In the wake of the COVID-19 pandemic, the healthcare landscape underwent profound transformations, with telehealth emerging as a pivotal tool for delivering medical services remotely. One sector that rapidly assimilated telehealth innovations was home healthcare, a field already burgeoning due to demographic shifts toward an aging population seeking alternatives to institutional care. However, despite initial enthusiasm and widespread adoption during the pandemic, recent findings from a comprehensive national survey reveal a concerning reversal in the use of telehealth services among home healthcare agencies. This study, spearheaded by researchers at the University of California, Irvine, together with collaborators from leading institutions such as UCLA, Brown University, and the University of Minnesota, sheds critical light on the trajectory of telehealth within home care environments before, during, and after the COVID-19 crisis.
The impetus for integrating telehealth into home healthcare was clear: the sudden necessity to reduce viral transmission risk, combined with acute shortages in staffing and medical equipment, made virtual visits a practical solution. According to the study, prior to the pandemic in 2019, only 23 percent of home healthcare agencies employed telehealth technologies, reflecting cautious or limited adoption. As the pandemic escalated, this figure dramatically rose to 65 percent by 2021, underscoring telehealth’s role as a vital intervention under crisis conditions. Yet, this adoption was not uniform nor unconditional; underlying challenges surfaced as the sector grappled with technological suitability and reimbursement policies that significantly influenced sustainability.
Central to the study’s findings is the issue of federal reimbursement, or rather its absence. The Centers for Medicare & Medicaid Services (CMS) notably did not provide reimbursement for telehealth services administered by home healthcare agencies, even as such services became integral during the pandemic. This reimbursement lacuna contributed to a growing disenchantment among providers, with 19 percent of those agencies that initially adopted telehealth discontinuing its use by 2024. The lack of financial incentives undermined the feasibility of continuing telehealth services, forcing agencies to weigh cost against care quality and practicality in a challenging operational context.
Technological suitability emerged as another decisive factor hindering the sustained implementation of telehealth. Home healthcare patients are predominantly older adults, many living with cognitive impairments such as dementia—a demographic particularly representative in the surveyed agencies, which reported an average of 33 percent of their clients having dementia. The study highlights that telehealth systems often clash with patients’ technological literacy, accessibility, and comfort levels, making virtual visits less effective or acceptable in certain home healthcare settings. These usability concerns intersect with clinical appropriateness, as home healthcare commonly requires hands-on, personalized care challenging to replicate through digital interfaces.
The trajectory of telehealth adoption and abandonment reveals a complex diffusion pattern disrupted by the pandemic. Data indicate a pre-pandemic upward trend in adoption, exemplified by the 23 percent uptake in 2019, which was rapidly accelerated by emergency response needs. However, this acceleration arguably outpaced agencies’ preparedness and structural capacity to embed telehealth sustainably. The subsequent partial retreat—reflected in the 19 percent discontinuation—reflects systemic barriers including inadequate policy frameworks, reimbursement mechanisms, and mismatch between technology and patient needs.
Delving deeper, the survey identified specific telehealth modalities and their respective adoption trends. Virtual visits accounted for the most significant surge in use during 2020, reaching 21.1 percent adoption, yet by around 2022, 22 percent of these users discontinued the practice. The report emphasizes that among those discontinuing virtual visits, a majority cited concerns regarding patient suitability, while a substantial proportion pointed to cost burdens and absence of reimbursement as primary obstacles. Complementary technologies such as remote patient monitoring and digital client feedback mechanisms experienced smaller increases in use and mirrored the tendency toward discontinuation, suggesting broader systemic issues rather than problems isolated to specific telehealth tools.
Importantly, the research underlines critical policy implications for CMS and other federal bodies responsible for regulating and funding home healthcare services. Without adjusting reimbursement policies to include telehealth adequately, providers risk abandoning innovative care models instrumental to managing increased demand and complexity. The growing older adult population, coupled with the preference for home-based care over institutional settings, signals an urgent need for sustainable frameworks that incentivize continued telehealth integration, optimize patient outcomes, and balance cost containment.
Parallel to policy reform, the study advocates for rigorous, empirical evaluations of telehealth’s cost-effectiveness and clinical impact within home healthcare contexts. Such data are essential to justify funding allocations and to tailor technologies to the unique needs of older, cognitively impaired patients. The research community and healthcare stakeholders must collaborate to develop adaptable telehealth solutions compatible with diverse care requirements and patient capabilities, ensuring equitable access and safeguarding quality.
The survey results also reveal a substantial subset of home healthcare agencies (33 percent) that never adopted telehealth, even amid the pandemic pressures. These agencies often expressed skepticism regarding telehealth’s compatibility with the traditionally hands-on model that defines home care. This reticence signals potential segmentation within the industry where differing perceptions of telehealth’s value and feasibility could fragment care approaches, thereby complicating broad-scale implementation strategies.
From a methodological standpoint, the study surveyed 791 home healthcare agencies between October 2023 and November 2024, achieving a response rate of 37 percent. The sample emphasized agencies serving dementia patients, a decision which, while strengthening insights into a particularly vulnerable population segment, invites further research to verify if observed trends generalize across non-dementia-focused home healthcare providers. The analysis leverages longitudinal data to comprehend not only adoption rates but also discontinuation rationales, providing a nuanced picture of telehealth’s evolving role.
This research contributes substantially to the discourse on digital transformation in healthcare by mapping how external shocks like a global pandemic catalyze, yet simultaneously challenge, the integration of emergent technologies. The findings prompt reconsideration of how telehealth is conceptualized—not merely as a temporary crisis response but as a fundamental component of future care paradigms requiring supportive infrastructure, tailored technology design, and adaptive reimbursement policies.
As policy makers confront burgeoning home healthcare demands fueled by population aging and chronic disease prevalence, the study underscores telehealth’s potential both as a facilitator of improved access and a mechanism for controlling costs. Yet, realizing this potential depends on reconciling divergent stakeholder needs, overcoming technological and reimbursement barriers, and ensuring telehealth tools serve the unique characteristics of home healthcare populations, particularly older adults with cognitive impairments.
In summary, this groundbreaking national survey offers a comprehensive lens on telehealth’s lifecycle in home healthcare: from embryonic adoption through pandemic-induced acceleration, to a partial contraction shaped by systemic hurdles. The research serves as a critical resource for health policy architects, providers, and technology developers striving to harness digital innovations in the service of sustainable, patient-centered home healthcare delivery. Without deliberate policy action and targeted research, the promising telehealth momentum risked during the pandemic may dissipate, unsettling care continuity for a rapidly growing vulnerable population.
Subject of Research: Telehealth adoption and discontinuation trends among home healthcare agencies before, during, and after the COVID-19 pandemic.
Article Title: Telehealth Use by Home Health Agencies Before, During, and After COVID-19
News Publication Date: May 28, 2025
Web References:
https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.14645
References:
Study conducted by researchers at University of California, Irvine; UCLA; Brown University; University of Minnesota.
Keywords:
Health care, telehealth, home healthcare, COVID-19 pandemic, Medicare reimbursement, dementia patients, virtual visits, remote patient monitoring, aging population, health policy, digital health technologies, care delivery.
