My name is Jenny Waycott.
I’m from the University of Melbourne, in Australia, and this is our CHI 2022 paper,
The Role of Staff in Facilitating Immersive Virtual Reality for Enrichment in Aged Care:
An Ethic of Care Perspective.
I’m presenting this on behalf of my co-authors.
The work that I’m presenting in this video comes from a program of research, funded by
the Australian Research Council, that aims to understand how emerging technologies can
be ethically and sensitively designed and deployed to provide social and emotional enrichment
in later life, especially in aged care settings.
In this work we use the term aged care to mean residential or institutional care for
people in the later stages of old age who usually have complex health and care needs
and can no longer live independently at home.
My colleagues and I have been looking at a range of technologies that are being used
in aged care, but one technology that seems to offer particularly unique opportunities
and challenges when used in aged care is immersive virtual reality.
There has been remarkable interest in both industry and academia in the possibilities
of using VR in aged care.
In the last five years or so, for example, we have seen many new technology companies
that specialise in introducing virtual reality into aged care homes.
Here is an example from Australia.
And an example from the United States.
At the same time, there has been growing academic interest in the design and use of VR with
older adults, especially in the HCI community.
So, much of this research has looked at older adults’ experiences or examined design and
usability issues.
One area that needs further exploration is knowing how to ensure the VR experience is
well-supported and facilitated by the people who are on the ground, working in the care
setting.
So this is particularly important when VR is introduced by technology companies or by
aged care providers and aged care staff are then tasked with ensuring that the experience
is positive and enriching for the people that they care for.
To investigate this, we conducted semi-structured interviews with eleven staff members working
across care homes that were part of the same aged care organisation.
Our participants were part of the lifestyle team within this organisation.
The lifestyle team is responsible for organising and running activities for residents to keep
them occupied and to encourage social participation.
So some typical activities they might organise include things like games of bingo and group
music activities.
So what were the key benefits and challenges?
These all hinged on the immersive nature of VR and the sense of presence this created.
Being fully immersed in the virtual environment creates the feeling that you are really in
another world.
You are right under the sea, for example.
And this can be powerful for those living in institutional care who have limited opportunities
to leave the care home environment and experience these other worlds in real life.
But the immersive nature of VR is a double-edged sword.
On the one hand, immersive VR can be tailored to individual interests and therefore provides
opportunities for personalised engagement.
It can be used to provide diversion and relaxation and virtual travel can help to resurface forgotten
memories.
On the other hand, immersive VR can be frightening.
It can be uncomfortable to wear the VR headsets and it can be difficult to carefully facilitate
the VR activity when someone is immersed in the experience and cannot see what is happening
in the physical world around them.
One of our participants shared this story about a care home resident who was bored with
the activities on offer in the aged care home.
So the lifestyle team member suggested that he try VR.
He used VR to travel to Africa, and through this virtual experience the staff discovered
that he had previously travelled to Africa in his younger years, so it helped to resurface
this forgotten memory.
And this was an experience that he had not previously shared with the care staff in this
home.
In a contrasting example, a participant shared with us a story about a resident who had used
the travel program and ended up standing at the edge of the Grand Canyon and this triggered
a fear of heights: “He put himself on the Grand Canyon or somewhere high and he was
terrified.
He had a panic attack.
But he didn’t tell me.
He just said, ‘I’ve had enough’ and off he went to his room.”
It wasn’t until a week later he came back and told the staff member what had happened.
This example highlights the care required when using virtual reality in aged care, which
is a particularly sensitive care setting.
In our paper we use an ethic of care framework, drawing on Joan Tronto’s 1993 book, Moral
Boundaries, to identify the phases involved in designing and facilitating immersive VR
experiences in aged care.
The first phase in Tronto’s framework is caring about and this means being attentive
to the needs of others.
We saw this in the way our participants tried to understand what their clients needed from
the VR experience.
One participant emphasised that the VR experience needed to be individualised and that meant
learning about the person being cared for and that meant knowing what they wanted from
the VR journey.
So he said, “We can’t take them on our journey.
We have to allow them to promote their journey to us.”
Having identified individual needs, taking care of those needs involves assuming responsibility
and determining how to best respond.
In our study this included, for example, participants noticing when someone was feeling agitated
or depressed and needed distraction.
As this participant said, “That’s part of our job, to make them feel happy in the
moment with what we’re doing and distracting them with something that interests them and
something that they enjoy.”
While residents were immersed in the VR experience, staff needed to provide careful facilitation
and reassurance.
This can be aligned with phase three in Tronto’s framework, caregiving.
A common strategy was for the caregiver to stay close by and to provide a reassuring
touch but this had to be done carefully because it could also break the spell of the immersive
experience.
Phase 4, care receiving, refers to the need to be aware of how a caregiving act is received
by the care recipient.
One key challenge of immersive VR is that it is difficult to assess how well someone
is responding to the care, especially if they are showing signs of distress that are obscured
by the head-mounted display and this concern is very clearly portrayed in this quote: “Creating
that environment when you are not in that world with people is extremely challenging
because agitation, anxiety, and all of those can be displayed in completely silent ways.
So without having communication through eye contact, it’s very difficult to know if
they are frozen through terror or relaxed.”
In summary, when used in aged care, immersive VR experiences need to be carefully selected,
deployed, facilitated, and monitored.
Applying an ethic of care framework can help us identify lessons for good practice in this
area, which we highlight in our paper.
Thank you for listening.
If you would like to know more about this research, please feel free to get in touch.