COVID-19 and NHS Rationing: Consequences for the Wellbeing and Care of Older Adults

Abstract

Introduction: This paper critically examines the care of older adults during the early phase of the COVID-19 pandemic (March–June 2020), drawing on social and occupational justice theories. It highlights systemic neglect and advocates for equitable access to meaningful engagement, autonomy, and participation in health-related decision-making for older adults.

Methods: A broad review was conducted using peer-reviewed literature, policy documents, UK print media, and international news sources such as CNN, Sky News, Al Jazeera through databases including the Cochrane Library, CINAHL, Medline, and Google Scholar were used.

Findings: The analysis offers a contextual critique of NHS and social care resource management in the UK, serving as a benchmark to compare healthcare responses in the United States during the same period. It reveals a moral polarization between rationing and rationalizing elder care and argues that promoting Advance Care Directives risks undermining professional ethical commitments to the sanctity of life.

Conclusion & Implications: For occupational therapists, this study provides a framework to examine and address structural determinants affecting older adults’ experiences, especially in crises. It calls for urgent, justice-oriented systemic reform that moves beyond reactive measures toward proactive preparedness. This paper advocates for the adoption of an Occupational Justice Audit Tool to guide equitable system responses, the establishment of mandatory community-based Advance Care Planning hubs and proactive policies to ensure equitable, dignified engagement for aging populations.