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Dangers Of Isolation At N.H. Long-Term Care Homes A Source Of Concern

Annie Ropeik / NHPR

New Hampshire's long-term care ombudsman is sounding the alarm about the harm that prolonged isolation is inflicting on residents of the state's long-term care facilities.

At a meeting of the State Commission on Aging Monday morning, Susan Buxton said the restrictive visitor rules in place at many nursing homes and assisted living facilities are hurting the very people they’re meant to protect, robbing them of both social interaction and access to outside advocates who can raise issues about the quality of their care.

“Visits from family and friends are vital to the health and well-being of residents in long-term care facilities,” Buxton said. “In addition to providing the social connection and emotional support that all humans need to thrive, visitors provide essential monitoring and care. And yes, visitors into long term care could potentially bring COVID — just like the staff members.”

(If you live, work or have a loved one in a New Hampshire long-term care facility, NHPR wants to hear from you. Click here to learn more and share your experiences.)

As ombudsman, Buxton serves as a watchdog and an advocate for the state’s long-term care residents. In that role, she’s been fielding a flood of worried calls about how these facilities are managing COVID-19: from residents who feel hopeless and helpless stuck inside these facilities, cut off from nearly all visitors for four months and counting; from family members who feel similarly hopeless and helpless from being stuck on the outside.

Under normal circumstances, Buxton’s team would make regular visits to long-term facilities to ensure they’re treating residents with dignity and respect. Under COVID-19 visitor restrictions, however, she said, she too has been barred from carrying out this part of her job. The people who call her office with concerns about not being able to check in on how their loved ones are doing “often surprised and disappointed to learn that we were not able to enter the facilities either,” Buxton said.

“There were concerns, and most families were aware of the staffing shortages and staff turnover that existed before COVID-19,” Buxton said. “And now, without their participation in providing care and monitoring their loved ones, they believe that it can’t be better and, most certainly, it’s worse.”

Buxton said her belief in the urgent need to reassess visiting guidelines is also informed by personal experience: She recently lost her once-vibrant 95-year-old mother at a local assisted living facility, after watching her “decline cognitively on an almost daily basis from the isolation.”

“There was no medical event. There was just no more life for her,” Buxton told the commission, through tears. “She died very peacefully, and I’m happy to say I was by her side, but the last three months of her life were dreadful for her. We need to do better than this.”

One proposal backed by Buxton and other advocates would allow New Hampshire long-term care residents to designate a “support visitor” who would be allowed to “visit on-site and provide emotional and other support.”

Health and Human Services Commissioner Lori Shibinette, who also attended Monday’s commission meeting on her first day back at work from what she described as a weeklong “staycation,” said the state is exploring whether it’s possible to implement this kind of policy. Shibinette said the state is open to suggestions about how to balance concerns about residents’ safety with their need for social interaction.

While Shibinette said she, too, is hearing direct pleas from families who want to visit their loved ones at long-term care facilities, she’s also hearing from others at facilities hit hard by COVID-19 who are pleading to keep restrictions in place — or raising concerns about a rise in family members visiting from out-of-state, bringing an added level of anxiety.

“I'd like to say they're just one-offs, but they're not,” Shibinette said. “I bet you I get three or four calls a week about family members coming from out of state, and that's causing great concern.”

The federal government directed nursing homes across the country to stop allowing visitors and “non-essential” personnel inside on March 13. Two months later, in May, the federal government released guidancefor states on how to safely reopen facilities. 

New Hampshire — where 33 percent of COVID-19 infections and 82 percent of deaths from the illness have been linked to long-term care facilities — has recently started to allow some nursing homes to resume some visits and other social activities. This option isn’t available to facilities experiencing COVID-19 outbreaks, and the state also leaves it up to each facility to determine whether to “limit the length of any visit, the days on which visits will be permitted, the hours during a day when visits will be permitted, and the number of times during a day or week a resident may be visited.” 

Indoor visits are permitted under limited circumstances “for residents who are unable to go outdoors (e.g., due to a disability or advanced dementia), are in end-of-life circumstances or for residents whose psychological wellbeing requires visitation.”

Casey is a Senior News Editor for NHPR. You can contact her with questions or feedback at

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