During the first COVID-19 outbreak and restrictions in 2020, members of the Outside In Collective worked with Australian aged care providers to connect with, stimulate and bring happiness to residents with cognitive impairment through window visits, courtyard sing-a-longs and video chats. During this year’s Delta outbreak, the group started ‘Zooming’ into aged care facilities to engage residents with a program called Creative Interventions and Connection Via Zoom Mates. Maurie Voisey-Barlin, Susan Kennedy and Lee-Fay Low explain how it works and offer examples and detailed tips so others can do the same
There have been reports from families and aged care providers that many elders living with dementia aren’t able to engage with video calls using platforms such as Zoom. However, some just assumed that their family member or resident couldn’t engage, without even attempting a call to check.
Perceived barriers to engagement include that this generation is not familiar or comfortable with technology. Providers may not have the equipment or sufficiently strong WiFi for video calls. For the facilitator engaging through Zoom, challenges include inability to see or hear elders properly, particularly in a group, which means 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 have questioned how Zoom could possibly replace their ‘in person’ sessions.
However, members of the Outside In Collective – an informal collective of engagement specialists, including the authors, who all work independently – have been experimenting and refining the process of engaging elders through Zoom. This article describes our process and what we’ve learned.
The Outside In Collective
The Outside In Collective was established in 2020 by a 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 elders 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.
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 we are based. Elders 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 innovated with ‘Window Therapy’, bringing meaning, connection and lightness to the lives of elders 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).
However, during the 2021 Delta outbreak, the virulence of the strain meant that the implementation of Window Therapy involved additional risk of virus exposure for elders. Window Therapy creator Maurie Voisey-Barlin (co-author here) therefore drew on the experiences of the Collective members with engaging through Zoom. There was a sense that, despite feelings of isolation, this generation may not embrace the modification of the intervention through video chat technology. We tested this assumption through feedback from participants.
How we’re using Zoom with elders
Collective member Jessica Conneely (Dance4Wellbeing) has been running Zoom dance classes for seniors living at home.
“My Zoom dance sessions enabled seniors to connect in community and care with the artists. For some seniors 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. Her seniors 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 facility in NSW. The mantra that informs her work is “This is not entertainment – it is engagement. Interactive, generative and spontaneous.”
Zoom elder engagement ‘how to’ tips
Maurie Voisey-Barlin has created a guide to engaging elders using Zoom. It’s suitable for use by art and music therapists or performers who are working with or have a connection with aged care facilities. Maurie advises that the person leading this type of engagement must be outgoing, a natural improviser, not afraid of spontaneity, playful, mischievous, curious, authentic and good at engaging with elders, rather than just entertaining. Musical skills are also a huge benefit. Click here to read more.
‘Zooming joy’: a manager’s perspective on Zoom Mates
By Robyn Blackwell
General Manager SummitCare Wallsend, NSW
These are difficult and challenging times.
I am always so happy when we, in aged care, can rise to the challenge and at the right time, exceed expectations. Here at SummitCare Wallsend, NSW, we have a program that has delivered amazing results for residents and is a much-needed salve for residents facing visitor restrictions, staff in full personal protective equipment (PPE) and worrying news during the pandemic.
Maurie Voisey-Barlin, aka ‘Moz’, is our creative engagement specialist. This translates in practice to a modern-day jester. Moz has worked with residents in our home for almost three years and is part of our support crew, along with medical and allied health professionals and arts therapists. So many people, so much expertise!
Moz’s expertise is in establishing a relationship with a resident, researching and nurturing the dynamics of the relationship and then bringing joy to those residents via various creative means. The foundations are strong because of the ongoing and sustained connection he has with the residents and his unique skill set.
When we were first forced to pivot Moz’s services last year, Window Therapy was born (see main article for more on this). The connection he had formed with residents morphed seamlessly into Window Therapy.
With the outbreak of the COVID-19 Delta variant he managed to not just pivot but pirouette to deliver sessions online – Zooming joy into the residents’ rooms with the support of our incredible leisure and lifestyle team. I was intrigued about how it would work but had faith that he could continue to deliver the outcomes because he knows residents’ stories, loves, triggers and needs.
When you see the interaction online you realise that the investment SummitCare makes in this work through thick and thin pays extraordinary dividends – residents’ mental health is greatly assisted but hidden benefits like unlocking memories and voice through song, increasing breathing and oxygenation of blood, stretching and moving differently in dance and connecting with someone who consistently makes you happy, even when it is on a screen. That’s magic!
Maurie 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’ elders 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 was a nice way of introducing video chat to some elders 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 and appearing on the TV screen above the ‘hot seat’. Residents take turns in the ‘hot seat’ as the focus elder.
Maurie reports some surprisingly positive results, especially with elders 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 “A sparkling connection exists between the arts and health and it offers a palette of possibilities for future healthcare.” During the initial Zoom trial of her ‘Drawing Memories’ art class, Margaret hosted a virtual walk around her garden to introduce a spring theme. As the class began, one of the elders repeatedly said, “It’s so lovely to see your smiling face”. It is easy to forget in all this mask wearing that elders in residential care are not seeing anyone’s face. Smiles have been reintroduced.
Lessons learned and reactions from providers
Zoom elder engagement sessions 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 elders with cognitive or hearing challenges. Buddies are someone to bounce ideas off and create positive energy
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 the 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’s sessions have a motivational and inspirational effect that makes both 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 elders, 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.
Maurie Voisey-Barlin with the YES/NO buttons which have pre-recorded spoken versions of YES/NO which he uses for playful quizzes during Zoom sessions
The outcomes of our Zoom Mates sessions have really surprised us and we believe that, given the portable nature of Zoom, 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. At the time of writing, aged care facilities are opening up to visitors, but there is still a desire to take things slowly. Some of the Outside In Collective members are still delivering engagement sessions with a mix of in-person and Zoom, while others are still strictly Zoom-only, especially in some regional NSW services.
Our aim now is to connect with other creative types who can potentially do this 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 firstname.lastname@example.org
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 our elders 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; and Australian War Widows NSW.
The authors (above, from left) Maurie Voisey-Barlin, Susan Kennedy and Associate Professor Lee-Fay Low are all members of the Outside In Collective. Maurie and Susan are creative engagement specialists in aged care and collaborated on Creative Interventions and Connection Via Zoom Mates. Maurie is the founder of Window Therapy. Lee-Fay is Associate Professor in Ageing and Health and NHMRC Boosting Dementia Leadership Fellow at the University of Sydney
Maurie Voisey-Barlin leads a Hot Seat small group Zoom Mates session at Merton Living, Denman, NSW. Photos: all are courtesy of Maurie Voisey-Barlin, the Outside In Collective
A Zoom Mates room visit between Baz and Maurie Voisey-Barlin at SummitCare Wallsend aged care facility in NSW
Zoom Mates allows Maurie Voisey-Barlin to bring elders into his world to meet his children, check out their new bike, say hello to his wife, see his waratah flower for the first time, and show them the home extensions that they have heard so much about for the past year