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. Author manuscript; available in PMC: 2023 Oct 1.
Published in final edited form as: J Gerontol Nurs. 2022 Oct 1;48(10):15–20. doi: 10.3928/00989134-20220908-02

Occupational Therapy Practitioner Perspectives of the Role of Caregivers in Video Telehealth

Megan E Gately 1, Dylan Waller 2, Emily E Metcalf 3, Lauren R Moo 4,5,6
PMCID: PMC9577539  NIHMSID: NIHMS1842496  PMID: 36169296

Abstract

The current article examines the role of caregivers to support patient participation in video telehealth, using data from interviews with occupational therapy practitioners at Veterans Health Administration. We found that caregiver participation allowed patients who might otherwise not be able to access video telehealth to do so, with patient factors, such as low technical literacy, contributing to caregiver involvement. In addition, caregiver participation varied by type of task performed. There were also benefits and barriers to caregiver participation. This study enhances our understanding of caregivers’ role enabling patients to access video telehealth, which has implications for nursing professionals.

In response to the coronavirus disease 2019 (COVID-19) pandemic, use of telehealth greatly expanded. According to the American Occupational Therapy Association (AOTA), telehealth is “the application of evaluative, consultative, preventative, and therapeutic services delivered through information and communication technology (ICT)” (Cason et al., 2018, p. 1). Video telehealth, one of the most common telehealth modalities, involves real-time communication between patients and clinicians at two separate locations. Veterans Health Administration (VHA), the largest integrated health care system in the United States, is a pioneer in telehealth, in recent years focusing on increasing video telehealth into Veterans’ homes or choice of location (Zulman et al., 2019). Benefits to video telehealth include reduced travel for patients and providers, at-home monitoring of chronic conditions, and increased access by hard-to-reach populations (Roytman et al., 2021).

Although clinicians from numerous disciplines use video telehealth, application varies by profession. Some video telehealth, such as mental health therapy, may be a mostly static encounter. Other video telehealth services, such as occupational therapy (OT) and nursing, may involve more hands-on and dynamic elements, necessitating guidelines for translating care to a video platform. Although telehealth is highlighted as a delivery method for nurses to provide health care communication, assessment, co-ordination, monitoring, and management as part of their scope of practice (American Nurses Association [ANA], 2019; National Council of State Boards of Nursing [NCSBN], 2014), comprehensive guidelines for providing nursing care through video telehealth are lacking (Rutledge & Gustin, 2021).

Further complicating implementation of video telehealth is lack of understanding about population-specific needs, particularly for older adults. A primary goal for many older adults is aging in place (Brim et al., 2021), meaning to stay in their familiar home environment and community for as long as possible. Video telehealth from interdisciplinary teams (including nursing and OT) may help enable this reality. However, older adults often have complex clinical profiles, sensory and age-related impairments, and decreased digital literacy, which may limit capacity for video telehealth (Schwartz et al., 2022). Although involvement of caregivers (e.g., spouses, parents, children) may lessen barriers, caregiver needs and willingness to participate in video telehealth, regardless of clinician discipline, are not well understood (Alexander et al., 2021). In the current article, we examine caregivers’ roles supporting patient participation in video telehealth from the perspective of OT practitioners. These results have implications for all clinical disciplines who might use video telehealth to provide complex care with potentially hands-on components, including nursing professionals.

METHOD

Study Design and Sample

Semi-structured qualitative interviews with OT practitioners (occupational therapists and occupational therapy assistants) from across VHA were conducted. The overall goal of the interviews was to examine OT practitioners’ experience using video telehealth to deliver OT services. Participants had to be a VHA OT practitioner with experience using video telehealth. There were no other inclusion criteria. Eligible participants were identified using internal VHA data and were invited to participate through email. Of 29 OT practitioners invited to participate, 27 (93%) were interviewed, with the remaining two not responding to invitations.

Study Procedures

A semi-structured interview guide with predetermined topics was used to gather data, while allowing for relevant deviation when appropriate. The interview guide included question prompts broadly related to video telehealth, including caregiver involvement and what caregivers did surrounding and during sessions. Interviews were designed to be ≤1 hour and were conducted by the first author (M.E.G.) remotely (via phone or Microsoft Teams) between January and March 2021. This project was reviewed by the VA Bedford Healthcare System’s Institutional Review Board and deemed quality improvement.

Data Analysis

All interviews were audio recorded and professionally transcribed. The initial codebook was drafted by the first author with feedback from the study team, including two other authors (D.W., L.R.M.), two doctoral OT students, and an occupational therapist with geriatrics experience. Transcripts were coded in Microsoft Word using conventional content analysis, an approach which aims to describe an experience (Hsieh & Shannon, 2005). Analysis involved repeatedly reading transcripts to identify themes related to caregiver participation in video telehealth. To enhance rigor, the coding team met frequently to discuss and resolve any coding discrepancies in an iterative, interactive process designed to ensure coding consistency (Hemmler et al., 2022).

RESULTS

Twenty-seven occupational therapists (n = 25, 92.6%) and OT assistants (n = 2, 7.4%) completed interviews. Participants averaged 17.4 (SD = 9.7) years of OT practice, and 10.3 (SD = 8) years of practice at VHA. Most (n = 21, 77.8%) participants had completed >100 video telehealth sessions with patients in the year prior to interviews and were from 27 geographically diverse medical centers with an overall average rurality of 43.6% (SD = 24.6%). Respondents were primarily female (n = 22, 81.5%) and White (n = 23, 85.2%), which aligns with demographics of OT practitioners nationally (AOTA, 2020).

Qualitative analysis revealed several findings related to caregiver participation in video telehealth. Namely, caregiver participation allowed patients who might otherwise not be able to access video telehealth to do so, with patient factors that appeared to contribute to caregiver involvement including patients’ low technical literacy and impairments, such as hearing loss. In addition, caregivers participated in video telehealth to varying degrees, providing support with technical and clinical tasks. There were also benefits and barriers to caregiver participation in video telehealth. Detailed quotes supporting these themes can be found in Table A (available in the online version of this article).

Table A.

Themes and Exemplar Quotes

Patient Factors Contributing to Caregiver Participation in Video Telehealth
Factor Exemplar Quote (Participant Number)
Fear of technology
“More than anything it’s the unknown. You know, they’re scared. They don’t -- they don’t know what it is or what they’re gonna have to do”
(13)
“The fear of technology. It was technology with this population for sure. I don’t know how -- I can’t even use my phone.”
(9)
Low technological literacy
“So they don’t really understand when I say email, link, application, so they just don’t have the knowledge base for that”
(6)
“Then sometimes they have to scroll to get down to the connect button, which is also really hard because some of them don’t just never use technology, so they don’t know what it means to scroll and if it’s not on the screen they’re like it’s not there, there’s no connect button”
(19)
“Don’t know how to flip the camera on their phone, you know, to the opposite side”
(16)
Cognitive impairment
“Some of these older Veterans they just struggle, you know, cognitive deficits, to even know to push the green button”
(13)
“A Veteran with like let’s say ALS or end-stage MS, TBI, they almost always have someone with them, a caretaker. Someone who’s cognitively impaired, late-stage Alzheimer, they always have someone with them”
(21)
Sensory impairments
“I have someone who is legally blind… then for sure the family member is there”
(11)
Impact of mental health conditions
“Most of them are 50 and older. They have schizophrenia, bipolar disorder, schizoaffective disorder, major depression and chronic PTSD. So, a lot of them will have executive functioning impairment associated with those diagnoses”
(19)
“Veterans with high anxiety or PTSD and extra stress, and they would just become nonfunctional trying to connect sometimes to these appointments, and they would tell me, sorry. I can’t do this because it got too stressful for them”
(21)
Physical impairments
“VA started handing out those iPads to these people for the Video-to-Home, so anyway she would set him all up and everything, you know, and he couldn’t use one arm hardly but he would just use his hand”
(12)
“And of course for my severely disabled veterans they have a caregiver present anyway. And so that person is going to be the one that holds the camera, the phone, the tablet”
(20)
Caregiver Participation in Video Telehealth
Technological Tasks Exemplar Quote (Participant Number)
Technological set-up
“I’ve had to work with a veteran to work with his son to establish a g-mail email account just so he can facilitate or get back into CIH approaches in groups”
(5)
“Some family members are really great or even the home health aide, what they’ll do is they’ll put the passcode in for them and click on the application and then they just let them sit and do the video visit”
(8)
Camera operation and angling
“Typically they’ll sometimes hold up the phone so that way the Veteran -- that way it’s not -- because it’s such a small screen so they can hold it closer and then we can get an idea”
(8)
“Like I have one veteran, his wife will hold the camera or angle the laptop, or you know, fix it so I can see his hands or whatever while we’re doin’ the exercise which is -- which is very helpful”
(10)
Clinical Tasks Exemplar Quote (Participant Number)
Assisting with communication
“A lot of the caregivers, I have that are there, they’re out of the picture but they’re there either to guide them because we have cognitive issues and one of the main reasons is because they can’t hear. So, they’re translating”
(9)
“We have a couple that are really hard of hearing so sometimes that caregiver has to be there just to reiterate the question to the Veteran and that does happen”
(8)
Assisting with safety
“I have somebody there whether it’s a caregiver or somebody that’s gonna have additional hands or kind of provide that care or are gonna be actively active -- do things and kind of maneuver him walk around the home, using a wheelchair for like a safety factor is there. So that extra pair of hands or the extra eyes”
(17)
“They would walk next to the veteran as he or she would ambulate through the house, make sure they were safe, or if they needed to rest”
(22)
Benefits of Caregiver Participation
Benefits Exemplar Quote (Participant Number)
Caregiver involvement in care
“Chiming in when the veteran isn’t maybe giving you a clear picture of things or, you know, telling me the specific problems, you know, like, oh, we can’t get his legs up in the bed or he’s having trouble here when he gets out of the tub”
(25)
“Someone in fact earlier today described it almost like the coaching model of, like you described, co-opting the caregiver into the session is going to make it easier to translate that learning when you leave, right. Like this is how you’re gonna help him transfer, or this is how you want him to be aware of, I don’t know his tendency to fall”
(11)
Barriers to Caregiver Participation
Barriers Exemplar Quote (Participant Number)
Lack of available caregiver
“He would only reach a certain limit on the range of the motion. Okay. And so that is why I went ahead and discharged him from VVC, is because we were going over the same things over and over and over because he was there by himself. So I could not have him -- I could not challenge him. I got so far and I couldn’t challenge him because he didn’t have anyone there to help him”
(22)
“I would say, unfortunately, most of our veterans don’t have support like that. You know we’re working with the – with the individuals who are most severely mentally ill, so a lot of them don’t have support in their lives, unfortunately. Some of them live in group homes but even those situations we haven’t been able to get staff help cause the staff are just overwhelmed and busy”
(19)
Caregivers’ own challenges with technology
“Especially if it’s a spouse. I’ve found that that can be, because they’re the same age, they have similar technological -- they’re just scared of it more than anything”
(8)
“Sometimes it’s simply they’re moving too fast, which happens a lot with the -- on the Veterans side if they’re running it, they move too fast and the picture can’t keep up”
(21)
“Usually, when a family member’s doing it, you might be looking at the ground for a while or up someone’s nose”
(13)
Privacy
“Because we’re on video if, you know, in a group with other veterans we have to maintain privacy”
(23)
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Note. ALS = amyotrophic lateral sclerosis; MS = multiple sclerosis; TBI = traumatic brain injury; BD = bipolar disorder; PTSD = posttraumatic stress disorder; VA = Veterans Affairs; CIH = complementary and integrative health; VVC = VA video connect; HUD VASH = Housing and Urban Development – Veterans Affairs Supported Housing

Caregiver Participation Enabling Patient Access of Video Telehealth

Findings revealed that caregiver involvement allowed patients who otherwise might not be able to participate in video telehealth to do so. Some patient challenges to participation in telehealth that caregiver involvement helped remediate were technological in nature. OT interview participants recounted that some patients experienced fear or hesitancy around technology or lacked technological experience. According to interviews, patients may also lack knowledge about their devices (e.g., whether their phone was a smartphone). Some reported technological challenges were specific to the VA-approved, HIPAA-compliant videoconferencing app, VA Video Connect (VVC), which in some instances requires accessing a unique visit link via email and entering personal details and a passcode. Additional steps required for video telehealth, such as enabling and positioning the camera and activating a microphone, were perceived challenges for patients with less experience with technology. Patient difficulty was exacerbated by technological failures (e.g., difficulty connecting, audio lag), which often necessitated troubleshooting by the OT practitioner. Myriad technological challenges influenced the need for caregiver involvement.

Beyond technical challenges, impairments related to patients’ health and age-related conditions appeared to influence caregiver participation in video telehealth. Cognitive changes, which were described as either due to normal aging or associated with specific health conditions (e.g., dementia), negatively affected patients’ ability to navigate video telehealth. Patients’ sensory challenges, such as vision loss and hearing impairment, also necessitated caregiver assistance. Several participants also discussed the negative impact of mental health conditions, such as bipolar disorder, anxiety, posttraumatic stress disorder, schizophrenia, and related impairments to executive function, stress, and frustration, as limiting patients’ capacity to log in and connect to the video visit. Physical impairments, such as fall risk, upper extremity paralysis, and chronic pain, also limited patients’ ability to physically maneuver the video-enabled device, thereby contributing to caregiver participation.

Varying Caregiver Participation in Video Telehealth

Interview data revealed that caregivers participate to varying degrees, assisting with technological and clinical aspects of video telehealth OT sessions. Related to technological assistance, caregivers were described as often helping with the initial set-up of video telehealth appointments, including establishing and accessing an email account (which many patients previously did not have) and entering a passcode. Sometimes caregiver involvement was limited to aiding with technology set-up, whereas in other instances, caregivers stayed to participate in the session. Regarding the caregiver role, although caregivers were most often described as patients’ family members (mainly spouses or adult children), it was not unusual for paid caregivers to be mentioned as assisting with technology on the patient side. In general, caregivers were described as more technologically fluent than patients.

In addition to assisting with technological tasks, participants reported that caregivers assisted with clinical aspects of video telehealth, such as aiding with communication and data gathering during evaluation. Caregivers remediated patient hearing loss and cognitive impairment by repeating or rephrasing clinician questions and information to the patient. Caregivers also reportedly took direction from clinicians on how to position the device to optimize the field of view of the environment and/or patient to guide evaluation or intervention. This assistance positioning the device was particularly relevant for home safety evaluations, for which caregivers also assisted by taking measurements. These more clinical support tasks during video telehealth were described as often involving caregivers maneuvering around the home so that the clinician could assess multiple rooms while following detailed instructions. Caregivers were also described as helping ensure patient safety and mitigate fall risks during sessions through supervision, particularly during walking or exercise interventions.

Benefits of Caregiver Participation in Video Telehealth

Caregiver involvement in video telehealth resulted in several perceived ancillary benefits to care provision. According to interviews, caregiver assistance with the technological aspects (e.g., operating the camera) afforded clinicians a more comprehensive view of the home, providing helpful contextual information. Similarly, caregiver assistance with communication during video telehealth, relaying or repeating information to the patient, fostered patient participation. Caregiver presence during sessions allowed clinicians to gather clinical information on patient function, as when caregivers provided proxy report. This enhanced clinical picture was a benefit of caregiver involvement in video telehealth. Caregiver presence during video also increased caregivers’ ability to take a more active role in care, particularly for sessions in which education or training related to implementing a care plan was provided.

Barriers to Caregiver Participation

Not every patient has a caregiver to assist them, which reportedly reduced patient access to video telehealth. According to OT practitioner interviews, lack of available caregivers was sometimes due to a general absence of social support. At other times, lack of caregivers to assist was a consequence of patients’ mental health conditions, which caused social isolation, particularly in late life. Similarly, lack of a caregiver could be a consequence of patient homelessness. Caregivers were also at times unable to assist because of COVID-19 restrictions, with concerns about transmission limiting their ability to go into patients’ homes to help.

Some caregivers themselves reportedly had challenges with video telehealth, were hesitant to try, or were nervous about technology. According to interviews, overcoming these challenges required finesse in the way the clinician communicated with the caregiver, such as by providing encouragement. Some caregivers also struggled with clinical tasks, such as taking measurements, requiring clinicians to provide training and education to the caregiver in addition to the patient. Similarly, some caregivers struggled with camera work (e.g., moving the camera too quickly, aiming the camera in the wrong direction), which limited the clinician’s view. Lastly, sometimes caregiver involvement had negative effects, such as when the presence of family or other household members during group video telehealth sessions reduced patient privacy for other members of the group.

DISCUSSION

To our knowledge, this is the first study to examine the role of caregivers to support patient participation in video telehealth, underscoring caregivers’ vital role in ensuring access to care. We found that caregiver participation helped compensate for patient challenges with technology and age- or health-related impairments. This finding aligns with evidence highlighting the importance of caregiver involvement in video telehealth with older populations and those with cognitive impairment to remediate impairments, such as communication challenges (Bertoncello et al., 2018; Padala et al., 2020), which may be worse in video telehealth than in-person (Gately et al., 2021). Even after COVID-19 and the expansion of telehealth, digital divide issues, such as difficulty accessing broadband, persist for many older and rural adults, due to cost and limited infrastructure (Kakulla, 2021). Given that older adults are less likely to have broadband than their younger counterparts (Faverio, 2022), they may rely on family members for internet with broadband strength sufficient for video telehealth.

Our findings also revealed that caregivers perform a wide range of tasks during video telehealth, enhancing the literature about what caregivers do during sessions. Although caregiver assistance with video telehealth technology has been reported elsewhere, specific to patients with dementia (Di Lorito et al., 2021; Yi et al., 2021), our findings show that caregiver involvement extends beyond technology to encompass clinical aspects of care. Caregiver participation in more clinical tasks, we found, enhanced patient care by allowing the clinician flexibility and range in the evaluation and intervention process. Although the enhanced value of video versus telephone has been highlighted (Moo, 2020), the specific clinical benefits of caregiver participation in video telehealth have not been well-documented. As involvement of family members in developing and carrying out intervention plans has been shown to improve patient outcomes (Fiest et al., 2018; Rodakowski et al., 2017), caregiver participation in video telehealth may have similar advantages to patients. This is an area worthy of further study.

Conversely, we found that the absence of a caregiver, whether due to serious mental illness, social isolation, or being unhoused, may limit patient access to video telehealth, thereby contributing to health disparities. This finding aligns with evidence for challenges by patients with serious mental illness accessing video telehealth during the COVID-19 pandemic (Talley et al., 2021), which resulted in reliance on telephone (Rosen et al., 2021). Although better than nothing, telephone care is limited, especially for highly hands-on specialties, such as OT and nursing. The current study also highlights that social isolation, which may be exacerbated by changing demographics, such as families being geographically spread out and juggling multiple responsibilities (Beadle et al., 2022), may limit patients’ ability to access video telehealth. COVID-19 spotlighted these concerns, in that even when families were available to assist, COVID-19 protocols restricted their ability to go into their loved ones’ homes (Lightfoot et al., 2021). Going forward, creative solutions for patients lacking caregivers to assist with video telehealth may be needed. These solutions may involve incorporating volunteer or peer support community-based models or tapping into the cohort of in-home paid care staff, such as home health aides, who reportedly use communication technology at similar rates to unpaid caregivers (Lee et al., 2022).

We also found that caregivers may themselves have difficulty with video telehealth. Caregivers of any age can have difficulty with technology and may need training to use video telehealth (Casillas et al., 2020; Gately et al., 2021; Lyu et al., 2022). In addition, caregivers may be called on to act as clinician extenders during video telehealth, which can pose unique challenges. Some of the tasks clinicians may ask caregivers to assist with, such as taking measurements during a home safety evaluation, can be complex (Gately et al., 2020), requiring thoughtful integration to avoid increased caregiver burden and burn-out. Further, caregivers with their own health- or age-related challenges may be limited in what they can do during video telehealth, particularly when it comes to providing hands-on support. Caregivers cannot do it all, and caregiver assistance with clinical tasks may require specialized training or education.

LIMITATIONS

Our high enrollment rate may reflect response bias, in that though we informed participants they were under no obligation to participate, they may have felt pressured to enroll. In addition, VHA has unique features, such as longstanding reimbursement for telehealth and existing telehealth infrastructure. These features may limit generalizability beyond VHA.

CLINICAL NURSING IMPLICATIONS

Given the growing aging population and projected increase in multiple complex chronic conditions, video telehealth is increasingly relevant for delivery of clinical services ranging from nursing and primary care to specialty services, such as OT. Clinical services, such as nursing and rehabilitation, involve a comprehensive evaluation process that may necessitate caregiver involvement with not just technological but also clinical tasks. Nurses frequently partner with caregivers during the evaluation process and to carry out treatment plans, such as ensuring proper use of a new medication. Although this relationship between nursing staff and caregivers is established, strategies to effectively partner with caregivers during video telehealth are not well-known. Identifying caregivers’ capacity for participation in video telehealth and attending to their unique concerns before and during video telehealth will increase the probability for success.

CONCLUSION

This is the first study to examine in detail caregiver participation in video telehealth. Future work should clarify the prevalence of caregiver involvement in video telehealth, as this information is not currently being systematically measured. More work is also needed to identify considerations for specific subsets of caregivers, such as older caregivers and those whose loved one has certain health conditions (e.g., serious mental illness, cognitive impairment), to tailor strategies to enable them to support those patients in accessing video telehealth.

Funding:

This work is the result of work supported in part by resources and the use of facilities at the United States Veterans Health Administration, including the VA Office of Rural Health and the New England Geriatric Research Education and Clinical Center. The contents do not represent the views of VA or the United States Government.

Footnotes

Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Contributor Information

Megan E. Gately, VA Bedford Healthcare System, New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts.

Dylan Waller, VA Portland Healthcare System, Center to Improve Veteran Involvement in Care, Portland, Oregon.

Emily E. Metcalf, VA Bedford Healthcare System, New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts.

Lauren R. Moo, VA Bedford Healthcare System, New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts; Massachusetts General Hospital, Cognitive Behavioral Neurology Unit, Boston Massachusetts; Harvard Medical School, Boston Massachusetts.

REFERENCES

  1. Alexander NB, Phillips K, Wagner-Felkey J, Chan C-L, Hogikyan R, Sciaky A, & Cigolle C (2021). Team VA Video Connect (VVC) to optimize mobility and physical activity in post-hospital discharge older veterans: Baseline assessment. BMC Geriatrics, 21(1), 502. 10.1186/s12877-021-02454-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. American Nurses Association. (2019). ANA core principles on connected health. https://www.nursingworld.org/~4a9307/globalassets/docs/ana/practice/ana-core-principles-on-connected-health.pdf
  3. American Occupational Therapy Association. (2020). 2019 workforce & salary survey. https://library.aota.org/AOTA-Workforce-Salary-Survey-2019/
  4. Beadle JN, Gifford A, & Heller A (2022). A narrative review of loneliness and brain health in older adults: Implications of COVID-19. Current Behavioral Neuroscience Reports, 9, 1–11. 10.1007/s40473-021-00237-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bertoncello C, Colucci M, Baldovin T, Buja A, & Baldo V (2018). How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews. PLoS One, 13(11), e0207332. 10.1371/journal.pone.0207332 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brim B, Fromhold S, & Blaney S (2021). Older adults’ self-reported barriers to aging in place. Journal of Applied Gerontology, 40(12), 1678–1686. 10.1177/0733464820988800 [DOI] [PubMed] [Google Scholar]
  7. Casillas A, Cemballi AG, Abhat A, Lemberg M, Portz JD, Sadasivaiah S, Ratanawongsa N, Semere W, Brown A, & Lyles CR (2020). An untapped potential in primary care: Semi-structured interviews with clinicians on how patient portals will work for caregivers in the safety net. Journal of Medical Internet Research, 22(7), e18466. 10.2196/18466 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cason J, Hartmann K, Jacobs K, & Richmond T (2018). AOTA position paper—Telehealth in occupational therapy. The American Journal of Occupational Therapy, 72(Suppl. 2), 18. [Google Scholar]
  9. Di Lorito C, Duff C, Rogers C, Tuxworth J, Bell J, Fothergill R, Wilkinson L, Bosco A, Howe L, O’Brien R, Godfrey M, Dunlop M, van der Wardt V, Booth V, Logan P, Cowley A, & Harwood RH (2021). Tele-rehabilitation for people with dementia during the COVID-19 pandemic: A case-study from England. International Journal of Environmental Research and Public Health, 18(1717). 10.3390/ijerph18041717 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Faverio M (2022). Share of those 65 and older who are tech users has grown in the past decade. Pew Research Center. https://pewrsr.ch/3HZd2ao [Google Scholar]
  11. Fiest KM, McIntosh CJ, Demiantschuk D, Leigh JP, & Stelfox HT (2018). Translating evidence to patient care through caregivers: A systematic review of caregiver-mediated interventions. BMC Medicine, 16(1), 105. 10.1186/s12916-018-1097-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gately ME, Tickle-Degnen L, McLaren JE, Ward N, Ladin K, & Moo LR (2021). Factors influencing barriers and facilitators to in-home video telehealth for dementia management. Clinical Gerontologist, 45, 1020–1033. 10.1080/07317115.2021.1930316 [DOI] [PubMed] [Google Scholar]
  13. Gately ME, Tickle-Degnen L, Trudeau SA, Ward N, Ladin K, & Moo LR (2020). Caregiver satisfaction with a video telehealth home safety evaluation for dementia. International Journal of Telerehabilitation, 12(2), 35–42. 10.5195/ijt.2020.6337 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hemmler VL, Kenney AW, Langley SD, Callahan CM, Gubbins EJ, & Holder S (2022). Beyond a coefficient: An interactive process for achieving inter-rater consistency in qualitative coding. Qualitative Research, 22(2), 194–219. 10.1177/1468794120976072 [DOI] [Google Scholar]
  15. Hsieh H-F, & Shannon SE (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. 10.1177/1049732305276687 [DOI] [PubMed] [Google Scholar]
  16. Kakulla B (2021). 2021 Tech trends and the 50-plus: Top 10 biggest trends. AARP Research. 10.26419/res.00420.001 [DOI] [Google Scholar]
  17. Lee S, Ory MG, Dahlke DV, & Smith ML (2022). Social support, sense of belonging, and communication technology use among paid and unpaid caregivers of middle-aged and older adults. Frontiers in Public Health, 10, 898042. 10.3389/fpubh.2022.898042 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lightfoot E, Yun H, Moone R, Otis J, Suleiman K, Turck K, & Kutzler C (2021). Changes to family caregiving of older adults and adults with disabilities during COVID-19. Gerontology & Geriatric Medicine, 7, 23337214211002404. 10.1177/23337214211002404 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lyu M, Zhao Q, Yang Y, Hao X, Qin Y, & Li K (2022). Benefits of and barriers to telehealth for the informal caregivers of elderly individuals in rural areas: A scoping review. Australian Journal of Rural Health, ajr.12869. 10.1111/ajr.12869 [DOI] [PubMed] [Google Scholar]
  20. Moo LR (2020). Home video visits: Two-dimensional view of the geriatric 5 M’s. Journal of the American Geriatrics Society, 68(11), 2425–2427. 10.1111/jgs.16843 [DOI] [PubMed] [Google Scholar]
  21. National Council of State Boards of Nursing. (2014). The NCSBN position paper on telehealth nurse practice. https://www.ncsbn.org/3847.htm
  22. Padala KP, Wilson KB, Gauss CH, Stovall JD, & Padala PR (2020). VA video connect for clinical care in older adults in a rural state during the COVID-19 pandemic: Cross-sectional study. Journal of Medical Internet Research, 22(9), e21561. 10.2196/21561 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rodakowski J, Rocco PB, Ortiz M, Folb B, Schulz R, Morton SC, Leathers SC, Hu L, & James AE III. (2017). Caregiver integration during discharge planning for older adults to reduce resource use: A meta-analysis. Journal of the American Geriatrics Society, 65(8), 1748–1755. 10.1111/jgs.14873 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Rosen CS, Morland LA, Glassman LH, Marx BP, Weaver K, Smith CA, Pollack S, & Schnurr PP (2021). Virtual mental health care in the Veterans Health Administration’s immediate response to coronavirus disease-19. The American Psychologist, 76(1), 26–38. 10.1037/amp0000751 [DOI] [PubMed] [Google Scholar]
  25. Roytman GR, Coleman BC, Corcoran KL, Goertz CM, Long CR, & Lisi AJ (2021). Changes in the use of telehealth and face-to-face chiropractic care in the Department of Veterans Affairs before and after the COVID-19 pandemic. Journal of Manipulative and Physiological Therapeutics, 44(7), 584–590. 10.1016/j.jmpt.2021.12.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rutledge CM, & Gustin T (2021). Preparing nurses for roles in telehealth: Now is the time! The Online Journal of Issues in Nursing, 26(No. 1, Manuscript 3). 10.3912/OJIN.Vol26No01Man03 [DOI] [Google Scholar]
  27. Schwartz AW, Driver JA, Pollara LM, Roefaro J, Harrington MB, Charness ME, & Skarf LM (2022). Increasing telehealth visits for older veterans associated with decreased no-show rate in a geriatrics consultation clinic. Journal of General Internal Medicine. Advance online publication. 10.1007/s11606-022-07598-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Talley RM, Brunette MF, Adler DA, Dixon LB, Berlant J, Erlich MD, Goldman B, First MB, Koh S, Oslin DW, & Siris SG (2021). Telehealth and the community SMI population: Reflections on the disrupter experience of COVID-19. The Journal of Nervous and Mental Disease, 209(1), 49–53. 10.1097/NMD.0000000000001254 [DOI] [PubMed] [Google Scholar]
  29. Yi JS, Pittman CA, Price CL, Nieman CL, & Oh ES (2021). Telemedicine and dementia care: A systematic review of barriers and facilitators. Journal of the American Medical Directors Association, 22(7), 1396–1402.e18. 10.1016/j.jamda.2021.03.015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Zulman DM, Wong EP, Slightam C, Gregory A, Jacobs JC, Kimerling R, Blonigen DM, Peters J, & Heyworth L (2019). Making connections: Nationwide implementation of video telehealth tablets to address access barriers in veterans. JAMIA Open, 2(3), 323–329. 10.1093/jamiaopen/ooz024 [DOI] [PMC free article] [PubMed] [Google Scholar]

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