Faced with an alarming resurgence of the coronavirus in senior living facilities, state health officials are recommending strict new guidelines around when and how these facilities should further open their doors to outside visitors.

The Minnesota Department of Health released detailed guidance Monday for the reopening of Minnesota's long-term care facilities to family members and outside caregivers. For the first time, state regulators are recommending that facilities consider COVID-19 infection rates in the community, among other factors, before any further relaxing of their visitation policies.

The guidelines mark a shift by state regulators toward a more cautious posture in allowing visitors to long-term care facilities, which have seen a surge of new coronavirus cases in recent weeks. They are recommending that facilities meet minimum safety standards and consider community infection rates, similar to the decentralized approach that was developed for schools. At the same time, state health regulators stopped short of pulling back on recent steps to ease visitor restrictions, citing concerns about the harmful effects of prolonged isolation and loneliness.

"Residents have been isolated for months, and that presents significant risks for their emotional and social well-being," Health Commissioner Jan Malcolm said in a written statement. "This guidance helps facilities keep their COVID-19 guard up while taking cautious steps toward ensuring residents have more social connections and interaction."

The state began to relax the lockdown restrictions in mid-June by allowing people to visit at windows and then face-to-face outside the homes, provided they wear masks and maintain social distancing. Then, last month, many long-term facilities began allowing limited indoor visits by designated family members and essential caregivers.

Those visitation policies remain in effect. But the new guidance allows facilities to open their doors to more frequent and longer indoor visits by multiple family members and friends. These visits would be under parameters set by the facilities and would not be subject to the strict time limits that were established under previous guidelines. For the first time since March, children and pets would be allowed inside the facilities, providing comfort for people who have spent months confined to their rooms with limited interactions.

However, state health regulators are recommending that facilities first demonstrate success in preventing and controlling COVID-19 infections before opening the door to such expanded visits. For instance, the state Health Department is recommending against further reopening at facilities that have had at least one case of COVID-19 within the past 28 days, among residents, staff or a visiting service provider. Facilities should also consider staffing levels, testing capacity and access to personal protective equipment before easing visitation rules under the guidance, which goes into effect Aug. 29.

The guidelines also reflect a growing recognition that senior care communities are not isolated environments — but are connected to the broader community. Nursing homes can be among the largest employers in small towns, employing hundreds of caregivers, cooks, janitors and social workers. These employees come and go each day and sometimes work at multiple senior care facilities, potentially spreading the virus to more residents.

As coronavirus cases surge again across the state, public health officials warn that there is increased risk that such workers will bring the virus into more senior communities, potentially causing another wave of deadly outbreaks. Minnesota has reported more than 2,300 infections with the novel coronavirus that causes COVID-19 over the past three days — a level of viral activity that approximates the first peak of the pandemic in the state in late May. On Monday, 625 new COVID-19 cases and three additional deaths were reported.

The rate of infections with unknown sources of community transmission remained at 34% on Monday, according to the state's COVID-19 dashboard. That is above the state target of 30% and indicates that the virus is spreading beyond the ability of Minnesota health leaders to track it.

To address this heightened risk, regulators are recommending that long-term care facilities regularly evaluate the level of virus transmission in their communities before allowing more frequent visits. Facilities are encouraged to maintain current limits on visits if there is an "elevated risk" of COVID-19 transmission in the community — which state regulators define as having 10 or more cases of the virus per 10,000 residents over a 14-day period. As of last week, about 40 of Minnesota's 87 counties exceeded that elevated risk level, state health officials said.

Before easing up on visitor restrictions, facilities are also encouraged to consider the capacity of local hospitals to accept transfers of infected patients and the extent to which staff are working at other long-term care facilities. Long-term care communities should also have capacity to test all residents and staff who develop symptoms of the respiratory illness, and have arrangements in place for processing and paying for the tests, the guidance states.

The measures are the latest effort by state regulators to balance sometimes conflicting goals: containing the spread of the virus in long-term care communities while seeking to reduce the harmful effects of social isolation and loneliness among a vulnerable population. Prolonged isolation has been linked to a wide range of serious health problems in older adults, including heart disease, dementia and stroke.

The strict lockdown measures that were imposed in late March, when families resorted to waving to their loved ones from parking lots, have come to be seen as unsustainable and even inhumane as the pandemic has dragged on for more than half a year.

"COVID-19 is not going away any time soon, and that means we need to be finding solutions that are sustainable over a long term," said Lindsey Krueger, director of the Department of Health's Office of Health Facility Complaints. "Walling off residents from a majority of their family and friends is simply not a sustainable approach. But neither is allowing wide open visitations with no thought to the real and persistent risks to the health of residents and staff."

The respiratory illness is known to be especially lethal to older adults and those living in nursing homes and assisted-living facilities, where people live in close quarters and workers move from room to room. Efforts to contain the spread of the virus have been made more difficult because many people who are infected with the virus do not show symptoms, such as coughing and a fever, and unknowingly spread it to others, researchers have found. So far, 75% of the state's 1,660 coronavirus-related deaths have been residents of nursing homes and assisted-living facilities.

Since early July, the weekly number of new infections among long-term care residents has nearly tripled, with 172 new cases last week. That increase has coincided with an increasing number of infections among employees in long-term care facilities. Over the past four weeks, 580 employees have tested positive for the new coronavirus, along with 438 residents.

Staff writer Jeremy Olson contributed to this report.

Chris Serres • 612-673-4308

Twitter: @chrisserres