024 revealed that telehealth use soared among dementia patients following the onset of the COVID-19 pandemic, with the most significant increases observed among those with longer drives to a clinic and the oldest patients.
This has been the University of Mississippi Medical Center's experience with offering telehealth-based dementia care as well.
"[COVID-19] changed things almost overnight," said Kim Tarver, MD, associate professor of medicine, chief of the geriatrics division and director of clinical services for The MIND Center at UMMC. "We have patients who travel three hours to see us, and so, to have the ability to communicate with them and not have them have to come to the clinic to see me every time is really helpful."
UMMC is one of several U.S. health systems that has embraced telehealth in its dementia care programs. However, health systems must contend with significant challenges to using the virtual care modality in dementia care, such as technology access and sustainability.
Exploring telehealth-based dementia care programs & their benefits
Dementia care is especially well-suited to telehealth. Not only can large swaths of the evaluation, treatment and follow-up be conducted virtually, but telehealth offers a level of privacy and flexibility that in-person appointments do not.
We have patients who travel three hours to see us, and so, to have the ability to communicate with them and not have them have to come to the clinic to see me every time is really helpful.
Kim Tarver, M.D.Associate professor of medicine, chief of the geriatrics division and director of clinical services for The MIND Center, University of Mississippi Medical Center
For instance, at UMMS, dementia care physicians use telehealth to perform the Montreal Cognitive Assessment, a widely used screening tool to detect mild cognitive impairment. Tarver explained that a nurse calls the patient to conduct the assessment, sharing their screen for any portions of the test that require visuals.
Tarver is also able to perform the patient's physical evaluation via telehealth.
"I usually ask the caregiver or whoever's with the patient to do the parts of the exam where I would need to actually be touching the patient," she said. "So, for example, a part of the exam where I'm testing their cerebellar function, I'll tell the family member what to do, 'Hold your finger out in front of them, and then move it slowly around.' And then I'll talk to the patient and say, 'I want you to touch your nose and then reach out and touch their finger,' so I can watch that happen as opposed to me doing it myself."
Though Tarver does meet with her patients in person to verify these virtual assessments, she finds that they are similarly accurate to those performed in person.
Not only do telehealth-based evaluations extend dementia care to bedbound or rural patients who may find it hard to travel to the clinic, but they also allow family members to share their concerns freely with clinicians. Tarver noted that sometimes family members or caregivers step into another room to privately discuss the patient's condition, which is especially helpful in cases where the patient may not remember their memory loss or be defensive about it.
Further, telehealth can help dementia care programs extend their workforce. At the University of California, San Francisco, patients and their families are connected with care navigators who are unlicensed but trained in dementia care.
"The navigators are the ones who each have a caseload of families that they're supporting," said Katherine L. Possin, Ph.D., John Douglas French Alzheimer's Foundation Endowed Professorship and professor in residence in the Department of Neurology at UCSF Memory and Aging Center. "When the issues exceed the scope of their role, then they can triage to or consult with one of the licensed experts. So this really extends the reach of that limited dementia specialist workforce."
The care navigators can conduct care protocols, like assessing safety gaps in patients' homes, and address questions and concerns from patients and their caregivers, leaving licensed clinicians to manage more complex cases and needs, she explained.
Though videoconferencing tools are available, the care navigators generally connect with patients and families over the phone. Possin noted that this alleviates caregiver burden as they don't need to wait for an appointment or bring the patient in to have concerns addressed.
Similarly, Banner Health's Dementia Care Partners program connects Certified Nursing Assistant-level health coaches with patients to perform initial assessments and support patients and caregivers through the care journey.
The impact is kind of like an exponential thing, right? If I train 30 people, and they see 3,000 each, you see how big the impact is. I think just empowering these people to take care of these patients in the community is what is required.
Ganesh Gopalakrishna, M.D.Associate clinical medical director, Stead Family Memory Center, Banner Alzheimer's Institute
Ganesh Gopalakrishna, M.D., associate clinical medical director of the Stead Family Memory Center at the Banner Alzheimer's Institute, noted that being able to virtually connect health coaches and patients saves travel time associated with in-person visits, allowing health coaches to support many more patients and freeing up clinician time.
Another way that telehealth is extending the dementia care workforce is via the Project ECHO model. The Project ECHO (Extension for Community Healthcare Outcomes) model uses telehealth technology to connect clinical professionals and community workers to share support, guidance and feedback.
In addition to using telehealth to conduct diagnostics, treatments and follow-up visits for dementia patients, Banner Health has a Dementia ECHO program to train a community workforce in dementia care.
"Anyone who has a role in healthcare for dementia, we invite them," explained Gopalakrishna. "We are a multidisciplinary group in Project ECHO… We have physicians, nurse practitioners, we have elder care attorneys now, occupational therapists, recreational therapists."
The group meets every two weeks for six months and completes a set curriculum. Each session is an hour long and covers a different topic, with Banner Alzheimer's Institute clinicians leading the sessions. However, program attendees can also bring up cases they want to discuss with the group.
Gopalakhrishna highlighted how training a community workforce can support overwhelmed dementia care teams in caring for the growing number of dementia patients.
"The impact is kind of like an exponential thing, right?" he said. "If I train 30 people, and they see 3,000 each, you see how big the impact is. I think just empowering these people to take care of these patients in the community is what is required."
Overcoming challenges of telehealth-based dementia care
Though health systems are reaping the benefits of using telehealth in dementia care, implementing these programs is not without its challenges.
Technology-related barriers were among the most significant hurdles at Banner Health, especially during the pandemic, Gopalakrishna explained, when adult children could not come over and offer technical support to their parents with dementia.
Technological competency and accessibility have grown over time, easing some of these challenges, but Banner Health also started leveraging cell phones to make telehealth-based dementia care more accessible.
How do you keep this program going? How do you convince your medical center to pay for this model of care, implement new billing codes, or get philanthropy? How do you pay for it so it can keep going and grow the program? So those are the biggest challenges, I think, from the provider or health system end.
Katherine L. Possin, Ph.D.John Douglas French Alzheimer's Foundation Endowed Professorship and professor in residence, Department of Neurology, UCSF Memory and Aging Center
"Initially, we were able to send an email to them, and then they would get on and register or even just use the email to get on," he said. "But now we are able to just send a text to the phones and the text has that link for the visit. Using the telephones rather than computers was a big shift."
It's not just patients who may not be wholly comfortable with technology. Providers, too, need added support when implementing telehealth tools.
Tarver pointed out that switching to telehealth can be difficult for various reasons. For instance, if the technology is not working well or there is miscommunication about patient preference, it can eat up a chunk of the appointment.
"You're trying to connect with somebody, and sometimes their connection doesn't work well at first, or you don't have the right phone number, or they wanted you to use their email as opposed to their phone number, and that's not documented well on the chart," Tarver said. "All those kinds of [things] definitely are part of what's frustrating for some team members."
Having a telehealth champion, someone who is comfortable using the technology and can help others troubleshoot, is key. At UMMC, a nurse practitioner fills this role.
In addition to technological challenges, reimbursement and sustainability are significant hurdles to telehealth-based dementia care.
"How do you keep this program going?" Possin said. "How do you convince your medical center to pay for this model of care, implement new billing codes, or get philanthropy? How do you pay for it so it can keep going and grow the program? So those are the biggest challenges, I think, from the provider or health system end."
The Guiding an Improved Dementia Experience (GUIDE) Model could offer one path to reimbursement for telehealth-based dementia care. Launched by the CMS Innovation Center, the alternate payment model (APM) aims to support dementia patients and their unpaid caregivers. The model offers Medicare payments for comprehensive care coordination, care management, caregiver education and respite services. However, Possin noted that becoming a GUIDE participant is difficult.
"There are certain reporting requirements, and there are certain required elements of being a GUIDE participant," she said. "For example, you need to provide respite. You have to have respite contracts in place to provide some respite to the caregivers. And these contracts are really hard to set up for health systems."
Still, dementia care providers believe that working through these challenges to offer telehealth-based care is worth it.
Possin concluded by highlighting the myriad benefits of telehealth, including reductions in caregiver burden, cost-savings associated with curbing unnecessary emergency room visits and hospitalizations and improvements in the quality of life for dementia patients.
"I hope that we can get to a place where it is the standard of care," she said.
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
