Contributor: Maya Dakessian, Doctor of Pharmacy Candidate, University of Rhode Island
Initially fueled by the pandemic, the world has seen a large increase in the number of patients “aging in place” in the comfort of their own homes.1A survey conducted by AARP demonstrated that most Americans are able to stay healthy and connected to their communities, avoiding having to move into a long-term care (LTC) environment.2 The switch from LTC facilities to at-home services has opened the door to a multitude of challenges for pharmacies in defining LTC.
Underappreciation of LTC Pharmacists: From a Care Team and Payer Perspective
The pandemic and subsequent increase in patients aging at home has highlighted the role of a pharmacist as a key player on the LTC team, yet they are still undervalued by many. Pharmacists in LTC settings have a myriad of responsibilities ranging from monitoring of conditions to medication management. Understanding the role of a pharmacist will help increase awareness of their worth and, in turn, may increase their value deemed from payers. Many pharmacies providing LTC services are still not classified or reimbursed for their level of service, as payment models are based on patient location, not service provided. Many pharmacies offer delivery of prescriptions by mail or courier and are labeled as a mail-order pharmacy despite the fact that they often facilitate delivery services face-to-face and provide additional services. In 2018, medicare advised payers to review the magnitude of the pharmacy’s services before classifying them as a retail or mail-order pharmacy.4 Over the years, there has been a push to define LTC in a way that acknowledges current pharmacists’ level of involvement, especially now in an at-home setting.
Defining LTC — Long-Term Care Definition Act of 2021
The Long-Term Care Definition Act of 2021 sought to clarify the regulatory framework of LTC pharmacies.3 This act defined LTC pharmacy as “a pharmacy licensed under applicable state law that is able to provide enhanced pharmacy and clinical services and reside in a facility.”4 Enhanced pharmacy and clinical services that were defined in this act included medications requiring specialized packaging, medication reconciliation services and other necessary clinical management, drug utilization review, emergency supplies of medication, and 24/seven availability of medication delivery and pharmacist clinical services. LTC reimbursement needs to be defined by the service they provide, not their location of facility. In paragraph four of the LTC Definition Act, facility is defined as those previously defined in section 1819(a), 1919(a), and 1905(d), as well as “any other setting in which individuals who require enhanced medication services reside as determined by the Secretary.”4 There is still a need to highlight and incorporate at-home services in this definition.
Technological Advances Needed to Support Patients at Home
As many are opting to age at home, technological advancements are needed to support the change in trends. Pharmacies, including LTC and retail-LTC combination pharmacies, have the opportunity to break into a new market by providing LTC services to those at home. In order to serve these patients, pharmacies will now have to include newer delivery care models, adherence tactics, and monitoring strategies to ensure the at-home lifestyle is conducive to proper management of conditions and medications.7
Many home apps have been created to assist the elderly with communication with caregivers and providers as well as management of medications. Apps including Jointly and Remind Me Care are available to assist with communication about an individual’s care, providing families and caregivers with the ability to create group messages, share calendars, and provide to-do lists and medication updates.5 There are also various apps available, including Medisafe Pill Reminder and Dosecast, that remind individuals to take their medications at the right time every day.6 If daily reminders fail to improve adherence, there are also pill dispensers available that essentially mimic an eMAR system, dispensing the medication and documenting doses taken daily. Additionally, as these patients may be alone at times or the majority of the time, there are also apps and panic buttons available to ensure that they receive the help that they need in an emergency.3
Telehealth and remote monitoring have become increasingly common as a healthcare option. In the LTC setting, there are numerous conditions and medications that can be monitored remotely. Using blood pressure monitors, blood glucose meters, pulse oximeters, and weight scales, healthcare professionals can now manage disease states including hypertension, diabetes, weight loss/gain, heart conditions, sleep apnea, COPD, and asthma.7 Living in a technologically advanced world, pharmacies should take advantage of this opportunity to make patient monitoring easier, and more frequent. For example, the European Heart Journal introduced using a scale that sends patient weights to healthcare providers to alter lasix dosing in heart failure.8
As for delivery care models, having the ability to contact patients for timely and monitored delivery of medications is imperative to providing at-home services. As there are many specialty medications given in this setting, pharmacies need to ensure that medications are packaged and stored at proper temperatures in order to be delivered. These settings should consider integrating software that calculates the most efficient driver routes and updates patients with the status of their medication.
Future of LTC
The decrease in the number of patients in LTC facilities and increase in those aging at home will likely be the new normal. To prepare for the heavier workload expected, LTC pharmacies will need to implement newer measures to support the monitoring and management of these patients. Taking advantage of the new advancements in technology through new apps as well as delivery software, remote monitoring, and adherence strategies will increase the efficacy of patient monitoring. By staying ahead of trends, LTC pharmacies will be able to operate and serve patients comparably to those that they serve in person at facilities.
1. https://www.nia.nih.gov/health/aging-place-growing-older-home
2. https://www.healthline.com/health/aging-in-place#concerns
3. https://seniorcarepharmacies.org/senate-introduces-long-term-care-pharmacy-definition-act-of-2021
4. https://www.congress.gov/bill/117th-congress/senate-bill/1574
5. https://www.agespace.org/tech/home-care-apps-technology
6. https://www.goodrx.com/healthcare-access/medication-education/medication-reminder-apps
7. https://telehealth.hhs.gov/providers/preparing-patients-for-telehealth/telehealth-and-remote-patient-monitoring
8. https://academic.oup.com/ehjdh/article/2/3/487/6259087
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Long-Term Care Pharmacy Resources
