Consideration must be taken for the patient’s unique user needs, socioeconomic status, and availability of internet access. There are ethical concerns with the use of telepresence services, one being the inability to establish a quality patient-provider relationship due to the reduction in face to face visits. The ability to create a therapeutic relationship can be challenging to manage in person and even more so remotely, and if a relationship has not been established before the utilization of telepresence devices a disconnect can be created, leading to an untrusting relationship. Patients with dementia are at risk of isolation since they already have low engagement in social interactions. The use of telepresence could further reduce their social contacts by telepresence, because they could stay home instead of engaging in community events. The decrease in face-to-face social interaction of health care providers and family members can lead to a patient feeling a sense of loss, an increase in objectification, a feeling of loss of control, and a sense of overall privacy. Family members utilizing telepresence may feel they are invading the patient’s privacy if the device is turned on without the patient being aware, especially if the patient has a lack of ability to control the device (Niemelä, Van Aerschot, Tammela, Aaltonen, & Lammi, 2019).
Currently, there is limited reimbursement in the use of telepresence services. The lack of reimbursement has caused a fragment of available services currently covered under insurance. This leads to a limited widespread use of both telepresence and telehealth services (Dorsey & Topol, 2016). Financial obligations in the installation, use, repair, maintenance, and the requirement for internet use has a high cost associated with the patient and organization prescribing the device. According to Dahl and colleagues, as the use of telepresence increases, the overall cost can decrease over time with reimbursement increasing (2013). Due to the fragmented use of the services in health care, there is also disjointed patient care with little standardization. There is little research on how to manage crisis situations in an online context of telepresence devices with little or no standardization of practice (Glueckauf et al., 2018). A common repeated and prominent area of an ethical concern for both health care providers and patients is the confidentiality of sensitive patient data used in telepresence technologies. A secure system must be put into place to ensure privacy is guaranteed for the patient and their family. The Giraff robotic system does not interface or record sensitive patient data (Moyle, Jones, Dwan, Ownsworth, & Sung, 2018).