The COVID-19 pandemic and resultant restrictions placed upon Canadians and residents of many other countries (ie, stay-at-home orders and social distancing mandates) significantly impacted elements of many people’s social connections over the last 2 years [1,2]. Social connectedness, defined as an individual’s subjective sense of having close relationships with others [3,4] is necessary for health and well-being [5]. During multiple phases of the pandemic, social connectedness was severely compromised for many people both directly and indirectly by restrictions placed on face-to-face engagements [6]. In Canada, older adults in congregate or institutional living environments, such as long-term care homes (LTCHs), were greatly affected during these times [7]. Older adults in LTCHs experienced some of the highest rates of COVID-19 mortality and morbidity of any population group [8,9]. Along with the systematic failure of some LTCH facilities [10], almost all LTCHs were mandated to implement extreme restrictions on visitors and staff, as an emergency infection control [11]. These drastic measures increased isolation and decreased the emotional well-being of older adults in LTCHs [6,12,13].

Before the COVID-19 pandemic, older adults in LTCHs were at risk of experiencing social isolation due to a variety of factors such as challenges with building new relationships, decreased autonomy, and geographical constraints on maintaining face-to-face or in-person connections with friends and family [14]. In older adults, social isolation is associated with negative health impacts such as reduced motor function, depression, cognitive decline, and mortality [15-19]. Similarly, loneliness is also implicated in health declines [20]. As people age, their likelihood of experiencing social isolation and loneliness increases [21,22]. In the United States, upwards of 40% of people older than 60 years reported feeling lonely [23]. In Canada, older adults also report elevated rates of loneliness and social isolation [24]. Moving to LTCHs can increase older adults’ likelihood of being lonely or socially isolated with reported rates of loneliness in older adults living in LTCHs varying from 22% to 75% [20,25,26].

With the start of the pandemic, social connectedness among older adults within LTCHs was severely compromised both directly and indirectly by restrictions placed upon visitors and other infection control measures [27]. This physical isolation of older adults in their rooms thereby compounded any preexisting impacts of isolation [6]. Detrimental impacts on older adults’ mental health associated with quarantine measures include emotional disturbance, insomnia, and low mood [28,29]. While these visitor restrictions were implemented in good faith as an effort to mitigate the spread of COVID-19, many older adults during the height of the pandemic died alone, with little to no connection with their family members or friends [30].

In the initial stages of the COVID-19 pandemic, research findings suggested that older adults may be less vulnerable to detrimental mental health effects of the disease and associated health measures, than their younger peers [30,31]. However, with time, additional studies indicated that the impacts of COVID-related restrictions and the resultant social isolation will have long-lasting repercussions on older adults’ health and well-being [27]. Furthermore, the protracted restrictions associated with the ongoing nature of the pandemic continue to negatively impact the physical and mental health of older adults and their family caregivers [9,12,30]. In Canada, during the first wave of the COVID-19 pandemic, when families were prohibited from in-person visits, there were 7260 deaths of older adults across LTCHs and retirement homes, representing 79% of all COVID-19 deaths [7]. Consequently, during the height of the pandemic, many older adults died isolated and alone [30-33]. Since that time, the policy changed first resulting in modified visitor restrictions that allow family members to be together in palliative circumstances and then removing visitor restrictions altogether [34]. However, challenges relating to the social isolation of older adults within LTCHs remain.

As COVID-19 led to widespread limitations on in-person gatherings and for a time halted in-person visits to LTCHs, attention turned to technology as a means to communicate and facilitate social connectivity between family members and older adults [35]. As we move forward from the pandemic it is critical to develop robust systems now, to mitigate the harmful unintended side effects (eg, decreased social connectedness and well-being) of infection control policies.

Web-based presence is the use of networked digital telecommunications technology to create the impression that a user is present in another environment [36]. Digital apps (eg, Zoom [Zoom Video Communications] and FaceTime [Apple Inc]) provide web-based face-to-face connection and may support social connectedness by providing meaningful social engagement in addition to being a point of access to community environments for older adults [37]. For LTCHs, web-based presence technology (WPT) has the potential to support social connectedness as a supplement to in-person engagement or a stand-in during outbreak situations such as the current COVID-19 pandemic. Acknowledgement of this potential has been highlighted by the COVID-19 pandemic, which has been a catalyst for myriad and lasting social changes, including the vastly accelerated use of WPT for communication in people’s personal and professional lives. However, the general uptake of WPT across LTCHs has lagged behind other sectors [38] for reasons including age-related bias about older adults’ physical and cognitive ability to use technology, costs of equipment, and a lack of education and support of staff, family, and older adults to use technology devices such as tablets or other mobile devices [39].

Early efforts to explore the application of technology within LTCH settings focused on aspects such as resident safety. However more recently, the role of technology to support social connectedness is also being investigated [40]. Emerging findings suggest that challenges of implementing WPT in LTCHs include limitations in staff shortages, training for staff on the use of WPT, dated LTCH building infrastructure, funding to support additional staffing and technology equipment, and processes supporting consistent use of WPT [41]. Addressing these challenges entails more than just the provision of additional funding. Instead, it asks for an enhanced systemic and context-specific understanding of technology implementation [42]. This understanding has to be cocreated with all relevant LTCH stakeholders (eg, residents, family members, staff, and administration) to effectively address user needs as well as financial, operational, and administrative constraints.

WPT can provide family members of older adults in LTCHs with the opportunity to visually observe the well-being of the older adult in real time. Visual confirmation of these older adults’ well-being can contribute to family members’ trust and confidence in the care being provided by LTCH staff [43]. Admittedly, WPT is not a panacea for fostering social connectedness among older adults in LTCHs [44]. However, it may be profoundly important to supplement in-person activities with hybridized web-based and in-person approaches for social connectedness in the context of distancing measures or other constraints on in-person engagement.

Given the potential benefits of WPT within LTCHs and the need to understand associated shortcomings, the proposed research goal is to explore experiences regarding the use of WPT in support of social connectedness between older adults in LTCHs and their family members, and to identify the contextual factors that must be addressed for successful WPT implementation in LTCHs. This study has 3 aims. First, to explore how older adults in LTCHs, their family members, and LTCH staff members experience, benefit from, and envision the role of WPT to support social connectedness in LTCHs. Second, to interview key stakeholders such as managers and directors of LTCHs, and to examine LTCH policy, funding, management, and operations in order to identify institutional challenges and facilitators impacting the uptake and spread of WPT within LTCHs. Third, to triangulate the findings from stages 1 and 2 to develop a framework that can inform the formal implementation of WPT in support of social connectedness within LTCH.

The faculty team recognizes that there is an implicit bias against some groups’ progression to academia’s higher ranks. Our faculty team is deeply committed to equity and diversity in recruiting, hiring, and training students. This research team will comprise emergent and seasoned scholars and researchers and a research assistant who is a graduate student at the university where the principal investigator is employed.

A growing body of literature demonstrates the benefits of various communications technologies such as social networking apps on older adults’ well-being, independence, and sense of connectedness with friends and family [62]. Knowing that social connectedness is a key contributor to the well-being of older adults in LTCHs [2], it will be important to optimize communications web-based technology in an efficient and timely way to avoid compounding further unintended detrimental effects to limit transmission of COVID-19, or any other future pandemics or epidemics.

As society continues to experience evolving disruptions to the ability to engage with one another, there is a need to reconceptualize social connectedness and to identify novel ways to attain fulfilling relationships with others particularly in the context of LTCHs. In the context of LTCHs, this could be represented by a hybridized system of web-based and in-person presence. However, more evidence is required to determine whether older adults in LTCHs and their family members benefit from WPT (eg, smartphones and tablets) as an approach to support their social connectedness. Further, there is a need to better understand how WPT can be implemented in LTCHs.

While WPT may have the potential to support meaningful social connectedness among many older adults in LTCHs and their family members, to date numerous uncertainties remain regarding leveraging WPT for social connectedness. These uncertainties include (1) the effectiveness of using WPT for social connectedness by older adults with cognitive impairments, (2) best practices related to the use of WPT by older adults with cognitive impairment, and (3) the role of extra supports for older adults with cognitive impairment when using WPT [44]. Additionally, it will be important to identify how an older adults’ physical condition could impact their ability to use WPT. For example, arthritis, vision impairments or neurodegenerative conditions such as Parkinson disease could necessitate the need for adaptive technology or additional assistance [63,64].

The proposed multistage approach and methodological triangulation will require the engagement of multiple stakeholders. Potential limitations may include challenges associated with conducting interviews with older adults living in LTCHs who may have cognitive or physical conditions that could limit their participation in in-depth interviews. Additional support from family members, LTCH staff or researcher staff may be required to facilitate interviews with older adults. Researchers will use flexible approaches to interviewing including in-person and zoom interviews, accommodating interview times and an honorarium to recognize their time and contribution. Researchers will also use strategies that can support older adults’ participation such as providing documentation in larger font size and providing a list of questions ahead of time.

The data obtained through qualitative description will consist of subjective perceptions and recollections of using technology for social connectedness and therefore may be biased toward a particular type of experience. Direct user observations, attained using an ethnographic approach, might be able to produce data that have a lower likelihood of being biased toward memorable experiences. However, actualizing this approach within LTCHs would be very challenging to practically implement.

The conceptual framework arising from this research on the role of WPT to support social connectedness between older adults in LTCHs and their family members will have a key role in informing LTCHs how to embed web-based presence as a mainstream communication tool to redefine and support social connectedness among older adults in LTCHs and their family members.