Facing a surging number of coronavirus cases in nursing homes, leaders of Minnesota's senior care industry and the state Health Department unveiled aggressive new measures aimed at stemming the spread, while painting a bleak picture of the industry's preparedness.

At a legislative hearing Tuesday, industry officials said nursing homes and assisted-living facilities are implementing stringent new measures to shield thousands of frail and elderly residents from COVID-19, the respiratory disease caused by the novel coronavirus. The new safeguards include constant mask-wearing by staff; more aggressive segregation of infected residents; the end of group dining and many other congregate activities, as well as more rigorous screening of all nurses, aides and other workers who enter the facilities.

At the same time, many families of elderly residents and their advocates have raised concerns that new restrictions on visits are being taken too far, even depriving people from seeing dying loved ones. In one case, a family was barred from visiting a resident days before the person's death, and then was denied the chance to view the deceased relative's body before it was cremated, according to Minnesota's state ombudsman for long-term care.

"Fear permeates our state right now," said Cheryl Hennen, the long-term care ombudsman, in testimony Tuesday.

Nursing homes and assisted-living facilities in Minnesota have already been on lockdown for weeks, as officials here scramble to prevent the sort of large-scale outbreaks that have devastated facilities in many other states, infecting scores of people and killing dozens. As of Tuesday, there have been 20 deaths from COVID-19 among residents of senior care facilities, accounting for more than half the deaths statewide. Across Minnesota, 103 residents of nursing homes and assisted-living facilities are now infected with the disease — six times the number of infections from just two weeks ago.

Now, responding to the grave and worsening threat posed to seniors, officials at the state Health Department said they are focusing testing for new COVID-19 cases at its public laboratory on congregate care facilities, including nursing homes and assisted-living facilities. The state is also in daily contact with every one of the more than 60 senior care facilities with confirmed COVID-19 cases, to help them access protective gear and implement preventive measures, officials said.

"Long term care residents and their staff are our No. 1 priority," said Kris Ehresmann, infectious disease director for the state Health Department.

Starting in late February, Minnesota's long-term care facilities have been focused on preventing the coronavirus from entering their buildings, through restrictions on visitors and screenings of workers. But as the virus spreads, and clusters of cases develop within facilities, they also have had to find ways to contain the spread between residents and staff. As of Wednesday, 12 facilities have more than two cases. One assisted-living facility, the Waters of Edina, said it has five residents who have tested positive for COVID-19. In response, the Waters is developing a "COVID-19 Care Area" for residents who test positive, according to a letter sent to residents and family members.

The response to the coronavirus has transformed virtually every aspect of daily life within senior care communities. Group activities, from card games to concerts, have been canceled. Meals are being delivered to resident rooms in disposable containers to avoid contamination. Once-bustling hallways are now eerily empty, with residents sometimes talking to each other through cracks in doorways. Facilities have become like small fortresses: Visiting family members are no longer allowed inside and can only see their isolated relatives through remote video calls. Some wave at their relatives through windows.

Deborah Veit, executive director of Oak Meadows Senior Living, a senior living community in Oakdale with 130 residents, said she is still struggling to get used to the silence and the sight of all her staff walking around in masks. "I sometimes feel like I'm in a 'Twilight Zone' episode," she said. "The way we do everything is hugely different. The hardest part is the quietness and not seeing our tenants out and about."

Now, after weeks of confinement in their rooms, some elderly residents are starting to show signs of depression and anxiety, Veit said. One woman suffered a panic attack after watching news of the pandemic on television. To alleviate the isolation, staff have begun singing in the hallways and dropping small treats, like chocolate Easter eggs and fresh fruit, in small bags hanging from their doors. "It's one tool to stay connected," she said.

But the pandemic has already deepened a chronic shortage of staff across Minnesota's long-term care industry. Many workers are self-quarantining because of exposure to the virus or because they are showing symptoms, and still others are staying home with their children. Meanwhile, facilities are struggling with widespread shortages of masks and other basic protective gear, industry representatives said.

Minnesota's two largest trade groups for senior care providers are calling on state regulators to remove certain regulatory barriers which, they argue, are standing in their way of responding to the crisis.

LeadingAge Minnesota has proposed waiving certain background checks requirements for people who have already been working in health care settings. The group has also suggested expedited licensing renewals for nurses and other trained medical professionals.

Deb Barnes, executive director of Lakeview Methodist Health Care, a nursing home in Fairmont, said her facility only has enough masks to last 25 days, though that inventory will deplete much faster if someone becomes infected. The facility is in such dire need for masks that it even reached out to a supplier in South Africa. Meanwhile, demands on staff have grown: Newly admitted patients are isolated in a separate wing of the facility, and staff entering the facility must be screened for symptoms. "It's an agonizing time," she said.

Star Tribune staff writer Jennifer Bjorhus contributed to this report.