For the past five decades, MaryAnn Falk has been the guiding force behind her family's annual Thanksgiving celebration.

The former factory worker from New Ulm, Minn., would spend weeks vetting every detail, from who would bring the turkey gravy and Swedish meatballs to the color of the flowers neatly arranged on her dining table. When dinner began, Falk would orbit the table like a maître d', not resting until her 15 children and grandchildren had eaten every last bite of her pudding-topped fruit salad.

But this year will be different.

For the first time in her 85 years, Falk will be alone on Thanksgiving Day. Her family made the anguished decision to keep their holiday gathering small to avoid contracting the coronavirus. Falk, who was weakened by a stroke three years ago, will spend the day largely confined to her room at an assisted-living facility, where in-person visits have been strictly curtailed since coronavirus cases began resurging across the Upper Midwest this fall.

"My heart aches," said Lynda Lange, her daughter, who lives in Minneapolis. "We can make the same food and put out the same decorations, but Thanksgiving just isn't the same without Mom's loving touch."

With virus cases soaring to new heights, families have made agonizing choices over whether and how to spend time with their loved ones over the holidays. Some are forming "pandemic pods" — small groups of friends and relatives who share the same precautions. Others are staggering visits to limit exposure. But many seniors are bracing for a long and lonely holiday season after determining that the risks of the deadly virus outweigh the benefits of connection. On Wednesday, Gov. Tim Walz limited social gatherings to individual households.

The impact of months of unrelenting isolation has been especially severe for the 85,000 Minnesotans who live in senior care facilities, which have been whipsawed by the pandemic. Many of these facilities opened their doors to family visitors this summer when virus cases ebbed, only to shut them months later when the virus surged again in their communities.

Statewide, the number of long-term care facilities with COVID-19 outbreaks has more than doubled over the past four months, from 512 facilities in early July to 1,049 as of Nov. 9, state records show. Nearly a third of Minnesota counties have a 14-day coronavirus-testing positivity rate of more than 10% — the level at which senior homes are encouraged to suspend indoor visits under state guidelines.

Minnesota reached another grim milestone last week when the death toll from COVID-19 in long-term care facilities surpassed 2,000 — representing nearly 70% of all fatalities from the virus statewide. Over a two-day period last week, state health officials reported a staggering 102 deaths in the state's 2,100 nursing homes and assisted-living facilities.

"Much of the anguish and guilt that family members are feeling ... comes from knowing their loved ones need social interaction right now, more than ever, and they can't provide it," said Joseph Gaugler, a professor of long-term care and aging in the University of Minnesota's School of Public Health.

The separations have been particularly hard on mothers and grandmothers, who tend to be the caretakers of culture and holiday traditions in many households.

Carol Tonkin said she has witnessed the "devastating effects" of separation on her 94-year-old mother, who has been isolated in her room at a senior home in St. Anthony, a Minneapolis suburb, since the spring. Her mother, Eunice Wollum, spends much of her days watching television and gazing out her window at a busy thoroughfare. Before the pandemic, Wollum was full of energy. Now she can barely walk 10 feet without needing rest, Tonkin said. And with group dining canceled, she has been less motivated to eat, losing nearly 20 pounds since the summer, Tonkin said.

"She's skin and bones and can barely walk," Tonkin said. "It's appalling."

Tonkin, a dental hygienist, is limited to a single, 90-minute visit with her mother in her senior home each week, during which time they are required to stay 6 feet apart and not hug, kiss or hold hands. Early this month, Tonkin delicately broke the bleak news: She would not be able to bring her home for Thanksgiving because of the worsening pandemic. Her mother, who has advanced dementia, initially looked confused and then became teary-eyed at the revelation that she would be alone on the holiday. Again and again, Wollum pleaded, "Do I get to come?" Tonkin said.

"It's awful to have to say 'no' to your own mother. It's just not natural," Tonkin said. "It also hurts to think that this may be her last Thanksgiving and she will spend it looking at the same four walls."

Danielle Jin said she sometimes "sneaks a hug" during her weekly visits with her 94-year-old mother, who lives in an assisted-living home in Vadnais Heights.

"I know hugging is not allowed, but I can't help it. She's my mother!" said Jin, a clinical research coordinator at the University of Minnesota. But on Thanksgiving, Jin will have to talk to her mother by phone from outside her bedroom window, touching her hands against the glass, because the facility has reached its capacity of in-person visits for the day.

For the first time in at least 15 years, Jin will not be able to embrace her mother on Thanksgiving. Their annual holiday traditions, of roasting a duck and decorating a Christmas tree after the big meal, will be celebrated without her mother's presence. "It makes me very sad," Jin said. "We will feel lost without her."

An emerging body of research has linked social isolation and loneliness to a range of serious health problems, including dementia, heart disease and strokes. In some cases, social isolation can hasten death — particularly if the person already has a serious illness. Since June, social isolation or "isolation due to COVID-19 conditions" has been a factor in the deaths of at least 12 Minnesota seniors, according to a Star Tribune analysis of death certificate records.

"You can draw a straight line between loneliness and increased mortality," Gaugler said.

But the pandemic and the resulting lockdown of hundreds of senior homes have shined a brighter spotlight on the problem, and local nonprofits and social service agencies are stepping forward with creative ways to help seniors feel more socially connected.

For instance, Little Brothers — Friends of the Elderly will be sending care packages with handwritten cards to more than 350 socially isolated seniors across the state during the holiday season. The Minneapolis-based nonprofit has also recruited dozens of high school choir members to sing holiday carols over the telephone. In the Twin Cities, local agencies on aging are delivering home-cooked meals and arranging small, online social gatherings via Zoom to relieve stress and isolation.

Still, the rapid rise in new infections — coming just before the holidays — has left many seniors feeling frustrated, lonely and depressed. A University of Michigan poll found that feelings of loneliness more than doubled among older adults during the first months of the pandemic.

Janet Nemmers, who was diagnosed with ovarian cancer in 2016, has spent most of the pandemic secluded in her small, one-bedroom apartment in Maplewood. Early in the pandemic, she would walk the building's hallways for exercise and play bingo while wearing a mask. But over the past two months, several residents in her building have contracted the virus, and Nemmers has decided that even such limited interactions were too risky while her immune system was weakened by chemotherapy.

The long and lonely days have taken a toll on Nemmer's mental well-being. There have been stretches of deep depression, when she has struggled to get out of bed in the morning or to cook a meal. This spring, she began taking antidepressant medications for the first time — to help lift the heavy weight of loneliness and despair.

"What I miss most are all the smiles and the 'hellos,' and finding out what's happening in people's lives," said Nemmers, who will spend Thanksgiving with her daughter. "It doesn't matter how old you are — we're all social beings."

Data editor MaryJo Webster contributed to this report.

Chris Serres • 612-673-4308