The State of America’s Direct Support Workforce Crisis 2022

The longstanding direct support workforce crisis, exacerbated by the COVID-19 pandemic, has led to closures of critically needed services and a denial of access to community-based supports.
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Capitol Correspondence - 04.21.20

Big Picture: Rural, Low-Income Populations Struggle to Access Telehealth

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As the use of telehealth becomes more common in response to the coronavirus outbreak, we encourage our members to be aware of broader policy discussions surrounding this technology. Politico Pro recently reported on challenges to accessing this technology faced by rural and low-income communities. While not the topic of the article, these are challenges that would also affect people with disabilities in rural or low-income areas.

As reported by Politico Pro:

“ Safety net health care providers treating some of the country’s most vulnerable patients are struggling to adopt telehealth during the pandemic, potentially widening the longstanding disparity in access to care between their patients and those better off.

While doctors and hospitals treating wealthier patients with better tech access are quickly embracing online visits during the coronavirus emergency, rural and community health clinics say they’re far behind because of scant funding, spotty broadband coverage and large populations of poor and uninsured patients who can’t afford the technology to keep in touch virtually.

While these safety net providers have long lagged their better-funded larger peers on telehealth adoption, many health care experts believe the recent demand for telehealth will last after the coronavirus crisis subsides. That could result in greater disparities in care based on a patient’s ZIP code, even as telehealth has been sold as an equalizer for disadvantaged and sparsely populated communities.

[…]

The Trump administration and Congress have sought to quickly erase barriers to telehealth adoption, boosting payment and relaxing privacy rules to encourage care during extreme social distancing. Telehealth advocates say the pandemic could be an inflection point for a field that’s grown slowly because of varying payment policies, high costs of entry and unease with technology — for patients and providers.

[…]

Large health systems have rapidly scaled up to telehealth during the crisis. Medstar, which employs several thousand nurses and doctors between Washington, D.C., and Baltimore, went from a few hundred virtual visits in February to more than 12,000 in March. Stanford University’s health system went from about 1,300 in February to 25,000 in March, according to the telehealth advocacy group Alliance for Connected Care.

But smaller rural and community health centers, many of which survive on grants, have struggled to keep pace with the digital wave at the same time they’re trying to stock up on personal protective equipment and life-saving ventilators. In the past few weeks, they’ve slapped together plans to treat underserved patients virtually, sometimes paying out of pocket for tablets, medical devices and internet access — without knowing how much of those costs will ultimately be covered by the federal government.

[…]

Even larger rural providers are scrambling to meet a sharp rise in demand for virtual care. Oklahoma State University’s health system in the next two weeks is rolling out 36 bedside telehealth carts to let patients show up to the hospital for video chats with doctors and specialists. Health system officials were concerned about patients’ access to internet at home, and they believe this set up will reduce the risk of coronavirus exposure. Before the pandemic, the system had just four of these carts, which cost upwards of $9,000 each.”