Loneliness and social isolation have been described as the ‘silent epidemic’ for older Australians. Loneliness is a feeling that people can experience, often due to social isolation or lack of meaningful connection.
For many older Australians, both those living at home and those in Residential Aged Care Facilities, the absence of meaningful connection is as harmful as chronic disease. In Australia, more than one-third of adults reported feeling lonely at least some of the time in 2022, and older adults are disproportionately affected (Australian Institute of Health and Welfare [AIHW], 2023).
Social isolation has been linked to mental illness, emotional distress, suicide, the development of dementia, premature death and poor health behaviours, as well as biological effects, including high blood pressure and impaired immune function. Loneliness has also been associated with depression, anxiety, frailty, cognitive decline, and dementia, as well as poor health behaviours such as physical inactivity, poor sleep, and smoking (Cacioppo et al., 2002; Grant et al., 2009). Conversely, frequent and meaningful social contact have been shown to improve overall health and quality of life (Botha, 2022).
In community settings, many older people face significant barriers to staying socially connected. Isolation at home is common, particularly for those living alone without regular family or community contact. In-home care packages are often focused on clinical and personal care needs, with limited funding available for companionship or social interaction. This lack of support is compounded by restricted access to public transport, limited local activities, and shrinking social networks, leaving many older adults vulnerable to loneliness.
In residential aged care facilities, the risk of social isolation can be just as profound. Residents frequently experience transition shock when moving into an unfamiliar environment, often leaving behind established routines, relationships, and familiar surroundings. Staff are funded to focus on completing essential care tasks, meaning less time is available for meaningful social engagement.
The prevalence of both moderate loneliness and severe loneliness amongst care home residents is high enough to warrant concern. Future studies should identify which interventions can address loneliness and promote meaningful social engagement to enhance quality of life in care homes. (Gardiner, Laud, Gott 2020)
Aged care practitioners are desperately trying to implement quality services provision. We report to and benchmark a number of clinical indicators. These clinical indicators include vague questions of residents that are supposed to measure “Resident Experience’ and ‘Quality of Life’. Whilst these questions are a starting point, they are not collecting empirical data about loneliness or social isolation.
The question has to be asked, and isn’t: “Are we truly measuring what matters most to residents’ wellbeing?” Without direct, evidence-based assessment of loneliness and social isolation, we risk missing this silent epidemic. Until we prioritise meaningful, validated measures and fund initiatives that foster genuine social connection, our understanding of “quality of life” will remain incomplete, and we will not be actually addressing the cause of multiple comorbidities, emanating from loneliness or social isolation.
How many times have we heard comments like “I wish I had moved in here earlier” or “Mum is always busy now and has such a great friendship group”. Companionship is a key to ‘fixing’ aged care, yet it is not recognised as an issue nor funded appropriately.
In Aged Care facilities, resident wellbeing depends not only on personal and clinical care but also on Lifestyle & Leisure (L&L) services that reduce loneliness, promote mental health, and enhance quality of life. Leisure and engagement scores remain among the worst-performing quality-of-life domains, highlighting critical gaps in current funding models.
The Royal Commission into Aged Care Quality and Safety (2021) highlighted this gap, clearly stating that the emotional wellbeing of residents must be valued alongside their physical care. Yet, systemic funding and policy frameworks continue to prioritise clinical compliance over lifestyle and engagement.
Since October 2022, residential aged care funding has been delivered through the Australian National Aged Care Classification (AN-ACC) model. Providers receive subsidies and supplements from the Australian Government based on resident care needs and classification. These payments are intended to cover both variable costs (e.g., individual care needs) and shared, fixed costs, which, in principle, include therapeutic, leisure, and lifestyle programs, however, there is no dedicated allocation for lifestyle or social engagement services. As a result, providers must fund leisure, lifestyle, and companionship programs from their general operational budgets, which are already under severe pressure.
The Australian Recreational Therapy Association has observed that post AN-ACC, some lifestyle/leisure roles have been downsized. Staff have been redirected towards personal care or let go entirely. (Iovina, Hellocare, 2024) This suggests that while the model theoretically covers lifestyle activities, in practice, those costs are often trimmed in favour of clinical services.
What is the fix?
- Introduce a dedicated funding stream or supplement for psychological and emotional support services, ensuring equitable access to qualified practitioners such as psychologists and counsellors.
- Incorporate “activity and companionship minutes” into the pricing framework to reflect the time and staffing required for non-clinical engagement, particularly for residents at risk of social isolation.
- Enable flexible funding models that support alternative, relationship-based and preventive models of care, not just rigid compliance with minimum care minutes.
The AN-ACC subsidy must be expanded to explicitly include funding for Lifestyle & Leisure (L&L) and psychological services. These services have been identified as essential for resident wellbeing in the Royal Commission into Aged Care Quality and Safety Final Report (2021), which called for greater attention to social, emotional, and mental health needs of older Australians. Additionally, a 2024 cohort study published in BMC Geriatrics involving over 1,700 aged care residents confirmed that social relationships and engagement activities scored among the lowest quality-of-life domains, underscoring the need for structured support through funded L&L and psychological interventions.
Loneliness among older Australians is not inevitable, but it will persist without targeted investment. With the right funding, Residential Aged Care Facilities can lead the way in creating environments where companionship and connection are not optional extras, but essential parts of care.
References
- Australian Institute of Health and Welfare. (2023). Social isolation and loneliness. AIHW. https://www.aihw.gov.au
- Botha, F. (2022). The association between social connections and wellbeing in older adults. BMC Public Health, 22(1), 1783.
- Cacioppo, J. T., Hawkley, L. C., & Thisted, R. A. (2002). Loneliness and health: Potential mechanisms. Psychosomatic Medicine, 64(3), 407–417.
- Gardiner, C., Laud, P., & Gott, M. (2020). Loneliness and social isolation in care homes: A systematic review. Age and Ageing, 49(5), 748–756.
- Grant, N., Hamer, M., & Steptoe, A. (2009). Social isolation and health. Annals of Behavioral Medicine, 37(3), 227–237.
- Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.
- JAMA Network Open. (2022). Interventions to reduce loneliness in older adults: A systematic review and meta-analysis. JAMA Network Open, 5(8), e222546.
- Royal Commission into Aged Care Quality and Safety. (2021). Final Report: Care, dignity and respect. https://www.royalcommission.gov.au
- Australian Recreational Therapy Association. (2024). Position statement on AN-ACC and lifestyle services.
- BMC Geriatrics. (2024). Quality of life domains in aged care residents: Findings from a national cohort study. BMC Geriatrics, 24(3), 311.
