Combating loneliness and isolation in nursing facilities – Herb Weiss

By Herb Weiss, contributing writer on aging issues

Almost four months ago, U.S. Surgeon General Vivek Murthy released an 81-page advisory report titled “Our Epidemic of Loneliness and Isolation,” putting a spotlight on a troubling national problem, the growing incidence of loneliness caused by isolation in our society. The nation’s chief advocate for public health reported that even before the COVID-19 pandemic, about half of U.S. adults reported experiencing measurable levels of loneliness.  And this mental health issue continues to escalate.

While the impact of isolation and loneliness can be felt in communities throughout the nation, it’s a real problem that must be addressed in the nation’s nursing facilities, warns aging advocates.  According to the National Consumer Voice for Quality Long-Term Care and National Center for Elder Abuse’s  Fact Sheet (NCEB), “The Value of Being Heard: Loneliness and Social Isolation in Long-Term Care,” released in June 2023, the problems of loneliness and social isolation is worse in long-term care settings. “One study found that more than half of all residents in nursing homes suffer from isolation,” says the Washington, D.C.-based nursing home resident advocacy groups.

“Social isolation can be a choice that people make. There are people who choose to be socially isolated, and remain content and happy. But when it’s not a choice, it can lead to loneliness and have negative psychosocial and physical effects. It can also lead to neglect and abuse, including for individuals living in long-term care settings,” explains the fact sheet.

The Fact Sheet also notes that loneliness and social isolation may be triggered by personal loneliness caused by the death of a spouse, sibling, or friend, or losing the personal connection of small groups that a person used to connect with regularly.  Losing the connection of a large community, such as a religious group, can also bring about feelings of loneliness. But, losing your independence can have an effect on one’s health and well-being, too.

A Personal Story

According to Kathleen Heren, Executive Director of the Warwick-based Alliance for Better Long-Term Care who serves as Rhode Island’s Long-Term Care Ombudsman, declining health resulting in being forced to relocate to a nursing facility can be traumatic and result in feelings of loneliness and isolation, especially when the individual has never lived in a conjugated setting before.    

Heren recalls one nursing facility visit that drove home this point. Walking to a room she saw Mary, a small woman, sipping from a cup of tea, gazing outside her window. When the Ombudsman asked if she had a few minutes to chat, Mary responded, “Sure, why not.”

During this conversation, Heren learned that Mary had been living at this facility for a little over a year, forced to leave her small comfortable home because of falling and breaking a hip. It had been three years since her husband of 52 years had suddenly passed away.

Mary’s two sons visit her when they can, but have to juggle their visits because of family responsibilities.  She has no real complaints about the facility. She can choose to attend many activities during the day but often stays in her room.

During our conversation, I ask “what happens that make you the saddest or most depressed?”  Mary became a little teary-eyed and said, “each day brings me a little closer to death,” noting that she thought about all the things she used to do for herself, but now had to rely on others for help. 

Mary confided in me that she regretted all the things she didn’t do in her younger days when she had the chance, explaining that it felt she was watching a replay of her life daily. The depressed resident admitted that she missed her husband, remembering how they would dine each night and read the newspaper together. Now she sits in a dining room with other residents who she doesn’t know, listening to them arguing about “someone sitting in their chair.”

“As our conversation ended, I could feel my tears going down my cheek,” admits Heren. “I could see myself in her and what awaited me in a few years,” she says.

Thoughts about isolation and loneliness in nursing facilities

“The problem of loneliness for older Americans is often the result of loss of significant others and the changing demographics of families,” explains John E. Gage, President & CEO. Rhode Island Health Care Association (RIHCA). “In reviewing the recently published advisory report to the Surgeon General, however, there was little mention of its impact on residents of nursing facilities,” he charges.  

“During the peak of the Covid-19 pandemic, the government locked down nursing homes. Visitors were barred from visiting except for compassionate visits, group activities were prohibited, staff members were masked and wearing face shields or goggles, congregate dining was eliminated, etc. Of course, isolation was a problem. Thankfully, nursing homes are in a much better situation clinically today, and residents’ lives have returned to normal,” says Gage.

“Many elders choose to move into a nursing facility or to stay after a short-term rehabilitative stay because of their feelings of isolation in the community. Nursing facilities provide a comprehensive array of activities and socialization opportunities based on each individual resident’s needs and preferences,” says Gage, noting that Recreation/Activities Directors provide a wide range of large group, small group, and individualized activity offerings to ensure that residents have an optimal level of social interaction and spiritual fulfillment.  “RIHCA has a very active Activities Professionals Group that offers ongoing training and education to member facilities and provides a comprehensive listing of outside entertainers and the like. LTC life in Rhode Island nursing homes is vibrant,” he says.

“Although the public health emergency has ended, I tend to think the impact of those restrictions still linger. Early on in the pandemic, state officials and private partners quickly responded to the challenges of social isolation and loneliness. Using Civil Monetary Penalty funds grants were provided to nursing facilities to purchase digital devices to connect residents with loved ones. CARELINK produced a TV show, ‘Room with a View’ aimed at nursing facility residents to keep them engaged,” says Maureen Maigret, Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council.

Maigret adds that she has worked with the state’s Office of Healthy Aging to initiate Project Hello to call older adults using vetted volunteers to keep them connected and to assist in starting its ongoing digiAge project that provides older adults and caregivers with digital devices, connectivity and training. “Partnering with URI and community organizations, digiAGE has brought hundreds of older adults into the digital world and has been shown to reduce loneliness and improve quality of life. Most recently, digiAge has expanded to work with residents transitioning from nursing facilities back to the community, she says. 

Gerontologist Deb Burton, Executive Director of RI Elder Info, says that social isolation and loneliness continue to be an issue in long-term care settings. “Some people enter facilities and have an expectation that family will still visit at the same frequency as they did before the individual went into the facility and needed more help from the family at home. When that expectation is not met it can leave the individual feeling lonelier,” she observes. 

“There are definitely situations when one spouse or partner must enter a facility in order for care needs to be met, and for the first time in decades, they are trying to sleep in a bed alone. That is what the Fact Sheet describes as personal loneliness,” says Burton. 

But on a positive note, Burton says that “entering a long-term care setting affords them the ability to interact socially with peers for the first time in years. Their family members can resume their role as family instead of caregivers and that can lead the resident to a greater sense of connectedness.”

Finally, the Alliance’s Heren believes that there is no better way to combat loneliness in facilities then to bring children together with residents. “During visits, working on activities together, residents and the visiting children can make an image of their handprints together,” she suggests.

A pet therapy program can also provide companionship and healing to residents especially to those individuals are bed-bound. “Weekly visits to facilities benefit residents by increasing their social interactions, mental stimulation and self-worth, adds Heren,” remembering as a floor nurse she would place bird feeders outside resident’s windows and fill with seed. Residents happily spent hours watching birds attracted to the feeders.  

The Consumer Voice’s and NCEB’s Fact Sheet provides sage advice gleaned from talking with residents and consumers as to what could  help address resident loneliness in nursing facilities. The message they gave was clear – “Spend time with us. Listen to us.” 

Here’s a listing of tips that families, friends and staff along with facility policies that can assist in combatting social isolation and loneliness, go to https://theconsumervoice.org/uploads/files/long-term-care-recipient/CV_NCEA_ValueofBeingHeard_digital.pdf.

To read this writers coverage of the recently released U.S. Surgeon General Vivek Murthy’s 81-page advisory report titled “Our Epidemic of Loneliness and Isolation,” go to https://rinewstoday.com/warning-being-lonely-and-isolated-is-hazardous-to-your-health-herb-weiss/.

For a copy of the Surgeon General’s advisory, go to https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf.

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Herb Weiss, LRI -12, is a Pawtucket-based writer who has covered aging, health care and medical issues for over 43 years.  To purchase his books, Taking Charge: Collected Stories on Aging Boldly and a sequel, compiling weekly published articles, go to herbweiss.com.