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Harnessing the potential of technology to strengthen the long-term care sector (part 1)

The Bottom Line

  • The COVID-19 pandemic has affected those in long-term care homes in Canada more than others. 

  • Making greater use of technology has been identified as a potential solution to help address some of the biggest problems in long-term care and to improve the health and well-being of residents. 

  • Several factors make it hard to identify and harness the potential of technology in long-term care homes, including: residents of long-term care homes have complex health and social needs; there are many long-standing issues in the long-term care sector across Canada; and the full potential of technology isn’t being used to address these issues and to improve the quality of life for residents, caregivers and their families.

The COVID-19 pandemic has affected those in long-term care homes in Canada more than others. This has been driven, in part, by residents being more at risk for serious and life-threatening health concerns from COVID-19. It has also been made worse by long-standing issues in long-term care homes that have been left unaddressed (for example, staffing problems and outdated buildings).(1; 2)

This has led to the development of several recommendations to strengthen the sector.(1; 3; 4) Making greater use of technology has been identified as a potential solution to help address some of the biggest problems in long-term care and to improve the health and well-being of residents. Technology may have various benefits, such as:
- helping residents who travel around the facility (for example, door sensors);
- promoting social interaction among residents (for example by delivering social programming online);
- facilitating virtual visits with care providers, caregivers, families and friends (for example through video calls);
- facilitate communication between facilities, and between the various care providers (for example, through electronic health-record systems);
- help to monitor the safety of residents (for example, global positioning systems (GPS) to locate wandering residents, health monitors, emergency response devices, and devices to monitor the usage of appliances);
- touchless hardware and voice-activated devices (for example, asking “Google” or “Alexa” to call the nurse and/or front-desk staff, and activate features in rooms such as lights, blinds, heating, ventilation and air conditioning, and entertainment); and
- artificial intelligence (for example, to support early disease detection, more precise diagnosis, and personalized treatments, or to continuously detect changes in activity and behaviour patterns for early detection of health issues).(1; 5; 6)

Figure 1 below describes some of the types of technologies that could be used in long-term care homes.

Figure 1: Types of technologies in long-term care homes (7)

Sans titre

With governments moving to address many of the concerns that have received attention during the COVID-19 pandemic, there is a unique opportunity to examine the potential of technology to strengthen long-term care homes. This blog post is the first in a series which examine evidence and experiences related to the role of technology in long-term care homes in Canada.

 

The problem: Why is harnessing the potential of technology challenging?

Several factors make it hard to identify and harness the potential of technology in long-term care homes, including:
- residents of long-term care homes have complex health and social needs;
- there are many long-standing issues in the long-term care sector across Canada; and
- the full potential of technology isn’t being used to address these issues and to improve the quality of life for residents, caregivers and their families.

Residents of long-term care homes have complex health and social needs
It is estimated that 1.2% of older adults in Canada live in long-term care homes.(8) Residents in long-term care homes have a wide range of complex physical and mental health needs. More and more residents have cognitive impairments, such as finding it hard to remember, learn new things, concentrate, or make decisions that affect their everyday life. Many also have several co-existing health conditions.

A profile of residents accessing long-term care services in 2019-2020 in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Newfoundland and Labrador and the Yukon was recently published.(9) The report revealed that:
- long-term care residents have an average age of 83;
- approximately 6.7% of residents are under age 65;
- 65.2% of residents are female;
- the most commonly diagnosed health conditions are:
     - neurological diseases (for example, dementia and other conditions caused by cerebrovascular accidents),
     - heart and circulation diseases (for example, hypertension, cardiovascular disease, and congestive heart failure), and
     - musculoskeletal diseases (for example, arthritis and osteoporosis);
     - 48.5% of residents are suffering with a mild/moderate form of cognitive impairment, and 32.7% of residents are suffering with a severe form;
     - 43.9% of residents have reduced physical function (meaning the ability to perform activities of daily living such as using the telephone, dressing, to managing medication, or managing finances);
     - 82.8% are dependent or require extensive assistance when performing daily living activities (for example, personal hygiene, toileting, moving around, and eating); and
     - 52.8% of residents may have possible depressive symptoms or depressive disorders.

The last point highlights the important social, emotional, cultural and spiritual needs of residents in long-term care. The health needs of residents are often intertwined with social needs. Unmet social needs put residents at greater risk for poor health outcomes.(10; 11) These residents may:
- lack social support;
- be lonely;
- be geographically isolated from their families and caregivers;
- be financially insecure;
- have limited access to services that are gender, linguistically, culturally or spiritually sensitive; or
- have marginalized identities that put them at greater risk for discrimination and being excluded.(12)

Addressing the wide range of health and social needs of residents is challenging, but must be considered when identifying and harnessing the potential of technology in long-term care homes.

There are many long-standing issues in the long-term care sector across Canada
There are many long-standing issues in the long-term care sector across Canada, including (but not limited to):
- a lack of coordination across the long-term care sector;
- limited collection and use of data to make improvements;
- limited staff training, satisfaction and retention; and
- limitations in the design and capacity of long-term care homes.

These long-standing issues have been made worse by the COVID-19 pandemic, with dramatic consequences. A federal report indicated that 82% of all COVID-19-related deaths in Canada were associated with long-term care homes.(1)

This is at least partially due to:
- long-term care home residents being at higher risk for COVID-19 because they live in close proximity to each other;
- exposure to staff who may be infected by COVID-19 (which is made worse by long-standing staffing problems); and
- most residents being frail and/or living with multiple complex conditions.(13)

The full potential of technology isn’t being used to address these issues and to improve the quality of life of residents, caregivers and their families
Technology can play an important role in modernizing the long-term care sector in a way that contributes to person-centred care.(14)

However, the adoption of technology in long-term care has been slower than in other sectors.(13) This is at least partially due to slow regulatory approvals that are required to use new technologies. Other barriers could include:
- the view that older populations lack the ability to learn about (and advocate for) new technology;
- costs that prevent long-term care residents from buying smartphones and smart devices; and
- lack of assistance and education on using technology and devices.(6)

These are just some of the key challenges to harnessing the potential of technology. In the next part of our series, we will examine the barriers to designing and using technologies in long-term care homes.


The content of this blog post is based on a document produced by the McMaster Health Forum to inform a series of citizen panels across Canada:
Gauvin FP, DeMaio P, Alam S, Drakos A, Lavis JN, Wilson MG. Citizen brief: Identifying and harnessing the potential of technology in long-term care settings in Canada. Hamilton: McMaster Health Forum, 15 January 2021.


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References

  1. Government of Canada. Infection prevention and control for COVID-19: Interim guidance for long term care homes. Ottawa: Canada: Government of Canada, 2020.
  2. Béland D, Marier P. COVID-19 and long-term care policy for older people in Canada. Journal of Aging & Social Policy 2020; 32(4-5): 358-64.
  3. Canadian Agency for Drugs and Technologies in Health. COVID-19 infection prevention and control guidance for long-term care facilities — Round-Up. Ottawa: Canada: Canadian Agency for Drugs and Technologies in Health, 2020.
  4. McGregor MJ, Harrington C. COVID-19 and long-term care facilities: Does ownership matter? Canadian Medical Association Journal 2020; 192(33): E961-E2.
  5. Appel L, Appel E, Bogler O, et al. Older adults with cognitive and/or physical impairments can benefit from immersive virtual reality experiences: A feasibility study. Frontiers in Medicine 2019; 6: 329.
  6. Eghtesadi M. Breaking social isolation amidst COVID-19: A viewpoint on improving access to technology in long-term care facilities. Journal of the American Geriatrics Society 2020; 68(5): 949-50.
  7. Chapman S, Miller J, Spetz J. The impact of emerging technologies on long-term care and the health workforce. San Fransisco: United States: UCSF Health Workforce Research Center on Long-Term Care, 2019.
  8. Estabrooks C, Straus S, Flood C, et al. Restoring trust: COVID-19 and the future of long-term care. Ottawa: Canada: Royal Society of Canada, 2020.
  9. Canadian Institute for Health Information. Profile of residents in residential and hospital-based continuing care, 2019–2020 — Quick Stats. Ottawa: Canada: Canadian Institute for Health Information, 2020.
  10. Northwood M, Ploeg J, Markle-Reid M, Sherifali D. Integrative review of the social determinants of health in older adults with multimorbidity. Journal of Advanced Nursing 2018; 74(1): 45-60.
  11. Daniel H, Bornstein SS, Kane GC. Addressing social determinants to improve patient care and promote health equity: An American College of Physicians position paper. Annals of Internal Medicine 2018; 168(8): 577-8.
  12. United Way. Seniors vulnerability report: Aging with dignity - making it happen for everyone. Burnaby, Canada: United Way, 2011.
  13. Stall NM, Jones A, Brown KA, Rochon PA, Costa AP. For-profit long-term care homes and the risk of COVID-19 outbreaks and resident deaths. Canadian Medical Association Journal 2020; 192(33): E946-E55.
  14. Wilson R, Cochrane D, Mihailidis A, Small J. Mobile apps to support caregiver-resident communication in long-term care: Systematic search and content analysis. JMIR Aging 2020; 3(1): e17136.

DISCLAIMER: Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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