The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has fundamentally changed how Canadians access health care. Although it is undeniable that the rapid adoption of virtual care has played a critical role in reducing viral transmission, the gap in equitable access to virtual care remains pervasive for Canada’s aging and ethnocultural minority communities. Existing virtual care solutions are designed for the English-speaking, health-literate, and tech-savvy patient population, excluding older ethnic adults who often do not see themselves reflected in these identities. In acknowledging the permanency of virtual care brought on by the pandemic, we have a collective responsibility to co-design new models that serve our older ethnic patients who have been historically marginalized by the status quo. Building on existing foundations of caregiving within ethnocultural minority communities, one viable strategy to realize culturally equitable virtual care may be to engage the highly motivated and skilled family caregivers of older ethnic adults as partners in the technology-mediated management of their chronic disease. The time is now to build a model of shared virtual care that embraces Canada’s diverse cultures, while also providing its older ethnic adults with access to health innovations in partnership with equally invested family caregivers who have their health at heart.

The Syndemic of Inequity and COVID-19 in Virtual Care

“…Pham et al [ 1 ] offer a good example of leveraging the strength of ethnic diversity to enhance quality of care. The paper presents important insights about unique cultural elements of filial piety and kinship values prevalent in Asian families.…”

“…The design of virtual care is susceptible to translating systemic inequities that may be embedded in existing models of health care. Crucial reform initiatives of cultural interventions [ 1 ] or designing methodical frameworks for equity analysis in digital health [ 9 ] are promising approaches for improving the equality aspects of health care, even if within the traditional systemic norms. To the extent the initiatives align with the culture-specific norms of the conventional system, targeted reform initiatives present good alternatives for improving the efficacy of care.…”

“…Yet, substantive accommodation of ethnicity in contemporary discourse on cultural equity in health and digital health designs requires a shift in paradigm in the content of health care policy principles and its strategic priorities and action imperatives, which should resonate with the values of all patients and consumers as aligned with the principles of pluralism . Nothing less will help to achieve the purpose described by Pham et al [ 1 ] of catalyzing the transition from an exclusive service to an equitable standard.…”

“…In a fundamental sense, the vision for transforming virtual care from that of an exclusive service that benefits only a few to that of a standard for providing equitable care for all [ 1 ] echoes the age-old debate between policy variations on the zip code and the genetic code. This commentary aims to further develop the key theme discussed by Pham et al [ 1 ]—engaging the “reimagining” of virtual care for older ethnic adults—by considering the syndemic nature of COVID-19 and the intersection of cultural interventions in care and equity in virtual care.…”

Virtual care use among older immigrant adults in Ontario, Canada during the COVID-19 pandemic: a repeated cross-sectional analysis

“…Older immigrants in Canada are even more vulnerable to breakdowns in the system, and may face additional challenges when accessing healthcare, including cultural differences, discrimination, language barriers, literacy, health beliefs, and spatial isolation[8-11]. In addition, some barriers to access for older adult populations, such as physical or mental disabilities, inexperience or discomfort with technology, or lack of digital equipment[12-14] may be even more pronounced among immigrants who migrated at an older age and have poor social determinants of health upon arriving in Canada. Furthermore, some recent immigrants may face further health decline with increasing years of residency in Canada and poor access to health care[15].…”