Despite an alarming surge in coronavirus cases, Gov. Tim Walz’s administration is rolling back a heart-wrenching policy that has prevented families from visiting their loved ones in nursing homes and assisted-living facilities during the pandemic.

The Minnesota Department of Health issued new guidelines Monday that allow indoor visits at most senior homes that have not had new COVID-19 infections in the preceding two weeks and the infection rate in the surrounding county is no more than 10%. But the state recommends that long-term care facilities limit how many visitors a resident can have at one time, as well as the duration of indoor visits.

The guidance was issued in response to a new federal policy and significantly eases restrictions in place since March, when nursing homes and assisted-living complexes across the state shut down and barred family visits in an attempt to protect older residents who are particularly vulnerable to the respiratory infection. As the pandemic wore on, advocates for residents and their families have been clamoring for an end to the lockdown, noting that many elderly residents have suffered anxiety and depression as well as physical decline since the ban was imposed.

In Minnesota and across much of the nation, the seven-month lockdown has turned many senior homes into small fortresses, with only staff and essential caregivers allowed inside. For months, many anguished residents have only been able to talk to their relatives via remote video feeds or through cracks in windows. Such limited interactions have failed to ease the anxiety of many who suffered from dementia, or those who simply wanted to hug or kiss their relatives, say eldercare advocates.

“We are really looking to make sure that we do everything that we can to have the residents and families be able to connect with one another,” said Lindsey Krueger, director of the Department of Health’s Office of Health Facility Complaints. “Facilities without recent cases in areas with low or medium-level community transmission must allow visitation, unless they have a reasonable or clinical safety cause not to,” such as a staffing crisis, Krueger said.

But the lifting of the lockdown poses fresh challenges for many of Minnesota’s 2,100 long-term care facilities, which are struggling to keep the virus at bay amid a troubling increase in cases across the region. The number of facilities with at least one confirmed infection in a resident or worker in the past 28 days has surged from 239 on Sept. 1 to more than 340 now, state health officials said Friday. Across the state, providers said they are still struggling with staffing shortages and limited supplies of personal protective equipment. Allowing more visitors inside the facilities could strain those resources, providers say.

With cases rising, public health experts fear a repeat of the desperate scenes this spring, when dangerous clusters of cases overwhelmed senior homes across the state and some residents had to be moved to hospitals. Last weekend, members of the National Guard stepped in to help contain an outbreak at a small nursing home, Sacred Heart Care Center, in Austin, according to the facility’s website.

More rapid testing and stricter isolation measures have reduced fatalities in long-term care communities since their peak in May, but these congregate facilities are still particularly vulnerable to a resurgence. Residents live in close quarters and often have other health conditions, such as heart disease or diabetes, that make them susceptible to the virus. So far, long-term care facilities account for 71% of the 2,144 deaths from the virus in Minnesota.

Social isolation and loneliness have emerged as serious concerns during the lockdown. Health researchers found that isolation is a risk factor for a number of health problems, including heart disease, strokes and dementia.

Cheryl Hennen, Minnesota’s long-term care ombudsman, said her office has been inundated with calls and complaints about the visitor restrictions since late March. Many residents have been isolated for so long that they feel hopeless and “report they have no purpose left to live,” Hennen said. Since the lockdown began, some seniors have died alone without any family or significant others by their side, she said.

“The harm caused to people living in long-term care communities due to prolonged isolation has been devastating,” Hennen said. “Restrictive visitor rules in place at many nursing homes and assisted-living facilities are hurting the very people they’re meant to protect, robbing them of both social interaction within their home and access to visits from family and friends.”

The looming winter amplified those concerns. The state has allowed outdoor visits at senior homes since June, provided visitors wear masks and maintain physical distancing. The outdoor visits were hugely popular, with more than 90% of long-term care communities across the state implementing them over the summer and fall. Yet colder weather will make many of these visits impractical.

The new, 22-page guidance marks the fourth time since June that state health officials have relaxed visitor restrictions, as the agency works to balance safety with the well-being of residents. The guidelines closely mirror those issued in September by the federal Centers for Medicare and Medicaid Services, which regulates nursing facilities.

Yet the latest policy goes further by laying forth a detailed road map for how indoor visits will take place, and by making it clear that providers could be subject to enforcement actions if they fail to open their doors, provided the conditions are met.

State health inspectors will now be surveying senior homes to determine if they are allowing in-person visits inside the facilities, and can cite them if they are not, officials said.

“It’s critically important that facilities are going to be held accountable for meeting these new visitation guidelines,” said Mary Jo George, associate state director of advocacy at AARP Minnesota.

Even so, state health officials cautioned that rising levels of community spread of the virus could still prevent many senior homes from opening their doors. Some 245 long-term care facilities have had at least one positive case of COVID-19 in the last two weeks, which means they will generally remain barred to indoor visits. Two counties, Martin and Redwood, have an infection rate of greater than 10%, and visitations in those counties will remain highly restricted under the new guidelines.

The Jones-Harrison Residence, a 157-bed nursing home in south Minneapolis, wasted no time in allowing indoor visits. Small numbers of residents talked to family members Monday through tall plexiglass barriers in the home’s conference room and chapel. Evelyn Solberg grew wide-eyed when she saw her daughter and grandson.

“I am so lucky, because you want to come,” Solberg said from her wheelchair. “We’re so glad to see ya!” replied her daughter, Carla Gillespie.