Bill Blanchard just wants to hug his mom — something he hasn’t been able to do since the pandemic started.

Before COVID-19, Blanchard and his sisters regularly picked up Shirley Bigley, 72, for outings with the family. Bigley has lived at the Sullivan County Health Care facility in Unity for three years because of her dementia, but she enjoyed going to her son’s house in Claremont to wash dishes, walk around the yard, or pat his dogs, her son said. Now, when Blanchard sees Bigley on video chat or through the window she has a blank, sad look on her face, he said.

“Do you have any idea how much my mother has declined in six months? I can show you how fast she’s declined because she’s been isolated,” Blanchard said.

Blanchard understands the virus — he’s a critical-care registered nurse and previously worked at the facility where his mom lives. But he also understands the real mental and emotional impact that limited visitation has on people, particularly those with dementia. He doesn’t understand why family members can’t wear protective equipment (he’s offered to buy it, he said) and have in-person visits with family members.

“How in the world do you say you trust a process of screening for your workers, but you can’t say you trust that for the families?” he asked.

Since the pandemic hit, visits from family members and volunteers in nursing homes in New Hampshire have been severely curtailed. That’s to protect vulnerable residents — about 80 percent of COVID-related deaths in the state have occurred in long-term care facilities. Still, workers in nursing homes and family members say that residents are suffering mentally and emotionally from missing out on visits with their loved ones and social opportunities within the nursing home.

“I’m definitely concerned about failure to thrive,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association, which represents 70 long-term care facilities in the state. “I don’t doubt that the residents have suffered the consequences” of limited visits and social engagement, he said.

There are many factors at play in deciding how and when nursing homes can begin relaxing restrictions put in place to protect residents from the coronavirus. The Centers for Disease Control and Prevention and The Centers for Medicare and Medicaid Services both issue guidance, as does the governor’s office. Many of these guidelines are aimed at reducing the risk of the coronavirus entering the building but do not fully consider quality of life for nursing-home residents, Williams said.

“I don’t think anyone can doubt that emotional well-being bears upon their physical well-being,” he said. “Clearly the restrictions that were put in place by the governor were intended to protect physical well-being, but to what extent does that impact mental and emotional health, and ultimately impact physical health?”

The state has outlined phased guidance to reopen nursing homes. Initially visitors were only allowed for “compassionate care” — usually for patients in hospice. Guidance issued on Aug. 13 by the state Department of Health and Human Services states long-term care facilities can resume outdoor visitation if they are located in a county with fewer than 50 active COVID-19 cases per 100,000 residents. This is known as Phase 1 reopening. After two weeks of successful Phase 1 reopening, a facility can move on to Phase 2: limited indoor visits. Facilities in counties with fewer than 10 active COVID cases per 100,000 residents can enter Phase 3: indoor visits with social distancing and masks.

However, facilities are not required to ease restrictions as they progress through the phases. As of Sept. 3 Sullivan County had 11 active COVID cases per 100,000 residents, but the Sullivan County Health Care facility still allowed only window visits, where residents and family members sit on opposite sides of the glass.

“They basically left it in the nursing home’s authority to determine how they want to do business,” Blanchard said. “I have no one advocating for my mom.”

Ted Purdy, administrator and director of health-care services at Sullivan County Health Care, said his team did not feel confident that they could ensure proper social distancing, which is why they have so far only allowed window visits. He said the facility recently hired another staff member to allow indoor visits starting Sept. 8. However, only one family member will be allowed to visit, so if Blanchard’s sister visits, he’ll still be unable to see his mom for the foreseeable future.

“We understand people’s frustration and concern, and it’s our concern, too,” Purdy said. “But we need to be able to determine what we think is best to be able to maintain the safety and well-being of our residents.”

The DHHS guidelines also outline protocol for group activities in long-term care facilities. The initial guidance called for no group activities, including communal dining. Under Phase 1, group activities are allowed for 10 residents or fewer, wearing masks and social distancing. Yet, for many older residents with hearing and cognitive loss, socialization is all but impossible under those circumstances, Williams said.

Bernie Seifert, a licensed clinical social worker, co-facilitates a support group for caregivers through the Dartmouth-Hitchcock Aging Resource Center. She said, like Blanchard, many family members are worried about their loved ones losing abilities during lockdown.

“When you have very limited contact, have to stay within the room, and aren’t spending time with visitors, that does have an impact on those preserved abilities,” she said. “It’s ironic that we’re trying to protect these people from a major public-health issue, but while we’re doing that there’s the unintended consequences of some mental-health issues that pop up.”

Earlier in the summer, long-term care facilities pushed to have barbers and hairdressers let back into facilities, Williams said. DHHS ruled that those services were non-essential and not worth the risk, but the facilities argued that they were important to wellness. Eventually, the state amended the policy.

“It makes residents feel more human and gets back to psycho-social well-being,” Williams said, adding that a similar debate over therapy animals is currently underway.

Many nursing homes have used video chat to try to keep residents in touch with family members. But for older adults with dementia, cognitive impairments, and hearing and vision loss, the technology often doesn’t result in a meaningful connection.

“My mom doesn’t do well with Zoom,” Blanchard said.

Some family members have taken to skirting the rules where possible. One support group member confessed to Seifert she hugged her father during a socially distanced outdoor visit.

“She said, ‘I gave my dad a big hug because that was so important to both of us, for him to know I’m still here’,” Seifert recalled.

With the pandemic stretching out indefinitely, Williams is hopeful testing will lead the way to more visitation opportunities in nursing homes. Rapid-result testing could be implemented before someone enters the facility, he said.

Williams points out that there is a minority of nursing-home residents and family members who appreciate the strict limitations on visiting and socialization and want to keep them in place.

“Their voices get lost sometimes,” he said.

With fewer family members and volunteers around, some staff at long-term care facilities have attempted to connect with residents. Courtney Parizo of Claremont works as a personal-care assistant at two long-term care facilities in New Hampshire. She said she started volunteering to do crafts with the residents even when she’s not working, despite the fact her shifts have become more stressful with residents becoming more angry or withdrawn because their routines have been interrupted.

“I’ve been trying extra hard,” she said. “Still, it’s so different than hugging your family.”

Blanchard made the same point: “You sitting and talking to my mother is not [the same as] me sitting and talking to my mother,” he said. “She needs to be treated like an individual. Seclusion and restraint is illegal. They need to provide a safe way to do visits.”

This article is being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.