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Caterina Salvi, 90, waits for a visitor inside a protective inflatable plastic tunnel at the Martino Zanchi nursing home in Alzano Lombardo, northern Italy, February 24, 2021. © 2021 Luca Bruno/AP Photo

Susan Robinson, a 68-year-old resident of a United States nursing facility, was lying awake one night in March when she heard her neighbor gasping for breath. “She was dying,” Robinson said. “They took her to the hospital. They didn’t tell us anything.”

The next several months were a blur for Robinson, who tested positive for Covid-19 and lost dozens of friends to the disease. She said she was bounced “like a ping-pong ball” from room to room as the virus spread like wildfire through her facility. Even after the outbreak subsided, she was increasingly isolated and depressed, unable to see friends and family except for brief stints outside.

Robinson’s experience is not unique. Government failures to contain Covid-19 have taken a devastating toll on older people, from those living in nursing homes to those whose livelihoods are threatened by lockdowns. The pandemic has exposed deeply ingrained ageism and underscored that failing to protect the rights of older people has serious consequences.

According to a report by Claudia Mahler, the United Nations independent expert on older people, the Covid-19 pandemic “drastically amplified prevalent ageism.” The report found discrimination in the delivery of health care services, insufficient prioritization of nursing homes in responses to the virus, and lockdowns that left older people more vulnerable to neglect or abuse.

Approximately nine in ten deaths in Europe and eight in ten deaths from Covid-19 in the US are among people over the age of 60. Nowhere has that toll been more severe than in congregate settings like nursing homes. According to one analysis, long-term care residents made up 46 percent of Covid-19 deaths in 21 countries for which there was data.

Reports from the United Kingdom to Italy show that the failure to prioritize personal protective equipment (PPE), and longstanding issues with infection control and insufficient staffing exacerbated the spread of the virus. In the US, infection control violations went largely unpenalized in the years leading up to the pandemic, and facilities with a history of poor staffing were more likely to have severe outbreaks.

And these are just the countries where we have semi-reliable data. In many countries, from Russia to Brazil, governments either do not report Covid-19 deaths in nursing homes or publish statistics inconsistent with what service-providing organizations or journalists have reported. In some US states, independent reporting has found a significant undercount of nursing home deaths during the pandemic. It is clear that in many places, we might never know the true toll of Covid-19 on older people.

Nursing home residents have faced not just Covid-19 itself but extreme isolation from visitor bans to stop the spread of the virus. Studies found that depression and other behavioral issues had increased during this time. With independent monitors and family members locked out of facilities in some countries, there was much less transparency into nursing home operations.  

In the United States and the UK, visitor bans have coincided with credible reports of neglect, including untreated bedsores and extreme weight loss. Prescribing of psychotropic drugs, which pose serious risks to the health of older people, increased in nursing homes in Canada and the UK, and there have been reports of inappropriate use of these drugs in people with dementia in Australian care homes.

Some governments have introduced age-based restrictions on movement during the pandemic, curtailing the rights of older people to leave the house, use public transport, or work.

In other countries, there has been an implicit expectation that older people, given their heightened vulnerability to the disease, should stay home to protect themselves even as lockdowns are lifted. Brazilian President Jair Bolsonaro, who flouted efforts to combat Covid-19, said that “Each family has to protect its elderly, not throw that on the state.”

But many older people, like everyone, need to leave the house to work, shop for food, access their bank accounts, or visit the doctor. Many governments in low-income countries don’t provide pensions, so older people have to work to survive. HelpAge International, a nonprofit organization dedicated to protecting the rights of older people, used World Bank data to estimate that 1.6 to 2.3 million more older people will become destitute in sub-Saharan Africa due to economic fallout from the pandemic.

In conflict zones like eastern Ukraine, older people living in parts of the country under the control of non-government armed groups have been almost completely cut off from pension payments, and pushed deeper into poverty, since March 2020 as a result of Covid-19 travel restrictions. Even in high-income countries like the UK, charities have reported increased requests for help from older people who were running out of food because they were afraid to go shopping.

Even before the pandemic, governments often failed to protect the rights of older people, whether in nursing homes or in other settings. But the pandemic has exposed the high cost of these policy failures: to livelihoods, wellbeing, and even survival. Contrary to what some politicians have said during the pandemic, older people should not have to “sacrifice” themselves for the rest of society.

Authorities across the globe should ensure that 2021 is the turning point for protecting older people’s rights. Older people should be able to safely make a living or collect pensions. They should have adequate access to health care. Governments should address longstanding staffing and infection control problems in nursing homes. Regulators should create more oversight to end abuse, including the inappropriate use of psychotropic drugs. Older people should have access to services in the communities where they live, so that living in a nursing home is a choice, not a necessity.

To find examples of how things could be different, it is enough just to look around. Robinson was weary after months of stress due to Covid-19 and confinement. When we spoke, she was in the process of moving out of the nursing home into a government-subsidized apartment, thanks to the Money Follows the Person Program in her state of Connecticut, which supports older people and people with disabilities to live in the community. She hoped she would soon be able to drive around with her fiancé and reconnect with some family members.

“I can’t wait,” she said.

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