LAKE SAINT LOUIS, Missouri (AP) — The barrier separating Kathy Miller from her mother was transparent enough that it was practically unnoticeable.

It was the first time in nearly a year that Miller was able to enter the Cottages of Lake Saint Louis nursing home to see her mother, Clestean Stroud, 91. Under the plexiglass shield, Miller and her son Jeremy touched their shoes to Stroud’s leopard print slippers, the St. Louis Post-Dispatch reports.

“You knew the barrier is there but you really feel like you’re there with her,” said Miller, of Dardenne Prairie, after the visit. It just brings hope.

“We need a lot of hope right now.”

The Cottages were among nursing homes in the St. Louis area slowly resuming limited indoor visits last week, nearly a year after the COVID-19 pandemic forced group homes for the elderly to shutter doors in mid-March.

On Wednesday, the federal Centers for Medicare and Medicaid Services declared that nursing home residents vaccinated against COVID-19 could get hugs again from their loved ones, allowing relatives to touch for the first time since homes were ordered to stop visits. The order also further relaxed COVID-19 restrictions to allow all nursing home residents more indoor visits.

COVID-19 infections in nursing homes — once hot spots — have plummeted recently to record lows. Missouri recorded 22 nursing home infections the week of Feb. 21 — according to the latest federal data — down from 1,201 infections the week of Dec. 13.

Health experts attribute the decline, in part, to a federal and state partnership with pharmacies to prioritize the nation’s first vaccines for up to 120,000 residents of skilled nursing homes, as well as staff, in late December.

“I think the thing that is getting us through, the light at the end of the tunnel, has been the vaccine,” said Nikki Strong, director of the Missouri Health Care Association, the state’s chief nursing home industry group.

Death toll

Federal officials ordered nursing homes to close their doors to visitors in mid-March last year, instituting a range of protocols designed to keep the virus out, including screening employees and isolating residents to their rooms.

But because they provide intimate, group care for patients most vulnerable to the virus, nursing homes were among the hardest hit by the pandemic.

As of Feb. 21, at least 3,497 residents of nursing homes in Missouri had died of COVID-19, according to data from the Centers for Medicare and Medicaid Services. Those account for roughly 42% of all COVID-19 deaths in the state. In all, the coronavirus has infected at least 21,270 Missouri nursing home residents.

The virus also killed 44 nursing home workers, infecting more than 16,161 across the state.

More than 400 nursing homes in Missouri have reported at least one COVID-19 death, and more than 500 reported at least one COVID-19 infection. At least 140 nursing homes have reported 10 deaths or more, and at least 56 homes reported 80 or more COVID-19 infections through the year.

Nationwide, more than 128,285 nursing home residents died of COVID-19, and more than 636,369 residents were infected. At least 1,591 nursing home employees were killed, and more than 546,457 employees infected.

‘Wake-up call’

The pandemic highlighted issues that had plagued nursing home care long before COVID-19, nursing home operators, employees and advocates say.

Chief among advocates’ concerns are low wages and challenging work conditions for frontline nurses, who provide skilled, essential care to multiple elderly patients at a time with physical, mental or developmental disabilities. In Missouri, personal care aides make an average $11.86 an hour — $26,490 a year, according to U.S. Bureau of Labor Statistics.

Some workers have long worked at multiple facilities to make ends meet — during COVID-19, that increased the risk they could unknowingly spread COVID-19, said Marjorie Moore with VOYCE, a Creve-Coeur based nonprofit that advocates for families of nursing home residents.

And workers have long been tasked with caring for more than a dozen patients at a time, cutting into the quality of care patients receive, she said.

“Residents are safer when the staff is safe, healthy and happy,” Moore said.

The state’s largest health care union, SEIU Healthcare Missouri, protested through the year to demand better pay and protections, including sick leave for infected workers and whistleblower protections for workers who report safety concerns.

The union has also called public policies like free transportation and child care they say would help frontline nurses, mostly Black and nonwhite women from disadvantaged neighborhoods, said Lenny Jones, president of SEIU Missouri

“This is a wake-up call,” Jones said. “This is an opportunity for us to say, ‘Hey, these are the mistakes we made during the pandemic, and this is what we need to be doing.’”

Nursing home operators, meanwhile, pointed to thin financial margins that made it more difficult to buy personal protective equipment and COVID-19 tests amid a national shortage. Federal Medicare and Medicaid reimbursements — the primary health care funding source for most elderly patients — have long fallen short of rising costs, Strong said.

“When you’re providing care that costs more than what you’re being reimbursed for, it’s difficult to be prepared for something like this pandemic,” she said. “While we understand frustrations about wages, the problem is, we have to find a way to pay for it.”

COVID-19 also prompted legislative changes to nursing home care. In July, the Missouri Legislature approved a longstanding effort by VOYCE and other advocates to allow families to place video cameras in nursing home residents’ rooms as a way to combat elder abuse or neglect.

In recent weeks, the Legislature has advanced a bill to limit COVID-related lawsuits against businesses — including nursing homes. Critics have said the bill would prevent families or employees from pursuing cases of wrongdoing.

Strong, with the industry’s chief lobbying group, said the bill would not protect nursing homes that were clearly negligent.

“The pandemic happened so quickly and there were so many unknowns that we navigated as best we could,” Strong said. “Instead of being sued and not having money to provide care, we need to look at the policies and find out how we can be better prepared.”

Meanwhile, Moore said she hopes federal regulators will soon resume regular health inspections and allow more family visits, to help counter harmful health effects of prolonged isolation. That requires a continued decline in COVID-19 cases in the community at large, she said.

“We need to work together as a community to make that happen.”

‘First in line’

The Cottages, which was among vaccinated nursing homes reopening indoor visits, recorded 20 COVID-19 infections and one death over the entire year, a relatively low number that included residents who arrived to the home already infected.

The home has six separate cottages with 10 residents each, and assigned staff who perform multiple roles. That made social distancing easier, said Al Beamer, CEO.

Miller and other families visiting Cottages residents last week said they preferred the home’s setup to other large nursing homes that can house hundreds at a time.

But Cottages currently doesn’t accept Medicaid payments, which may put the home out of the price range for lower-income families.

Shirley Jeffers, a Cottages resident, was “one of the first in line,” to get vaccinated in December, she said.

Jeffers, 86, hasn’t seen her family since the COVID-19 pandemic hit. She passes the time with James Patterson novels and television, but wants to see how her great grandkids have grown over the past year.

“They shoot up like weeds,” she said. “It’d be nice to go with them to the zoo.”