Virtual Presence for Social Connectedness in Long-Term Care: A Protocol for a Qualitative Multi-Methods Study

Social connectedness, defined as an individual’s subjective sense of having close relationships with others [1,2] is necessary for health and well-being [3]. During multiple phases of the pandemic, social connectedness was severely compromised for many people both directly and indirectly by restrictions placed on face-to-face engagements [4]. In Canada, older adults in congregate or institutional living environments, such as long-term care homes (LTCH), were mandated to implement extreme restrictions on visitors and staff, as an emergency infection control [5]. These drastic measures increased isolation and decreased the emotional well-being of older adults in LTCHs [5,6,7]. While the visitor restrictions were implemented in good faith as an effort to mitigate the spread of COVID-19, many older adults during the height of the pandemic died alone, with little to no connection with their family members or friends [8]. In Canada during the first wave of COVID-19, when families were prohibited from in-person visits, there were 7,260 deaths of older adults across LTCH and retirement homes, representing 79% of all COVID-19 deaths [9]. As COVID-19 led to widespread limitations on in-person gatherings and for a time halted in-person visits to LTCH, attention turned to technology as a means to communicate and facilitate social connectivity between family members and older adults [10]. As we move forwards from the pandemic it is critical to develop robust systems now, to mitigate the harmful unintended side effects (e.g., decreased social connectedness and wellbeing) of infection control policies. Virtual presence is the use of networked digital telecommunications technology to create the impression that a user is present in another environment [11]. Digital applications (e.g., Zoom, FaceTime) provide virtual face-to-face connection and may support social connectedness by providing meaningful social engagement in addition to being a point of access to community environments for older adults [12]. For LTCH, virtual presence technology has the potential to support social connectedness across a range of situations and contexts. This protocol for a qualitative multi-methods study stemmed from the negative impact of the COVID-19 pandemic on the social connectedness between older adults residing in long-term care homes (LTCH) and their family members. The resultant restrictions on social gatherings during the pandemic severely impacted older adults’ sense of belonging and closeness with others, taking a toll on their mental and physical health. Moving forwards from the pandemic, there is a need to increase our understanding of how social connectedness between older adults and their families can be facilitated within long-term care using virtual presence approaches. The proposed research goal is to develop a conceptual model of the role of virtual presence technology in support of social connectedness between older adults in LTCH and their family members and to identify the contextual factors that must be addressed for successful virtual presence technology implementation in LTCH. In pursuit of this goal, the proposed study will address the following research objectives: (1) To explore how older adults in LTCH, their family members, and staff experience, benefit from, and envision the role of virtual presence technology to support social connectedness in LTCH. (2) To examine LTCH policy, funding, management, and operations in order to identify institutional challenges and facilitators impacting the uptake and spread of virtual presence technology within LTCH. (3) To create a conceptual model of the role of virtual presence technology in support of social connectedness and of the contextual determinants for successful virtual presence technology implementation in LTHC.

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