Visala Goswitz felt a surge of relief early this summer when she learned that Minnesota health regulators were allowing senior homes to reopen to family visits after a prolonged and painful lockdown stemming from the coronavirus pandemic.

The biochemist had not seen her 80-year-old mother, who lives in an assisted-living home in Eden Prairie, since late March — and the separation left her anxious and uncertain for her mother's health. Was she getting enough to eat? Was she bathing properly? Was the pandemic causing her mental distress?

"There are signs of trouble that you can only see when you lay your eyes on someone," Goswitz said.

But weeks later, Goswitz and her siblings have still not been allowed inside the senior home apartment where their mother spends most of her days. In late July, the facility reimposed a lockdown on family visits after one of its residents tested positive for COVID-19, the deadly respiratory illness caused by the coronavirus. Now, Goswitz must content herself with daily phone calls and dropping off care packages at the front door of the senior facility.

Across Minnesota, a spike in coronavirus cases has dashed hopes among many families that they would be able to see and hug their loved ones after months of separation. Some of the state's largest nursing homes and assisted-living communities have yet to open their doors to visits by family members and outside caregivers, despite new state guidelines allowing such visits. Other facilities have moved to curb outdoor visits, which began in June, because of a recent surge of coronavirus cases.

The visitor restrictions are now entering their sixth month, and many residents and their relatives are reaching the breaking point. With no end in sight, many families said they are debating whether to move their loved ones out altogether and care for them at home, where they can recover from their prolonged isolation and have more regular interactions.

"It's been too long, much too long," Jean Peters, president of Elder Voice Family Advocates, said of the visitor restrictions. "Residents are stuck and families are stuck."

State health officials and long-term care industry leaders cite a host of reasons for why facilities have remained cautious about lifting visitor restrictions. About a third of Minnesota's nursing homes still have active outbreaks of COVID-19 among residents or staff, which has put them on high alert about reopening. Many others are in counties with a high prevalence of the virus, and they are waiting for the case numbers to decline before risking the health of their residents.

Staffing is another barrier: Many senior communities were short of staff even before the pandemic hit and have struggled to find enough employees to regularly screen and monitor visitors, industry representatives.

Even so, there are signs that the severe lockdown imposed in late March is being lifted. The state's two largest industry groups surveyed nearly 400 nursing homes and assisted-living facilities this week and found that more than 60% had implemented programs allowing for indoor visits by family members and essential caregivers. Some 94% of senior communities said they had started outdoor visits, according to the statewide survey by Care Providers of Minnesota and LeadingAge Minnesota.

"We deeply miss daily presence of our families and communities in our care settings, but we have all worked too hard to control exposure to this deadly virus to do anything other than move forward with an abundance of caution, careful planning and constant vigilance," said Gayle Kvenvold, president and CEO of LeadingAge Minnesota.

Guidelines loosened

In late March, senior homes across Minnesota and the nation imposed unprecedented restrictions on visits to prevent the spread of the pandemic. Residents were barred from seeing relatives, and adult children resorted to talking to their aging parents through cracks in windows. Others left care packages outside locked entrances and waved at their loved ones from parking lots.

Yet a decline in virus cases early this summer, combined with a loosening of state guidelines, stirred expectations that long-term care facilities would reopen their doors to families.

At first, family members were allowed to visit with residents outdoors at scheduled times, provided they wore masks. Then, in early July, the state gave facilities the green light to work with families to allow for visits by "essential caregivers." These care­giv­ers could be a fam­i­ly member, friend or vol­un­teer who pro­vid­ed regu­lar care and sup­port to the res­i­dent before the pan­dem­ic, under the new guidelines.

Overnight, senior care communities across the state were inundated with requests for in-person visits at all hours of the day, which left facilities scrambling to craft safety protocols and bolster staffing.

"Managing expectations became a major challenge," said Deborah Veit, executive director of Oak Meadows, a senior community in Oakdale that began allowing scheduled indoor visits by family members a month ago. "As soon as people heard that visitor restrictions might be lifted, they sprang into action. Sometimes we had to say, 'Whoa, that's just a guideline and we have to determine what's best for the whole community.' "

At many senior homes, a single case of COVID-19 can be enough to keep the doors closed to outside visitors.

Jones-Harrison Residence, a nursing home in south Minneapolis, decided to maintain its restrictions on indoor visits last week after two of its staff members tested positive for the virus.

"It's hard, so very hard," said Annette Greely, president and CEO at the 167-bed nursing home. "I feel deeply for our families and for our residents, who can't have hugs and can't hold someone's hand."

Isolation risks

Social isolation and loneliness have emerged as serious concerns during the lockdown. Researchers found that isolation is a risk factor for a number of health problems, including heart disease, strokes and dementia.

One recent study found a link between the visitor restrictions during the pandemic and significant weight loss. Residents at a Chicago-area nursing home ate less because they were not engaged in mealtime conversation, and families were no longer bringing them food, the study found.

Jackie McNamara and her sister, Jennie Koss, said they have been alarmed by what appears to be a stark decline in their mother's cognitive and physical abilities since they were barred from visiting her in late March. Their mother lives at the Residence at North Ridge, a large senior community in New Hope that has not allowed indoor visits.

The sisters said their mother, JoEllyn Rucke, 72, a former nurse, has lost 30 pounds in the past month — a decline the sisters attribute to her lack of social interaction. She is allowed three 30-minute visits outdoors with family members each week. On those visits, however, she has looked increasingly frail; she has barely been able to speak or open her eyes, as if she had just been awakened, the sisters said.

The sisters said they would like to be allowed inside North Ridge so they can see firsthand if their mother is receiving adequate food and medical care.

"Loneliness is killing our mother," said Koss, a business consultant who lives in Brooklyn Park. "Our mom is in crisis from being physically, emotionally and socially isolated from her loved ones."

Austin Blilie, vice president of operations at North Ridge, said the high rate of COVID-19 infections in Hennepin County was among the reasons why the facility could not allow indoor visits by family members and other essential caregivers. He noted that, since the beginning of the pandemic, North Ridge has encouraged window visits and remote video calls between residents and families.

State health officials have recommended that long-term care facilities closely monitor the rate of COVID-19 spread in their county, and consider it when determining whether to reopen to visitors. A key metric is the number of cases per 10,000 residents over a 14-day period. Hennepin County has about 20 cases per 10,000 residents over the past two weeks, which is among the highest rate in the state.

"Hennepin County infection rates continue to rank high, at a level that we feel is unsafe for inside visits to occur," Blilie said.