AMS Virtual Visits Facilitation Guide

For Medical Students Joining the

Combating Social Isolation Via Virtual Visits During the COVID-19 Pandemic Initiative

 By Swechya Banskota (MS1)

(With the guidance of Dr. Cheryl Reed and Anne Quinn)

Warren Alpert Medical School of Brown University

Why?

With the closure of nursing facilities and ALFs to visitors during the COVID-19 pandemic and the strict isolation and self-quarantine measures they must follow to stay safe, older adult residents are becoming more isolated than ever. While social distancing is crucial to keeping our public healthy, loneliness is associated with depression, worse physical health outcomes, and even all-cause mortality.  Previous research has shown that video conferencing tools can be used by older adults in Assisted Living Sites/nursing home facilities and in the community to help maintain community, connectivity, and combat loneliness/isolation.  Nursing homes and ALF sites already use Skype and FaceTime to help connect residents to their family members. Additionally, per research, 67% of older adults, including minorities, use the internet. This population also has a rapidly growing smartphone ownership rate (42% in 2017). Due to the importance of combating social isolation in the older adult population, this initiative empowers medical students to use video-chat tools (Skype, FaceTime, and Zoom) and/or phone call to check in on and visit older adults during the COVID-19 pandemic. This guide may also be used for a longitudinal program where medical students connect with older adults after the pandemic to combat isolation and loneliness in the elderly.  Please fill out this short google form if you decide to start this initiative and/or use this facilitation guide at your school.

Logistics:

1. How to reach out to older adults and advertise the program?

• Medical Student Coordinators should reach out to Assisted Living Facilities (ALFs), Nursing Homes, and/or other organizations that work with older adults in their community to determine if older adults in their program(s) could benefit from a Virtual Visit from medical students. You may find it helpful to run the idea by geriatricians at your school and your Doctoring course leaders to see if they are connected to these organizations.
• When you reach out to ALFs, nursing homes, and other organizations, please acknowledge to them that you are aware that staff are running at full capacity, and that it may be asking a lot to be requesting their help in getting seniors connected to this program. If you have the bandwidth, let them know that you can facilitate the process on their end by creating and sending them a flier with all the necessary information that they could distribute to their residents. Hence, if an older adult is interested, they can sign up themselves if they are able to. Older adults who are unable to sign up may benefit from extra support from caregivers.
• Since the older adults voluntarily participate in the program, and since the objective of this program is to provide social support and medical information will not be collected through this initiative, a signed consent/HIPAA release form may not be needed. However, medical students coordinating the program should consult with their medical school administrators and Doctoring course leaders to determine if there is a need to get a signed consent/HIPAA release form from the older adults. If it is determined that a signed consent/HIPAA release form is not needed, medical student volunteers should still take measures to protect (securely store and dispose) private information that may be released by older adults during their participation.

2. How to facilitate medical students’ participation?

• Medical student coordinators should send an email to their class about the need for social support that the older adults have right now. They should also create a Google Form that students can fill out if they are interested in volunteering.

• Collect names, contact information, and their preferred technology/approach to maintain contact of both older adults and medical students. Also, collect some dates/times the older adult prefers to be contacted for the first time. Match medical students with older adults. Provide older adults and medical students with information about their partners. At some participating sites, caregivers may ask for the student’s name and contact information as well.  *It is imperative the medical students also have the name and contact information of the ALF/nursing home coordinator and/or older adult’s caretakers, so that they have someone to contact if concerns arise during the visit.  
• Encourage medical students to fill out a google form to provide feedback about the visit after each visit. An example form can be found here: Google Form @ Brown University
• Medical students should arrange for potential follow-up times with their partner during the first visit. Some follow ups may have to be arranged/coordinated with the resident’s caregiver.

Things Medical Student Should Keep in Mind

Please consider and review the following with your conversation partner:

• It is imperative that you review the nature and goals of the virtual visits with your older adult virtual visit partner.

• If any concerns arise during the virtual visits/calls (i.e., severe depression, health concerns), please report them to the ALF/Nursing Home Coordinator. If the coordinators are not available, the supervisor of the site should be contacted. Supervisors can be accessed by calling the site’s main phone number and asking for the supervisor. If it is an emergency, student volunteers should call 911.  Medical Student Leaders should also discuss and determine with geriatricians/their Doctoring course leaders/school admins who would be the best person to contact if medical concerns arise.

• You should introduce yourself as a medical student. However, you should make it clear that your goal is to provide social support during a time of social distancing, and that you are not able to give any medical advice and do not have any way of connecting with their medical providers.

• You should try to decide on a mutually agreeable time and schedule for call. A consistent schedule would be best for these older adults at this time (ex: 10AM every 2-3 days), as it gives them consistency, helps them plan their days, and would give them something to look forward to.

• Please keep to the schedule or let your residents know when you need to make an adjustment to it as they may come to count on your virtual visits/phone calls.

• Furthermore, please note that some older residents may have cognitive or underlying mental health issues which may impact how they are coping and your conversation with them.

• Your conversations may get emotional. Please feel free to express empathy, but do not take anything personally. (If students find it extremely difficult to relate with their virtual visit partner, or the opposite, in that they find that their partner reminds them of a loved one or someone else they know, and this causes difficulty in continuing the relationship, volunteers should let the program coordinators know. Coordinators should attempt to match student volunteers with another individual.

AMS Virtual Visits Conversation Guide

For Medical Students Joining the

 Combating Social Isolation Via Virtual Visits During COVID-19 Initiative

By Jeffrey Lam (MS3) and Swechya Banskota (MS1)

Warren Alpert Medical School of Brown University

How to be a good conversational partner:

1. Start by telling them a little bit about yourself. This will help your conversation partner feel more comfortable to share things about themself.
2. We know that we have a lot of suggested questions below, but please start slow with the questions because it may cause them to feel insecure and become guarded.
3. Listen! And don’t be intimidated by silences.
4. Find shared interest(s), and recognize this is a two-way conversation.
5. Maintain conversational awareness. Take cues from your participant and take/give space as needed.
6. Be ready to address and acknowledge feelings related to COVID-19 -- it is okay to be worried, angry, frustrated, negative, stressed or none of the above.
7. Whenever possible, start out with open-ended questions.
8. Be yourself. Be empathetic. Be present.
9. Be aware of things that they get excited talking about, and follow up on the topic(s) during the next visit.

Suggested conversation topics (arranged from “small-talk” to “big-talk”)

Please understand that you don’t need to ask all of these questions in one phone call, Skype session, etc. Just choose a couple of questions you would like to ask during one session, and take it slow. Some older adults may get nervous and become guarded with too many questions.

1. Introduce yourself and establish goals

1. If you are using Zoom/Skype/FaceTime, you may want to address this and ask how the resident feels about this mode of communication.
2. Introduce your role as a medical student.
3. Establish goals: to provide social support during a time of social distancing.
4. Start slowly, there is no need to rush. *You don’t need to get through every question on this list.*
5. Ask them how long they have been at the facility/where they live and where they lived before this, and whether they have been able to stay in contact with their family/loved ones during the pandemic.
6. Share with them where you are from and where you are currently located as well. Sharing some facts about yourself can help the older adult trust and feel connected to you.

2. Current Events  

1. *Be ready to validate and acknowledge 
2. How has the virus (*instead of COVID-19, because they may not be aware of the scientific naming) impacted you and/or changed your routine?
3. What continues to be the same about your routine?

3. Friends / Family / Relationships

1. Can you tell me a little bit more about who you have most contact with? How are you keeping in touch with them over the past couple of days?
2. How are you feeling about this situation? Are you missing seeing loved ones?
3. What do you value most in a friendship?
4. How would your friends describe you in a few sentences?

4. Hobbies

1. Tell me what some of your interests are.
2. Tell me what your favorite things to do for fun are. What do you like most about them? Have you been able to do these lately?
3. Television? Books? Movies? Sports? Games? What are your favorites?
4. If you had the chance to meet any famous person, who would you choose? Why? What would you like to talk about with them?

5. Work

1. Tell me a little about what you used to do for work.
2. What was your childhood dream? Did you follow it? Has it changed?
3. Why do you do what you do?
4. What makes you feel most alive?

6. If you get lucky enough to find shared interest(s), you may:

1. Ask for advice on how you can continue to make time for them
2. Ask for tips & tricks to succeed

7. Gratitude

1. Tell me about some of the things you are most grateful for.
2. Is there anything you are looking forward to in the near future?
3. Who are you most grateful towards?
4. What is one of the kindest things someone has ever done for you?
5. What is the kindest thing anyone has said to you?

8. Time

1. Tell me about something that makes you lose track of time.
2. What has been your favorite age so far and why?
3. What was a turning point in your life?
4. What advice would you give yourself at the age of 10? At the age of 25?

9. Self

1. What do you wish more people knew about you?
2. What does your perfect day look like?
3. What was a turning point in your life?
4. What do you consider your greatest strengths to be?

10.  If your resident is tired and would like for you to carry the conversation, you may ask if they would like for you to read a book to them or tell them a story.

Please fill out this short google form if you decide to start this initiative and/or use this facilitation guide at your school.

Acknowledgements:

Thank you, Dr. Cheryl Reed and Ms. Anne Quinn! Your guidance and feedback were invaluable resources in helping create this document.

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