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How Nursing Homes Are Curbing Loneliness During COVID-19

Older adult woman sitting indoors visiting with masked granddaughter and dog through a window.

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Key Takeaways

  • Nursing home staff members are doing more to combat loneliness and encourage resident engagement during the COVID-19 pandemic.
  • Isolation and loneliness are also issues for older adults living at home, as many community centers have been forced to close and they may not be able to visit with family and friends.
  • The holidays and increased restrictions are making it harder for residents to connect with others. People can do simple things to help residents feel more connected, like writing letters or making phone calls.

Older Americans living in nursing homes, long-term care centers, senior housing, and other assisted living facilities are at high risk for COVID-19 infection and complications—but that’s not the only thing they’re battling. Experts say loneliness and social isolation are hitting older adults especially hard during the pandemic.

Initial lockdowns were completely isolating, but many nursing homes have either eased restrictions or found innovative ways to keep residents connected to others while still keeping them safe during the pandemic.

Older Adults and Isolation

Living in a senior housing complex or similar facility can be isolating in and of itself. Confining residents to their rooms at the outset of the pandemic took a toll on their physical and mental health.

Many community senior centers had to close, meaning that isolation is also affecting older adults who live independently.

“People need to know that they’re not in this alone,” Alice Bonner, PhD, RN, a geriatric nurse practitioner, and a senior advisor for aging at the Institute for Healthcare Improvement, tells Verywell. “People get very isolated, and of course that gets magnified with COVID-19."

But that physical isolation is necessary. New weekly cases among nursing home residents rose nearly four-fold—from 1,083 to 4,274—from the end of May to late October. Resident deaths more than doubled from 318 per week to 699, according to a report by the Associated Press.

How Nursing Homes Are Coping

The surge in overall cases correlates with the number of cases in nursing homes. Experts say that’s because COVID-19 cases in a surrounding community indicate that an outbreak in a nursing home will occur.

“Someone has to care for vulnerable nursing home residents, and those caregivers move in and out of the nursing home daily, providing an easy pathway for the virus to enter,” Tamara Konetzka, PhD, a researcher at the University of Chicago, told the Associated Press. “Trying to protect nursing home residents without controlling community spread is a losing battle.”

Nursing homes are prioritizing socialization for residents. Bonner says that many places have activities coordinators trying to adapt to changing circumstances and do their best to keep residents connected and engaged.

That need for adaptation and a little creativity is how the National Nursing Home COVID-19 Action Network came to be. Through regular conference calls, staff members were able to share best practices on everything from infection control measures to socially distanced activities.

Alice Bonner, PhD, RN

We’re trying to create a home-like environment for people wherever they live.

— Alice Bonner, PhD, RN

Those calls helped nursing homes come up with innovations for keeping residents engaged, such as family visits through windows and introducing residents to video calls. They also had masked staff members wear name tags that include a photo of their face.

After gathering for meals was put on hold, "snacktivities," where residents meet in their doorways while staff members deliver snacks door-to-door, have also become popular.

Playing music is also instrumental for keeping residents engaged and connected with others—even if it’s just having a radio on in one room. Amid the pandemic, many facilities have opted to bring in piano or organ players or string quartets instead of performers who sing or play a wind instrument.

Booner explains these simple strategies can make a big difference to someone who is in a facility with restrictions. "We’re trying to create a home-like environment for people wherever they live,” she says.

Getting Residents Involved

While making these changes is important, keeping them person-centered is what matters most. Staff members should be encouraged to ask residents what they miss doing from before the pandemic and then try to create an individualized plan of care around those activities.

For example, some people who enjoyed traveling might perk up if staff help them put up pictures of places they've traveled (or would like to travel) in their room.

Communal dining with proper distancing, where allowed, has boosted the spirits of many residents, a spokesperson for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) tells Verywell.

Kelly Potter, the life enrichment director at The Sarah Community in Bridgeton, Missouri, says that residents have adapted to using tablets for video conference calls and games, as well as participating in exercise programs on TV.

“There is some confusion as to what and how the iPad is able to work the way it does," Potter says. "But once shown, the residents have really enjoyed playing online games with all the different colors and sounds that are featured in each game."

Themed snack cart visits, pet adoption carts, happy hour carts, and activity carts are also popular. In-room bingo has also replaced gathering for bingo in a large room.

“We do have a large number of residents, and making sure we can interact with them in any manner of their choosing is important, so we have really tried to be diverse in what we offer,” Potter says. “We base a lot of our interactions on what the resident chooses.”

The staff act as mail carriers to transport notes between residents who want to write letters back and forth. “We wanted to make sure those [relationships with other residents] were maintained and that they could talk to their friends if [the] technology wasn’t an option and so residents would write letters or have little gifts for each other,” Potter says.

Angela McAllister, the director of quality of life and culture change for Signature HealthCARE, said that using technology has also helped residents attend church services virtually, which has helped them maintain community connections.

Tech for Older Adults

Several technologies have emerged to keep older adults connected. GrandPad is a tablet that was built specifically for older adults and features a simple interface that lets them video chat, browse the Internet, share photos, and more.

Another example, RESTORE-Together, offers a multiplayer platform that lets residents play skill-building games with other residents, family members, and friends.

Holiday Challenges

Usually, the holiday season means that nursing home residents can look forward to enjoying visits with friends and family members, but that's not the case this year, Bonner says. Many people are traveling less because of the pandemic and some nursing homes are putting more restrictions on visitation.

Residents in colder areas may not be able to be outside as much, meaning that creative activities for connecting, like window visits or dining in a tent in the yard, won't be possible for a few months at least.

“We’re still in kind of a wait-and-see mode,” Bonner says. Ultimately, individual facilities will decide how they plan to handle holiday visits.

Combatting Loneliness

Potter says engaging residents goes beyond combating loneliness. “It’s not just loneliness that has set in, but some residents feel like [their] family has forgotten them or some have even forgotten their families," she says. "Our goal here is to of course combat loneliness in our elders but to also continuously remind and ensure to them, that they are loved and appreciated.”

Kelly Potter, life enrichment director, The Sarah Community

We are doing whatever we can to ensure that residents always remember how much they matter.

— Kelly Potter, life enrichment director, The Sarah Community

Potter says that she always knew working at a nursing home would mean that she would become like family to the residents. “In a time like this, that statement couldn’t be truer," she says. "The staff in my department do their best to make sure the residents know that their voice is being heard…we are doing whatever we can to ensure that residents always remember how much they matter."

Long-term care staff members are filling the void of family members who may not be able to visit. A spokesperson for the AHCA says that practices have adapted to provide more one-on-one care.

"Just sitting and talking to the residents is the best low-cost option that can make a world of difference," the spokesperson says.

What This Means For You

If you have a loved one in a nursing home or long-term care facility, find out how the facility is helping residents stay connected during the COVID-19 pandemic.

Even if you don't know someone in an assisted living facility, you can still reach out to your community's facilities for older adults and find out if there are ways you can help.

How You Can Help

While finding ways to help residents stay engaged does fall mainly to the facilities, just about anyone can help promote socializing for older adults.

Call your local assisted living facility or nursing home and ask if they accept cards or notes as part of a pen pal program. You might be able to volunteer to teach a resident how to use video conferencing or sign up to make a weekly phone call to a resident for a chat.

Potter says that your time is a valuable thing to give residents—if not the most valuable. “In my opinion, giving the residents your time, energy, and focus is one of the most important things that can be shared," she says. "Sure, games, crafts, concerts are all fun, but showing interest and getting to know someone better or finding out two people share similar interests can be so much more important. Spending time with someone and creating a meaningful connection combats loneliness better than anything.”

“Only meaningful relationships can cure loneliness,” McAllister says. “It really has to go deeper than surface-level activities programming to include something that is really impactful to everyone involved.”

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Article Sources
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  1. Associated Press. Nursing home COVID-19 cases rise four-fold in surge states. Updated November 8, 2020.

  2. American Health Care Association and National Center for Assisted Living (AHCA/NCAL). JUST THE FACTS: WHAT CAUSED COVID-19 OUTBREAK IN NURSING HOMES.