# Telehealth Use and the Quality of End-of-Life Care for Nursing Home Residents with Alzheimer's Disease and Alzheimer's Disease-Related Dementias

> **NIH NIH R01** · WEILL MEDICAL COLL OF CORNELL UNIV · 2024 · $858,870

## Abstract

PROJECT SUMMARY/ABSTRACT
Expanded Medicare coverage for telehealth services during the COVID-19 public health emergency (PHE) has
removed many of the barriers to telehealth provision in nursing homes (NHs). For NH residents with
Alzheimer's disease and Alzheimer's disease-related dementias (ADRD), who make up over 60 per cent of NH
residents, increased telehealth provision may allow more timely access to specialty care at the end of life
(EOL) and provide clinicians and caregivers with an important layer of audiovisual information to make
informed patient-centered decisions. However, EOL care is highly variable across NHs and there are
substantial disparities in the quality of EOL care associated with race/ethnicity and socioeconomic
disadvantage. For example, residents who are racial and ethnic minorities are less likely to complete advance
care planning and are more likely to die in a hospital. It is not clear how telehealth may impact these
disparities. Additionally, there may be unintended consequences and challenges of telehealth provision for
residents with ADRD. Over three years after the start of the PHE, the expansion and phase out of telehealth
flexibilities requires a careful evaluation of its capacity to impact the quality, utilization, and cost of care for NH
residents. The overall objectives of this study are to leverage the natural experiments surrounding changes in
Medicare telehealth benefits to examine changes in access to telehealth for NH residents with ADRD and in
the last 90 days of life. We will focus on the following specific aims to achieve these objectives: (1) To
characterize patterns of telehealth provision at the EOL for NH residents with ADRD, including the overall and
relative rates of telehealth to in-person services; (2) To evaluate the extent to which access to telehealth
mediates the relationship between resident race/ethnicity, dual-eligibility, and rurality of the NH, and the use of
specialized medical care at the EOL; and (3) To measure the relationship between telehealth provision and the
quality and cost of care at the EOL for NH residents with ADRD, overall and by race/ethnicity, dual-eligibility,
and rurality. This application is innovative because it leverages a quasi-experimental approach to estimate the
effect of telehealth use, with a focus on the extent to which telehealth may impact disparities in EOL care for
residents with ADRD. This project it will be the first to measure telehealth use in NHs for both Medicare FFS
beneficiaries and residents enrolled in MA, who constitute over 25% of long-stay NH residents. The proposed
research is significant because as coverage for many telehealth services are set to expire December 2024, this
study will shed light on the potential impacts of reducing access to telehealth for NH residents and individuals
with ADRD. This project will also importantly inform NIH goals for expanded research on the use and efficacy
of telehealth to improve the delivery of care for...

## Key facts

- **NIH application ID:** 10985247
- **Project number:** 1R01AG089702-01
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Jiani Yu
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $858,870
- **Award type:** 1
- **Project period:** 2024-09-15 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10985247

## Citation

> US National Institutes of Health, RePORTER application 10985247, Telehealth Use and the Quality of End-of-Life Care for Nursing Home Residents with Alzheimer's Disease and Alzheimer's Disease-Related Dementias (1R01AG089702-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10985247. Licensed CC0.

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