Appl Clin Inform 2021; 12(04): 933-943
DOI: 10.1055/s-0041-1735974
Research Article

Consequences of Rapid Telehealth Expansion in Nursing Homes: Promise and Pitfalls

Kimberly R. Powell
1   Sinclair School of Nursing, University of Missouri, Columbia, Missouri, United States
Gregory L. Alexander
2   School of Nursing, Columbia University, New York, New York, United States
› Author Affiliations
Funding This study was funded by U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality (AHRQ; grant no.: RO1HS022497). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ.


Background Expectations regarding use and potential benefits of telehealth (TH) in nursing homes (NHs) are high; however, unplanned and unexpected consequences can occur as a result of major policy and technological changes.

Objectives The goal of this study was to elicit stakeholder perspectives of consequences of rapid TH expansion in NHs.

Methods Using a qualitative descriptive design, we drew a sample based on findings from a national study examining trends in NH information and technology (IT) maturity, including TH use. We used maximum variation sampling to purposively select participants who (1) participated in our IT maturity survey for two consecutive years, (2) completed year 1 of the IT maturity survey prior to TH expansion (before March 6, 2020) and year 2 after TH expansion (after March 6, 2020), (3) represented a broad range of facility characteristics, and (4) were identified as an end user of TH or responsible for TH implementation. Using six questions from the IT maturity survey, we created a total TH score for each facility and selected participants representing a range of scores.

Results Interviews were conducted with (n = 21) NH administrators and clinicians from 16 facilities. We found similarities and differences in perceptions of TH expansion according to facility TH score, NH location, and participant role. Desirable consequences included four subthemes as follows: (1) benefits of avoiding travel for the NH resident, (2) TH saving organizational resources, (3) improved access to care, and (4) enhanced communication. Undesirable consequences include the following five subthemes: (1) preference for in-person encounters, (2) worsening social isolation, (3) difficulty for residents with cognitive impairment, (4) workflow and tech usability challenges, and (5) increased burden on NH staff/infrastructure. Participants from rural NHs perceived lack of training, poor video/sound quality, and internet/connectivity issues to be potential pitfalls.

Conclusion Clinicians and NH administrators should consider leveraging the desirable consequences of rapid TH expansion and implement mitigation strategies to address the undesirable/unanticipated consequences.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by The University of Missouri Institutional Review Board.

Publication History

Received: 20 June 2021

Accepted: 13 August 2021

Article published online:
06 October 2021

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