Volunteers aren’t extra — they’re essential to nursing home care

I didn’t plan to work in long-term care. I was a music major, performing in nursing homes to bring a little joy to older adults. But something happened as I kept visiting more nursing homes: I saw the same people, week after week, sitting alone. No visitors. No conversation. Just waiting.

That experience changed me. I went back to school to study gerontology and eventually founded the National Association of Long-Term Care Volunteers. I’ve seen firsthand what most Americans don’t: Volunteers are not a “nice-to-have” in nursing homes — they are essential.

More than half of the 1.2 million people living in long-term care communities in the U.S. receive no personal visits. Not from family or friends. The U.S. surgeon general has declared loneliness a public health crisis linked to dementia, heart disease, and early death. In fact, people who don’t receive regular visits are twice as likely to die in the same period as those who do.

Think about what people lose when they enter a nursing home. First, they lose a degree of autonomy — they can no longer make decisions the way they used to. Next, they lose mastery — the ability to manage daily tasks without help. But the most devastating loss may be relatedness — that fundamental human need to feel connected, seen, and valued.

When that sense of connection is missing, the consequences go far beyond loneliness. People may become withdrawn, depressed, or even stop eating. They begin to feel invisible, like they no longer matter. One woman put it bluntly when I asked how she was doing since her move into a nursing home: “The emotional pain I feel is far greater than any physical pain I feel.”

The spark that keeps someone engaged in life can quietly fade. And it’s not just emotional. Disconnection leads to more medical interventions, a greater staff burden, and an increased risk of hospitalization. In short, loneliness drives up the cost of care.

But this is where volunteers can make all the difference.

In those early days, I began asking staff what people living there really needed. Almost unanimously, they said, “One-on-one visits.” Not more games, not more entertainment, just someone to sit with, talk to, and be present.

One afternoon, I was visiting a woman when an aide came with her medicine. She turned to me and said: “This is what they think I need. What you are doing for me is what I need.”

On another visit, a different woman confided, “I have a lot of people around me — aides, nurses — but there is no one here just for me.”

Then there’s Clarence, 92 years old, who once looked me in the eye and said: “To be human is to love someone and to have someone love you. As far as I can tell, I’m still human.”

These aren’t just touching moments. They’re reminders that connection is care.

Strong volunteer programs do more than ease loneliness. They improve quality of life, support overburdened staff, and change how care communities are seen from the outside. When volunteers walk through the door, they bring the community with them. And they often stay — many professionals in aging services, including myself, got their start as volunteers who saw a need and decided to act.

Yet, volunteers remain underused, undervalued, and overlooked in long-term care policy. In April 2022, the National Academies of Sciences, Engineering, and Medicine released a comprehensive report titled “The National Imperative to Improve Nursing Home Quality.” While the report acknowledges the value of volunteers, its recommendations fall short of calling for robust, structured volunteer programs as part of the formal care strategy. There is no actionable plan to integrate or expand volunteer programming across the long-term care system.

That omission speaks volumes. We’ve medicalized long-term care so much that we’ve forgotten the people at its heart.

Care can’t be complete if it’s only clinical. People need purpose. They need presence. They need someone to ask, “How are you doing today?” and then have the time, the luxury of time, to listen to their story.

That’s why we launched our national campaign: One Hour, One Visit, One Heart. Because sometimes that’s all it takes to change a day — or a life. An hour of your time. A single visit. One person whose spirit is lifted simply because someone showed up and truly saw them.

Based in Philadelphia, NALTCV trains and supports volunteers here and across the nation. We work with care communities to build sustainable programs. And we help shift the mindset: Volunteers are not visitors. They are part of the care team.

Let’s stop treating them as extra — and start recognizing them as essential.

Paul P. Falkowski is the president and founder of the National Association of Long-Term Care Volunteers. He teaches online gerontology courses for the University of Nebraska at Omaha and is the author of “Creating the Volun-Cheer Force: Rethinking How We Use Volunteers in Nursing Homes.”