How Telehealth Helps Family Caregivers Get Care Without Losing Work

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By Matthew Berrios, DO — Founder, DevotedDOc | Healthcare Technology and Policy | Addiction & Specialty virtual care

A woman in her fifties comes to the emergency department at eleven at night with chest pain that started three days earlier. She waited because her mother has dementia and there was no one else to sit with her. She has not had a primary care visit in four years. Her blood pressure is 178/102, and she tells me she knew it was high because she checks her mother’s cuff on herself sometimes.

I have had some version of that conversation hundreds of times. The father working two jobs who coordinates therapy for a son with autism. The husband driving his wife to chemotherapy three days a week who has not filled his own metformin in two months. The grandmother raising grandchildren who postponed a mammogram twice. The patient in recovery from opioid use disorder who is also the only person available to an aging parent, and cannot attend a treatment program and still be home.

These are not people who fail to value their health. Their health has been sorted to the bottom of a list that never gets that far.

The scale is larger than most clinicians appreciate. Caregiving in the U.S. 2025, released by AARP and the National Alliance for Caregiving in July 2025, found that 63 million Americans — nearly one in four adults — provided ongoing care for an adult or a child with a complex medical condition or disability in the previous year, a 45% increase since 2015 [1]. Caregivers provide an average of 27 hours of care per week, and 24% provide 40 or more. More than half now perform medical or nursing tasks such as wound care and injections, though only about 20% have any training to do so [2].

We have long asked these patients to solve an impossible scheduling problem: take a weekday off work, arrange coverage for the person who depends on you, drive across town, and sit in a waiting room — for care that could often be delivered another way. When they cannot, we document them as non-adherent.

The equation has changed, not for every clinical problem, but enough that the old tradeoff between your health, your family, and your job is no longer the only option.

Why Caregivers Delay Their Own Medical Care

When I ask why they waited, the answers are consistent and almost never about denial.

• Time is the binding constraint. An analysis of the American Time Use Survey found the average ambulatory visit consumes 121 minutes — 37 traveling, 84 in the clinic — of which only about 20 minutes is spent with a physician. The average opportunity cost per visit was $43, exceeding the average out-of-pocket cost of $32 [3]. For a caregiver, those two hours are subtracted directly from someone who needs supervision.
• Coverage is the second constraint. A person with dementia, a child with significant disability, or a spouse recovering from surgery cannot simply be left. Respite care is expensive, rarely available on short notice, and frequently not covered.
• Transportation compounds both. For caregivers in rural counties or without a reliable vehicle, one appointment can consume most of a day.
• Lost wages are real money. Seventy percent of caregivers under 65 work, and half report caregiving has affected their employment [1]. Hourly workers have no paid time to spend in a waiting room.
• Stigma keeps a specific subset away entirely. Most pronounced in behavioral health and addiction treatment, where the fear is not only judgment but consequences — to employment, to custody, to standing within a family.

The downstream cost of that delay is measurable, and it is significant.

A CDC analysis of Behavioral Risk Factor Surveillance System data found that caregivers had worse age-adjusted outcomes than noncaregivers on 13 of 19 health indicators during 2021–2022, including measures related to mental health, chronic disease, and access to care. [4]. A separate study found only 17% of caregivers were up to date on recommended preventive screenings, with caregiving intensity independently predicting lower adherence after controlling for age, income, and health status [5].

Earlier CDC surveillance found unpaid caregivers for adults were roughly three times more likely than non-caregivers to have avoided urgent or emergency care they needed [6]. That matches what I see clinically: caregivers do not present less often — they present later and sicker, through the emergency department, the most expensive and least continuous entry point in the system.

This is a population health problem, not a willpower problem. When 63 million adults systematically defer preventive and chronic care, the aggregate result is more advanced disease at diagnosis, more emergency utilization, and higher total cost — borne by patients, employers, and payers alike.

How Telehealth Removes Traditional Barriers

Telemedicine does not make anyone healthier by itself. It removes the logistical requirements that have nothing to do with the medicine and for caregivers, those requirements are the whole obstacle.

• Same-day and after-hours appointments. A visit at 7:00 a.m. or 9:00 p.m. requires no shift off and no coverage. For caregivers and shift workers, appointment timing often determines access more than insurance status does.
• Care delivered where the patient already is. Travel, parking, and the waiting room disappear. The caregiver stays home, with the person who depends on them, during the visit.
• Secure asynchronous messaging. Many clinical questions a side effect, a dose clarification, a lab result — do not require an appointment at all. Handling them asynchronously removes the delay between the question arising and the answer.
• ePrescribing and electronic ordering. Prescriptions route directly to the pharmacy. Laboratory and imaging orders can be completed close to home at a time the patient chooses, rather than bundled into one clinic day.
• Medication management and chronic disease follow-up. Hypertension, diabetes, hyperlipidemia, and depression are managed largely through history, home data, and laboratory values conditions well suited to virtual management, and precisely the ones caregivers most often let lapse.
• Care coordination across settings. Someone has to reconcile the discharge summary, the specialist’s recommendation, and the primary care plan. Done properly, coordination is the core of virtual care rather than an add-on.

The honest limitation is that some care requires hands. A virtual clinician cannot palpate an abdomen, drain an abscess, or perform a Pap smear. Good virtual practice knows its boundaries and refers rather than improvising — one of the most reliable ways to distinguish a serious practice from a prescription-fulfillment service.

Telehealth for Addiction Treatment

No area demonstrates the caregiver access problem more starkly than opioid use disorder, and no area has better evidence that virtual care works.

Traditional treatment models often require frequent in-person attendance, in some programs daily. For a caregiver that is functionally disqualifying: you cannot attend daily dosing and also be the only person available to a parent with dementia. Add the fear of being recognized in a clinic parking lot in your own community, and many people who want treatment never start.

Buprenorphine treatment, including the formulation known by the brand name Suboxone, changed what is possible, because it can be prescribed in office-based settings rather than only through opioid treatment programs. Telemedicine extended that reach further, and the evidence comes from federal researchers.

A collaborative study by CDC, CMS, and NIDA published in JAMA Psychiatry examined 175,778 Medicare beneficiaries with opioid use disorder and found that receipt of telehealth services was associated with improved retention in medications for opioid use disorder and reduced odds of medically treated overdose [7]. A follow-up analysis published the next year, linking Medicare data with the National Death Index, found that beneficiaries who began a new episode of OUD-related care during the pandemic and received OUD-related telehealth services had a 33% lower risk of fatal drug overdose. Receipt of buprenorphine in office-based settings was associated with 38% lower odds of fatal overdose, and medications received through opioid treatment programs with 59% lower odds [8].

Those are mortality outcomes, not satisfaction scores. For this diagnosis, access is the treatment.

The regulatory framework currently supports this. DEA and HHS have extended telemedicine flexibilities for prescribing controlled medications through December 31, 2026, permitting practitioners to prescribe Schedule II–V medications via audio-video telemedicine without a prior in-person examination, with audio-only encounters permitted for FDA-approved medications for opioid use disorder [9]. A separate final rule expanding buprenorphine treatment via telemedicine encounter took effect December 31, 2025 [10]. Both ASAM’s National Practice Guideline and SAMHSA’s TIP 63 identify medication as the standard of care for opioid use disorder, and neither conditions that standard on the care being delivered in person [11][12].

Practically, for a caregiver: evaluation, induction, prescribing, and ongoing management can occur from home, around a schedule built by someone else’s needs — with behavioral health and recovery support integrated into the same relationship rather than requiring separate appointments across town.

Beyond Urgent Care: Modern Telemedicine Is Specialty Care

A persistent misconception is that telemedicine means a fifteen-minute video visit for a sinus infection and an antibiotic that probably was not indicated. That model exists and deserves the skepticism it receives — it is transactional, discontinuous, and disconnected from the rest of a patient’s care.

It is also no longer representative of what virtual medicine can do. Specialty telemedicine now credibly encompasses:

• Addiction medicine, including medication for opioid use disorder and alcohol use disorder
• Behavioral health and psychiatric medication management
• Weight management, including GLP-1 receptor agonist programs with appropriate monitoring
• HIV prevention, including PrEP and PEP with associated laboratory surveillance
• Primary care and preventive services
• Chronic disease management — hypertension, diabetes, hyperlipidemia, asthma
• Laboratory ordering and interpretation
• Diagnostic imaging ordering and review of results
• Specialty consultation and second opinions
• Structured longitudinal follow-up and care transitions

The distinction that matters is not virtual versus in-person — it is episodic versus longitudinal. An encounter that ends when the video call ends is a transaction. A relationship in which a physician knows your history, tracks your laboratory trends, adjusts your medications, and follows you after a hospitalization is medicine, and there is no inherent reason it must be conducted in a waiting room.

What Patients Should Look For in a Telemedicine Platform

Because the quality range in this market is genuinely wide, patients need evaluation criteria. These are the questions I would want a family member to ask.

Who leads it clinically?

Ask whether physicians hold authority over protocols and prescribing, or whether those decisions are shaped by operators and growth targets. Physician-owned and physician-led organizations are structurally better positioned to decline a clinically inappropriate request, because no one’s revenue model depends on approving it.

Is there real clinical governance?

Look for named medical directors — ideally regional ones familiar with state-specific requirements — documented evidence-based protocols, tracked quality metrics, and peer review. Ask directly: who reviews the care, and against what standard?

Does prescribing appear appropriate?

A practice that prescribes what you ask for is not practicing medicine. A quality virtual practice will sometimes decline a request, will refer you for in-person evaluation when the situation warrants, and will tell you plainly when a symptom needs to be seen with hands.

Is there continuity, or only encounters?

Will you see the same clinician again? Is there a longitudinal record? Can they order and interpret your labs? Continuity is what converts a series of visits into actual care, and it is the single most reliable marker of quality in virtual practice.

Is it genuinely integrated?

Laboratory ordering, imaging, pharmacy coordination, referral pathways to in-person care, and HIPAA-compliant record-sharing with your other clinicians. Fragmentation is the chronic failure mode of virtual care.

This is the framework we built DevotedDOC around: physician-owned and physician-led, with regional medical directors, evidence-based protocols developed through the DevotedDOC Institute, and informatics infrastructure supporting continuity across specialties rather than isolated encounters. That is not a claim of superiority — it is what I think these criteria require in practice, and readers should hold any organization, including mine, to them.

The Future of Healthcare Access

Three forces make virtual-first care structurally necessary rather than merely convenient.

The population is aging while the caregiver supply shrinks, so each remaining caregiver absorbs more. If the care model requires two hours per medical visit, the arithmetic does not resolve.

Clinician distribution is uneven and worsening. Rural counties and many urban neighborhoods have no addiction medicine specialist, no endocrinologist, and sometimes no primary care physician accepting new patients. Virtual specialty care redistributes scarce expertise without relocating either party — a healthcare equity mechanism, not a luxury.

Clinical informatics and AI-assisted tools are maturing. Used carefully, they surface the patient whose blood pressure trend is deteriorating and flag the missed follow-up. Used carelessly, they generate volume without judgment. The determining variable is whether physicians govern the tools or the tools govern the practice.

The likely endpoint is hybrid rather than virtual-only: most longitudinal management delivered remotely, with in-person care reserved for examination and procedures. That is not a lesser version of medicine. For 63 million caregivers, it is the difference between having a physician and not.

A Physician’s Perspective

In emergency medicine you develop a sense for the patient who has been managing alone for too long. It shows up in the history, symptoms measured in weeks rather than hours, medications that ran out some time ago, a last physician visit that predates the current illness by years.

A striking proportion of those patients are caregivers. They can recite their mother’s medication list from memory and cannot name their own blood pressure medication. They apologize for taking up a bed. Also, they ask how long this will take, because someone is waiting at home. I have admitted patients more worried about who would cover their caregiving shift than about the diagnosis I had just given them.

What struck me was how avoidable most of it was. Not exotic disease — hypertension untreated for six years, diabetes diagnosed by the complication rather than the screening, depression never mentioned to anyone, opioid use disorder that never reached treatment because treatment required being somewhere at a fixed time. Every one is manageable in an outpatient setting — if the patient can get to the outpatient setting.

That gap is why I built DevotedDOC. Not because virtual care is better than sitting across from a patient — it is not. But a great deal of medicine does not require physical proximity, and pretending otherwise has quietly excluded millions of people busy taking care of everyone else. Emergency medicine taught me what happens at the end of that pathway. The more useful intervention happens years earlier.

— Matthew Berrios, DO

Healthcare Should Adapt to Patients

The central design flaw in how we deliver care is that we built it around institutional convenience, then treated patients who could not accommodate it as the problem. Caregivers have absorbed that flaw more than any other group, and quietly, because they are accustomed to being the person who copes.

If you are caring for someone else and deferring your own care — the blood pressure you know is high, the mood worsening for a year, the drinking that has escalated, the treatment you wanted to start and could not schedule — these conditions are far easier to treat now than later. Nearly everything I see go catastrophically wrong in the emergency department was manageable at an earlier stage.

Care that fits around your obligations is not a lesser standard of care. Often it is the only version you will actually receive, and receiving it is what matters.

To learn more about physician-led specialty telemedicine — including addiction medicine, behavioral health, primary care, and chronic disease management — visit DevotedDOC.

Frequently Asked Questions

References

• [1] AARP and National Alliance for Caregiving. Caregiving in the US 2025. Washington, DC: AARP; July 24, 2025. doi:10.26419/ppi.00373.001 https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-us-2025/
• [2] American Hospital Association. 63 million Americans are family caregivers. AHA News; July 25, 2025 (summarizing Caregiving in the US 2025). https://www.aha.org/news/headline/2025-07-25-63-million-americans-are-family-caregivers
• [3] Ray KN, Chari AV, Engberg J, Bertolet M, Mehrotra A. Opportunity costs of ambulatory medical care in the United States. Am J Manag Care. 2015;21(8):567-574. https://pubmed.ncbi.nlm.nih.gov/26295356/
• [4] Kilmer G, Omura JD, Bouldin ED, et al. Changes in Health Indicators Among Caregivers — United States, 2015–2016 to 2021–2022. MMWR Morb Mortal Wkly Rep. 2024;73(34):740–746. https://www.cdc.gov/mmwr/volumes/73/wr/mm7334a2.htm
• [5] Caregivers and Colonoscopies: A Quantitative Comparative Study of Caregivers’ Preventative Health Behaviors. Innovation in Aging. PMC10738095. https://pmc.ncbi.nlm.nih.gov/articles/PMC10738095/
• [6] Czeisler MÉ, Marynak K, Clarke KEN, et al. Delay or avoidance of medical care because of COVID-19–related concerns — United States, June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(36):1250-1257. https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm
• [7] Jones CM, Shoff C, Hodges K, et al. Receipt of telehealth services, receipt and retention of medications for opioid use disorder, and medically treated overdose among Medicare beneficiaries before and during the COVID-19 pandemic. JAMA Psychiatry. 2022;79(10):981-992. https://pubmed.ncbi.nlm.nih.gov/36044198/
• [8] Jones CM, Shoff C, Blanco C, Losby JL, Ling SM, Compton WM. Association of receipt of opioid use disorder–related telehealth services and medications for opioid use disorder with fatal drug overdoses among Medicare beneficiaries before and during the COVID-19 pandemic. JAMA Psychiatry. 2023;80(5):508-514. https://pubmed.ncbi.nlm.nih.gov/36988913/
• [9] Drug Enforcement Administration and U.S. Department of Health and Human Services. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. Effective January 1, 2026 through December 31, 2026. https://www.federalregister.gov/documents/2025/12/31/2025-24123/fourth-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled
• [10] Drug Enforcement Administration and HHS. Expansion of Buprenorphine Treatment via Telemedicine Encounter. 90 FR 6504; 21 CFR 1306.51. Effective December 31, 2025. https://www.federalregister.gov/documents/2025/01/17/2025-01049/expansion-of-buprenorphine-treatment-via-telemedicine-encounter
• [11] American Society of Addiction Medicine. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020;14(2S Suppl 1):1-91. https://pubmed.ncbi.nlm.nih.gov/32511106/
• [12] Substance Abuse and Mental Health Services Administration. TIP 63: Medications for Opioid Use Disorder.
• [13] Centers for Medicare & Medicaid Services. Telehealth policy and coverage resources. CMS.gov. https://www.cms.gov/medicare/coverage/telehealth
• [14] Opportunity Cost: The Hidden Toll of Seeking Health Care. Health Affairs Forefront. https://unitimesofficial.wordpress.com/wp-content/uploads/2021/05/opportunity-cost-the-hidden-toll-of-seeking-health-care.pdf
• [15] Consuming patients’ days: time spent on ambulatory appointments by people with cancer. PMC11067814. https://pmc.ncbi.nlm.nih.gov/articles/PMC11067814/

This article is for general educational purposes and does not constitute medical advice or establish a physician-patient relationship. Regulatory provisions described here, including DEA telemedicine flexibilities, are subject to change. Individual treatment decisions require evaluation by a licensed clinician.