For residents of Minnesota's senior care facilities, one of the most wrenching aspects of the pandemic has been their extreme isolation from loved ones.
Since late March, visitors have been all but banned from nursing homes and assisted-living facilities across the state. Family members have been forced to leave care packages outside locked doors and wave at residents from a distance. Many have been forced to limit visits to remote video feeds.
"It has been utterly heartbreaking," said Jean Peters, a nurse and president of Elder Voice Family Advocates. "People are literally dying of loneliness."
Now, amid encouraging signs that the virus is waning in long-term care, state health regulators are allowing people to visit their loved ones through the windows of their facilities.
The change marks the first easing of lockdown restrictions that have deepened the isolation of seniors, making it more difficult for families to monitor the care of their loved ones and ensure their daily needs are being met. It reflects a growing recognition that while coronavirus outbreaks could stretch on for months or even years, seniors in care facilities cannot be cut off from their support networks indefinitely. Prolonged isolation has been linked to reduced life expectancy and higher rates of heart disease and dementia.
"We are very aware of the negative impacts on persons residing in congregate settings as well as their families in not being able to be together," said Health Commissioner Jan Malcolm. "We have been looking at and working on ways that might represent low risk and wanting to get that guidance up quickly."
Long-term care facilities continue to account for most of the deaths from COVID-19 in Minnesota, but there are signs that the virus is on the decline in these communities. The weekly tally of cases has declined from a high of 1,049 cases in mid-May to fewer than 170 cases last week, the lowest level since late March.
The weekly death toll also has declined significantly, from 143 to 41 deaths over the same period. And there are encouraging signs of progress in facilities that had smaller outbreaks: More than half with one or two cases no longer have any active cases.
"We believe the combination of visitor restrictions, vigorous screening, enhanced infection control and more widespread testing have played key roles in helping mitigate the spread of the virus," said Gayle Kvenvold, president and CEO of LeadingAge Minnesota, a long-term care industry group.
Despite these promising signs, many senior care communities remain like small fortresses, with "No Visitors" signs blanketing their entrances. Rules on window visits have varied from one facility to the next; some allow people to talk through screens or slight cracks in windows, while others prohibit such visits altogether.
The new guidance allowing for window visits is a modest easing of the lockdown. Limits on indoor visits will remain in place, but those who choose to make a window visit at a long-term care facility will be expected to maintain physical distancing. Both the resident and visitor should wear cloth masks and stay 3 feet back from an open window. Staff can be creative about how they mark where families can sit outside the window, the guidance says.
Danielle Jin, a clinical research coordinator at the University of Minnesota, said the lockdown has made it difficult to monitor the physical and emotional well-being of her 91-year-old mother, who has dementia and lives in an assisted-living facility in Vadnais Heights. Each evening, Jin drops by the home and talks to her mother by phone while watching her through the window. But her mother often seems confused and upset that they can't meet in person, and Jin has to remind her each night of the pandemic and why they can't see or hug each other.
Recently, Jin said she was told she can drop off meals for her mother only once a week rather than every day. Each night, Jin squints through the glass at her mother's slight frame and wonders if she is getting enough to eat.
"Physical touch is so important to both of us, because I don't know how much longer my mother is going to live," Jin said. "It's a painful thought to think she might die alone in lockdown without me seeing or touching her."
