Reducing Isolation and Loneliness with Care at Home

It is fair to say that in the United States today, there is an epidemic of loneliness and isolation affecting a substantial number of adults. In fact, early in 2023 the United States Surgeon General issued an advisory addressing what it calls a “public health crisis” due to the impacts of loneliness on physical and mental health, not to mention society as a whole. 

There are many causes for this, and many potential solutions. On the healthcare front, the Surgeon General has tasked providers with assessing patients for risks of loneliness and providing interventions. Given the nature of the serious morbidity and even mortality caused by loneliness and isolation, we need innovative approaches to addressing this in healthcare. 

One way that we can have a profound impact on reducing isolation and loneliness through healthcare is to offer patients comprehensive healthcare services where they most prefer to be— at home. There are unique advantages of receiving care in a familiar home environment. Not least among them is that patients eligible for care at home may have access to a more social and connected experience than the alternative of staying in a hospital bed. 

The health effects of isolation and loneliness

There is evidence supporting the assertion that isolation and loneliness impacts health in profound ways. It’s often said that loneliness is as bad for your health as smoking regularly. The Centers for Disease Control (CDC) notes that studies have shown many negative health effects, including: 

• Increased risk of premature death from all causes  
• An increase in the risk of dementia by 50%, heart disease by 29% and stroke by 32% 
• Detrimental impacts on heart failure patients such as 68% increased risk of hospitalization and 57% increased risk of emergency room visits, along with a nearly four times greater risk of death  

Along with these physical health outcomes, there is also the profound impact that isolation and loneliness have on emotional well-being and mental health. Not surprisingly, loneliness is a factor in both depression and suicidal behavior. 

As is often the case with poor health outcomes, these negative effects impact certain populations with a greater disparity than others. This includes lower-income adults, those living alone, older adults, people with chronic diseases or disabilities and immigrant and LGBTQIA+ populations.  

Social determinants of health, then, are deeply intertwined with social connection or lack thereof. With an eye to how this plays out in care outcomes, we must also look at how our care impacts isolation and loneliness. 

Typical impacts of a hospital stay on isolation and loneliness

Hospitalization is an event that can often be disempowering for patients, placing them in a foreign environment surrounded by well-meaning people that they may have never met before. These same patients may, at home, have more access to more familiar faces.  

Because of the general increase in stress levels that a hospital stay can cause, it’s understandable that it has been found to lead to increased feelings of depression and anxiety, along with difficulty adjusting and coping. We know these issues are potentially exacerbated even more for patients with dementia.  

Being in the hospital also often adds another layer of inaccessibility to social connection. Necessary restrictions on visiting hours and numbers of visitors can restrict access to friends and family who might otherwise reduce a sense of loneliness and offer support during this time. Often, patients are alone in their room, waiting for the next time a visitor, nurse or provider arrives to break their isolation.  

Perhaps even more significantly, if we as healthcare providers are tasked with assessing these patients for risk of loneliness, this snapshot of patients’ social connections does not reflect what their day-to-day environment is like at home, and whether they are isolated outside the four walls of the hospital. It is easy to miss how this context could be affecting their overall health. 

How bringing care home reduces isolation and loneliness

For patients who are appropriate and eligible for treatment in these models, bringing care home is often an enhancement from a social perspective. The medical care is the same quality care patients have come to expect in the hospital, and it comes with improved access to deep social connection that would be more elusive in an inpatient setting. 

In the home, our models enable us to dig a little deeper into relevant background information to execute care, and, as permitted by our patients, to reach out to patients’ families and their support network. Because of this, oftentimes we have access to insights we would never have if we were just treating them with a stethoscope or prescription pad. 

One of the things that may happen with an acute medical event is that it brings attention to a patient’s situation that the family may not be aware of. Because care at home tends to involve collaboration between patients, their families and our providers in real time, it often highlights scenarios like, “Oh, I didn’t realize that mom was doing so poorly. I didn’t realize she wasn’t taking her medications. I talk to her every day, but I haven’t seen her in a while.” It is not uncommon to discover a hoarding situation of which family members were unaware. 

These are the specific home circumstances that make a person more likely to come back into the hospital and more likely to have a poor outcome. In the home, we reaffirm their social setting, and whatever determinants are recognized can sometimes be fully fixed. We make family part of the solution instead of spectators. 

Care in the home is a growing solution to improving healthcare

As models of care in the home continue to expand and increase in popularity, we may have found one solution to loneliness and isolation that consistently resonates with patients and their families. With nearly 80% of adults ages 50 and older expressing a desire to age in place, and over 90% of patients in Contessa’s programs expressing satisfaction with their care, we can clearly see that continuum of care at home continues to serve as an opportunity for families to gather around the patient and participate in their care plan.  

As we approach the holiday season, it’s worth noting that isolation and loneliness are often exacerbated during holidays. For someone alone by themselves in the hospital without access to family, it can be even more difficult. Bringing care home and reducing the physical and mental health impacts of loneliness is just one of many ways this approach is improving healthcare delivery wherever it is available.