The Deadly Effects of Nursing Home Lockdowns

COVID-19 tore through nursing homes with staggering lethality. As of March 2022, two years into the pandemic, more than 150,000 US nursing home residents had died of COVID-19 – roughly 10% of the total U.S. nursing home population. Sadly, well-intentioned lockdowns made things worse

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Prior to the development of vaccines, the primary strategy for protecting nursing home residents from COVID-19 was physical distancing and isolation. Residents were often confined to their rooms, unable to socialize with family and friends or even interact with fellow residents.

From the outset, it was clear that these draconian measures would have devastating effects on nursing home residents’ quality of life, cognitive functioning and mental health. In mid-2020, only 5 percent of nursing home residents surveyed reported having visitors three or more times per week, compared to 56 percent before the pandemic.

Many nursing home residents expressed anguish at having their social lives suspended. “I have become more anxious and depressed due to the separation from my loved ones. I have little appetite and am losing weight,” shared one resident. “If the virus doesn’t kill me, the loneliness will,” said another.

This suffering was justified, some argued, because isolation was effective at blunting the spread of COVID-19. It wasn’t until September 2020 that the Centers for Medicare & Medicaid Services (CMS), the agency overseeing the two federal health insurance programs, eased the visitation restrictions it had imposed in March 2020 and began permitting nursing home visits under limited circumstances.

In recent research, I show that the overall effect of COVID-19 nursing home lockdowns on residents’ health was sharply negative. Using cell phone tracking data, I create an index of isolation measures at more than 10,000 nursing homes in the U.S.

I find that while stricter isolation measures were associated with fewer COVID-19 cases and deaths, they were also predictive of substantially higher rates of non-COVID and total deaths in the second year of the pandemic. Overall, I estimate that isolation measures were associated with substantially more total deaths: A one standard deviation decrease in isolation in all nursing homes is predictive of 7,305 fewer overall deaths.

The effects are largest in facilities with higher proportions of residents with dementia. Because regular social contact is critical to slowing the progression of diseases like Alzheimer’s, this finding supports the hypothesis that isolation measures harmed residents’ health.

These results join other post-mortem analyses of the pandemic response, exposing egregious — and, in cases like this one, deadly — miscalculations by public health officials. Learning from these mistakes is essential. COVID-19 will not be the last pandemic.

My findings also have immediate relevance. Even in the absence of a pandemic, airborne pathogens are common, and CMS guidelines urge nursing homes to implement physical distancing and isolation to limit transmission. Yet there are very limited data on the effectiveness of isolation procedures in reducing infections. Nor have the broader impacts of these policies on mental health outcomes been sufficiently scrutinized.

There’s no escaping it: A trade-off exists between shielding nursing home residents from infectious disease risk and inflicting harm on them through denial of social interaction. Let’s do better at striking the right balance.