Virtual skilled nursing and physical therapy: What is possible?

Published June 24, 2019

The home is becoming the center of care. Services that have been traditionally offered only in doctors’ offices and hospitals are now being delivered directly to patients where they live. For example, until recently, dialysis for end-stage renal disease was only available at dialysis centers or hospitals. Today, it is possible for patients to receive dialysis at home. The success of these programs prompts the question: What other services can patients receive at home?

Skilled nursing facilities lead the way

Among the benefits of home care is that it lessens the need for elderly and disabled patients to receive care in skilled nursing facilities (SNFs). Ironically, the SNFs themselves are piloting technologies that may allow seniors and others to receive care at home instead of in a SNF.

Telemedicine

In 2018, a SNF in Long Island, NY, became one of only 3% of facilities nationwide to qualify for a Medicare bonus, thanks to their use of telemedicine to decrease acute-care hospital transfers. Using virtual 24/7 access to physician services, this SNF was able to reduce hospital transfers by 44%. If constant access to physicians is available to SNFs, isn’t it possible to expand these services to patients’ homes?

Of course, patients in SNFs have more complex care needs than patients who can heal at home. Nevertheless, the advantages offered by 24/7 access to a physician by telemedicine might help prevent the need for transfer to a SNF. For example, a patient who recently underwent a shoulder replacement may require pain medication, among other services. Access to telemedicine may help these patients adhere to their pain control plans, avoiding unnecessary visits to the hospital.

Virtual reality

Originally conceived for gaming platforms, virtual reality (VR) is now being adapted for rehabilitation applications. Some SNFs are using proprietary VR platforms — such as Jintronix — to help guide patients to achieve rehabilitation goals. These devices have proven more engaging than traditional therapies and have received high praise from patients and caregivers. These same platforms can be used by patients in their homes to continue or perhaps replace therapies available only in SNFs. Jintronix, for example, designed its device to be used in patients’ homes as well.

MyndVR is another VR application designed for patients in SNFs and long-term care facilities. This device was designed to provide cognitive stimulation to patients with dementia and mood disorders, and to help them cope with social isolation. If the device works in SNFs, can it work at home as well?

The answer, of course, is yes. On its website, the company suggests that home care providers can incorporate the device into rehabilitation services. If that is the case, then patients at home who are capable can use VR devices themselves.

What about physical therapy?

Reflexion Health developed a physical therapy platform called the Virtual Exercise Rehabilitation Assistant (VERA). The platform was designed specifically to replace the need for a physical therapist during the course of a rehabilitation program. The device provides guidance through exercises and facilitates contact with online care providers. In one clinical study, VERA successfully guided a cohort of patients through rehabilitation following knee replacement surgeries.

Advances in robotics also provide opportunities to create physical therapy devices. These devices help patients regain strength, muscle mass, and coordination, and perform activities of daily living. Such devices have proven to be particularly helpful with patients recovering from strokes.

Physical therapists (PTs) need not worry that their jobs will be taken by robots. The initial evaluation, an essential component of physical therapy, must still be performed by a skilled practitioner. More severely impaired patients will also require hands-on therapy that can only be provided by PTs.

Nevertheless, in the future, many patients currently cared for by both SNFs and PTs will be cared for by their virtual counterparts. Given the growing scarcity of resources as well as the aging of the population, the advent of VR and robotics should be greeted with enthusiasm by the SNF and PT community, who will continue to care for the patients who need their services the most.