Courage in Accommodation: Connecting With Older Adults During the COVID-19 Pandemic

To the Editor:

The Department of Veterans Affairs Home-Based Primary Care (HBPC) Program employs a model of care that is focused on meeting patients where they are at, providing in-home multidisciplinary care to medically and socially complex veterans. However, the COVID-19 pandemic upended home-based care and necessitated a push toward virtual visits to protect patients and providers. In a matter of weeks, as health care institutions were tasked with changing the way care was delivered, providers had to ask patients to meet them where they were at.

During the COVID-19 pandemic, everyone has been seeking ways to connect; for younger generations, finding solutions to physical isolation might seem trivial. We often take the ease of digital connection for granted. For older adults, especially HBPC patients, however, virtual communication is a challenge that can cause confusion, frustration, and anxiety. The barriers to virtual communication can feel insurmountable, and being excluded from digital modes of connection may leave older adults feeling even more isolated.

As medical students working with the HBPC program to increase virtual visit rates, we watched patients and their caregivers courageously step into this new territory. During our interviews with HBPC patients, many expressed difficulty operating the hardware used for virtual communication (e.g., computers, cell phones, tablets), accessing email reminders and video conferencing software, and acquiring adequate internet connectivity. For those with cognitive or neurological deficits, the challenges were magnified.

Despite these barriers, many patients still asked for video visits with their providers and were open to troubleshooting any technology-related issues they faced with us, citing a sense of greater connectedness and their desire for more comprehensive care. Through our work with these veterans, we were constantly reminded of their determination and humbled by their openness. We viewed their willingness to accommodate these changes as a profound expression of their trust in us and a testament to the value they placed in connecting face-to-face with their providers.

As providers implement and adapt to changes as a result of the COVID-19 pandemic, we urge them to not forget the vulnerable older adults who are struggling to keep up with the demands of an increasingly digital age. As trainees, we are reminded of the importance of considering the ways we ask patients to accommodate us as we endeavor to serve them. With our patients’ courage and our tenacity, we are hopeful that we can walk together, virtually hand in hand, into a new age of health care.

Acknowledgments:

The authors thank Drs. Theresa Allison and Daphne Lo as well as countless HBPC team members, all of whom worked with and supported them during this time.