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RESEARCH
ABSTRACT
Using Online Consultations
to Facilitate Health and
Social Care Delivery During
COVID-19: An Interview
Study of Care Home Staff
KRYSTAL WARMOTH
CHLOE BENNETT
JENNIFER LYNCH
CLAIRE GOODMAN
Context: During the COVID-19 pandemic, UK care homes rapidly adopted
videoconferencing to communicate with health and social care colleagues. Studies
show that health and social care professionals adapted well to online consultations.
Less well known are the views of care home staff on using online consultations and
how it impacted their workload and responsibilities.
Objective: To explore the experience of using videoconferencing for consultations
during the COVID-19 pandemic from the perspective of care home staff.
Method: Online interviews with care home staff [n = 13] who had facilitated
videoconferencing between residents and health and social care professionals. Data
were collected from June to October 2021 and analysed thematically.
Findings: Experiences varied but key facilitators were having the infrastructure,
training, and support for staff. Barriers were concerns about the benefits and suitability
for use with older people living with dementia and/or frailty. Care home staff discussed
new ways of working and undertaking new tasks. Consequently, staff developed new
skills and confidence in using the technology. However, considerable time was needed
to schedule, prepare, and facilitate consultations. Videoconferencing had the potential
to support staff and strengthen working relationships with external professionals.
Limitations: This is a small study with 13 participants from 11 care homes. It
complements professional accounts of videoconferencing privileging the care home
view.
Implications: Fewer face-to-face meetings are anticipated to discuss residents’ care
with visiting professionals. We need to address care home IT infrastructure and implicit
expectations that care home staff can assimilate these changes amidst staffing
shortages. A better understanding is needed about how to support care home staff in
these roles, how this changes interdisciplinary working, and effects on residents’ care.
CORRESPONDING AUTHOR:
Krystal Warmoth
University of Hertfordshire, UK
k.warmoth@herts.ac.uk
KEYWORDS:
videoconferencing; online
consultations; care homes;
long-term care; residential
care
TO CITE THIS ARTICLE:
Warmoth, K, Bennett, C, Lynch,
J and Goodman, C. 2023.
Using Online Consultations to
Facilitate Health and Social
Care Delivery During COVID-19:
An Interview Study of Care
Home Staff. Journal of Long-
Term Care, (2023), pp. 100–109.
DOI: https://doi.org/10.31389/
jltc.184
*Author affiliations can be found in the back matter of this article
101Warmoth et al. Journal of Long-Term Care DOI: 10.31389/jltc.184
INTRODUCTION
Care homes deliver housing, 24-hour care, and in some
settings, nursing to some of the oldest and most frail
within the UK population. Medical and specialist nursing
support and assessment of social care needs are provided
by visiting health and social care professionals (Davies et
al., 2011). During the COVID-19 pandemic, care home
residents accounted for 33% of COVID-19 related deaths
in England (Comas-Herrera et al., 2020). Social distancing
measures to control the spread of the virus were put in
place so health and social care services moved much
of their provision online (NHS England, 2020). This
resulted in an increased uptake of videoconferencing
technology by care homes to facilitate residents’ access
to appointments and maintain contact with health and
care professionals (Helmer-Smith et al., 2020; Newbould
et al., 2019). Little is known about care home staff
experiences and perspectives of videoconferencing and
how its ongoing use in this sector may affect workload
and engagement with primary and acute care services.
During the height of the pandemic, visiting health
and social care practitioners working with care homes
reported positive experiences using videoconferencing
to maintain contact, sustain working relationships,
conduct examinations, and make clinical decisions, and
care home staff were recognised as vital in facilitating
these remote consultations (Warmoth et al., 2022).
Videoconferencing has been demonstrated to be
an effective way of accessing health and social care
provision in care home settings that can allow faster
access to services (Newbould et al., 2019; Helmer-Smith
et al., 2020), reduced hospital admissions, and improved
cost-effectiveness (Hex et al., 2015; Baxter et al., 2021).
Little is known about the impact of this adoption in social
care settings.
Before the COVID-19 pandemic the number of people
working in adult social care was not meeting the level of
demand (National Audit Office, 2018). During COVID-19,
the loss of input from family carers and staff shortages
led to increased workloads (The Health Foundation,
2020; White et al., 2021; Hanna et al., 2022). Post-
pandemic, there continues to be significant recruitment
and retention challenges, exacerbated by staff burnout
and low pay (Health and Social Care Committee, 2021;
Skills for Care, 2022). In a work setting where staff are
already under multiple pressures it is unclear if using
videoconferencing mitigated or contributed to strain
experienced by the workforce.
The use of online or video consultations in care homes
requires a reliable IT infrastructure and a workforce able
to adapt to different methods of consultation (Goodman
et al., 2017; Newbould et al., 2019). The pandemic forced
UK care homes to rapidly adopt videoconferencing to
communicate with health and social care colleagues. The
known digital divide was further exposed by COVID-19
and its relationship with ethnicity, poverty, poor health,
and age (Bibby and Leavey, 2020; Cheshmehzangi et al.,
2022). The lack of digital infrastructure also reinforced
a known inequity experienced by care homes around
access to information and resources for those who are
most vulnerable and the people who care for them (Iliffe
et al., 2016).
This qualitative study explored the experience of
using videoconferencing during the COVID-19 pandemic
from the perspective of care home staff. The objectives
were to investigate the barriers and facilitators of
using videoconferencing with health and social care
consultations for older people and its perceived impact
on their care work and working relationships.
MATERIALS AND METHODS
PARTICIPANTS
Care home staff were recruited to participate in interviews
via emails sent to existing care home staff networks (i.e.,
local community NHS trust and third sector support
organisations), a national WhatsApp (WhatsApp LLC)
group for care home staff, and contacts arising from
the earlier study with primary care and social care
practitioners (Warmoth et al., 2022). Individuals who
expressed an interest in being involved in the study
were sent study details via email and offered a phone
conversation for further information.
DATA COLLECTION AND ANALYSIS
Semi-structured interviews were conducted from
June to October 2021 with a topic guide that explored
participants’ involvement with videoconferencing, which
professionals they had used it with, situations when it
had been useful (or not), and thoughts about its future
use. All interviews were carried out via videoconferencing
(Zoom Video Communications, Inc.). Interviews lasted
an average of 31 minutes and ranged in length from 22
to 58 minutes. Interviews were recorded and transcribed
verbatim.
A thematic approach was adopted to analyse the
interview transcripts. We drew on assumptions that this
is an iterative, reflexive process, focused on meaning and
meaning-making that is context-bound, to understand
what the care home staff experienced (Braun and Clark,
2006; Braun and Clarke, 2019). A single researcher
familiarised themselves with the data by reading and re-
reading the transcripts and organised the data initially
by interview prompts. Coding focused on recurring issues
and observations by participants as they described
their experiences and represented what was important
or difficult. Codes were organised to build a thematic
account and evidence for each theme reviewed and
discussed by the research team. The data were organised
and mapped initially as descriptive categories using
NVivo 12 (QSR International Pty Ltd, 2018).
102Warmoth et al. Journal of Long-Term Care DOI: 10.31389/jltc.184
ETHICAL CONSIDERATIONS
The study received ethical approval from the University of
Hertfordshire Ethics Committee with Delegated Authority
(protocol number aHSK/SF/UH/04595). Participants we
remunerated for their time with a £30 voucher. As the
interviews could trigger difficult memories and explored
emotive topics, participants were offered information on
places of support at the end of the interview.
RESULTS
Thirteen care home staff with direct experience using
videoconferencing technology to communicate with
health and social care professionals were interviewed.
Participants all had senior roles within their care home,
see Table 1. They represented 11 care homes across
England, nine of which were classified as medium-sized
(11–49 beds) and two were large (50+ beds) (Care Quality
Commission, 2017).
The analysis and organising themes address the study
objectives of: (1) the facilitators and barriers to using
online consultation and (2) the impact of using this
technology on care home staff.
FACILITATORS AND BARRIERS TO ONLINE
CONSULTATION
IT Infrastructure
The lack of digital infrastructure undermined the staff’s
ability to participate in videoconferencing. For example,
unreliable Wi-Fi connections and insufficient electronic
devices in the care homes (e.g., tablets, laptops, and
mobile phones) to support online consultations. This was
further complicated by the lack of consistency in which
platform was used. Staff described using any one of three
commercially available platforms including Zoom (Zoom
Video Communications, Inc.), Microsoft Teams (Microsoft
Corporation), and WhatsApp (WhatsApp LLC), as well
as the healthcare specific platform, Attend Anywhere
(Attend Anywhere Pty Ltd.).
The practical consequences of this variability were
that depending on who they were communicating with,
care home staff were using different platforms for the
same resident. To be able to connect residents with
social workers, physiotherapists, speech and language
therapists, and, most frequently, General Practitioners
(GPs) required staff to master how to use each of these
different platforms.
To address the shortcomings of the care home IT
infrastructure and the asynchrony between the software
used in care homes and that used in GP surgeries, care
home staff described using workarounds. This included
relying on their personal mobile phones to support
appointments. This was intrusive and potentially costly,
affecting their data usage contracts, as this participant
reflected: ‘I’ve got one nurse who didn’t have unlimited
data and stuff, she was like “why am I using my stuff?’”
Participant 6.
Over time, most care homes in the study were able to
acquire more devices and upgrade their Wi-Fi connection
which facilitated the use of online consultation and less
reliance on staff workarounds. Buy-in from care home
providers and senior staff, dedicated budgets, and
existing technology availability enabled the infrastructure
to be put in place and faster adoption of this new way of
working.
Care home staff skills and training
Care home staff skills and training influenced the use
of this technology. Staff familiarity and experience with
technology affected who was involved. Senior members
of staff were more likely to organise and participate in
the remote consultations. This was, not only because
of limited access to equipment and the nature of the
appointment (e.g. healthcare assessment), but also a
feeling that other members of staff were not confident
using the technology. Who, from the care home staff,
took on the role appeared to be an ad hoc process. None
of the care homes interviewed had access to formal
training for using this technology for consultations in the
initial stages of the pandemic. Often, a key member of
staff who was confident with the technology had been
identified within the care home to support others:
No, nothing formal [referencing training], no we’ve
got like a home administrator, [name omitted]
who’s really, really good with tech so I sat down
with her a couple of times saying ‘ahh help, log
me on, how do you get on this?’ … [name omitted]
helped me a bit but nothing formal, no. I don’t
think anyone did. Participant 6.
There was no consistent approach or agreed minimum
skill set to take on this role of remote consultations
coordinator or champion. Participants described drawing
on existing skills and knowledge within the home and
worked together to develop their skills.
Staff were more likely to be engaged with the
implementation of videoconferencing for online
consultations when management listened and reacted
ROLE NUMBER OF PARTICIPANTS
Manager 7
Assistant/Deputy Manager 3
Team Leader 1
Clinical Lead 1
Senior Carer 1
Total 13
Table 1 Number of participants in each care home role.
103Warmoth et al. Journal of Long-Term Care DOI: 10.31389/jltc.184
to staff needs about using this technology. One manager
explained that they had to think through how staff might
react, and prepare staff with the equipment and set up
consultations:
You know, they, people don’t want to use tablets –
they lose them, they don’t charge them correctly,
everyone, they like a computer or a laptop and
so we had to you know, really think about that.
Participant 4.
The manager recognised how inexperienced their staff
was with this technology (tablets) and decided to employ
technology that their staff was more familiar with (laptop
computers) to enable online consultations. This theme
illustrated how care home staff relied on their existing
skills and knowledge, informal training, and peer support
to use videoconferencing for consultations.
Efficacy and appropriateness of using video
consultations
Staff thought the technology was not always useful
or appropriate, especially when many residents were
unable to understand that they were communicating
with medical or social care professionals. Care home
staff thought it also constrained the detail and depth
of the discussions. In one situation, even when a
resident did understand, they had difficulty maintaining
concentration or remembering what they wanted to
discuss. The usual cues and prompts of a face-to-face
consultation were missing:
I think the resident found it hard [because]
he couldn’t really understand what was going
on, he could hear what was going on and was
able to answer but I think it was not as easy for
him as if he’d been sat in an office. And I think
equally so, possibly because it’s being done on a
television you don’t remember to say as much.
And this is somebody that’s you know, with it
and able to answer and it flummoxed him, as to
what he needed to do and how he needed to be.
Participant 12.
These concerns about residents’ understanding, related
to worries about the quality of residents’ care. As video
consultations became routinised, participants perceived
that the information exchanged was increasingly
superficial and meaningless.
They’ve just been doing monthly videoconferencing
calls just to sort of say hello to the resident and
they just basically say ‘hello I’m Dr so and so’ and
then the resident says their name and then the
doctor says hello and then we move onto the next
person. It’s not really about having a consultation
at all, it’s just I think a paper exercise for the GPs so
that they can say they’ve seen someone in the last
28 days. That’s how we see those calls because
they’re not particularly useful, generally … our
monthly calls with the doctors. Participant 13.
During the study, UK government guidance allowed
professionals providing care to residents to enter care
homes. However, many participants reported that
professionals had chosen not to visit the home. For
some, this was reassuring as they felt this protected their
residents from the virus. Most, however, suspected that
the time-related benefits of not doing on-site visits were
the reason for the continued use of videoconferencing,
especially once in-person visits were acceptable or
allowed. In some circumstances, videoconferencing had
the unintended consequence of losing the spontaneous,
indirect support that staff usually gained when
healthcare professionals visited. The technology was not
seen as increasing or improving care home staff’s ability
to access external advice and support when compared to
pre-pandemic encounters.
There were also concerns about how videoconferencing
put residents at a disadvantage for assessments of a
mental capacity or those assessing someone’s condition
to be eligible for financial support.
Just I feel like it’s not been fair to them, they’re
not getting the best – the benefit of the doubt I
suppose because they’re … I’ve had times when
I’ve had a DoLS [Deprivation of Liberty Safeguards]
assessor saying that they’ve got absolutely no
capacity when I know they’ve got a bit more than
that but it’s because of the way it’s being done.
Participant 6.
Care home staff gave multiple examples of the potential
for misdiagnosis or misinterpretation of somebody’s
mental capacity. Participants felt that video calls with
a healthcare professional were most appropriate or
effective when a resident had a visible, minor condition
that could be seen whilst maintaining a resident’s
privacy. For more complex conditions (situations where
it was unclear why the resident was unwell or those that
were related to intimate areas) participants were clear
the healthcare professional should visit in person, and
not use online consultation.
Participants also worried about dignity with death
and end-of-life decisions being made using video calls.
During the pandemic, some care home staff were asked
to certify death and assess residents as end-of-life via
video call. This delegation of responsibility and practice
was described as uncomfortable and inappropriate:
When you’ve got another lady that has died and
you are waiting for somebody to verify her death
104Warmoth et al. Journal of Long-Term Care DOI: 10.31389/jltc.184
and you are making phone call after phone call
after phone call asking for somebody to come and
verify her. And after sixteen hours still no-one has
been to verify her and then you get a phone call
from the doctor saying they’re [going to] do it via
video link…And you’re doing all of the checks on
this lady that the doctor should be doing. There is
no dignity, no respect, for this poor lady that might
not mean anything to that doctor on that video
call but means a great deal to the carers that have
been looking after her. Participant 8.
Participants shared the diverse ways that video
consultations were being used with health and care
professionals when it was unclear if it was in the best
interest of the resident. It was represented as offering a
poorer experience of quality health and social care.
IMPACT OF USING THIS TECHNOLOGY ON
CARE HOMES
Staff development and empowerment
One of the positive outcomes of the rapid adoption of
remote consultation during the COVID-19 pandemic
was care home staff reporting greater confidence using
the technology, performing some healthcare tasks,
and acquiring greater clinical knowledge through being
involved in the conversations between the healthcare
professional and the older person. The increased use of
online consultations meant it became incorporated into
their day-to-day work.
I think we did improve over time. No, and – no,
I don’t think we did, we definitely did! We did
improve as we became more familiar, and it
became more commonplace. Participant 3.
The repeated use and support from peers resulted in
staff being less apprehensive about conducting video
consultations.
To prepare for and facilitate online consultations, care
home staff were required to record resident observations,
for example, skin breakdown and temperature, and
report them to the doctor. One care home owner (a
nurse) who provided training to staff to enable them
to interpret the significance of vital signs such as
temperature, respirations and responsiveness described
her experience:
Talking to the staff they’re actually struggling
with it. I’m familiar with it [because] I’m a nurse
but it’s a residential care home and they’ve had
a steep learning curve with learning new sorts
of, types of observations and then learning what
those observations mean. So it’s about them
having training as well. So we’ve had to spend a
lot of time training the staff, getting them to show
me the observations so that I check they’re ok.
Participant 13.
The use of videoconferencing could blur the distinction
between the roles of the care home and external health
and social care practitioners, as care home staff were
conducting these examinations. Where visibility was
limited by the camera, participants described offering
suggestions as to what they thought the diagnosis was.
This was challenging especially if staff were unsure of
their ability to do this. However, as online consultations
were embedded into practice, care home staff felt they
became more skilled and knowledgeable, taking on
responsibilities that they would not have done before the
pandemic.
Effect on workload and time use
The impact of online consultations on staff workload
varied. Some participants reported a reduced workload
because virtual ‘visits’ were shorter and more focused
than in-person visits to the care home. Others described
how it was more time-consuming because of needing to
set it up and inconvenient and disruptive to the care home
routines due to scheduling of the video consultations
to suit the healthcare professionals. As this participant
describes:
They leave it till the end of the day when we
haven’t got as many staff around, so it takes
someone, one person at least half an hour to do
that call. You can’t tell when it’s coming. I mean
it’s usually before half past six but that’s quite a
busy time for us. So that’s a bit of a frustration
with it and it does take time because the residents
aren’t all in one place. We’re a 32 bedded care
home so they could be anywhere in the building
and we’ve [got to] go and find them so that takes
time. Participant 13.
The move to online working, including consultations,
could change the dynamics within the care home. Some
participants explained that they were less available to
colleagues, spending greater time in their offices. One
participant was concerned that moving things online
was making her seem less approachable as a manager:
I think there is a little bit of – so because I do quite
a lot of them, then there is a bit of like my door
being closed to the team. Participant 4.
This required managing staff expectations, for example,
pre-empting interruptions with a ‘do not disturb’ sign on
the door. Some participants reported having to be more
prepared for calls, gathering the data that they would
need before the call (such as recording observations
and collecting any other relevant information for the
105Warmoth et al. Journal of Long-Term Care DOI: 10.31389/jltc.184
resident). Although the increased preparation could
make the encounters more efficient.
I think in a way it’s made it a little bit easier,
although I’m having to get the prep ready,
I’m more confident when I do a meeting then
because I know I’ve got the information I need.
Participant 7.
Preparing for the calls was time-consuming but some
staff were more confident and engaged during the
consultations.
Staff played an active role in facilitating
videoconferencing calls from managing the set-up
and use of equipment to answering and repeating
questions. Unlike face-to-face encounters, sometimes
two care home staff needed to be involved during an
appointment, especially when residents had cognitive
impairment. The following participant reflected on their
role in the appointments:
So, … with any of those appointments then there
needs to be somebody present to hold the device
… otherwise a lot of residents will touch what’s
in front of them and not realise that they’ve
disconnected. And also to remind them where
the voice is coming from [because] sometimes
sight plays a part and they won’t know where it
is and it can be quite confusing for someone with
dementia if there isn’t somebody there to reassure
them. Participant 4.
All these activities (scheduling, preparing for, and
facilitating consultations) took time away from interacting
with the residents, which was what they enjoyed and
valued about their work. Although participants did not
agree on whether their workload was increased, how
they spent their time did change.
Working relationships with health and social care
professionals
Participants’ experiences of working relationships
with health and social care professionals during the
pandemic were mixed. Some reported feeling well-
supported through videoconferencing and able to build
new relationships or maintain existing good relationships
with external professionals. These relationships
helped to reduce isolation and work as a team during
unprecedented times.
But yeah so, it has been tough but yeah I mean,
with the videoconferencing when nobody was
allowed in, couldn’t come into the care homes
and that, it was good that it kept us in touch with
the people we knew as well … your district nurses,
your GP’s and that because you could still see that
familiar face and not just a name. So it still made
you feel like you had people out there helping
you, assisting you and helping you fight the cause.
Participant 10.
Practical support and assurance from external
professionals were valued ꟷ videoconferencing was a
way to stay connected with their wider social and health
networks.
Conversely, for some care home staff, when compared
to in-person consultations, videoconferencing was unable
to mitigate staff’s feelings of being alone, forgotten, and
abandoned. Even in cases where they had previously had
good existing relationships with health and social care
colleagues.
It’s broken, I was having this conversation
recently, we had a very good relationship with our
doctors and our mental health team but that’s
broke down. Participant 11.
The rapport achieved during face-to-face appointments
was lost due to the impersonal nature of videoconferencing.
Participants reported the absence of the usual preamble
and chat before doing an assessment, which helped the
professionals get to know the residents and staff. There
were examples of when the time was taken to have
informal conversations, and this was identified as helping
to maintain the relationship. The different impacts on
their working relationships with health and social care
professionals appeared to hinge on whether the use of
the online consultations was evidence of the care home
being supported as part of a team caring for the resident.
DISCUSSION
This study explored the experiences of using
videoconferencing to communicate with health and
social care colleagues during the COVID-19 pandemic
from the perspective of care home staff. Experiences
varied but key facilitators were having the infrastructure,
training, and support for staff to develop skills. Staff used
workarounds when they were unprepared and did not
have the necessary equipment. There were concerns
as staff perceived video consultations as potentially
undermining residents’ dignity and access to care.
The perceived benefit of using this technology on
staff’s care work and working relationships was mixed.
The organisation and delivery of video consultation could
create opportunities to learn new skills, become more
clinically aware of residents’ needs and be recognised
as a valued member of the wider team. It was unclear
if their workload had increased, but more time was
needed for scheduling, preparing, and facilitating online
consultations with residents. These advantages were less
106Warmoth et al. Journal of Long-Term Care DOI: 10.31389/jltc.184
obvious if staff perceived the consultations were to reduce
travelling time, the length of visits and opportunities to
raise additional concerns.
The lack of staff preparation at the beginning of
the pandemic compounded by limited technological
infrastructure (e.g. Wi-Fi connection or device capabilities)
affected the uptake of remote consultations. This has
been documented in previous literature as a major barrier
to implementation (Shulver et al., 2016; Warmoth et al.,
2022; Wherton et al., 2020). A key finding from this study
is how care home staff implemented workarounds, often
using their own mobile phones and data. Workarounds
are not uncommon when new technology is adopted
and can lead to a lasting restructuring of the technology
(Procter et al., 2016). The pandemic functioned as a
catalyst to improve investment in technology provision
in this setting for consultations. Some care homes were
provided with tablets to help residents receive ongoing
care (Department of Health and Social Care, 2020).
Nevertheless, the current infrastructure and workarounds,
with some care homes better equipped than others,
created a situation of inequity widening the digital divide
(Bibby and Leavey, 2020; Cheshmehzangi et al., 2022).
Participants in this study (care home staff) were also
concerned about the quality of the information obtained
using this medium and its suitability for undertaking
intimate assessments or deciding on a person’s mental
capacity; concerns that were mirrored in a study that
focused on the experiences of visiting health and social
care professionals using videoconferencing (Warmoth
et al., 2022). GPs in the community reported that video
consultations often lacked detail about residents and
the increased ease of access did not mitigate the stress
of making clinical decisions, prescribing, and assessing
risk (Murphy et al., 2021). Similar to the present study
findings, GPs have also expressed concerns about
assessing a person’s capacity via video consultation,
describing it as almost impossible (Dixon et al., 2022).
Given the prevalence of dementia and complex health
conditions in the care home population (Barker et al.,
2020), further research is required to investigate how
consultations via videoconferencing can be sensitive to
these needs. Warmoth et al. (2022) study participants
described a hybrid approach (combining in-person visits
with video consultations) as more appropriate for these
examinations and assessments.
Key to delivering high-quality health and social care
to care home residents is good working relationships
between the home and external professionals
(Goodman et al., 2017). This study found that whilst
videoconferencing was preferable to phone calls it was
not always sufficient to maintain effective working
relationships and could damage them. There were
examples in this study of how videoconferencing led to
the loss of informal support and relationship-building
through spontaneous or informal interactions. GPs
have also reported lower work satisfaction from using
remote methods of consultation due in part to the loss
of face-to-face interactions (Dixon et al., 2022). This
may have been heightened by the extreme pressures
and isolation experienced by care homes throughout
the pandemic (Hanna et al., 2022), although for some
staff videoconferencing was seen as having provided
much-needed assurance and support to the care homes.
Further research could address what needs to be in place
to foster and maintain relationships between health and
social care professionals and care home staff.
At a time when there were limited staff resources
(Newbould et al., 2021) and staff shortages (National Audit
Office, 2018; Health and Social Care Committee, 2021),
this study provides new insights into care home staff’s
experiences of using videoconferencing throughout the
pandemic and its impact on them. It also complements
work on the visiting professionals’ experience (Warmoth et
al., 2022) and experiences of Welsh care homes (Johns et
al., 2021). For care home staff, these changes to working
practices led to a redistribution of roles within care homes
and responsibilities that for some, increased skills in
assessment. However, there was no extra remuneration
or recognition for a workforce that experiences high levels
of burnout, high turnover, stigma, low pay, and poor job
satisfaction, before (National Audit Office, 2018) and
during COVID-19 (Hanna et al., 2022; Skills for Care, 2022;
Health and Social Care Committee, 2021). The upskilling
found in this study may be beneficial when caring for
people with more complex needs compared with 10 years
ago (Skills for Care, 2022) but it raises questions about the
kind of training and opportunities for career progression
this reallocation of roles and responsibilities requires.
LIMITATIONS
Firstly, this study is limited by being based on the
accounts of 13 care home staff despite a wide range of
experiences being described from different regions in
England. These views may not represent the experiences
of other care home staff. This small sample reflects
the difficulty of recruiting care home staff during
the pandemic when they faced higher pressure and
competing demands. The logistics of identifying and
recruiting care home staff can mean that the accounts
of visiting professionals dominate the literature and care
home staff voices are seldom heard. This paper provides
an opportunity to balance the narratives of saving
professionals’ time and improving residents’ and staff’s
access to healthcare with accounts that highlight the
need for additional support and guidance for care home
staff. Secondly, only care home staff’s perceptions of the
resident experience were reported. Future work should
explore residents’ experience using video consultations
during the pandemic and see whether, and if so how,
they differ from the care home staff and health and
social care professionals.
107Warmoth et al. Journal of Long-Term Care DOI: 10.31389/jltc.184
CONCLUSION
Care homes experienced new pressures and rapid
changes during the pandemic. This study highlights the
key role that videoconferencing played in maintaining
health and social care provision for residents. The findings
provided a new understanding of how care home staff
facilitated online assessments and consultations and
its impact on working lives and relationships. Future
directions for research should address how best to
engage with older people (especially those with cognitive
loss) and how to foster and maintain relationships
between health and social care professionals and care
home staff. Videoconferencing has a clear place in future
care delivery and this study has identified future areas for
staff development and support to optimise its potential.
COMPETING INTERESTS
The authors have no competing interests to declare.
AUTHOR AFFILIATIONS
Krystal Warmoth orcid.org/0000-0003-0615-5778
University of Hertfordshire, UK
Chloe Bennett
University of Hertfordshire, UK
Jennifer Lynch orcid.org/0000-0002-2601-7498
University of Hertfordshire, UK
Claire Goodman orcid.org/0000-0002-8938-4893
University of Hertfordshire, UK
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TO CITE THIS ARTICLE:
Warmoth, K, Bennett, C, Lynch, J and Goodman, C. 2023. Using Online Consultations to Facilitate Health and Social Care Delivery
During COVID-19: An Interview Study of Care Home Staff. Journal of Long-Term Care, (2023), pp. 100–109. DOI: https://doi.
org/10.31389/jltc.184
Submitted: 18 October 2022 Accepted: 28 April 2023 Published: 09 June 2023
COPYRIGHT:
© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-
NoDerivs 3.0 Unported International License (CC BY-NC-ND 3.0), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by-nc-nd/3.0/.
Journal of Long-Term Care is a peer-reviewed open access journal published by LSE Press.
