VR-CARES: Feasibility of Virtual Reality for Caregiver Assembly, Relief, Empowerment, and Support to Improve Social Connection, Health, and At-home Dementia Care

The escalating demand for home-based caregiving, combined with a high turnover rate and prevalence of stress and burden in this workforce, presents a unique challenge within the healthcare sector. High turnover rates are especially difficult for care recipients with dementia who benefit from consistency. Caregivers are often socially isolated at work due to the intimate care they provide to socially isolated clients. The VR-CARES initiative is an innovative response to these issues built upon Rendever's existing social engagement VR platform and vast content to provide a novel caregiver support virtual reality (VR) platform for dementia caregivers providing in-home care that generates real community and connectivity. Rendever, a pioneer in VR for older adults, enables shared experiences with networked communication technology that overcomes geographical distance, lack of transportation, mobility issues, low vision, or cognitive impairment so they can connect with others for group travel, activities, games, and sharing life stories.

Study Design. The proposed 3-aim project takes a human-centered design approach grounded in an in-depth qualitative understanding of the target population with multiple stages of user feedback to inform an iteratively developed VR platform to support home care workers and to test the feasibility of the resulting VR Caregiver platform with them. The investigators refer to this project as "VR Cares: Virtual Reality for Caregiver Assembly, Relief, Empowerment, and Support to improve social connection, health, and at-home dementia care" (VR CARES). The process followed has been summarized by the IDEAS framework and the Stanford d.school as encompassing 5 phases: "empathize" (understand target population), "define" (identify goals and scope), "ideate" (brainstorm potential solutions), "prototype" (build potential solutions), and "test" (gather feedback from target users).

Participants. The investigators will recruit dementia caregivers (n=30) to participate in pre/post-focus groups/interviews and up to 16 weeks of product use. The investigators will recruit caregivers across the United States who are employed by an in-home care agency. Demographics will be gathered during the screening process to help ensure our study represents the general population of direct care workers with roughly 34% White, 26% Hispanic, 26% Black, and 14% Non-Hispanic Other racial identification. Direct care workers will be at least 18 years of age, proficient in English, and provide care for at least one older adult client living with mild cognitive impairment (MCI) or dementia. Exclusion criteria include extreme motion sickness preventing an individual from participating in VR activities or a history of seizures.

AIM 1: Once enrollment is complete, at Time 1 (T1), the investigators will conduct the baseline survey (Survey #1). A trainer/implementation specialist from Rendever will provide each caregiver with a Rendever social engagement VR system consisting of 2 VR headsets and 1 control tablet and will train them on how to use the basic Rendever engagement platform in VR that will be the backbone of the VR-CARES support platform. During this baseline period, RAND will conduct focus groups/interviews with caregivers to empathize with the target users and gather their insights to ground the development in a behavioral theory with responses to qualitative research questions such as, "How can a VR platform support social gatherings and support groups to help manage stress and improve job satisfaction?". RAND will analyze findings from these focus groups/interviews and share them with the Rendever researchers and Rendever's CTO to inform the development of the VR-CARES platform prototype.

AIM 2: During the ~4-8 weeks Rendever's development team of software engineers builds the platform, the Caregivers will use the core Rendever social engagement VR platform alone and/or with their clients to familiarize themselves with what can be done on the basic platform, allowing them to become familiar with using the basic platform before being introduced to the additional features and capabilities of the VR-CARES platform that will be added to it. This will also allow the researchers to tease out the barriers to use of the basic VR platform versus the barriers to use of the added features of the VR-CARES platform. It also allows us to control for the impact of using Rendever's basic VR engagement platform alone and with clients versus the additional impact of using the VR-CARES platform to engage with other direct care workers for social support.