For the first time in four months, fami­lies will be al­lowed to vis­it their loved ones in­side seni­or care homes, as Min­ne­so­ta health auth­ori­ties cau­tious­ly lift lock­down re­stric­tions meant to pre­vent the spread of the novel co­ro­na­vi­rus among vul­nera­ble old­er adults.

The Min­ne­so­ta Department of Health is rec­om­mend­ing that nurs­ing homes and as­sist­ed-liv­ing fa­cili­ties al­low cer­tain fam­i­ly mem­bers and out­side care­giv­ers in­side these fa­cili­ties to help mon­i­tor resi­dents' care and al­le­vi­ate the harmful ef­fects of pro­longed i­so­la­tion and lone­li­ness. These "es­sen­tial care­giv­ers" will be de­sig­nat­ed by the fa­cili­ties and will be al­lowed to make sched­uled vis­its last­ing up to three hours a day, or until caregiving tasks are completed, un­der new guide­lines is­sued Fri­day.

The an­nounce­ment marks the most sig­nifi­cant step so far toward the re­open­ing of Min­ne­so­ta's 1,700 seni­or care com­mu­ni­ties, which have come to re­sem­ble locked fortresses since the pan­dem­ic be­gan. With vir­tu­al­ly all visi­tors bar­red from nurs­ing homes since mid-March, seni­or home resi­dents have en­dured months of wrenching i­so­la­tion in their rooms.

Across the state, seni­ors have not hugged or kissed their loved ones for months. A­dult chil­dren have re­sort­ed to wav­ing at their par­ents from a dis­tance and talk­ing to them through cracks in win­dows, like visi­tors to pris­ons.

"Words cannot express how significant this [guidance] will be for families," said Dustin Lee, chief executive of Prairie Senior Cottages, which operates seven assisted-living and memory care homes statewide. "This has already brought such intense relief that families have been calling us, quite literally, with tears of joy."

Amid en­cour­ag­ing signs that COVID-19 is a­bat­ing in Min­ne­so­ta's seni­or homes, state health regu­la­tors are pub­lic­ly recognizing the criti­cal role that fam­i­ly mem­bers play in the care of vul­nera­ble seni­ors as well as the sig­nifi­cant risks posed by i­so­la­tion and loneliness. It also re­flects a grow­ing rec­og­ni­tion that while co­ro­na­vi­rus out­breaks could stretch on for months or even years, seni­ors in care homes can­not be cut off from their sup­port net­works indefinitely.

Pro­longed i­so­la­tion has been linked to a wide range of se­ri­ous health prob­lems in old­er adults, in­clud­ing heart dis­ease and stroke. As a risk factor for early death, social isolation now eclipses obesity, according to national research. At least two residents of Minnesota nursing homes have died partly due to social isolation related to COVID-19 restrictions, according to a Star Tribune analysis of death records.

"Some of the most heart­break­ing stor­ies of the whole epi­dem­ic, frank­ly, in­volve the sep­a­ra­tion of loved ones from their fami­lies and the very real psycho­logi­cal and phys­ic­al harm that i­so­la­tion caus­es," Health Com­mis­sion­er Jan Mal­colm said in an inter­view Fri­day. "I think many of us have fam­i­ly and friends in that very sit­u­a­tion and we have seen the re­al­ly in­cred­i­ble toll that [i­so­la­tion] takes."

Some families said they have become so troubled by the prolonged confinement of their aging relatives that they have considered removing them from their senior homes and bringing them home.

"It's been torture," said Karen Schneider of Coon Rapids, whose 91-year-old mother moved into an assisted-living facility in March after she suffered a stroke.

Schneider said her mother, a former factory worker, has recovered physically from the stroke but is starting to show mental and emotional stress from spending months confined to her room with little human interaction. In recent telephone calls with her children, Schneider said her mother has broken down and pleaded to be taken out of the facility. "She will cry and say, 'Get me out of here, get me out of here, I'm going downhill,' " Schneider said. "It's just killing my mother not being able to see her children and friends."

Lee said the severe lockdown measures were necessary at first, but he has become increasingly concerned that they were eroding the health of seniors living at his homes. In recent weeks, staff at his facilities have noticed increased levels of anxiety, depression and insomnia among residents at Prairie Senior Cottages stemming from their sense of isolation. Several of his homes have seen an increased number of falls as residents have become more disoriented without human contact, he said.

"They say social isolation is deadly, and I agree," said Lee, who expects to begin allowing visits early next week. "When you're not connected to others, you lose part of your humanity."

The decision to permit limited indoor visits by relatives and outside caregivers is the third time in the past month that state health authorities have relaxed lockdown restrictions on senior homes. In mid-June, people were allowed to visit their loved ones through the windows of their facilities. Then they were permitted to visit with them outside, provided they wore face masks and avoided touching. It marked the first time in months that many vulnerable residents had seen their loved ones in person, without the use of video conferencing technology.

The state's latest loosening of restrictions comes amid signs that the pandemic is finally ebbing in long-term care settings after ravaging hundreds of facilities this spring. The weekly death toll in long-term care settings has declined significantly since early May, and several nursing homes that had large and deadly clusters of the virus have reported no new cases for several weeks. Overall, however, long-term care facilities continue to account for nearly 80% of the deaths from COVID-19, state health data show.

"We know it has been a long four months for our residents and essential caregivers," said Patti Cullen, president and CEO of Care Providers of Minnesota, a long-term care industry group. "We hope that this designation will provide the needed support as an interim step until it is safe to resume visitations on a broader scale."

Under the new guid­ance, seni­or care homes are en­cour­aged to work with fami­lies to de­vel­op a proc­ess for de­sig­nat­ing cer­tain peo­ple as "es­sen­tial care­giv­ers." These care­giv­ers can be a fam­i­ly mem­ber, friend or vol­un­teer who pro­vid­ed regu­lar care and sup­port to the res­i­dent before the pan­dem­ic. The move is a recognition that a res­i­dent's rela­tives and close friends are of­ten the most in­vest­ed in their care, and can be best positioned to de­tect chan­ges in their condition and ad­vo­cate on their be­half, of­fi­cials not­ed.

The new guid­ance is vol­un­tary, which means that some nurs­ing homes and as­sist­ed-liv­ing fa­cili­ties may not per­mit the vis­its. Es­sen­tial care­giv­ers must also com­ply with a num­ber of rules, such as wear­ing face masks and eye pro­tec­tion while in­side the fa­cili­ties and main­taining phys­ic­al dis­tanc­ing. Visiting care­giv­ers won't be al­lowed to take resi­dents into the com­muni­ty ex­cept for es­sen­tial med­i­cal ap­point­ments. They should also not vis­it resi­dents who have COVID-19 or who have ex­peri­enced symp­toms, the guid­ance states.

In some cases, seni­or home resi­dents may be able to de­sig­nate more than one es­sen­tial care­giv­er based on their daily needs and past in­volve­ment. Long-term care fa­cili­ties have un­til July 25 to draft poli­cies and prepare to implement the new visits.

Twit­ter: @chrisserres