Loneliness can lead to illness and death, and is such a painful experience that a resident may not verbalize it directly. Quality nursing care requires that problems of social isolation are identified and a plan developed for adequate intervention. Impaired residents will be more successful socially when they can access a variety of interesting activities in small groups where familiar staff take initiative and establish a rapport. Institutional nurses are in a unique position to request the structural and personnel changes necessary to bring creative activities to the nursing units of impaired elders.