Pandemic isolation takes toll on the nation's elderly

Nursing homes have put in place some of the strictest safeguards to protect the nation's older population from COVID-19. But those regulations are taking a toll, creating a bigger chasm between residents and the outside world and their family, friends and loved ones.

"Hearing an elder say they feel like they are in prison is heartbreaking. We need to change this," said Sarah Slocum, co-director of Altarum's Program to Improve Eldercare.

For months, nursing homes have restricted visitation and activities of residents in nursing homes, following CMS guidance to limit the spread of COVID-19 among a population that is more vulnerable to the effects of the disease.

CMS on Sept. 17 revised its nursing home visitation guidance, recommending outdoor visitation whenever possible and limited indoor visitation, citing the effects that isolation was having on residents.

"While we must remain steadfast in our fight to shield nursing home residents from this virus, it is becoming clear that prolonged isolation and separation from family is also taking a deadly toll on our aging loved ones," CMS Administrator Seema Verma said in a statement.

A survey by Altarum conducted among nursing home residents found that 76% of respondents feel lonelier under COVID-19 restrictions, and 64% said they don't even leave their rooms to socialize with other residents.

Altarum survey respondents reported weight loss and feeling hopeless, sad or depressed and said things like, "If the virus doesn't kill me the loneliness will," and "I have become more anxious and depressed due to the separation from my loved ones. I have little appetite and am losing weight."

"Hearing the residents' own words about how restricted and lonely they feel really hit home," Slocum said.

Even before the pandemic, loneliness and isolation among the elderly were big problems in the U.S., said Dr. Eric Rackow, co-founder of eFamilyCare, a digital platform for family caregivers. The pandemic has made that situation more acute.

Basically, loneliness and isolation increase your risk of having a problem with your health," Rackow said. Those who are isolated can be depressed, less likely to take medications and not sleeping as well, which can exacerbate existing health conditions, he said.

A new survey by AARP Foundation and United Health Foundation found that among adults 50 and older who reported experiencing social isolation during the pandemic, 50% felt less motivated, 41% were more anxious and 37% felt depressed.

"Many people don't know that social isolation can have lasting effects on not only mental health but also physical health," said Dr. Rhonda Randall, executive vice president and a chief medical officer at UnitedHealthcare.

Nationwide, there have been 238,283 confirmed cases, 138,783 suspected cases and 57,008 COVID-19 related deaths in nursing homes, according to the latest CMS data. In Minnesota, "social isolation" has been listed as a cause or contributing factor of death for at least three residents at long-term care facilities.

"We started to see a negative mental and physical impact on residents," said Julie Thorson, president and CEO of Friendship Haven, a long-term care facility in Fort Dodge, Iowa. "Residents feel like they're in trouble, like they're being punished."

Concerned by the toll the pandemic was taking on residents, nursing homes and other long-term care facilities have organized outdoor visits, set up video calls and even held drive-by parades to connect people with their loved ones.

Friendship Haven employs 16 companions to socialize with its 110 residents. Companions are typically those in high school or in early retirement who come visit with residents and keep them company.

"They've just been lifesavers," Thorson said. "During the pandemic, they have really been instrumental in combating loneliness."

With companions' help, the staff are able to focus on resident care and dealing with COVID-19, Thorson said.

The facility, like many long-term care sites, struggles with filling open positions, especially during the pandemic, leaving fewer people to engage with residents.

"We're constantly recruiting. We staff really well but there still are lot of openings in our area," Thorson said. "It was a critical need before, and now it's a daily challenge."