Survey of Nursing Home Residents Reveals Deep Emotional Toll of Social Isolation Under Covid-19

October 01, 2020

A new survey of nursing home residents by Altarum provides a rare glimpse into how Covid-19 restrictions of nursing facilities have impacted nearly every aspect of resident life and led to the unintended consequence of drastically reducing frail elders’ connection to community and family, a fundamental human need.  

The survey—the first known to directly poll nursing home residents about their pandemic experience—comes at a critical time as nursing homes grapple with balancing infection control measures with maintaining quality of life for their residents, often the most frail and vulnerable members of our society.  

365 nursing home residents in 36 states responded to the survey, which was conducted from early July to August 31, 2020. The survey asked residents how often they engaged in various common social and other activities after the Covid-19 restrictions were imposed compared to before the outbreak.  

The findings show that residents’ ability to move freely around their homes, leave the facility, have outside visitors, or even socialize with fellow residents has declined sharply since March and that those restrictions have taken a toll on their emotional health.  

Below are highlights from the survey: 

Social interactions outside the nursing home have dropped sharply  

  • Only 5 percent of respondents reported having visitors three or more times per week, compared to 56 percent before the outbreak.  
  • 93 percent of respondents reported that they did not leave their nursing home in a given week for routine activities such as shopping and visiting family, compared to 42 percent before the outbreak. 
  • Only 28 percent reported they went outside to enjoy fresh air one or more times a week, compared to 83 percent before the outbreak. 

Social interactions and activities within the nursing home have also dropped sharply 

  • 54 percent reported they are not participating in any in-home organized activities (such as exercise classes, art classes, resident meetings, and religious services), compared to 14 percent before the outbreak. 
  • Only 13 percent reported eating their meals in the dining room, compared to 69 percent before the outbreak. 

Additionally, 76 percent of respondents reported that they felt lonelier under the restrictions, an unsurprising finding given that 64 percent also indicated they no longer even leave their rooms to socialize with other residents.  

Previous research has demonstrated that social isolation, an already common reality for many older adults pre-pandemic, can accelerate declines in physical and mental health. The findings of Altarum’s survey add to this body of evidence by capturing how the current health crisis has exacerbated this further.  

The open-ended question in the survey asking residents how they are coping provides additional insight into the emotional toll of these restrictions, including candid comments about feeling more depressed, anxious, sad, and lonely. 

“Hearing the residents’ own words about how restricted and lonely they feel really hit home,” said Sarah Slocum, co-director of Altarum’s Program to Improve Eldercare. “Hearing an elder say they feel like they are in prison is heartbreaking. We need to change this.” 

The report also includes survey responses to questions about how safe residents feel, their access to technology that can connect them to people and activities, advance care plans and bereavement, and changes in basic quality of nursing home care and support. 

Finally, the report provides a detailed set of recommendations on ways nursing homes and policymakers can reduce social isolation and loneliness while still limiting the spread of the virus, largely through  measures that improve distance socializing, access to technology, individualized plans to head off loneliness, and nursing home staff support.  

“This survey shows that it’s not enough to try to keep residents from being infected; frail elders must have something to live for,” said Anne Montgomery, co-director of the Program to Improve Eldercare. “For many, that means seeing their family and friends, going outside and socializing—all of which can be arranged while social distancing and taking other precautions recommended by CMS. We hope that some of the ideas and resources offered in the report will help with that.” 

Read the report: 
Experiences of Nursing Home Residents During the Pandemic: What we learned from residents about life under Covid-19 restrictions and what we can do about it