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Case Study: Increasing Social Engagement through a Digital Avatar during COVID-19

January 1, 2022

Hannahoe, K., Davis, K. (2021). Increasing Social Engagement through a Digital Avatar during COVID-19. LeadingAge Center for Aging Services Technologies (CAST).

Project Description

In March 2020 when West PACE was required to suspend non-clinical center attendance and could not offer in-person recreation and social support, the nonprofit deployed care. coach avatars to a group of pre-identified participants. With these internet-enabled devices, West PACE was able to provide real-time support to participants, offering immediate interventions and assessment of symptoms before escalating to a West PACE on-call team member. West PACE continues to grow the avatar and video visits program by offering a device to those who will benefit from having one.

Socialization Modality

Social Network, Video Chat, Audio Chat, Photo Sharing, E-Reader, Electronic Books, Games, Exercise, Music, Facilitated Communications with West PACE Staff and Facilitated Conversations with Avatar. Virtual Reality. Other: Spiritual Services, Games, Poetry.

System Embodiment

Fixed Tablet / Touch Screen Running a Digital Avatar, Voice Activated Assistance Technology and Captioning.


Increased Participant Engagement & Satisfaction, Social Networks, Quality of Life, and Staff Efficiencies, Reduced Social Isolationism, Depression, and Feelings of Loneliness

Implementation Approach

West PACE originally implemented the avatar system during the COVID-19 pandemic as a means to stay connected with participants who would otherwise visit the PACE center multiple times a week. Those who were able to manage using the tablets and avatar system were identified by their care teams and assigned devices. Additionally, the enrollment specialists assessed new participants and made recommendations to the recreational therapist to add a avatar to their initial care plan. Participants with devices are provided initial training in the home and receive ongoing support to ensure they are comfortable with the avatars and have a positive experience. Participants can opt in or out at any time. Among the core objectives of the program is increasing engagement and promoting safety for the participants, reducing unnecessary visits to emergency rooms and urgent care clinics, and providing peace of mind for family members. West PACE developed an integrative approach to providing this level of coordination by promoting the efficacy and usage of the avatar program to facilitate consistent communication between participants and members of their care team at West PACE.

In addition to the standard CORE protocols (Coach, Observe, Report, and Engage), West PACE integrates personalized services based on participant requests and observed needs, including:

  • Support for social engagement featuring games, music, poetry, e-books, and photo sharing.

  • Coaching to improve self-management of health status and exercise regimens.

  • Spiritual services to provide comfort and support as needed.


The avatar is a critical technology to ensure the safety and well-being of senior participants in their homes during the COVID-19 pandemic and beyond. West PACE continues to promote and achieve participant-centered interventions as well as improve clinical outcomes.

For certain individuals, the need for calls and visits to the local emergency rooms have declined. Telehealth video visits with West PACE have increased allowing patients to self-manage their health and wellness, as well as reducing social isolation, which is prevalent among the senior population and has been amplified by the COVID-19 pandemic. Currently, 28% of West PACE participants use a avatar (35 participants). The West PACE team can continue to deliver in-language services in English and Spanish as needed, both on-screen or through audio-only features, through the avatar or through video calls with West PACE staff.

West PACE plans to increase avatar usage congruent with the program’s growing participant census. The avatar program has helped West PACE achieve the following outcomes:

  • Reduced social isolation and feelings of loneliness, participants report the avatars are “great company.”

  • Encouraged self-management of health and wellness, prompting participant to take their medication, wash their hands, and put on their PERS/fall device if they were not wearing it.

  • Increased staff efficiencies, as West PACE team members can provide immediate assistance remotely to triage incidents and provide the right care and support to the participant at the right time, thus reducing staff travel time.

Challenges and Pitfalls to Avoid

It’s a delicate balance to ensure that the participant receives the right care at the right time, and to avoid the perception of overreach or intrusion.

The notifications sent from the avatar to the care team at West PACE are frequent by default and, prior to calibration, may create unnecessary outreach to the PACE team regarding a participant who did not require assistance. It takes time to calibrate and customize the notifications.

It is important to conduct a thorough assessment of the participant’s physical limitations before issuing a care. coach avatar, to ensure maximum appropriate use.

While the device has internet access built in, some participants have challenges with consistent access and limited signal strength in their residences. There is the option to connect via the participant’s WiFi if they have a residential service provider, but connectivity is still a challenge for the participants and may result in decline in consistent use and engagement.

Lessons Learned/Advice to Share with Others

For greater efficacy, our care team reminds participants to keep the device in the area of their home where they spend the most time, to ensure they are within reach or earshot and to also participate in daily check-ins when prompted. When there is no action on the device for extended periods of time, staff is notified through our customized escalation process. During check-ins with the participant, staff members are often told the device was not with the participant (or it was unplugged or the battery drained), or the participant was spending more time in a part of the residence other than where the device is located.

The West PACE care team is investigating the use of group features on the avatars, to connect multiple devices among participants so they can engage in group activities in a similar fashion as when the center was open for in-person congregation. They are also looking at offering connectivity between participants and their family and friends, across different devices and platforms.

The West PACE care team members are having active discussions about what role the avatars will play in participant care and connection once they welcome participants back to the center for in-person services and engagement. There are a few currently enrolled in the program who may prefer in-person interactions that the center offers, and this may lessen the need for a device. However, since a participant’s family can virtually call their loved one through the avatar, we are determining best methods to inform families and position the avatar as an enrollment benefit. With family interaction, this can build additional familiarity for the participant with the device, which can increase interaction time.

Testimonials devices have helped our participants remain socially engaged and mentally stimulated while remaining safe at home during the pandemic, helping to maintain their emotional wellbeing.” — Kelly, Recreational Therapist, West PACE

“I like it a lot and it is great company. It's sweet and nice to hear someone else talking to you and I am so happy. It covers all the bases. It’s worth a million dollars and truly a blessing.” — Participant A

"It is so much fun to have my avatar Buddy the dog teach me about different places around the world. He shows me pictures of wonderful places." — Participant B

“I love it and I would be lost without it. It’s the best thing for me.” — Participant C is a real lifeline for Mom. She relies heavily on her relationship with Fluffy, her cat. It is a tool that provides great peace of mind for me.” — Daughter of Participant D


The pandemic has demonstrated to West PACE the power of virtual care services to extend the reach and richness of participant-provider interactions. As the pandemic recedes, West PACE plans to continue to expand virtual care offerings to enhance physical, emotional, and spiritual health of participants, many of whom will remain isolated and house bound. The avatars are a vital part of participant engagement. As we approach a post-pandemic reality, it contributes to positive health and wellness outcomes of PACE participants.

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