LTCcovid Country Profiles

Responses to 3.10. Use of technology to compensate for difficulties accessing in-person care and support

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It is compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project are moderating the entries and editing as needed.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.


To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors. LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science. https://doi.org/10.21953/lse.mlre15e0u6s6

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.


 

Overview

Evidence on how technology has been used to maintain social contacts or to deliver care remotely is beginning to emerge.

Use of technology maintain social contacts during the pandemic

Loneliness and isolation in LTC facilities are salient issues, which were amplified during COVID-19 as facilities were largely inadequately prepared to support the socioemotional needs of their residents during the mandated lockdowns. Information and communication technologies (ICTs) can be a useful tool to enhance social connectedness for residents by facilitating communication with family and friends.

There are descriptions of increased use of technology to support communication, particularly for people living in care homes that were not able to have face to face contact with their family and friends due to visiting restrictions. The evidence so far shows that a large proportion of residents in care homes were not able to use technology for communication, for example a study in the US found that only 42% of residents were able to do so (Schuster and Cotten, 2022). People with dementia or other conditions accompanied by cognitive impairment have more difficulties with technology, appearing to face more difficulties in recognising virtual conversation partners (Lorenz-Dant and Comas-Herrera, 2021) and in some cases having negative emotional reactions (Leontjevas et al., 2021). Other researchers, suggest that, with the right kind of tools, some of these barriers can be overcome (Hung and Mann, 2020).

There are also examples, from Belgium and the Netherlands (see below), of the use of robots in care homes to facilitate video calls between the residents and their families (Getson and Nejat, 2021)

Telemedicine

While there has been much enthusiasm about the potential role of telemedicine, in many cases there have been substantial organisational and even financing barriers. The organisational readiness to adopt telemedicine has been identified as being particularly important (Seifert et al., 2020).

A study of the views of nursing home staff in the Netherlands suggests while psychologists, physicians and nurse practitioners thought it would be good to continue to do part of their work remotely after the pandemic, more than half staff of activity coordinators did not feel their tasks could be done remotely (Leontjevas et al, 2021).

Adapting therapeutic interventions to virtual delivery

An international collaboration piloted a 14-session virtual Cognitive Stimulation Therapy (vCST) programme for people living with dementia, as a result of services needing to move online during the pandemic. The protocol was field tested in Brazil, China (Hong Kong), India, Ireland and the UK, using the feedback to improve the protocol. The pilot showed that vCST is a feasible intervention for many people living with dementia and maybe useful for people who cannot attend in person groups beyond the pandemic (Perkins et al., 2022).

A qualitative study in Italy describes examples of using technology (personalised pre-recorded videos) to provide remote access to people with dementia to music therapy and low-impact exercise, as well as to group activities such as cognitive stimulation, physical activities and support groups (Chirico et al., 2022).

Digital inclusion and access to information for people with Intellectual Disabilities

A rapid review and international bricolage of evidence regarding the digital experiences of people with Intellectual Disabilities (ID) during the pandemic covering literature up to June 2021 found that, internationally, people with ID had inadequate support for digital access and accessible information on COVID-19 and how to keep safe. Existing barriers to digital inclusion have persisted, but there were positive impacts from digital solutions for those who could access them and had adequate support, for example in service provision, education and therapeutic services. NGOs had an important role in providing direct support for digital inclusion and COVID-19 information, whereas Governmental and crisis organisations were often found to be unprepared (Chadwick et al., 2021).

References:

Chadwick, D., Ågren, K.A., Caton, S., et al. (2022). Digital inclusion and participation of people with intellectual disabilities during COVID-19: A rapid review and international bricolage. Journal of Policy andPractice in Intellectual Disabilities,115. https://doi.org/10.1111/jppi.12410

Chirico, I.Ottoboni, G.Giebel, C.Pappadà, A.Valente, M.Degli Esposti, V.Gabbay, M., & Chattat, R. (2022). COVID-19 and community-based care services: Experiences of people living with dementia and their informal carers in ItalyHealth & Social Care in the Community001– 10https://doi.org/10.1111/hsc.13758

Getson C, Nejat G. (2021) Socially Assistive Robots Helping Older Adults through the Pandemic and Life after COVID-19. Robotics; 10(3):106.  https://doi.org/10.3390/robotics10030106

Hung, L. and Mann, J. (2020) ‘Virtual special issue – Using touchscreen tablets for virtual connection’, Dementia, 19(5), pp. 1346–1348. doi: 10.1177/1471301220924578.

Leontjevas, R., Knippenberg, I., Bakker, C., Koopmans, R., & Gerritsen, D. (2021). Telehealth and telecommunication in nursing homes during COVID-19 antiepidemic measures in the Netherlands. International Psychogeriatrics, 33(8), 835-836. https://doi.org/10.1017/S1041610221000685

Lorenz-Dant, K. and Comas-Herrera, A. (2021). The Impacts of COVID-19 on Unpaid Carers of Adults with Long-Term Care Needs and Measures to Address these Impacts: A Rapid Review of Evidence up to November 2020. Journal of Long-Term Care, (2021), pp.124–153. DOI: http://doi.org/10.31389/jltc.76

Perkins L, Fisher E, Felstead C, Rooney C, Wong GHY, Dai R, Vaitheswaran S, Natarajan N, Mograbi DC, Ferri CP, Stott J, Spector A. Delivering Cognitive Stimulation Therapy (CST) Virtually: Developing and Field-Testing a New Framework. Clin Interv Aging. 2022;17:97-116
https://doi.org/10.2147/CIA.S348906

Schuster, A. M., & Cotten, S. R. (2022). COVID-19’s Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators. JMIR Aging 2022;5(1):E32442 Https://Aging.Jmir.Org/2022/1/E32442, 5(1), e32442. https://doi.org/10.2196/32442

Seifert A, Batsis JA and Smith AC (2020) Telemedicine in Long-Term Care Facilities During and Beyond COVID-19: Challenges Caused by the Digital Divide. Front. Public Health 8:601595. doi: 10.3389/fpubh.2020.601595

The government of Australia announced over $1.5 billion AUD in funding for the aged care sector during the pandemic. A portion of this amount has gone towards telehealth development for people over the age of 70. The Department of Health also recommends that older people opt for telehealth appointments instead of in person appointments (source: DoH).

Last updated: December 22nd, 2021


In Belgium the James robot (by ZoraBot) was deployed to help in nursing homes during COVID lockdowns to help residents keep in contact with their family through video calls, using only voice commands (Getson and Nejat, 2021). The robot is able to measure body temperature, count people in a room, check if people are wearing masks properly and can be operated for disinfection duties (Raje et al., 2021).

References:

Getson C, Nejat G. (2021) Socially Assistive Robots Helping Older Adults through the Pandemic and Life after COVID-19. Robotics; 10(3):106.  https://doi.org/10.3390/robotics10030106

Raje S., Reddy N., Jerbi H. et al. (2021) Applications of Healthcare Robots in Combating the COVID-19 Pandemic. Applied Bionics and Biomechanics. https://doi.org/10.1155/2021/7099510

Last updated: February 11th, 2022


A study among unpaid carers in Canada using remote services reported some advantages but also disadvantages and some reported technical barriers (Lorenz-Dant & Comas-Herrera, 2021).  A report recommends the use of technology to ensure care in place for people in residential care settings (https://www.ic.gc.ca/eic/site/063.nsf/eng/h_98049.html).

References:

Lorenz-Dant, K and Comas-Herrera, A. 2021. The Impacts of COVID-19 on Unpaid Carers of Adults with Long-Term Care Needs and Measures to Address these Impacts: A Rapid Review of Evidence up to November 2020. Journal of Long-Term Care, (2021), pp. 124–153. DOI: https:// doi.org/10.31389/jltc.76

Last updated: February 11th, 2022


Telemedicine and telehealth are covered under the Medical Services Plan. Individuals seeking care may also contact the non-emergency medical support phone line by dialing 811.

Last updated: November 6th, 2021


The National Association for Older People organizes supports for using technology to access friends, social networks and health services (https://www.aeldresagen.dk/om-aeldresagen/lige-nu/corona/faa-gode-raad/saadan-ser-du-den-du-taler-med?scrollto=start).

Last updated: September 8th, 2021


Investment of 6bn euros across the health and social care system – for renovations and technology upgrades (https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf0).

Telephone support lines were rolled out with some success for support, and according to the DGCS France has performed third worldwide after the US and China in the number of teleconsultations performed over the pandemic, especially in care homes (https://www2.assemblee-nationale.fr/static/15/pdf/rapport/i3633.pdf).

Last updated: September 8th, 2021


A study among unpaid carers in Germany found that a considerable proportion of respondents started using technology for social contacts (https://www.socium.uni-bremen.de/uploads/Schnellbericht_Befragung_pflegender_Angehoriger_-_print.pdf).

Last updated: September 8th, 2021


NGOs in Hong Kong have provided older people with tablet computers that provided them with access to home sports videos, cognitive training games and equipment to monitor their help. The system would inform relevant persons (medical teams/family) if the health monitor registered abnormality. Other NGOs offers videos for sensory stimulating activities anti-epidemic exercise or remote activities and counselling for people with mild to moderate dementia (https://ltccovid.org/wp-content/uploads/2020/07/Hong-Kong-COVID-19-Long-term-Care-situation_updates-on-8-July-1.pdf).

Last updated: September 8th, 2021


The Administration of Disabilities at the Ministry of Welfare and Social Affairs provides services for people with intellectual developmental disabilities and other cognitive disabilities, individuals with autism, and individuals with sensory and motor disabilities. The initial action plan for COVID-19 included a transition to virtual education and community-building programs, the upstart of a food distribution program, and technology (e.g. tablet) distribution.

JDC Eshel in collaboration with the Ministry for Social Equality and Digital Israel have put forth the development of digital technology among people over the age of 60 as one of their goals, especially during the pandemic.

Last updated: December 5th, 2021   Contributors: Shoshana Lauter  |  LIAT AYALON  |  


To compensate for limited access to visiting in nursing homes for difficulties in meeting families and caregivers, care providers have used tools such video calls, dedicated apps and telemonitoring.

A qualitative study found that in May 2020 family carers of people living with dementia began to have access to remote support from community-based services, through mobile smartphones, tablets and personal computers, using existing applications such as Whatsapp, Skype, Google Duo, and Meet. There were examples of the use of personalised pre-recorded videos to continue activities previously done face to face such as music therapy and low-impact expercise and videoconferencing to deliver group activities such as support groups, physical activities and cognitive stimulation. These were perceived to be helpful in reducing feelings of isolation and loneliness and maintaining relationships with therapists (Chirico, 2022).

References:

Chirico, I.Ottoboni, G.Giebel, C.Pappadà, A.Valente, M.Degli Esposti, V.Gabbay, M., & Chattat, R. (2022). COVID-19 and community-based care services: Experiences of people living with dementia and their informal carers in ItalyHealth & Social Care in the Community001– 10https://doi.org/10.1111/hsc.13758

Last updated: February 22nd, 2022   Contributors: Eleonora Perobelli  |  Elisabetta Notarnicola  |  


A study of the implementation of infection control measures in a nursing home in rural Japan includes a description of the use of Information and Communication Technology (ICT) using a system called Mame-net established by the local government. This system enabled the nursing home to share information regarding the health condition of the residents with the local clinic, and, if there were immediate concerns, there was direct phone communication between the care home staff and the clinic. The system is also used to share information about the residents’ condition with their family members (Ochta et al., 2021).

References

Ohta R, Ryu Y, Sano C. (2021) Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes. International Journal of Environmental Research and Public Health. 18(11):5805. https://doi.org/10.3390/ijerph18115805

Last updated: February 17th, 2022


In the Netherlands the SARA robot, developed as part of EIT Digital, was offered to care homes to support the residents in communicating with their family and friends. The company offered care homes to have the robot for one month.

A survey of 175 nursing home staff found that practitioners thought there was value in continuing to use telecommunication between residents and their loved ones, in addition to the preferred face to face contact. However there were challenges in using telecommunication with residents with advanced dementia, with reports of negative emotional responses. With regards telehealth, some practitioners (particularly psychologists, physicians and nurse practitioners) would like to continue working partly remotely after the pandemic, whereas more than half activity coordinators reported that this would not be possible for their tasks (Leontjevas et al., 2021).

References:

Leontjevas, R., Knippenberg, I., Bakker, C., Koopmans, R., & Gerritsen, D. (2021). Telehealth and telecommunication in nursing homes during COVID-19 antiepidemic measures in the Netherlands. International Psychogeriatrics, 33(8), 835-836. https://doi.org/10.1017/S1041610221000685

 

Last updated: February 24th, 2022


The government introduced online or telephone medical consultations when feasible to compensate for lack of face to face consultations as well as to contain spread of infections (source: Ageing policies – access to services in different EU Member States).

Last updated: November 24th, 2021   Contributors: Joanna Marczak  |  Agnieszka Sowa-Kofta  |  


Online physician consultations for care homes were implemented (https://coronakommissionen.com/wp-content/uploads/2020/12/summary.pdf).

Last updated: November 30th, 2021


A considerable proportion of unpaid carers in the UK reported to have used technology for social contacts, a smaller proportion for health and long-term care services. The use of technology for remote support received mixed feedback. A report by Age UK (2021) has found that there was no significant change in the use of digital engagement during the first few months of the pandemic. The main barrier reported for peopled aged 75 and older was ‘lack of digital skills’.

A press release by the Department of Health and Social Care (DHSC) on April 24, 2020, announced that they, together with the Ministry for Housing Communities and Local Government, had awarded up to £25,000 to 18 innovative digital solutions as part of the TechForce19 challenge. Among these, one app that received funding aims to ‘help carers identify health risks and deterioration within elderly communities’.

Research by Lariviere et al. (2020) accompanying the virtual cuppa project, which offered unpaid carers the possibility to connect virtually for half an hour on weekdays with others in similar situations, facilitated by a professional carer coach, found that over time, carers developed friendships with other members participating in the project, shared resources and experience, and that the virtual cuppa group became “a resource in its own right to develop individual resilience” (p.22).

The digital lifeline initiative during the COVID-19 crisis, funded by the Department for Digital, Culture, Media and Sport (DCMS), enabled over 5,000 adults with intellectual disabilities in England to receive internet-enabled devices, with data and local support to help people learn how to use their device, with promising impact in the short term (Mackey et al. 2022).

Published on November 3, 2021, the Adult social care: COVID-19 winter plan 2021 to 2022 sets out the key elements of national support available for the social care sector for winter 2021 to 2022. This sets out continued support for care providers to make best use of technology to support remote monitoring, enable secure online communications, and enable people within care homes to remain connected with friends and families. NHSX, a joint unit of DHSC and NHS England, will provide a package of support over the winter to help care providers make the best use of digital tools, safely and securely. A new ring-fenced care provider Digitising Social Care fund of up to £8 million will be available. Additionally, there will be implementation funding support to all 7 NHSEI regions to significantly increase levels of technology-enabled remote monitoring within care homes. Plans have been agreed for over 100,000 people living in a care home to receive digitally enabled support by March 2022.

References: 

Age UK (2021). Digital inclusion and older people – how have things changed in a Covid-19 world? Age UK briefing paper, Retrieved from: ageuk.org.uk briefing papers. Accessed on 24/03/2022

Mackay, J. et al. (2022). Digital Lifeline: A Qualitative Evaluation , Full evaluation report. Retrieved from: DCMS Digital Lifeline Fund: Evaluation Report Accessed on 24/03/2022

Giebel, C., Cannon, J., Hanna, K., Butchard, S., Eley, R., Gaughan, A., Komuravelli, A., Shenton, J., Callaghan, S., Tetlow, H., Limbert, S., Whittington, R., Rogers, C., Rajagopal, M., Ward, K., Shaw, L., Corcoran, R., Bennett, K., & Gabbay, M. (2020). Impact of COVID-19 related social support service closures on people with dementia and unpaid carers: a qualitative study. 25(7), 1281–1288. DOI:https://doi.org/10.1080/13607863.2020.1822292

Giebel, C., Hanna, K., Cannon, J., Eley, R., Tetlow, H., Gaughan, A., Komuravelli, A., Shenton, J., Rogers, C., Butchard, S., Callaghan, S., Limbert, S., Rajagopal, M., Ward, K., Shaw, L., Whittington, R., Hughes, M., & Gabbay, M. (2020). Decision-making for receiving paid home care for dementia in the time of COVID-19: A qualitative study. BMC Geriatrics, 20(1), 1–8. DOI:https://doi.org/10.1186/S12877-020-01719-0/TABLES/2

Lariviere, M et al. (2020). Caring during lockdown: Challenges and opportunities for digitally supporting carers. Research report, Retrieved from: 007_Aspect-Virtual-Cuppa-Report-4-compressed.pdf (shef.ac.uk); Accessed on 24/03/2022

Last updated: March 24th, 2022   Contributors: William Byrd  |  


A recent study by Schuster and Cotten (2022) explored the use of ICTs across 70 LTC facilities (12 nursing homes and 58 assisted living facilities) in South Carolina during the pandemic. 61% of the LTC facility administrators surveyed reported an increase in technology spending at their facility, although the main method of purchase was through facility funds (with only 45% reporting funding through Medicaid or Medicare services). Roughly 42% of residents used the technology provided by facilities and a quarter were unable to use the ICTs (owing to health or other impairments). Overall, the study found that the key benefit of ICTs was promoting feelings of connectedness to family, friends, and other residents. Barriers to ICT use by residents included a shortage of staff to assist with ICT use and technology that didn’t work.

References:

Schuster, A. M., & Cotten, S. R. (2022). COVID-19’s Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators. JMIR Aging 2022;5(1):E32442 Https://Aging.Jmir.Org/2022/1/E32442, 5(1), e32442. https://doi.org/10.2196/32442

Last updated: February 17th, 2022


Contributors to the LTCcovid Living International Report, so far:

this list is regularly updated to reflect contributions to the report, if you’d like to contribute please email a.comas@lse.ac.uk

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica BreuerJorge Browne Salas, Jenni Burton, William Byrd, Sara CharlesworthAdelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin HämelNina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’DonovanCamille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. SchmidtAgnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.