This is a common sentiment I hear among clients I’ve worked with during my near decade as a telehealth based licensed clinical social worker and therapist specializing in chronic illness support.
People who live with chronic illness often feel forgotten, lonely and isolated. In 2023, the US Surgeon General declared Loneliness an epidemic. The report declared that studies found ‘the highest prevalence for loneliness and isolation among people with poor physical or mental health, disabilities, financial insecurity..’ as well as ‘..individuals from ethnic and racial minority groups, LGBTQ+ individuals, rural residents, victims of domestic violence, and those who experience discrimination or marginalization.’ In other words, among those who experience loneliness, these individuals experience it disproportionately more.
For people with limited mobility their illness can be isolating. Mental health care specifically, makes a world of difference in their lives. For some, a therapist they talk with for an hour is the only person in their lives they feel they can talk openly with about their medical problems, while getting instrumental support around how to manage a chronic disease. For others, it helps the often common depression and anxiety elicited by the many demands life with chronic illness and disability throws at them. Many who have experienced traumatic medical events, utilize this care to help work through their fear of going back into another medical setting. Telemental health care is life changing for people who are sick.
Before the pandemic, Medicare required me to see clients in person. Back then, I lamented at the challenge it brought my clients who were disabled in ways that rendered them unable to leave their homes, often in need of higher levels of support. How could Medicare not see that by refusing to cover telehealth, the elderly and disabled, who are most likely to be utilizing Medicare in the first place, could be left unable to access mental health and other forms of medical care?
When the pandemic led to greater access to telehealth based care, I started observing clients accessing care who never would have been able to before. I saw clients, for example, with severe and progressive neurological conditions, immunocompromised clients, clients undergoing cancer treatment, clients with long covid, clients with chronic fatigue and other conditions that cause mobility issues. Moreover, I saw clients reporting accessing other types of medical care besides mental health, such as specialty care, psychiatric care and primary care, a sign of increased engagement in their overall health. Research supports my observation, showing that telehealth is associated with improvements in healthcare quality, particularly for chronic disease management and health engagement. Moreover, researchers have found that telehealth administers care in a way that can decrease feelings of social isolation, preventing the domino effect it has on exacerbating chronic health conditions.
This begs the obvious question, ‘Why are we restricting telehealth access for the individuals who need it most?’
Since the pandemic, mental health conditions remain the top telehealth diagnosis rising from 34-67%. People aged 65 and over are the most frequent telehealth users (43%), those of Medicare age, according to the CDC. Of people with chronic illness, during the pandemic an estimated 40% utilized telehealth. Considering that, according to the CDC, an estimated 133 million Americans or 42% of our population, have at least one chronic disease, it seems like common sense to increase access to telehealth, not restrict it.
What can we do?
At the end of this month, the telehealth protections continued from the pandemic are ending. What this means is Medicare recipients will no longer be able to access general telehealth based care. There is an exception for mental health, however continuing forward there will be an in-person requirement which still restricts access to care for the people who need it most.
As an insurance provider, I’ve also seen that other insurance companies follow Medicare’s lead in many ways, which means that for insurance beneficiaries, these restrictions could set a precedent resulting in wider restrictions impacting telehealth. I’d love to see every one of us fighting for expansion of this important access point to health care.
You can do this by writing or calling your representatives and urging them to expand and make permanent the telehealth access we’ve come to rely on, some more than others. Doctors and other medical providers can also advocate on behalf of patients and their families, sharing with politicians the positive impacts telehealth has had for their patients. If an in-person appointment is needed, the provider should be determining that, not politicians or the insurance company.
In the face of many divisive issues, this is one that we can and should all support.
Amanda Pratt, LCSW
Imagine Life Therapy
Sources:
https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
https://www.cdc.gov/nchs/products/databriefs/db445.htm
https://digital.sandiego.edu/dnp/113/