JMIR Publications

ABSTRACT

Background:

Older adults face barriers to specialty care such as occupational therapy (OT), challenges which are worse for rural older adults. While in-home video telehealth may increase access to occupational therapy, older adults’ health and technology-related challenges may necessitate caregiver assistance.

Objective:

This study examines caregiver assistance with in-home occupational therapy video telehealth visits from the perspectives of OT practitioners at Veterans Health Administration (VHA).

Methods:

A web-based national survey of VHA OT practitioners about caregiver role in video telehealth was conducted between January and February 2022. Items were developed with input from subject matter experts in geriatrics and occupational therapy, and gathered patient factors that necessitate caregiver participation, the extent to which caregivers assist with different types of tasks (technological and non-technological tasks), and perceived facilitators, benefits, and barriers to caregiver involvement.

Results:

Of approximately 1787 eligible VHA OT practitioners, 286 (16.0% response rate) participated. Most respondents were female (183/226, 81.0%), White (163/225, 72.4%) occupational therapists (275/286, 96.2%). Respondents were from 87 different VA medical centers, the catchment areas of which served a patient population which was 34% rural on average. Most participants (162/232, 69.8% of responses) had more than 10 years of OT experience serving a patient cohort which was mostly 65 or older (189/232, or 81.5%) in primarily outpatient rehabilitation (132/232, 56.9% of responses). The top patient factors necessitating caregiver involvement were lack of technical skill, cognitive impairment, and advanced patient age, with health-related impairments (e.g., hearing or vision loss) less frequently cited. Technological tasks caregivers most frequently assist with were holding, angling, moving, re-positioning or operating the camera (136/250, 54.4%), enabling and operating the mic and setting volume (126/248, 50.8%), and enabling the camera (115/248, 46.4%). Clinical tasks caregivers most frequently assist with were providing patient history (143/239, 59.8%), assisting with patient communication (124/240, 51.7%), and receiving education and training to support patient care (124/239, 51.9%). The top facilitator was OT-delivered caregiver education about what to expect with video (152/275, 55.3%) while the top barrier was poor connectivity (80/235, 34.0%). Increased access to video (212/235, 90.2%) was the top-rated benefit of caregiver assistance. Most (164/232, 70.7%) respondents indicated that caregivers were sometimes-often-always either not available or were unable to assist with video, in which case the appointment most often shifted to phone.

Conclusions:

Caregivers routinely assist patients of Veterans Health Administration with in-home occupational therapy video visits, enabling access by providing both technical and clinical support. Such assistance is invaluable to patients who are older and have complex medical needs, and for clinical services like occupational therapy which rely on visualization of the home and patient. However, caregivers themselves may face challenges with video, and older patients may lack an available or able caregiver to assist.