Loneliness in Plain Sight: Inequities in Long-Term Care
Loneliness isn’t just a feeling, it is also a major public health crisis within the walls of many long-term care facilities around the world. For many older adults of color, it is a reflection of lifelong inequities that don’t disappear with age. Isolation lives behind the sterile walls of assisted living centers and nursing homes, quietly shaping who gets heard, and who gets forgotten.
The U.S Surgeon General has described loneliness as an “epidemic of isolation”, linking chronic loneliness with higher rates of premature death, heart disease, anxiety, and depression. Loneliness also does not affect everyone equally. Studies show that older adults of color experience deeper isolation due to systemic inequities that follow them into later life. A lifetime of barriers such as unequal access to healthcare and education can accumulate and shape who has strong networks and who does not. This does not only limit opportunities for connection, but also influences how comfortable older adults may feel in seeking support in care environments that may not reflect their cultural or linguistic identities. Understaffed facilities and high turnover create situations where certain residents can fade into the background, and if someone doesn’t have visitors or advocates, their needs such as eating and bathing assistance, or medication management can go unnoticed. When caregivers are stretched thin, the focus often shifts to completing essential medical tasks rather than fostering meaningful interactions. Over time, this lack of engagement can erode trust and contribute to feelings of abandonment.
Our understanding of loneliness must also include the role socioeconomic status plays. Studies show that income is an incredibly powerful mediator of loneliness. Older adults with higher income often have more social options, whereas lower income older adults may face constraints that limit their ability to maintain relationships or engage in social life. Financial limitations can restrict access to transportation or social outings that prioritize emotional well-being and community engagement. Those living on fixed or limited incomes may also have fewer opportunities to participate in activities that foster connection, such as cultural events or wellness programs. This is a clear indication that loneliness is not just personal, but also a social outcome of inequity.
Cultural misunderstanding can lead to unintentional neglect. If a caregiver is unfamiliar with a resident’s traditional foods or religious practices, they may overlook vital aspects of their well-being. When individuals don’t see themselves reflected in their environment, they may retreat further, deepening their isolation. What might seem like small details, such as how someone prefers to eat, pray, or celebrate, are often central to their sense of identity and dignity. When these elements are ignored, residents may feel unseen or misunderstood, reinforcing feelings of alienation in an already unfamiliar environment. Representation matters. Something as simple as hearing one’s native language spoken, sharing a familiar meal, or observing cultural holidays can transform the atmosphere of a facility. Training staff in cultural humility, hiring bilingual or culturally diverse caregivers, and partnering with local community organizations can help bridge the gap between institutional care and cultural connection.
So, what do we do with all this knowledge? How do we make lasting changes that ensure these same challenges don’t happen to us and our children? We start by reframing loneliness as a societal inequity, rather than a quiet, individual problem. Loneliness should be screened just as blood pressure or depression, and this can be done by care facilities incorporating social connection assessments into regular check-ins. Overburdened staff cannot meet the emotional needs of residents without systemic support. Comprehensive training, fair pay, and adequate staff are all essential to residential care. Ultimately, creating a sense of belonging means building care environments where older adults are not only housed, but truly seen, valued, and connected.
References
1. Almeida, J., Molnar, B. E., Kawachi, I., & Subramanian, S. V. (2009). Ethnicity and nativity status as determinants of perceived social support: Testing the concept of familism. Social Science & Medicine, 68(10), 1852–1858. https://doi.org/10.1016/j.socscimed.2009.02.029
2. Harry Owen Taylor, Chen, Y.-C., Tsuchiya, K., Cudjoe, T. K. M., Qin, W., Nguyen, A. W., & Roy, A. (2024). Racial/Ethnic Differences in Loneliness among Older Adults: The Role of Income and Education as Mediators. Innovation in Aging, 8(8). https://doi.org/10.1093/geroni/igae068
3. Niedzwiedz, C. L., Richardson, E. A., Tunstall, H., Shortt, N. K., Mitchell, R. J., & Pearce, J. R. (2016). The relationship between wealth and loneliness among older people across Europe: Is social participation protective? Preventive Medicine, 91, 24–31. https://doi.org/10.1016/j.ypmed.2016.07.016
4. Office of the Surgeon General (OSG). (2023). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. US Department of Health and Human Services.
More about the author!
Kishori Raj holds a Master of Public Health in Community Health from the University of Illinois Chicago and works as Program Coordinator for the Urban Health Program at UIC, where she coordinates healthcare pathway programs for undergraduate students. Passionate about addressing the needs of marginalized populations, she was inspired to write this article through her personal experience observing her grandmother in a long-term care facility, where she witnessed firsthand how social connection and culturally responsive care profoundly shape quality of life.
