Table 1.

Recommendations: ETHICS based on empirical data and literature.

	Data extract example	Literature example
E - Engagement of stakeholders  To address ethical tensions that arise in implementing technologies, relevant stakeholders (e.g., residents, families, staff) should be involved in making planning. All plans and decisions must, as much as possible, appeal to reasons that are mutually agreed for shared goals. Decision-makers should document, and be prepared to justify, the decisions that they do or do not make.	I do not think I have time to do this. It becomes problematic when it does not work. We have people with dementia here. They may use it a weapon to hurt others. We do not have a lot of space here. The robot can get in the way (A care aide)	Although many technologies were available to support elder care, they were significantly underused. Efforts should be made to adapt technologies to meet users’ needs and preferences and address concerns. 20
T - Technology benefit and risk assessment  Benefits and harms, risks and burdens should be assessed. Decisions should promote the well-being of stakeholders (resident, family and staff) and increase the common good while minimizing the overall burdens. The distribution of technology should not place unfair burdens on particular individuals/groups, which can perpetuate systemic or structural inequities.	I have seen it (telepresence robot) and used it. I think it is good therapy. Many people here are very lonely and depressed. I know some people worry about it is not a person and it moves around. People can move away from it or shut it down. The robot is a useful tool because it helps people (A resident)	Factors such as social position, age, disability, education, income, gender, and generational status can contribute to inequity. Attention should be paid to ensure technology are developed and implemented as supportive tools, enabling older adults to feel safe, both physically and psychologically. 32
H - Harm mitigation  Stakeholders and those impacted by decisions should be protected, as much as possible from harm. If harm cannot be fully mitigated, do the stakeholders view the benefits of the technology outweigh the risks?	Family should be involved to have conversation about how to protect choice and build care plan. People in LTC should be allowed to take risk if everyone agrees it is acceptable and reasonable, if the benefits of the technology outweigh the risks (A family member)	Care ethics focuses on relationships, roles, and responsibilities. The development and evaluation of robots a care context should pay attention to the relational nature of care activities. 14
I - Individual autonomy  Pay attention to how procedures and care plan are built to support technology use to protect individual autonomy. Avoid infringements on individual autonomy and choice.	The telepresence robot or PARO may be fine for some people, whereas for other people they can be unacceptable. We have to embrace different people just have different value systems. Some people have immense distrust with technology (An ethics expert)	Older adults should retain the right to control, to grant permission for use, to turn off or decline use.  If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly. 11
C - Cultural safety and justice  Practice leaders should inquire diverse perspectives of stakeholders of all groups to ensure inclusion. Respecting stakeholders’ worldview and lived experiences, incorporation cultural safety into all aspects of decision-making and practice is essential for justice and fairness. LTC should be environments that are socially, spiritually, physically and emotionally safe. Attempts should be made to ensure that individuals are respected and will not be judged for their identity, age, racial background, and disabilities.	I think it’s a fantastic opportunity to use the robotics in LTC. During the pandemic, people really need someone to talk to and something to hold on to. I had a Chinese resident with dementia who passed away a month ago. She always looked for company and she was scared. We gave her the PARO. It was super amazing how much she cared for it. I wish we have more than two (An operational leader)	Companion robots could enrich the social lives of elderly people; social interaction could be facilitated by robots that enabled virtual visits from friends and family. The deception and infantilisation of elderly people that might result from encouraging them to interact with robots as if they were companions. 11
S - Support of privacy  Practice leaders have a responsibility to put appropriate strategies in place to mitigate any risk of infringement of privacy. For example, policies, regulations, practice guidelines should be developed to support for team to deal with ethical challenges. Investment should be made to provide staff education about ethical decision making. Residents, families and all staff should have access to ethicists’ support and resources.	One major problem is the robots have camera and can see everyone around. When it goes out to the dining hall, not everyone may want to be seen. I am uncomfortable if it watches me when I provide care (A nurse)	A person with Alzheimer’s would probably forget that the robot in the room, and could perform acts or say things thinking that they are in the privacy of their own home. The person’s right to their own privacy should be respected. 11