The Loneliness Epidemic: Long Term Care Edition

As humans, we all need varying degrees of meaningful human interaction and connectedness to function and not feel like we are alone. This need became very apparent during the pandemic–introverts joked that they had been training for social isolation all their lives, while some extroverts actively started to crumble as their means of socializing in person disappeared. 

In May 2023, the U.S. Surgeon General declared that loneliness was a new public health epidemic. We are certainly no different in Canada. Social isolation and minimal opportunities for meaningful social connectedness, were exacerbated by the many changes that occurred during and after the pandemic. People of all ages were impacted, but unfortunately, individuals in long term care and group homes have carried a very heavy toll. 

During the pandemic, regular social activities were significantly reduced or eliminated to minimize human interaction and the risk of outbreaks. Outings were stopped completely and only essential visitors were allowed inside on a regular basis. The activities that seniors depended on to keep them engaged and connected were all of a sudden withdrawn with limited replacements. 

We all remember the heartbreaking news stories that showed family members camped outside long term care homes. Some holding signs, hoping for a glimpse of their loved ones. If they were lucky and their mothers, fathers or other relatives on the inside were on the ground floor and in good enough health, they tried to have conversations through windows and would place their fingers against the glass panes to mimic connection through touch.

Inside the homes, perhaps the most devastating aspect of social isolation was the extended quarantines in resident rooms (10 days on average). Imagine being a senior, already managing any number of health concerns, separated from your family and friends, possibly confused by all the changes, and now disconnected from human contact. Stuck in a small room day after day, in some cases with no phone, radio or television. Just silence and occasional staff visits for medication and food. 

Humans need regular meaningful connections to thrive and survive.  

The lack of mental stimulation and emotional connection over the past few years, has undoubtedly resulted in residents deteriorating much more quickly than they might have, had there been no catastrophic social isolation and no pandemic. We are approaching another season of outbreaks and the quarantine cycle will begin again for long term care.

In addition to figuring out more humane quarantine scenarios when residents are at risk, more effective interventions to help reduce regular day to day social isolation caused by institutionalization are required. 

In many cases, there aren’t enough family members who are able to visit every day or stay for extended visits. Residents therefore depend on the staff and what little social support they can provide. Personal Support Workers (PSWs) are often responsible for as many as ten residents. Homes continue to be understaffed; workers are rushed and can only provide basic care and limited interaction.  

Adding to that challenge is the fact that senior residents who live in long term care homes are at varying stages of physical and cognitive decline. They should be engaged and supported, instead of the usual peanut butter approach to care and activities programming. 

If existing staff, programs and family time are insufficient in reducing the impact of social isolation and loneliness, is there a real solution?

The go-to recommendation has always been a call for “more staff” in order to improve the PSW to resident ratio. In fact, in Ontario’s 2021-2025 staffing plan for long term care homes, “the government has committed to increasing direct care to an average of four hours per resident per day.” If this plan is successful, it will help, but the increased interactions still need to be more meaningful. Staff may need to receive specific training around how to effectively engage with residents to make them feel seen (such as is done in the Butterfly Model of Care).

The types of programming provided may also need to be expanded to include more innovative approaches where residents can more effectively interact and be mentally stimulated and emotionally engaged (e.g laughter yogavirtual reality technology and music therapy). Recreation teams would of course need more people to help manage these programs and potentially more training. Recruiting and welcoming more volunteers from the community to assist with programs and one to one meaningful interaction with residents may also be helpful for residents in this scenario.

In a real life example of this type of community support, Jan Stevens in the Niagara Region is a visiting volunteer who connects with long term care residents who would benefit from having more individual social time. Some long term care homes have programs that encourage student volunteers of all ages to go in and do crafts with or perform for the residents. In a program in Seattle, residents share their space with a nursery school to promote intergenerational learning and to “counterbalance the loneliness and boredom that so often characterize life in a nursing facility.”

Social isolation and loneliness is an epidemic in long term care facilities in Ontario. The pandemic made it worse and put a spotlight on the existing deficits (in all areas).

Sadly, it may be too late for many of the residents who suffered through the last two to three years, but hopefully everything they had to endure–the quarantines, isolation and resulting loneliness and any impact to their health, was not in vain.

Tymbi Gonsalves, Concerned Friends Volunteer

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130 Merton St, Suite 600
Toronto, ON M4S 1A4