Key Findings About Nursing Home Resident Experiences During the Pandemic

A sobering illustration from the report

The COVID-19 pandemic has altered not only how nursing homes function, but also how residents experience life.

Altarum, a nonprofit research and consulting organization, released an October 2020 special report, “Experiences of Nursing Home Residents During the Pandemic.” The report summarizes findings from an online survey of 365 nursing home residents from 36 states, conducted from July to August, 2020. While this report focuses primarily on nursing homes, it contains valuable information and insights that all senior care facilities can use moving forward.

Social Isolation and Loneliness: The Second, Silent Crisis

Nursing homes faced a crisis in 2020, as reports documented that 40% of COVID-19 deaths were occurring within both nursing homes and assisted living facilities. Gaps in infection control procedures, difficulty sourcing PPE for staff and residents, and many other challenges contributed to this initial crisis.

But while nursing homes worked to implement social isolation and procedures to keep both staff and residents safe, the second crisis of social isolation and loneliness emerged. Survey respondents identified that this social isolation took on multiple forms, including isolation from family and friends, within the facility, from the outdoors, and from participating in the larger community.

Pre-pandemic, 83% of residents responded that they went outside one or more times a week, but that figure dropped to 28% during the pandemic. Prior to COVID-19, 58% of residents reported that they left the nursing home each week to attend community events, but that decreased to 6% during the pandemic.

Instead, residents now spend most of their time in their rooms, with 64% of respondents stating that they do not leave their rooms to socialize with others at all. While 69% of respondents reported that they had previously eaten meals in the dining room, only 13% of residents continued that practice during the pandemic. In turn, 75% of residents reported that they are lonely, and 57% responded that they are “a lot” lonelier than usual.

Understanding the Results

The survey respondents provide key information about how social isolation has altered their lives. This physical separation also contributes to increased loneliness. A 2020 survey found that 50% of people age 60 and over are at risk of social isolation. One-third of those age 60 and over will experience loneliness later in life.

Social isolation can be harmful, and it doesn’t just affect mental health. The Centers for Disease Control and Prevention report that social isolation is linked to serious health risks. More than one-third of adults age 45 and older have reported feeling lonely, and one-fourth of adults age 65 and up are socially isolated.

Social isolation and loneliness contribute to health risks:

• Social isolation is associated with an increase in the risk of premature death and a 50% increased risk of dementia.
• Loneliness is associated with higher depression, anxiety, and suicide rates.
• Poor social relationships are associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.

Addressing Loneliness in Nursing Homes

While socially isolating residents may have helped to reduce COVID-19 transmission, nursing homes now face the challenge of alleviating the loneliness that these efforts have caused. The special report recommends that nursing homes focus on ways they can increase distance socializing while still maintaining the physical distancing necessary to protect residents. Nursing homes can create visiting plans and arrange visits that follow CMS visitation guidelines.

Technology also plays an important role in socialization. A nursing home can ensure that residents have access to videoconferencing with equipment like tablets and laptop computers. Nursing homes can host online and in-person events that maintain physical distancing. Reaching out to residents and asking what types of activities they most appreciate can help a nursing home to plan and improve the activities that it hosts.

Moving Forward

The special report includes survey respondents’ answers to a question asking them what they would like to share about how their lives have changed since the COVID-19 restrictions. It’s well worth taking a few minutes to read some of these responses, contained in Appendix A. Loneliness is a common thread, and some of the answers state that the social distancing is worse than the virus.

While physical distancing is an essential element of COVID-19 prevention, senior care communities also need to recognize the effect this has on resident loneliness and quality of life. Facilities that actively seek out ways to keep residents engaged and connected, even while physically distanced, can better support residents’ social needs and overall health during the pandemic.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.