Telehealth adoption in skilled nursing facilities has doubled since 2023, with 78% of facilities now offering virtual care capabilities compared to 39% two years ago. The expansion, accelerated by pandemic-era regulatory flexibility that has been largely preserved, is transforming how nursing home residents access specialty care and reducing potentially avoidable hospital transfers.
Current State of Adoption
A survey by the American Health Care Association found that telehealth is now used for a wide range of clinical applications in SNFs. Psychiatric and behavioral health consultations lead adoption at 82% of facilities with telehealth, followed by primary care (74%), wound care (68%), and cardiology (61%). Newer applications including infectious disease consultation and dermatology are growing rapidly.
The technology infrastructure supporting telehealth has also matured. Most facilities have moved beyond basic video conferencing to integrated platforms that connect to electronic health records, support peripheral device data capture (vital signs, images), and facilitate care coordination with external providers.
Clinical Impact
Research published in JAMDA found that SNFs with robust telehealth programs experienced 18% fewer hospital transfers for conditions amenable to virtual consultation. The reduction was most pronounced for psychiatric emergencies, skin and wound complications, and medication-related issues that could be managed through remote physician guidance to on-site nursing staff.
Specialist access has improved significantly, particularly for rural facilities. Prior to telehealth expansion, residents in rural SNFs often waited weeks for specialty consultations or faced lengthy transportation to distant providers. Virtual consultations now provide same-day or next-day access to specialists for most non-emergent conditions.
Reimbursement Landscape
Medicare has permanently extended most pandemic-era telehealth flexibilities for SNF patients, allowing billing for a wide range of virtual services that were previously reimbursable only for in-person visits. The expansion of covered services and eligible provider types has made telehealth economically viable for facilities that previously viewed it as a cost center.
Medicaid telehealth policies vary by state, creating a patchwork that complicates implementation for multi-state operators. However, the trend is toward expansion, with 42 states now covering SNF telehealth services at parity with in-person rates.
Implementation Challenges
Despite high adoption rates, implementation quality varies widely. Common challenges include unreliable broadband connectivity, particularly in rural areas; staff training gaps that limit effective use of telehealth platforms; resident cognitive or sensory limitations that make virtual visits challenging; and workflow integration issues that create documentation burdens.
Facilities report that successful telehealth programs require dedicated staff time to coordinate visits, prepare patients, and facilitate communication between on-site and remote providers. Programs that treat telehealth as an add-on rather than an integrated care model often underperform.
Future Directions
The next wave of telehealth innovation focuses on remote patient monitoring (RPM) and AI-assisted clinical decision support. RPM devices that continuously track vital signs, weight, and activity levels can identify clinical deterioration before it becomes emergent, enabling proactive intervention. Several pilot programs are demonstrating 25-30% reductions in hospitalizations through integrated telehealth and RPM approaches.