Report: Using Virtual Reality in Senior Care

 

Background 
Twenty-five percent of Americans are predicted to be 65 or older by 2030 (U.S. Census). The overwhelming majority of these baby boomers (approximately 90%) aim to age-in-place. Interestingly, these numbers drop significantly when physical and mental deterioration sets in. In a recent LeadingAge survey, 40% of baby boomers said they wanted to live somewhere other than the place they currently call home if they had a physical disability impacting their day-to-day lives, and 70% want to be in a staffed senior care facility if they have dementia and need help with daily activities. These statistics are telling and suggest a growing need for senior care professionals. Between 2016 and 2026, the direct care workforce is expected to grow from 4.4 million to 5.8 million--an increase of 30%. This places a heavy burden on staffed senior care facilities to recruit, onboard and train direct care workers to meet the complex needs of seniors.

 

“70% of baby boomers want to be in a staffed senior care facility if they have dementia and need help with daily activities”
Normal aging is associated with a number of physical, emotional and cognitive changes that senior care staff must be aware of and that require special skills to address. High-quality education and training can provide workers with the knowledge required to assist seniors. This will allow senior care facilities to mitigate many of the preventable circumstances and accidents associated with normal aging by reducing preventable risks and providing tools for addressing these risks through education. For example, training on how memory loss affects daily functioning, how to calm a confused and frustrated senior, how to make the living quarters and bathroom safe from falls, how a healthy diet and regular exercise can benefit those living with diabetes, and how mood swings and depression can be mitigated are critical.
 
Contents
I. Brain Science
The Psychology and Neuroscience of High-Quality Education & Training 
Unfortunately, high-quality education and training can be difficult to find, harder still to replicate, and in too many cases, minimal and often ineffective training is provided. When training is made available, it usually comes in the form of textbooks or training manuals. These are notoriously difficult to process and lead to poor initial learning and weak long-term retention.
To build effective educational tools for senior care staff, one must leverage research on the cognitive neuroscience of learning. One fact that is clear is that experiential learning is most effective, and is more effective than learning by reading text or PowerPoint. Experiential learning engages multiple learning and memory systems in the brain (e.g., experiential, behavioral, emotional and cognitive) in synchrony whereas text and PowerPoint predominantly engage cognitive systems.
“Experiential learning engages multiple learning and memory systems in the brain (e.g., experiential, behavioral, emotional and cognitive) in synchrony whereas text and PowerPoint predominantly engage cognitive systems.”
In addition, text provides only an abstract representation of a real-world phenomenon that must be translated by cognitive processing systems in the brain into something concrete and actionable. This is cognitively challenging and relies on working memory and executive attention, both of which decline with normal aging and are adversely affected by stress, pressure and anxiety. On the other hand, there is no better way to learn than through experience. By spending time with a senior, watching them struggle to avoid falling, seeing them depressed and lonely, or struggling to recall names and places. Unfortunately, experiential training is time- and cost-intensive, and difficult to do well at scale.
Thus, although only marginally effective, the most common approach to education and training for the professional frontline workforce is to rely upon text-based documents and classroom-based instruction.
A Virtual Reality (VR) Approach To Senior Care Training 
There is a quandary. As we’ve pointed out, while experiential learning is ideal, it is not time- or cost-effective, and it is not scalable. These issues are addressed with modern training tools such as virtual reality (VR). VR trains through experience, but is time-effective, cost-effective and scalable. Virtual reality (VR) provides senior care staff with a first-person immersive experience. When combined with interactive storytelling the lines between real and virtual immersive experience blur to the point that the senior care worker has a sense of “presence”. They feel like they are somewhere else.
“VR trains through experience, but is time-effective, cost-effective and scalable.”
Senior care education and training is ripe for the application of modern technologies such as VR. Unlike text-based training content that engages only the cognitive learning systems, VR broadly engages multiple learning systems in the brain in synchrony by transporting a learner into a novel experience. For example, a certified nursing assistant (CNA) or home care therapist might be transported into a “A Day in the Life of Senior Caregiving” where they are given immersive experiences with the residents, staff, and living environments.
Alternatively, a senior care worker can be instantly transported into difficult situations, including into the perspective of a senior where they might experience the disorientation and frustration associated with poor memory functioning, visual impairments, or sundowning. They can then shadow an experienced senior care worker as she interacts with a depressed patient while also providing useful tips and demonstrating best practices for improving their mood. Finally, a senior care worker can be transported into living quarters that were just “fall proofed” while another caregiver describes the choices necessary to enhance safety.
The applications are many and the potential for high quality education and training for senior care staff is high.
II. Recruiting
VR can be used to enhance frontline senior care recruiting efforts for the direct care workforce, from certified nursing assistants (CNAs) to non-clinical home health aides and the myriad roles in between. For years recruitment for these roles has appeared to be a constant uphill battle, as evidenced by headwinds from shortages, turnover, and wage costs to name a few. Although frontline staff turnover rates are difficult to estimate, a recent review conducted by the Paraprofessional Healthcare Institute (PHI) found turnover rates between 45% and 65%. But the issues go far beyond turnover; in fact, they begin much earlier in the recruitment cycle, with candidate qualification.
Qualification is atop many organizations’ minds, even for roles with relatively low legal requirements per state regulations. And while the definition of ‘qualified’ varies by company and by state, it’s rather telling that in a 2016 CareinHomes survey, the top quality that home care companies looked for in a caregiver is someone who is compassionate and personable. An overwhelming majority—82%—said this is the most important quality in a potential hire. So it should be little surprise to us that no one is worried about a lack of applicants, only that companies are not getting the people they want.
Well, if what the overwhelming majority of recruiters are looking for first and foremost is a compassionate, personable hire to determine qualification, we would be hard-pressed to think of a better quagmire to find ourselves in, given what we now know about the benefits of virtual reality.
Let us set aside the question of choosing between the two types of candidates, and instead focus on how VR can be combined with traditional approaches to senior care education and training so that recruiters can be confident in hiring both types of candidates. The need for frontline senior care professionals is great. Recruiters need to be able to hire candidates with particular strengths like “compassion” or “skill” knowing full well that a candidate’s weaknesses can be addressed quickly and effectively through education and training.
The “compassionate” recruit is personable and wants to help. They are emotionally driven to “give back” and to provide seniors with comfort and care. The compassionate recruit may not have years of experience working in the senior care sector, and may even have skills gaps. They may need an overview of the industry’s many rules and regulations, or training on fall prevention measures and techniques, and even education regarding the changes in mood and memory associated with normal aging or dementia. Once hired, it is critical to fill this skills gap quickly and effectively as a passionate worker might become discouraged quickly if they are not performing their tasks effectively.
The best way to fill this skills gap is with a combination of traditional education and training through text with VR and measurable experiences. Traditional training tools provide the recruit with the necessary information on rules, regulations, fall prevention techniques, as well as details on emotional and cognitive changes. VR provides the recruits with something altogether different, yet far more impactful: experience. The recruit can experience a “Day in the Life of Senior Caregiving” where they watch the rules being followed or broken — along with the consequences. Or they might shadow a seasoned professional mitigating a fall, or experience the challenges associated with memory loss. When effective education and training of this sort is combined with the recruit’s innate passion, the hiring professional can rest assured that the frontline worker is prepared and that the residents will receive excellent care from those compassionate, skilled individuals.
”The best way to fill the skills gap in senior care is with a combination of traditional education and training through text with VR and measurable experiences”
The “skilled” recruit is someone who has experience in senior care or in other clinical settings. The skilled recruit knows the rules and regulations, the techniques for mitigating falls, and the emotional and cognitive challenges associated with normal aging or dementia. Where they may be lacking is in compassion and being personable. If coming from another clinical setting, the recruit may not have a deep understanding of the unique set of people skills needed in senior care or in their specific role.
This is where interactive storytelling in virtual reality truly shines.
The recruit can experience a “Day in the Life of Senior Caregiving”, much like the compassionate recruit does. However, in this case the immersive VR experiences can emphasize communication, responsiveness, and empathy by allowing the recruit to “walk a mile in a senior’s shoes”.
They can obtain a first-person virtual experience with an apathetic or non-communicative frontline worker.
They can obtain a first-person virtual experience of the senior’s frustration when a frontline worker states that they will “only be a minute”, but don’t return for ten to twenty minutes.
These “walk a mile in my shoes” experiences are visceral. They engage emotional learning centers in the brain that quickly and effectively build empathy.
When effective education and training of this sort is combined with the recruit’s strong prior skill set, the hiring professional can rest assured that the frontline worker is prepared and that the residents will receive excellent care.
III. Onboarding
VR can be used to enhance frontline senior care onboarding efforts for the direct care workforce. Onboarding is a critical process for at least two reasons. First, the likelihood of an accident, injury, or violation of standard operating procedures is more likely when new employees are still learning. It is important to provide new employees with as much knowledge and experience as possible, as quickly as possible, but without overloading them, to reduce these risks. Second, new employees form long-term impressions of the workplace and management within a few weeks on the job. Employees want to know that they are valued, and providing a high-quality onboarding program goes a long way toward instilling this belief in new employees.
Onboarding involves getting new employees “up to speed” as quickly and efficiently as possible. VR educates and trains through experience, making it an ideal tool for direct care staff onboarding. VR provides experiential learning through interactive storytelling in an immersive virtual world. The learner is immersed in the story and becomes a part of it. It is interactive storytelling in VR that engages experiential, emotional, cognitive, and behavioral learning system in the brain in a time-effective, cost-effective, and scalable manner.
”VR educates and trains through experience, making it an ideal tool for direct care staff onboarding”
We now outline a number of areas in which VR could be usefully applied to i) speed the onboarding learning process; ii) strengthen long-term retention of the relevant information; and iii) build the behavioral repertoire needed in frontline senior care staff.
One of the best ways to give a new recruit a feel for their particular senior care setting as they begin the onboarding process is to have the recruit experience a “Day in the Life of Senior Caregiving”. This can begin with a virtual tour of the facility to familiarize the learner, through experience, with the layout of the facility. During the virtual tour, standard operating procedures that are most relevant in a given location can be described by the CNA tour guide. During the tour the new recruit can witness a challenging situation between two residents or between a resident and a CNA. The recruit can observe as a seasoned CNA diffuses the situation, then offers the recruit tricks and tips on how to mitigate similar situations that they might face. The new recruit can even experience an emergency situation and observe the seasoned CNA follow the emergency protocols in a calm and methodical manner.
Keep in mind that this approach can now be accomplished in a familiar, safe environment for the learner, which not only results in better-prepared hires, but also goes a long way towards demonstrating an organization’s commitment to its employees. After all, studies show that effective onboarding can improve retention rates by 52 percent, time to productivity by 60 percent, and overall satisfaction by 53 percent.
”Studies show that effective onboarding can improve retention rates by 52 percent, time to productivity by 60 percent, and overall satisfaction by 53 percent.”
Simply put, following a 5-minute VR experience your candidate will obtain a rich interactive storytelling experience that will be both memorable and go a long way toward preparing him or her cognitively, behaviorally, and emotionally for the job.
This approach is much more effective than providing the recruit with text and PowerPoint showing the rules and regulations, the emergency procedures, and written tips for how to deal with challenging situations.
This “Day in the Life” experience could be followed by VR experiences focused on communication, responsiveness, and empathy. The recruit could “walk a mile in a senior’s shoes”. They can obtain a first-person virtual experience with an apathetic or non-communicative frontline worker, and could experience first-hand the senior’s frustration when a frontline worker states that they will “only be a minute”, but don’t return for ten to twenty minutes. “Walking a mile in someone else’s shoes” is visceral and engages emotional learning centers in the brain that quickly and effectively build empathy. These advantages are unique to VR and ought to be utilized in senior care settings.
”With a 5-minute VR experience your candidate will obtain a rich interactive storytelling experience that will be both memorable and go a long way toward preparing him or her cognitively, behaviorally, and emotionally for the job.”
To complement traditional text-based onboarding content, VR onboarding experiences can be developed that provide experiential training on emergency procedures, dealing with aggression or anger in a resident, understanding the changes in mood and memory associated with dementia, or keeping the home safe. The sky’s the limit!
Once a VR onboarding strategy is implemented, it is important to measure its effectiveness. Subjective surveys and objective tests of knowledge acquisition can be administered following the VR experience while the learner is in the VR headset. This way data is recorded quickly, accurately, and automatically and can be shared with nursing and HR directors. These data can also be used to identify areas of strength and weakness in the onboarding process and can be used to modify the VR experiences for future recruits.
IV. Continuous Training
Once the onboarding process is complete, the next step is to initiate an ongoing education and training program. This program will provide frontline senior care professionals with the high-quality education and training required to assist seniors. This might include training on a) the rules, regulations, and standard operating procedures; b) the many physical, emotional and cognitive changes associated with normal aging; c) the people skills needed to ensure that staff are responsive to residents, communicate effectively, and show the empathy required to provide the best care; and d) proper care for a tracheostomy tube, drain, or central line, for instance.
Unfortunately, high-quality education and training can be difficult to find, harder still to
replicate, and in too many cases, minimal and often ineffective training is provided. When training is made available, it usually comes in the form of textbooks, training manuals or possibly video. These are often difficult to process and can lead to poor initial learning.
“Unfortunately, high-quality education and training can be difficult to find, harder still to replicate, and in too many cases, minimal and often ineffective training is provided.”
Even if the training materials are well designed and frontline professionals show quick learning, there is still the problem of forgetting. The brain is hardwired to forget so what is learned to perfection today will be lost in the days to come. Thus, ongoing training is required to maintain competence and to build long term memory representations.
Finally, some skills that are critical to high-quality senior care are difficult to train with text or video. These are what are referred to as “people skills”. People skills are about what we do, how we do it and our intent. It is one thing to know “what” to do, but something completely different (and mediated by distinct learning systems in the brain) to know “how” to do it. People skills include showing empathy, communicating effectively, listening, and being responsive to residents’ needs. People skills are best learned through experience.
“People skills are about what we do, how we do it and our intent. It is one thing to know ‘what’ to do, but something completely different (and mediated by distinct learning systems in the brain) to know ‘how’ to do it.”
To build effective educational tools for senior care staff, one must leverage research on the cognitive neuroscience of learning. Two results stand out. First, one must “Train for Retention” to mitigate the brain’s natural tendency to forget. This is done by combining periodic testing
of previously trained material followed by retraining. Second, one must complement traditional training tools such as text and video with experiential training such as live observation and simulation. By spending time with a senior, watching them struggle to avoid falling, seeing them depressed and lonely, or struggling to recall names and places staff gain an experiential understanding and also develop people skills.
Unfortunately, experiential learning through live observation and simulation is time-intensive, cost-intensive, and is difficult to do well and with consistency at scale. This is where VR comes in. VR trains through experience, but is time-effective, cost-effective and scalable. VR provides senior care staff with a first-person immersive experience. When combined with interactive storytelling the lines between real and virtual immersive experience blur to the point that the senior care worker has a sense of “presence”. They feel like they are somewhere else.
Given these considerations we now outline an approach to ongoing frontline staff education and training that is grounded in the cognitive neuroscience of learning:
First, there is no need to replace your current Learning Management System or abandon your current training content. Rather, you should augment/enhance/complement your current approach with VR.
Second, for training the rules, regulations and standard operating procedures, as well as the physical, emotional and cognitive changes associated with normal aging, you should start with your existing text- or video-based training content. However, in addition, make sure to incorporate spaced testing and targeted retraining to ensure that the information is stored in long-term memory. Many Learning Management Systems offer testing and spaced training and it is highly effective.
Third, train frontline staff with existing tools but complement them with VR experiences. For example, to strengthen the staff’s understanding of the standard operating procedures or physical and cognitive changes associated with normal aging, you might have staff don a VR headset and be instantly transported into a situation in which some regulations or standard operating procedures are violated while an experienced senior care staff “guide” explains what went wrong and how to fix it. Staff might then be transported into a situation in which they are shadowing an experienced senior care worker as she interacts with a depressed patient while also providing useful tips and demonstrating best practices for improving their mood. This might be followed by another experience where useful tips are provided for addressing memory loss, or where a senior care guide describes the changes that need to be made to fall proof a resident’s quarters. The applications are many and the potential for high quality education and training for senior care staff is high.
Finally, people skills training should start and end with VR. Simply put, text- and video-based training are relatively ineffective at training people skills whereas VR is ideal. With VR the staff member can “walk a mile in a senior’s shoes”. Imagine a VR experience in which the staff member is transported into the body of a senior who is experiencing the disorientation and frustration associated with poor memory functioning, visual impairments, or sundowning. Imagine having staff experience first-hand the senior’s frustration when a frontline worker states that they will “only be a minute”, but don’t return for ten to twenty minutes. Finally, imagine being present during the “end of life” experiences so often seen in palliative and hospice care. “Walking a mile in someone else’s shoes” engages emotional learning centers in the brain that quickly and effectively build empathy. These advantages are unique to VR and ought to be utilized to develop people skills.
“Walking a mile in someone else’s shoes” engages emotional learning centers in the brain that quickly and effectively build empathy. This is a unique advantage of VR that ought to be utilized to develop people skills”
As with any learning tool, it is important to measure its effectiveness. Subjective surveys and objective tests of knowledge acquisition can be administered following the VR experience while the learner is in the VR headset. The same approach can be taken with the Learning Management System content, and the ongoing education and training protocol can be adjusted accordingly. This way data is recorded quickly, accurately, and automatically and can be shared with senior care clinical education and nursing directors to provide immediate feedback on their staff’s learning progress.
V. Conclusions
The senior care industry is ripe for the introduction of immersive, VR education and training technologies to complement existing training tools and to facilitate recruitment, onboarding, and continuous training. These tools educate and train through experience. Experiential learning is effective because it broadly engages multiple learning systems in the brain that are critical for providing seniors with exceptional care. These technologies have the potential to improve all aspects of senior care from recruitment through onboarding to continuous training and confidence building.
Put plainly: VR builds knowledge, confidence, empathy and expertise — one experience at a time.