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.
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.
The Psychology and Neuroscience of High-Quality Education and 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.
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.
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.
VR Applications in Senior Care
The usefulness of experiential learning and applications of VR in senior care are many. We briefly summarize VR applications using three aspects of the senior care workforce life-cycle.
Recruiting: Direct care staff turnover rates are difficult to estimate since no large-scale comprehensive assessment has been conducted. Even so, a literature review conducted by Paraprofessional Healthcare Institute (PHI) found turnover rates between 45 and 65%. This means that senior care facilities are constantly recruiting new workers. One commonly noted cause of the turnover problem is a lack of ability to evaluate whether a new recruit is prepared and whether they know “what to expect”. In much the same that it is nearly impossible to describe to someone verbally what “Black Friday” is like in Walmart, it is equally difficult to adequately describe the challenges and rewards of working in senior care. Walmart addressed this issue by building a “Day in the Life of Black Friday” VR experience that immerses workers in the Black Friday experience. In much the same way, imagine having a potential recruit put on a VR headset and experience a “Day in the Life of Senior Caregiving”. They could be given an immersive virtual tour of the facility, observe residents interacting, eating meals, preparing for bed, and even be a bystander watching an experienced senior care worker deescalate a potentially dangerous situation. Recruits would leave the interview better prepared for what to expect, and the HR department would have an initial sense of how the potential recruit might react.
At the end of the day, healthcare providers for older adults want the best candidates as much as those candidates want a role that meets their needs and expectations. What better scenario than to find a passionate, hard-working individual with little-to-no clinical experience and to provide them with the resources they need to be successful? Likewise, VR can help a candidate with experience in other clinical settings decide whether she is not suited for a particular role or would perhaps not remain in a given role over the long term, thereby potentially saving that organization the $2,200 it costs to replace direct care workers on average.
Onboarding: Direct care staff are federally required to complete 75 hours of training. Although the specific training requirements vary by state, the goal is to equip staff with the skills and competencies needed to provide quality care. This is another area where experiential learning and immersive VR could be invaluable for senior care. During the onboarding process, new recruits could be asked to complete the “Day in the Life of Senior Caregiving” VR experience. This will serve to refresh their memories on what to expect and to obtain a “big picture” understanding of the senior care facility and their role in its operation. They could then complete a suite of VR experiences that expand upon the “Day in the Life” experience. For example, VR experiences focused on safe lifting and walking practices, diffusing dangerous situations, medication adherence and safety, and wandering and sundowning to name just a few. Within a short time a new recruit would have the experience and knowledge to perform their job effectively. This would increase employee engagement, productivity and satisfaction and would ultimately enhance resident satisfaction, and most importantly result in exceptional care for seniors.
Continuous Education and Training: The human brain is hardwired to forget. Because VR broadly engages multiple learning systems in the brain it leads to better retention and slower forgetting. Even so, workers still need continuous refresher training as well as education and training as new technologies and procedures are introduced. VR can be effective here as well and can supplement traditional training with Learning Management Systems should they be in place. In addition to the suite of “Day in the Life” VR experiences, other experiences that offer more detailed training on diet and exercise, memory and dementia, end of life issues, and just about any other topics could be incorporated with access to high-quality content creation, distribution, and analytics.
The senior care industry is ripe for the introduction of immersive, VR education and training technologies. 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 and expertise — one experience at a time.
This is the first entry of a four-part series on virtual reality applications in senior caregiving. The next 3 parts will focus on applications for recruitment, onboarding, and ongoing education and training.