The scandalous effects of nursing home isolation during COVID-19

With the pandemic state of emergency coming to a close, and with flu season now flu-and-COVID-19 season, experts are shifting their focus to what we can learn from the experience and apply to future public health challenges. COVID’s tragic and devastating effects on nursing home residents have been well-documented, but the time has come for an impartial look at the full effect of the measures implemented to reduce the impact of the virus.

New academic research includes data showing that for vulnerable nursing home populations, the response to the pandemic may have been even deadlier than the virus itself. While we understand that this has been a controversial idea, in some cases, isolation can indeed do more harm than good in the long run.

By now, people know the story. During the deadliest health crisis in living memory, the oldest among us were in the most danger. In 2020, policymakers and health professionals understandably took far-reaching steps to slow the virus’s spread. Nowhere were these social distancing measures more disruptive or drastic than in nursing homes.

Residents were separated from their spouses and children, and many weren’t allowed to leave their rooms to socialize with other residents. Non-residents were not allowed on premises, even to visit family. In some cases, residents did not have in-person interactions with loved ones for many months.

Nearly everyone understood that being able to see friends and family is essential for quality of life, and that even short-term isolation would come with significatn consequences. Many younger Americans who lost their jobs, worked from home or saw their interests and hobbies shut down suffered from loneliness and depression.

Less understood was that this is especially true for the elderly. Considering the stakes, it was easy to dismiss warning signs as temporary, such as the elderly resident who in August 2020 said, “I want my daughter. She takes care of me. I saw her every day and now she can’t come. I am scared.” Or the one who said, “If the virus doesn’t kill me, my loneliness will.”

The response to the pandemic failed to account for the fact that isolation at nursing homes was far more extreme than what most people experienced. Loneliness is serious, especially among older adults for whom social interaction, mental acuity and physical health are deeply intertwined. By some estimations, social isolation increases mortality by over 25 percent, and the effects of such extreme isolation on nursing home residents may be even larger.

A recent working paper from the Mercatus Center explores the effects of isolation measures on nursing home residents over the course of the first two years of the pandemic. It finds that social distancing measures in nursing homes were indeed effective in reducing the spread of COVID-19. But this came with a price: In 2021 and early 2022, nursing homes with the most stringent isolation measures had far more non-COVID related deaths than facilities with fewer isolation measures. In the long run, these facilities also report far more total deaths than facilities with less restrictive isolation measures.

That’s not to say that no response to COVID-19 is warranted. Caring for the elderly and ensuring they have dignity in their final years is difficult under normal circumstances. It’s even more difficult in a pandemic. We face an inescapable tradeoff between longevity and quality of life; between the dangers of isolation and the deadliness of COVID-19.

Knowing what we now know, how should we respond?

Nursing homes have a history of sensibly reducing visitation during bad flu seasons. New knowledge about the harm done by extreme and extended social distancing measures, even after the measures were lifted, can help them use these rules more effectively. Nursing homes need to do everything possible to safely allow residents to see their loved ones.

To reduce the death toll of the pandemic (deaths of all sorts) a delicate balance must be found between zero COVID and zero isolation. Rather than a one-size-fits-all federal or state policy, nursing homes themselves should weigh the risks presented by an area’s COVID-19 surges with the quality of life and social needs of their residents.

Isolation reduced nursing home residents’ chances of contracting COVID-19, but the cost was steeper than we imagined. This mistake should never be made again.

Vitor Melo is a postdoctoral fellow with the Open Health Project at the Mercatus Center at George Mason University and fellow with the Initiative on Enabling Choice and Competition in Healthcare at the University of Chicago. Conor Norris is the assistant director of the Knee Center for the Study of Occupational Regulation at West Virginia University.