"What Good Is That?"-Perspectives of Using Telehealth to Discuss Serious Illness with Urban-Dwelling Low-Income Older Adults in Assisted Living.

Telehealth offers an avenue for older adults to access providers, discuss care needs, and have serious illness conversations. However, telehealth is embraced by some and not by others. Urban-dwelling, low-income older adults have unique challenges in accessing continuous care, engaging with the healthcare system and receiving support to address serious illness care needs. To investigate telehealth acceptance in low-income older adults, we conducted individual semi-structured qualitative interviews with 46 residents of three Medicaid-funded assisted living facilities (MALFs) which provide social, functional, and clinical support to underserved populations. Interview transcripts were analyzed using conventional content analysis. Four qualitative themes describing telehealth acceptance in low-income assistant living communities were identified. Benefit: Telehealth offers convenience-participants highlighted how telehealth facilitates access to healthcare appointments, making it easier to receive care. Barrier: Technology fluency and access is not universal-many described physical and technological barriers that limit their ability to use telehealth effectively. Preference: general distaste for telehealth-this theme captures participants' overall attitudes and gut reactions to telehealth, ranging from enthusiasm to skepticism. Concern: mistrust in clinical connection-patients expressed concerns about trust, security, and the ability to build meaningful connections with providers through telehealth. While telehealth can make care more convenient, telehealth encounters may hinder trust in the therapeutic relationship between urban-dwelling low-income older adults and providers. For telehealth conversations discussing serious illness, additional efforts are needed to support engagement, foster trust, and provide patient-centered care in populations that have been historically marginalized.