Will My Parent Use a Patient Portal, a Video Call, or a Text From the Home Health Agency?

The discharge nurse says the home health agency "will send everything through the portal." Or the agency asks for a cell number so it can text visit times. Your mom is 87. She has a flip phone in a drawer and reads the newspaper with a magnifier.

I'm an occupational therapist, and I've worked inside home health agencies. A lot of what I do is figure out whether a person can actually do a task, not whether they say they can. Technology is a task like any other. This guide covers what a national Medicare survey says about older adults and the internet, how to test whether your parent will really use a portal or video call, and what to ask the agency for on paper.

Below, a rule means a federal regulation, and I'll quote it. Anything else is my own suggestion from working in the field, and I'll say so.

What the Survey Says

CMS runs the Medicare Current Beneficiary Survey every year. In 2026 it published 2025 preliminary estimates on internet access and use. The survey covers people on Medicare who live at home, not in a nursing home. It doesn't track home health patients as a group. The numbers below are national only. Every figure I use from the tables has a margin of error of 2.5 percentage points or less, so I've rounded them.

The biggest gap is by age. Here's the 85 and older group next to everyone on Medicare who lives at home.

Source: CMS, 2025 MCBS Internet Access and Use Among Medicare Beneficiaries, preliminary estimates. The "few times a year or less, or not at all" row adds two of CMS's categories together.

Read the 85 and older column again. About four in five have internet access. But only about one in three used it to talk with a health care provider. Having Wi-Fi in the house is not the same as using a portal.

A note on the video row: it counts any video or voice call over the internet, including a FaceTime with the grandkids. It isn't a count of telehealth visits.

The Closest Stand-In for a Home Health Patient

In my experience, most home health patients need help with everyday things like bathing, dressing or walking. This survey table doesn't split internet use by help with daily activities like bathing and dressing. The closest group it has is people who report two or more disabilities, which is the survey's own grouping. Treat it as a rough stand-in, not a measure of home health patients.

Your parent may be in both groups at once: 85 or older and living with more than one disability. The survey tables don't combine the two, so I won't guess at a number.

Other Groups Worth Knowing About

A patient portal is mostly reading. Two other rows in the survey show that clearly. Among people on Medicare living at home who said they read English well, not well, or not at all (rather than very well), about 31% had used the internet to communicate with a provider. Among people without a high school diploma, it was about 18%. If English is your parent's second language, or reading was never easy, ask the agency about phone calls and printed material in the language your parent reads best.

How to Tell if Your Parent Will Really Use It

This whole section is my suggestion, not a rule. It's how I'd look at it as an OT.

People say yes to technology to be polite. "Sure, I'll check the portal." Then the login email goes to a spam folder and nobody sees the visit time. Don't ask your parent if they can do it. Watch them do it once, with you sitting on your hands.

Vision. Can they read the text on the phone at the size it comes up? Cataracts, macular degeneration and glaucoma all make small gray text on a bright screen hard to read. If they hold the phone at arm's length and squint, a text with a visit time will get missed.

Hearing. Can they follow a video call on a phone speaker? Many older adults hear fine in a quiet room face to face and lose half the words on a small speaker. If your parent wears hearing aids, find out whether they work with the phone.

Hand function. Arthritis, a tremor, neuropathy, or weakness after a stroke can make tapping a small target close to impossible. Dry fingertips often don't register on a touchscreen. Watch whether they can hit the right button the first time and swipe without opening the wrong thing.

Memory and new steps. A portal means a username, a password, a code sent by text, and a menu that changes with updates. That's a lot of new steps for someone just home from the hospital, tired, and on new medicines. If your parent can't log in again a week later without help, they don't have a portal. You do.

Energy. In the first weeks after a hospital stay, people tire fast. The 20 minutes it takes to fight with a login may be 20 minutes they needed to rest before therapy.

Who sets it up. Be honest about who will do the setup and the fixes. If it's you, and you live two hours away, the portal is really your tool. That can work. Just plan it that way on purpose.

A simple test I like: after the first visit, ask your parent what day and time the next visit is, and who is coming. If they can tell you without looking it up, the system they have is working, whatever it is.

Ask the Agency What It Sends, and How

Agencies handle this differently, so don't assume. Ask on the first call or at the first visit:

• How will you tell us the visit time? A call, a text, or a portal message?
• Who gets that message? Can it go to me as well as my parent?
• What do you give us on paper?
• If my parent misses a call, what happens?
• What number do we call after hours?

Some of the paper isn't optional. Medicare's rule says the agency "must provide the patient and caregiver with a copy of written instructions outlining" these (42 CFR §484.60(e)):

• "Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA"
• "Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel"
• "Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services"
• "Name and contact information of the HHA clinical manager"

The clinical record can be on paper too, if you ask. The rule says: "A patient's clinical record (whether hard copy or electronic form) must be made available to a patient, free of charge, upon request at the next home visit, or within 4 business days (whichever comes first)" (42 CFR §484.110(e)).

So if your parent will never open a portal, that's fine. Ask for paper.

If the Agency Mentions Video Calls

Medicare's home health payment rule does mention video. It says "Telecommunications technology, as indicated on the plan of care, can include" remote monitoring, teletypewriter (TTY), and "2-way audio-video telecommunications technology that allows for real-time interaction between the patient and clinician" (42 CFR §409.46(e)).

The plan of care rule sets the limit. Those services "cannot substitute for a home visit ordered as part of the plan of care, and cannot be considered a home visit for the purposes of patient eligibility or payment" (42 CFR §409.43(a)(3)(i)(B)).

My suggestion: if an agency brings up video, ask whether it's written on your parent's plan of care, and how often a clinician will still come to the house. Then use the checks above to decide if your parent can actually manage the call.

Name a Family Contact

This is my suggestion, not a rule. Pick one person in the family as the main contact, and tell the agency who it is at the first visit. Ask them to write it in the record. Give them that person's cell number and when to call it.

One person matters. When three siblings each call the agency with a different question, messages get lost, and the clinician spends the visit answering the phone instead of treating your parent. Agree as a family who calls and who passes news along.

Your parent still has the final say on their own care, and the agency will want to hear it from them. A family contact is for the logistics: times, changes, supplies, the after-hours number.

Put the Paper on the Fridge

Also my suggestion. When the written instructions come, put a copy where everyone can see it. The fridge works. So does a folder on the kitchen table that never moves.

What I'd keep there:

• The visit schedule, with who comes when (nurse, therapist, aide).
• The medication list from the agency, the current one. Cross out old versions so nobody uses them.
• The clinical manager's name and number.
• The after-hours number.
• The doctor's office number.

In my experience, the paper is what saves the day when the power is out, the phone is dead, or a neighbor or substitute aide shows up and needs to know what's going on. A paramedic can read a medication list on a fridge. They can't log in to your mom's portal.

If the medication list changes, ask for a new printed copy at the next visit. Our guide to the first home health visit goes through the medication review and the papers your parent will sign that day.

What a Home Health Visit Is Still in Person For

From my own work, these are the things I've needed to be in the room for:

• Seeing the home. Rugs, stairs, the path to the bathroom at night, the height of the bed and the toilet. I can't check how your dad gets off a low couch through a phone camera pointed at the ceiling.
• Watching movement. How someone stands, turns and sits. Balance problems often show up only when I'm close enough to catch them.
• Hands-on care. Wound care, dressing changes, checking skin, teaching a safe transfer with my hands guiding theirs.
• Looking at the actual pill bottles. Not the list. The bottles, including the old ones in the bathroom cabinet.
• Noticing what nobody mentions. An empty fridge. A smell. A bruise. Someone who seems more confused than last week.

Our guide to who does what on the home health team explains which clinician comes for which of these.

If You Run an Agency

The numbers above are a reminder that the oldest patients on most home health caseloads are the least likely to be online. In this survey, about 37% of people on Medicare 85 and older living at home used the internet for information a few times a year or less, or not at all. The written instructions in §484.60(e) are already required. A printed schedule and medication list, updated when they change, and a phone call to a named family contact will reach people a portal won't.

Frequently Asked Questions

How many people on Medicare aged 85 and older use the internet?

In CMS's 2025 preliminary estimates from the Medicare Current Beneficiary Survey, about 78% of people on Medicare 85 and older who live at home had internet access, compared with about 92% of all people on Medicare who live at home. Only about 31% of the 85 and older group used the internet for information every day, and about a third had used it to communicate with a health care provider.

Does the home health agency have to give my parent anything on paper?

Yes, some things. Medicare's rule says the agency must give the patient and caregiver a copy of written instructions with the visit schedule, the medication schedule, any treatments the agency will give, and the name and contact information of the clinical manager. Your parent can also ask for the clinical record, in hard copy or electronic form, free of charge, at the next home visit or within 4 business days, whichever comes first.

Will home health visits happen by video instead of in person?

Not in place of the visits on the plan of care. Medicare's rule allows 2-way audio-video technology when it is on the plan of care, but says it cannot substitute for a home visit ordered as part of the plan of care. If an agency mentions video, ask whether it is written on your parent's plan of care and how often someone will still come to the house.

How do I know if my parent can manage a patient portal?

Watch them try it, with you sitting on your hands. Can they read the screen, hear the call, tap the right button, and remember the password next week? If any of those is a no, plan for paper and phone calls, and name a family member as the contact.

Sources

• 2025 Internet Access and Use Among Medicare Beneficiaries Preliminary Estimates PUF (CMS)
• Medicare Current Beneficiary Survey (CMS)
• 42 CFR §484.60, Care planning, coordination of services, and quality of care (Cornell LII)
• 42 CFR §484.110, Clinical records (Cornell LII)
• 42 CFR §409.43, Plan of care requirements (Cornell LII)
• 42 CFR §409.46, Allowable administrative costs (Cornell LII)