Senate Committee on Aging: Impact of Isolation and Loneliness on Seniors During COVID-19

Published in RINewsToday.com, on June 17, 2020

As the COVID-19 crisis has shuttered businesses throughout the nation, state and federal health officials scramble to stop the spread of this deadly virus. As states begin to slowly open up their economies, a growing number of researchers are finding that mandated social distancing and isolation through self-quarantine may have significantly impacted senior’s mental health and emotional wellbeing.

Just days ago, a U.S. Senate Special Committee on Aging morning hearing, chaired by Chairman Susan Collins (R-ME) and Ranking Member Bob Casey (D-PA), was held to address the growing isolation and loneliness seniors across the nation are experiencing due to COVID-19 and to explore what policies can better assist those working with this vulnerable population.

The Senate Aging Committee hearing, titled, “Combating Social Isolation and Loneliness During the COVID-19 Pandemic,” pulled together a panel of experts who are supporting older adults in hospitals, nursing homes, assisted living, home health, and the community. On July 11, the two hour and twenty-minute hearing, at Senate Russell Office Building 253, featured a new released report published by the National Academies of Science, Engineering, and Medicine (NASEM) titled, “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care SyCommstem.”

America’s Seniors are Isolated and Lonely

According to the Washington, DC-based NASEM’s findings, nearly one quarter of older adults are socially isolated, and more than 40 percent report being lonely. During the COVID-19 pandemic, early studies have suggested that for some older adults, social distancing guidelines and stay-at-home orders are resulting in increased rates of social isolation and loneliness, which can have serious, even deadly, consequences for the health and well-being of our nation’s seniors. Prolonged social isolation and loneliness have been found to have adverse impacts on health comparable to smoking 15 cigarettes per day.

This hearing builds on the Aging Committee’s long-standing leadership on the issue of social isolation and loneliness, including holding the first Congressional hearing on this topic in 2017 and leading the 2020 reauthorization of the Older Americans Act (OAA), which included several policies to reduce social isolation and loneliness, says a statement issued by the Senate Aging Committee.

“As the pandemic continues and the epidemic of loneliness and isolation worsens, we run the risk of an infectious disease causing a mental health crisis. Already, calls to Maine’s mental health support line have increased an estimated 40 percent since the beginning of the pandemic,” says Collins in an opening statement.

According to Collins, isolation and loneliness also have a fiscal cost, too. The Maine Senator highlighted a 2017 paper published by AARP’s Public Policy Institute, that reported isolation among older adults increases federal spending by an estimated $6.7 billion annually, as isolated people are often sicker and have to rely more heavily on skilled nursing care.

Combating Social Isolation

In his opening statement, Casey stated: “Before COVID-19, millions of seniors faced social isolation and loneliness every day, we know that. Now, they are looking at relatives through windowpanes. He urged his Senate colleagues to support his legislation, which would combat the impact of the COVID-19 pandemic by providing additional funding to expand senior nutrition programs and SNAP delivery and combat social isolation through the purchase of technology by nursing homes so residents can connect with their loved ones.”

During the hearing, Betsy Sawyer-Manter, President and CEO of SeniorsPlus in Lewiston, Maine, an agency that oversees the Area Agency on Aging’s (AAA) nutrition services, caregiver services, Alzheimer’s respite, Medicare, counseling, and health and wellness programs, discussed her work to shift to virtual programming in place of home visits and to scale up the nutrition program to meet growing needs amid the COVID-19 pandemic. She told the committee how these practices have helped to combat social isolation for older adults.

Najja Orr, President and CEO of the Philadelphia Corporation for Aging (PCA), discussed the steps PCA has taken to help seniors during this public health crisis, including their work to strengthen their home-delivered meal program. He called for increased funding and education to bridge the digital divide in communities as the COVID-19 pandemic has shifted many programs and resources to online platforms. Additionally, Orr urged Congress to expand flexibility of funding awarded to states and AAA’s through the Older Americans Act, which would allow local governments and agencies to better meet the needs specific to their communities.

Carla Perissinotto, MD, associate chief for Geriatrics Clinical Programs at the University of California San Francisco, who has studied the health impacts of loneliness on seniors for a decade, noted that “the prevalence rates for loneliness and isolation range from 20 percent to 50 percent and the corresponding health effects are disquieting.” According to Perissinotto, isolation and loneliness are associated with a 50 percent increased risk of developing dementia. Those people with heart failure who are experiencing loneliness also have a four-fold increase in the risk of death, a 68 percent increased risk of hospitalization and a 57 percent increase in risk of hospitalization use.

Perissinotto expressed concern to the committee about the downstream health effects of the pandemic. “Seemingly overnight, we saw our social structures dissolve as we were all forced to socially distance ourselves,” she says. “The challenge of all of this is that to protect our lives and health now, we have had to subject ourselves and others to the potential risks that we may be worsening our health and shortening our life expectancies in the future.”

Although video and internet technology are being used to communicate with those shuttered in their homes and nursing home and assisted living facilities, a large number of seniors do not have access to these technologies, says Perissinotto. These technologies are especially difficult for the hearing and visionally impaired persons to use, she says.

Finally, Dr. Peter Reed, Director of the Sanford Center for Aging at the University of Nevada Reno, discussed a portal he created for older adults in Nevada to easily communicate their needs in areas including telehealth, social support, and food and medicine. This portal, called the Nevada COVID-19 Aging Network Rapid Response (Nevada CAN), was launched on April 1st and has served hundreds of seniors during the pandemic.

Ending Legislative Gridlock in the Senate

COVID-19 related legislative proposals await consideration in the Senate. As the Presidential election approaches, voters must demand that the Senate end legislative gridlock, allowing swift bipartisan action to pass legislative proposal that will help seniors affected by the COVID-19 virus. We can’t sit back and wait.
To purchase a copy of NASEM’s “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System,” go to
https://www.nap.edu/catalog/25663/social-isolation-and-loneliness-in-older-adults-opportunities-for-the .

Herb Weiss, LRI’12, is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Bill Protects Nursing Home Residents, Providers

Published in the Pawtucket Times on June 1, 2020

This month, U.S. Senator Bob Casey (D-PA) and Senator Sheldon Whitehouse (D-RI) throw a bill in the legislative hopper to slow the spread of novel coronavirus (COVID-19) in nursing homes. It’s a common-sense legislative proposal and needed.

A recently released Kaiser Family Foundation study reported, “COVID-19 has had a disproportionate effect on people who reside or work in long-term care facilities, including the 1.3 million individuals in nursing homes; 800,000 in assisted living facilities; 75,000 in intermediate care facilities; and 3 million people who work in skilled nursing or residential care facilities.”

Combatting COVID-19 in Congregate Settings

With COVID-19 quickly spreading throughout the nation’s nursing homes and intermediate care facilities, Casey and Whitehouse’s legislative proposal, S. 3768, The Nursing Home COVID-19 Protection and Prevention Act, seeks to provide needed resources to facilities to protect frail residents and staff. Residents in these facilities are among the most vulnerable because of their age and underlying medical conditions. According to an analysis conducted by Gregg Girvan for the Foundation for Research on Equal Opportunity, as of May 22, in the 39 states that currently report such figures, 43 percent of all COVID-19 deaths have taken place in nursing homes and assisted living facilities

As more than 20,000 nursing homes residents and workers have died due to COVID-19, according to the latest reports, on May 19, 2020, Casey and Whitehouse introduced S.3768 to help states, nursing homes and intermediate care facilities put the brakes on the spreading of the deadly COVID-19. The legislative proposal, with 14 Democratic cosponsors (including Rhode Island Senator Jack Reed}, would help states implement strategies to reduce the spread of COVID-19 in congregate settings, including through the purchase of personal protective equipment (PPE) and testing and to support nursing home workers with premium pay, overtime and other essential benefits.

S. 3768 was referred to Senate Health, Education, Labor, and Pensions. As of March 30, 2020, a Congressional Budget Office cost estimate or this measure has not been received.

Days after the introduction of 25-page Senate legislative proposal, a House version (H.R. 6972) was introduced by Rep. Ana G. Eshoo (D-CA), cosponsored by Reps. Janice D. Schakowsky (D-IL), Donna E. Shalala (D-FL), Madeleine Dean (D-PA), Seth Moulton (D-MA) and David N. Cicilline (D-RI). The House bill was referred to House Energy and Commerce

“This virus spares no state, no county, no facility. The unprecedented crisis unfolding in our Nation’s nursing homes demands an immediate, extraordinary response. Reports indicate nursing home residents and workers account for roughly 1 in 4 deaths from COVID-19 in the United States,” said Casey, who serves as Ranking Member of the U.S Senate Special Committee on Aging, in a statement announcing the bill’s introduction. “The Nursing Home COVID-19 Protection and Prevention Act would provide $20 billion in emergency funding [for staffing, testing, Personal Protective Equipment, etc.] to devise a sorely needed national, coordinated response to stem the spread of this terrible virus in nursing homes and intermediate care facilities,” notes Casey.

According to Casey, the Senate bill would also require the U.S. Department of Health and Human Services (HHS) to develop guidance on cohorting best practices, including on how to safeguard resident rights. It would also instruct HHS to collect and publish data on COVID-19 cases and deaths in nursing homes and intermediate care facilities, and finally fund surge teams of nurses, aides, and other critical staff to fill in at facilities where multiple residents and staff members have been infected.

“COVID-19 poses an immediate threat to the more than 1.3 million Americans, including more than 7,000 Rhode Islanders, who live in nursing homes,” says Whitehouse, noting that frontline staff across the nation are “doing heroic work under very challenging circumstances.”

“We need to get vastly more personal protective equipment and tests to nursing homes, which care for the patients who are most vulnerable to the coronavirus. Our legislation would also help states fund surge teams, sending additional staff reinforcements to facilities where they are needed to care for patients and prevent infection,” adds Whitehouse.

Before S. 3768 was officially introduced, in early March, Washington, DC-based AARP announced its support for the Senate proposal. “AARP supports the draft of the Nursing Home COVID-19 Protection and Prevention Act that would help protect the health and save the lives of people in nursing homes and other facilities by supporting testing, personal protective equipment, staffing and more,” said Megan O’Reilly, Vice President of Government Affairs for AARP. “The proposal would also improve public transparency and help protect the rights of residents and their families, adds O’Reilly, calling on Congress “to act immediately to stem the loss of life and slow the spread of the virus.”

In the House Chamber, Rhode Island’s Cicilline, a member of the House Democratic Leadership as Chair of the Democratic Policy and Communications Committee, has also pushed for Congressional funding to stop the spread of COVID-19 in nursing homes. The fifth term Congressman has called for additional funding for the Public Health and Social Services Emergency Fund in the next package for congregate care facilities, including nursing homes. He also signed a letter to HHS Secretary Azar and Administrator Verma, of the Centers for Medicare and Medicaid Services (CMS), urging that HHS and the CMS to ensure that a significant portion of the newly allocated $25 billion for testing in the recently passed CARES Act be utilized for testing in nursing homes and other congregate living facilities.

State-wide Efforts to Combat COVID-19 in Nursing Homes

With Governor Gina Raimondo declaring a state of emergency on March 9, 2020, with the COVID-19 arriving in Rhode Island, the deadly pandemic virus spread quickly throughout the state’s nursing homes. At press time, it has been reported that 75 percent of all related COVID-19 deaths are in nursing homes.

According to Joseph Wendelken, Public Information’s Officer for the Rhode Island Department of Health (RIDOH), the state moved quickly to stop the spread of the COVID-19 virus in the community and in nursing homes. He stated: “We curtailed and then prohibited visiting early on, and we have been doing extensive testing in every assisted living facility in the state. We are doing cyclical testing, meaning that we are continually testing all residents in all homes on a rotating basis. We are giving tailored infection control guidance to specific homes, and we are helping them procure additional PPE.”

Adds Wendelken, RIDOH has established two COVID-19 Specialty Nursing Homes [at Oak Hill Center in Pawtucket and Oakland Grove Health Care Center in Woonsocket] to be a COVID-19 Specialty Nursing Home. “These are centralized facilities to accept patients who are being discharged from the hospital and who are COVID-19 positive but no longer require acute-level care. This strategy allows COVID-19 positive patients leaving the hospital to receive specialized rehabilitation and step-down, post-acute care while reserving hospital beds for patients who need acute-level care,” he said.

On Smith Hill, the Rhode Island House Republican Caucus has recently called for members of the House Committee on Oversight to meet to address the increasing COVID-19 death rate in the state’s nursing and assisted living facilities.

Putting Politics Aside…

With less than 156 days until the upcoming 2020 Presidential election, will S. 3768 reach the Senate floor for a vote. Since the beginning of 2019, more than 350 House-passed bills—including hundreds that have bipartisan support—have been buried by Senate Majority Leader Mitch McConnell (R-Kentucky) in his legislative graveyard. With no Republican Senators supporting Casey and Whitehouse’s COVID-19 bill, will it even reach the Senate floor for a vote?

It’s time for McConnell, who has called himself the “grim reaper” of Democratic legislation, to lay down his deadly scythe, making the safety of millions of residents who reside in the nation’s 15,583 skilled nursing facilities a legislative priority. The GOP Senator from Kentucky, who is in a close Senate race with Democratic opponent Amy McGrath, might consider putting politics aside during a raging COVID-19 pandemic sweeping across the nation to work with Senate Democrats to protect frail residents and nursing home staff. Kentucky voters might view protecting residents against COVID a bipartisan issue.