Connecting with Zoom Mates

The Outside In Collective was established in 2020 by an informal group of creative engagement specialists who had been working in-person with aged care residents for between two and 10 years, creating individualised social interaction opportunities and using the sessions as a therapeutic tool.

The group members have backgrounds in drama, visual arts, dance and music, combined with expertise in connecting with older people living with dementia. This in-person engagement approach was evaluated in a randomised controlled trial and shown to reduce agitation and antipsychotic use and increase happiness (Low et al 2013; Low et al 2014). Professor Lee-Fay Low (co-author here) brings dementia and evaluative expertise to the Collective.

‘Window Therapy’

With the arrival in Australia of COVID-19 in 2020, many residential aged care facilities went into lockdown, including in the Greater Sydney and Hunter areas of NSW where most of the Collective members are based. Older people were no longer able to receive visits from family, volunteers, musicians, entertainers, community service visitors, creative therapists and engagement specialists.

In response, members of the Collective, including the authors, developed an engagement program called ‘Window Therapy’, bringing meaning, connection and lightness to the lives of aged care residents and staff via interactions through windows in their rooms or common areas. Some members also tried successfully engaging with residents via Zoom, but ‘windows’ were more popular with many facilities. (The Window Therapy approach is described in detail in the July/August/September 2020 issue of the AJDC).

With the arrival of the COVID-19 Delta variant in 2021, the virulence of the strain meant that the implementation of Window Therapy involved additional risk of virus exposure for residents. Members of the Outside In Collective again faced the prospect of their ‘in person’ creative ageing programs being withdrawn from care homes as a precautionary measure.

In response, we approached our aged care service partners about trying platforms such as Zoom as a way of maintaining our programs – but were met with a chorus of doubt. Most spoke of poor experiences using similar formats to engage older people living with dementia. There was a sense that, despite feelings of isolation, residents would not embrace the modified Window Therapy program using video chat technology and would not engage with video calls. They also noted that family members had expressed similar views.

Other potential barriers to engaging via Zoom included providers not having the equipment or sufficiently strong WiFi for video calls; facilitators being unable to clearly see or hear the residents, particularly in a group, meaning they can’t read face, tone and body language as easily; and not having an appropriate camera and microphone at home. Clinicians and those who work in the creative arts questioned how Zoom could possibly replace their ‘in-person’ sessions.

Over the past five months, members of the Outside In Collective have been experimenting and refining the process of engaging older people through Zoom and testing some of these assumptions and perceived barriers through feedback from the Zoom Mates facilitators, participants and aged care providers. This article describes our process, successes and what we’ve learnt.

How we’re using Zoom

Collective member Jessica Conneely (Dance4Wellbeing) has been running Zoom dance classes for older people living at home.

“My Zoom dance sessions enabled [them] to connect in community and care with the artists. For some it’s a reason to get dressed that day, and an opportunity to do something physical, social and creative that supports their wellbeing,” Jessica said. Jessica picks a theme for each session (at the time of writing she was working through the colours) and picks music, paintings, and movements to match. Participants come dressed in the week’s colour!

Susan Kennedy (co-author here), also a Collective member, has been experimenting with running Zoom sessions at Warrigal Mt Terry residential care home in NSW. The mantra that informs her work is “This is not entertainment – it is engagement. Interactive, generative and spontaneous.”

Tips for engaging via Zoom

Maurie Voisey-Barlin (also a co-author here) has devised three different formats of engaging through Zoom, each of which can successfully engage residents with dementia. At the time of writing, he’s running these sessions at four partner services.

For Zoom to work in this context, it is crucial not to aim solely for group sessions. One-on-one sessions (Zoom Room Visits) involve Maurie ‘visiting’ residents in their rooms engaging in banter, a joke, a photo or perhaps validation and sometimes a song.

‘Zoom Around the Room’ occurs in group areas, where staff drop the computer in front of different residents for a quick chat, a kind of spontaneous quick-fire one-on-one. It has proven to be a nice way of introducing video chat to some of those who were initially not keen. The ‘Hot Seat’ model has one resident at a time sitting in front of the camera and screen engaging with Maurie, with a small group watching from behind as he appears on the TV screen above the ‘hot seat’. Residents take turns in the ‘hot seat’ as the focus.

Maurie reports some surprisingly positive results, especially with people further along their journey living with dementia. “The success and impact relies on knowing your elders. Be curious. Know their stories, loves, triggers, their humour. Know what they think of the world and present things that might interest or provoke. Otherwise, the magic does not happen easily on Zoom,” says Maurie.

Known for his playful approach, Collective member Rob Feldman says, “One fun advantage of Zoom is that I can grab things from around my house for ‘show and tell’. Recent examples were a painting done by my late uncle, my Mum’s retro ’70s orange enamel teapot, and our cat. Wonderful conversation starters, and there’s no way I could have brought our cat into residential care!”

Visual artist and Collective member Margaret Rolla believes that, “A sparkling connection exists between the arts and health and it offers a palette of possibilities for future health care”.

During the initial Zoom trial of her ‘Drawing Memories’ art class at SummitCare Wallsend, Margaret hosted a virtual walk around her garden to introduce a spring theme. As the class began, one of the participants repeatedly said, “It’s so lovely to see your smiling face”. It is easy to forget in all this mask wearing that people living in residential care are not seeing anyone’s face. Smiles have been re-introduced.

Lessons learned and reactions from providers

Zoom engagement sessions for older people and people with dementia require active, collaborative support from a staff member (buddy) often from the lifestyle or activities team. The buddy sets up the technology, is an integral part of the interactions and assists in facilitating communication when needed for people with cognitive or hearing challenges. Buddies are someone to bounce ideas off and create positive energy.

Aged care provider Whiddon’s Head of Strategy and Innovation, Karn Nelson, says, “It takes a collaborative approach for the sessions to be successful and our teams are working closely with Maurie to achieve this. While we were unsure at first how residents may respond to the sessions, we are very pleased to see how interactive and spontaneous they have been. It really is fantastic to see residents laugh along and have such a great time and that this can continue, despite restrictions.”

At Warrigal Mt Terry, NSW, Lifestyle Team Leader Linda Winter and Lifestyle Officer Kim Lillie say the musical creativity and humorous exchange in Susan Kennedy’s sessions have a motivational and inspirational effect that makes their residents and staff feel happy. They add, “Susan’s community engagement program is the art and science of engaging and motivating our Warrigal residents with energy and happiness.

“Connections with others are vital for mental and physical health and wellbeing. That’s why, in a time of social distancing, it’s more important than ever before to connect meaningfully.”

Importantly, staff are not passive. They are active participants in this three-way play. Most report that moments to playfully engage under these testing times brings some relief. Whilst this is an intervention for the residents, it also aims to boost morale for the onsite team.

It is our desire to know more about others and it is the two-way interaction this brings that fosters deep meaningful connections. If it’s not interactive and on equal terms, if it’s not spontaneous, then it’s performance rather than creative engagement.

Zooming ahead

The outcomes of our Zoom Mates sessions have really surprised us and, given the portable nature of Zoom, we believe there may well be space for this format to continue to be used alongside our ‘in-person’ sessions in aged care long after visitor restrictions and lockdowns are a thing of the past.

Just as aged care facilities were opening up to visitors, the Omicron variant arrived so there is a desire to take things slowly. Some of the Outside In Collective members are delivering engagement sessions with a mix of in-person, Zoom and Window Therapy while others are still strictly Zoom-only, especially those delivering in some regional NSW services.

Our aim now is to continue to connect with other creative types and providers interested in this format of engagement work in their aged care facilities and then mentor them through to excellence.

To find out more about Zoom Mates and the work of the Outside In Collective, contact Maurie Voisey-Barlin at mauriebarlin@gmail.com

Photo Gallery

Acknowledgements

This work would not be possible without our ever-enthusiastic service partners and their frontline teams who continue to innovate and collaborate with us in exploring new ways to keep older people living with dementia motivated and connected with the outside world. We acknowledge and thank: SummitCare, Wallsend; Whiddon Largs, Redhead, Easton Park and Belmont; Warrigal, Mt Terry; Merton Living; Cranbrook Care; Bella Vista Gardens; Allity Aged Care, Normanhurst and Pemulwuy; NovaCare Community Services, and Australian War Widows NSW.