The Need for Disability-Inclusive Telehealth Services

by Hazel Jessica

Image of a female sitting at a desk in a wheelchair. The desk has pink flowers and a laptop computer. She is smiling and waving at the computer.

Following the lockdown restrictions, telehealth services saw an unprecedented boom nationwide. Within the first few months of 2020 alone, patient adoption saw a 33% jump. This has led experts to predict the telehealth market value to be worth a staggering $185 billion by 2026. And this is no doubt, boosted by the level of convenience and safety that the service provides.

However, while this bodes well for the able-bodied, it is quite the opposite for those with disabilities. In fact, rather than equally empowering those with physical and developmental disabilities, telehealth largely accentuates the gaps in healthcare inclusivity.

Why Telehealth May Be Deepening the Disability Divide

While the telehealth-related constraints that plague persons with disabilities are heavily nuanced per individual, there are two main issues that need to be addressed. First, there is the issue of persons with disabilities who need extra assistance to communicate. Although the Americans with Disabilities Act (ADA) does obligate telehealth providers to extend their services via auxiliary aid and services, there are no clear guidelines that outline how this should be satisfactorily done. This creates a grey area that leaves most disabled patients wanting. The most common source of conflict arises from a failure to provide qualified sign language interpreters for those hard of hearing and limiting telehealth communications between just the healthcare workers and the individual patient. While telehealth providers insist that this is a privacy and security measure, many persons with disabilities require third-party aid to accurately relay and translate their feelings. These communication issues may be further exacerbated when choosing a therapist. Already a sensitive decision as it is, the confusion, anxiety, and frustration that a person with a disability may experience could lead to further depression or alienation.

Second, while telehealth, in theory, seems perfect for those with physical disabilities—in practice, it may prove harder. For instance, a telehealth consultation removes the need for wheelchair users to find appropriate transportation. But it also eliminates the hands-on intervention of aides, nurses, or doctors who can move the patients’ limbs during an examination. For instance, the routine check-ups that those with partial paralysis must undergo to keep track of muscle atrophy are near impossible to perform on one’s self. On top of this, certain devices may need specific positioning during a session, which a person with a physical disability may not be able to execute. Case in point, a doctor may require a patient to hold the webcam up closer to a certain body part. But gripping such an item may be hard for those with arthritis—which is one of the leading causes of disability. In some cases, this may even result in certain symptoms being left unnoticed or untreated.

How to Boost Telehealth Accessibility and Inclusivity

Thankfully, though, steps are being taken to make telehealth more accessible across the board. Still very much a work-in-progress, telehealth providers are currently looking to the healthcare workers themselves to improve inclusivity. Since digital literacy significantly streamlines and enhances the consultation process, medical professionals with advanced training are especially crucial.

Nurses, for instance, who are among the most involved in patient care and observation, should be able to translate these services through a virtual medium. Especially since the Institute of Medicine (IOM) has stated that nurses will soon be expected to take “greater ownership of the healthcare field”. As such, it is recommended that more nurses take further studies on digital competency in healthcare. This can include learning how to navigate healthcare software, data security, and how to translate their bedside manner on a digital medium. Among the concentrations taught in doctor of nursing degrees, digital services and complex healthcare systems can help nurses better approach digital-based care without leaving out the needs of persons with disabilities. Furthermore, having completed such a course helps nurses be more sensitive to the experience of their telehealth patients. This can result in a more pleasant and accurate consultation.

Aside from healthcare workers, though, staff-wide and inter-departmental telehealth seminars can create an efficient workflow for better patient experiences. In these sessions, all staff members must be educated on troubleshooting and interpersonal sensitivity. This allows them to properly manage any technical and personal concerns patients may have. This could mean having a patient assistance line to help them remotely set up, or it could mean having an administrator explain how the platform works. Because when patients are assured that there is a compassionate and efficient system in place to help them, they are more likely to continue regular treatments.

Can We Expect Inclusive Telehealth Services Soon?

In response to the issues presented above, some providers are already exploring specific disability-focused telehealth initiatives. For example, a recent 12-month pilot program in New York successfully reported a 90% resolution rate. What’s more, the same initiative resulted in significant healthcare savings for patients and payers. That said, while this data is promising, there is still no exact date that this—or any similar—effort will be rolled out nationwide. Hence, while those in power are making slow but steady progress towards inclusivity, current telehealth may provide more pain points than it relieves.

Article exclusively written for centerfordignity.com

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