It had been five months since Ellen Bowen had seen her husband, Eddie, face to face. There he was, her partner of 58 years, just 6 feet away in his wheelchair. She perched on the edge of her seat in the fireside lounge at Durgin Pines, a nursing home in Kittery.

She chatted through her mask. He napped a bit, his face bare because he removes any coverings. Now 84, the former carpenter and millwright survived COVID-19 last November. She’s not sure he recognizes her after nine years with Alzheimer’s disease, but she sees glimmers now and then. And he did tell her that he loves her before she left their half-hour reunion last Wednesday.

“It was a blessing to see him after all those months,” said Bowen, 78. “He looked good. It makes me feel so good to go in and see that they’re taking good care of him. I would like to have given him a hug and a kiss. We haven’t touched since last spring and we used to hold hands all the time.”

They’re both vaccinated now, she said, so maybe someday soon.

But Bowen knows the return of in-person visits at Durgin Pines last week is a fragile gift that could be taken away at any moment. It happened last fall when COVID-19 cases began to surge again and the facility reported its second outbreak. And it happened last month at a nursing home in South Portland after a brief reopening.

It worries Bowen that some staff members at Durgin Pines and other long-term care facilities have declined to be inoculated against the virus that has killed at least 264 nursing home residents in Maine in the last year – more than one-third of 704 deaths statewide. And it troubles her that long-term care facilities that once were the focus of a federal vaccination program are now struggling to get vaccine for new patients or residents who arrive from hospitals unvaccinated.

“I was so disappointed when they shut down again last fall,” Bowen said. “It’s devastating when you can’t see your people.”

As community case counts of COVID-19 have fallen in recent weeks after a monthslong winter surge, most long-term care facilities in Maine are resuming in-person visits under strict public health protocols, reuniting family members who have been separated for months. But concern is growing that these are precarious gains.

Nationally, new COVID-19 cases among nursing home residents have declined by 82 percent since late December, when weekly infection numbers were at their peak, and the number of deaths has dropped 63 percent, according to an analysis of federal data issued by the American Health Care Association and National Center for Assisted Living. The report drew a correlation to the vaccine rollout in long-term care facilities, noting that new infections in the general population fell only 46 percent in the same period through early February.

In Maine, weekly case counts among nursing homes dropped 86 percent, from 224 cases in early January to 32 cases in mid-February, while the number of deaths each week fell 67 percent, from 24 deaths to eight deaths during the same period. Similarly, COVID-19 outbreaks in long-term care facilities monitored by the Maine Center for Disease Control and Prevention declined 86 percent within a month, from 49 outbreaks Feb. 3 to seven outbreaks last week.

But nursing homes and assisted-living facilities that initially were given top priority in the nearly completed federal pharmacy partnership now have no vaccine allocated to them by the state for new patients or residents who arrive unvaccinated from hospitals under strict distribution guidelines set by the Maine CDC.

Moreover, many long-term care facilities are operating with employees who have refused to be inoculated – for a variety of health and personal reasons – and administrators report feeling hampered to take action for fear of legal or staffing repercussions.

Facilities also report that some unvaccinated staff members also refuse or are reluctant to wear N95 respirators, said Dr. Jabbar Fazeli, medical director at Durgin Pines and head of the Maine Medical Directors Association for nursing homes. While N95 respirators would help stop disease spread, they can be uncomfortable and some people dispute the need.

“Facilities are worried if they require either (inoculation or N95 masks), staff will leave and go to another facility, and there’s already a staffing shortage,” said Fazeli, who had COVID-19 last year and has been vaccinated.

In long-term care facilities across Maine, about 92 percent of residents and 65 percent of employees have been vaccinated, according to a survey last week by the Maine Health Care Association, which represents 92 nursing homes and 105 assisted-living facilities.

Sixty members of the association responded, many of which offer both skilled-nursing and assisted-living options. Most have resumed in-person visits under infection control guidelines. Data on mask compliance was unavailable.

The association has mounted a campaign to encourage long-term care employees to get vaccinated, said Rick Erb, president and CEO. But information provided in person by medical and nursing directors at individual facilities has proven most effective in convincing staff members to get shots.

“That kind of guidance and assurance counteracts a lot of the hearsay that’s out there on social media and from other sources,” Erb said. “It’s a serious concern because anyone coming into a facility is a risk, and with limited staffing, further restrictions would make things difficult.”

The Maine CDC was unable to provide data showing inoculation rates or percentages of residents and employees of nursing homes and assisted-living facilities who have been vaccinated.

According to the Maine CDC, the pharmacy partnership led by Walgreens and CVS has reported delivering 38,393 doses of vaccine – 21,256 first doses and 17,137 second doses – to residents and employees of long-term care facilities across the state.

Pinnacle Health & Rehab in South Portland, formerly the South Portland Nursing Home, experienced the disappointment of a sudden shutdown last month. In-person visits that resumed in early February came to an abrupt halt two weeks later when two staff members tested positive for COVID-19.

Jeff Ketchum, the nursing home’s administrator, hopes to restart in-person visits this week if no one tests positive and the community transmission rate remains low in Cumberland County. But he knows some things are beyond his control.

About 90 percent of Pinnacle’s 60 residents and 65 percent of its 100 employees have been vaccinated, Ketchum said. Staff members have declined for a variety of reasons, including pregnancy, health problems that would make it risky, discomfort with the fast rollout of the vaccines and lack of confidence in their safety.

“I’d love to have more vaccinated, no question,” said Ketchum, who has been vaccinated. “But you can only push so much.”

Ketchum said it doesn’t help that the nursing home has completed vaccination clinics provided by Walgreens, its partner in the federal pharmacy program offered to long-term care facilities. Now, Ketchum said, he must scramble to find doses for any new residents who arrive unvaccinated from hospitals and encourage employees to get inoculated at community clinics.

In the near future, Ketchum said, he hopes the Maine CDC relaxes the rule that requires long-term care facilities to ban in-person visits for two weeks after a resident or employee tests positive for COVID-19.

“At some point we’ve got to evolve our thinking on this,” Ketchum said. “We can’t be closing our doors every time we have a case. What is this going to look like down the road? With 90 percent of our residents vaccinated, I think it’s pretty safe to have visits under strict protocols.”

While maintaining in-person visits is a concern for Fazeli, the medical director at Durgin Pines, his priority is getting more vaccine for new residents and staff members who want it.

Fazeli said many people don’t realize that skilled-nursing facilities have significant turnover, with new patients arriving regularly, some for short-term rehabilitation and others for long-term care.

When Walgreens completed its clinics at Durgin Pines in early February, all 60 residents and 92 of 120 employees (77 percent) were fully vaccinated, having received both Pfizer shots. Now, only 46 of 60 residents (77 percent) are fully vaccinated – 10 of 19 short-term rehab patients and 36 of 41 long-term care residents.

Last week alone, Durgin Pines welcomed six new patients or residents who came from hospitals for rehab or other skilled-nursing care. Fazeli insisted that they be tested for COVID-19 before their arrival, but none were vaccinated.

“There is no mandate for hospitals to vaccinate patients before discharge to nursing homes,” Fazeli said. “We’ve got to use whatever resources we can find in the community.”

One attempt to vaccinate a newcomer at a community clinic – via a van trip with a vaccinated driver – would have required a two-hour wait, Fazeli said, so the driver brought the patient back to Durgin Pines and returned later.

Fazeli said he has tried to get vaccine through the community pharmacy that serves Durgin Pines, but it couldn’t meet the 1,000-dose minimum required by Maine CDC. Fazeli fears that the state’s neglect of long-term care facilities in the wake of the pharmacy partnership could undo benefits that are being reaped now.

And he believes it would take few doses to make a difference – perhaps 2,000 across the state each week to start.

“If they would just remove the obstacles and allow us to have the vaccine we need,” Fazeli said. “If they allocated just 10 vaccines per week per facility. We could achieve a lot at Durgin Pines with just 10 vaccines per week.”

Rick Erb, whose group represents Maine’s long-term care facilities, said families also are getting caught in the gap between the federal pharmacy partnership, which has nearly completed its contracted clinics at nursing homes and assisted-living facilities, and mass vaccination clinics that are being set up across the state.

Erb talked with one woman last week who was struggling to find a vaccination option for her mother, who was being discharged from a hospital and wanted to be vaccinated before she entered a long-term care facility.

“We’ve been concerned for some time about what would happen after the partnership with Walgreens and CVS is over,” Erb said. “It’s more complicated for (nursing home) residents than it is for staff members. Staff can be sent to a community clinic to be vaccinated. Getting residents to a community clinic in many cases just isn’t practical or even possible.”

Erb said he continues to lobby state officials for more vaccine, and he believes providing it through community pharmacies is a model that has worked in a few other states.

During a media briefing last week, Dr. Nirav Shah, head of the Maine CDC, said state officials are working to try to provide vaccine to long-term care facilities that are no longer being served by the federal pharmacy program.

Shah also noted the continuing challenge of fluctuating vaccine supplies and the need for people to keep wearing masks and following other COVID-19 protocols in long-term care facilities.

“It really needs to be all in in a nursing home where there are new residents coming in, there’s new staff coming in,” Shah said. “You may not know on any given day whether every single person in the building has been fully vaccinated. And so in nursing homes, we’re not changing our guidance.”

Marjan and Hanna Frank, sisters who operate an art gallery in Kittery Point, have no problem following COVID-19 protocols. Hanna Frank took a job as an activity aide at Durgin Pines so she could keep an eye on their 96-year-old mother, Johanna Frank, when in-person visits were prohibited.

Now that in-person visits have resumed at the nursing home, Marjan Frank is looking forward to spending time with their mother later this week. They haven’t seen each other since last fall, when the weather got too cold for outdoor visits. Window visits weren’t an option because they upset their mother, who doesn’t understand why visitors won’t come inside to see her.

“I haven’t touched my mom or had a really good talk since March 12,” Marjan Frank said.

And while all three women are vaccinated, the sisters worry that another outbreak at Durgin Pines could end in-person visits before Marjan gets a chance to see their mom. A close family, they’ve missed a lot in the last year, kept from usual daily visits when they would do their mother’s nails, talk about current events, and share tea and cookies from their native Holland.

“It’s been very painful for me, but I’m glad my sister has been there,” Marjan Frank said. “I’ve been so afraid (my mother) would die before I get to see her again. If in-person visits shut down again, it will set me back. It’s a big void. I feel empty when I don’t see my mother.”

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