Virtual Reality (VR) presents opportunities for improving the quality of life of older adults living in long-term care (LTC) homes. While current research primarily examines the feasibility of VR implementation, there remains a lack of studies addressing the ethical considerations pertinent to older adults residing in care settings.

Drawing upon case studies from LTC settings in Canada and the Czech Republic, this paper compares common challenges and unique ethical issues associated with VR implementation. We employ a human rights-based approach to discuss lessons learned in the two countries and implications for further research and development of VR interventions for LTC residents.

Our reflection focuses on lessons learnt: 1) LTC residents have restricted access to benefits from VR in LTC, 2) risk aversion culture in LTC, 3) involvement of LTC residents in VR development and adoption, 4) cultural relevance, 5) ageism and exclusion, and 6) respecting the right to decline VR. The reflection underscores the importance of engaging relevant partners (residents, families, care partners, leadership teams, industrial partners, and researchers) to develop implementation plans and create collective ownership of the virtual reality program.

Continuous team reflections on the design process, technology uptake, and implementation are crucial in ensuring residents’ well-being, equity, and cultural sensitivity in adopting technology in LTC. Informed by the reflection, we developed six practical strategies focusing on Access, Balance, Connection, Diversity, Engagement and Freedom to say no, acronymized as ABCDEF. Future research should explore system support, policies, and guidelines to support the ethical use of virtual reality in LTC settings.