When a loved one is living with dementia, meaningful connections can be hard to come by on a good day.
Physical touch and direct eye contact are often key components of creating a successful interaction in a memory support environment. It’s easy to understand the struggle to connect that families might feel when those options are stripped away.
Nine months ago, it was unimaginable that COVID-19 would have the impact we are experiencing now. As we navigate these unprecedented waters, it has fallen to the average healthcare worker to fulfill the day-to-day psychosocial needs left unmet in the absence of physical family presence.
While venturing into new territory, we remained committed to our goals of providing the highest level of connectivity, transparency and reassurance — to our residents and their loved ones.
Technology would be key, but we knew it wouldn’t be easy. Cognitive impairment often lends itself to frustration and overwhelming sensations when a task becomes too intricate. A struggle for comprehension can be a recipe for disaster, leading to combative and destructive behaviors. That said, modern technology is often a foreign language among the dementia population.
Here’s how we bridged the gap and made virtual visits work despite those challenges.
Conversations from the front
“It’s easy, all you’ll need is an iPad. Now connect it to the WiFi. No, I don’t remember your password. It’s simple, just enable the camera. Oh, you have a MS-DOS from ’83? I think you’re still on mute.”
What I’ve learned on this journey is that getting a person living with dementia to be open and willing to try this scary new thing is way easier than teaching myself all the tech speak. This has been one bumpy, exhausting road; Trust me I’ve got the bruises to prove it! But, at the end of the day, one success story makes it all worthwhile. That smile, a blown kiss or an “I love you” is all I need to push forward.
We knew that introducing something completely unknown to our dementia population could be overwhelming for everyone involved.
After all, rule number one is to never set residents up for failure. We modify tasks to ensure successful outcomes.
Many of these folks are not familiar with the concept of a telephone that fits in your pocket, so expecting them to embrace an iPad as a replacement for the hug of a loved one is a pretty big deal.
The coupling of a familiar visual image and a known voice is often enough to allow the cognitively impaired to focus on the screen and actively engage. We have seen some incredible engagement on the resident side of the screen. We’ve also seen great success in the use of wireless headphones to block out environmental distractions and keep the person living with dementia focused.
A high percentage of spouses might not be prepared for the Virtual Visit concept either. Many in the Silent Generation are not well versed in the latest, greatest tech advances. This has held true and is probably still the biggest speed bump.
Every person logging in on the other side of the screen is operating their own device. The best advice I can muster for this challenge is patience and building a strong report with each family member. When you spend 20 minutes talking them through the icons over the phone so they can figure out how to enable the webcam, they know you care.
The unexpected: overloaded platforms
The whole world hit pause, and we almost broke the internet. If you’ve ever stared at “waiting for meeting host” and watched the clock tick by, then you’ve experienced this issue first hand. After splaying the calls across a variety of platforms, this hurdle is in the rearview mirror. Each of our residents is assigned a personal meeting ID on one of five platforms so that we can now accommodate multiple calls concurrently, maximizing the potential number of engaged residents per day.
Another curveball was just how popular this idea of virtual connectivity became. It quickly became apparent that we were going to need some significant structure to this program. In the beginning, there weren’t any concrete rules. As the demand grew exponentially, setting parameters for length and frequency of calls was crucial.
In the dementia world, 15-20 minutes is the ideal length of focused engagement. Remaining focused on a single task for that period of time is very taxing on the cognitively impaired brain. As they begin to tire and struggle with maintaining presentation it can cause overstimulation and frustration in the person living with dementia.
Keeping in mind the goal of quality — not quantity — 30 minutes, once a week per caller has been the sweet spot. Some residents have several children that wish to participate, and while one person can tolerate a group chat, others are too overstimulated and benefit from single-caller sessions spread throughout the week.
Remember that strong report we were building with the families? Well fortunately, this has always been on the forefront of dementia care so we were already there with most. That means having everybody’s e-mail address and communicating with them readily. It made it that much easier to reach out and gather preferences and requests at the start. Once you’ve gauged each individual’s emotional needs and preferences, it enables the development of a recurring schedule.
The surprise takeaway
This virtual visit program isn’t going anywhere once COVID-19 is behind us. Family members living at a distance who have struggled with making meaningful connections through telephone calls are in awe of the quality time they are now spending with their loved ones. While we will obviously need to dial it back to accommodate the reinstatement of group programming, there will be a continued desire and need for connectivity.
Staving off feelings of isolation and depression has not been an easy hurdle but we’ve created something new to combat the problem, and it’s working. It wasn’t easy, but it’s working. It has been exhausting, but it’s working. Our residents are reaping the benefits, our families are in the loop, and everyone is expressing satisfaction and gratitude. Goals met!
Whitney Hackman is a recreational therapy coordinator and certified dementia practitioner at a continuing care retirement community in Lancaster, PA.