COVID-19, Telehealth and Access to Care

*Charles M. Lepkowsky*

## **Abstract**

Telehealth has become increasingly prominent during the COVID-19 pandemic, highlighting limitations in access to care for older adults less fluent in information technology (IT). Although the 20 percent disparity in IT use between younger and older adult cohorts remains unchanged over several decades, insurers, institutional and independent providers of health care have made increasing use of IT for patient communication. Data demonstrate an age-related decline in the frequency of IT use for accessing health care. Restrictions on reimbursement for the use of the telephone for accessing health care during the COVID-19 pandemic are discussed as a barrier to access to care. Recommendations are made for assessment of media most available to older adults for accessing health care, as well as providing funding to support increased access to care.

**Keywords:** COVID-19, older adults, access to health care, information technology (IT), FACETS

### **1. Introduction**

The COVID-19 virus (SARS-CoV-2) was first identified in December of 2019 [1]. COVID-19 spread rapidly, and by the end of January 2020, the World Health Organization (WHO) had officially labeled the COVID-19 outbreak a pandemic [2]. At risk populations were soon identified, including older adults [3–6]. In an effort to contain the growth of the contagion, in early 2020 shelter in place practices were adopted in many countries, forcing the closure of routine businesses including schools, restaurants, and outpatient healthcare facilities [7–11]. Patient care rapidly shifted to virtual contact using telehealth platforms including internet-based videoconferencing software [12]. In the United States (US), the Center for Medicare and Medicaid Services (CMS) made changes liberalizing standards allowing reimbursement for videoconferencing telehealth, increasing access to care [13, 14]. However, the rapid shift to telehealth brought to the forefront an access to care issue that had been simmering for some time: compared with younger age cohorts, most adults over the age of 65 make limited use of information technology (IT) [15–18]. The intersection of the rapid growth of telehealth, age-related declines in IT utilization, and access to care is a growing area of concern for the health care systems with strong implications for the future of healthcare delivery.
