It had been a year since Mike June could visit his wife, Neelima, in her own room at Rockwood Retirement.

The pandemic cut off visitation between the couple for the better part of 2020. They could only see each other outdoors, through cracked open windows, on opposite sides of a plexiglass barrier, always at a distance and for just an hour at at time.

In March, with COVID-19 vaccination efforts at long-term care facilities almost complete, Washington state loosened restrictions on visitation, allowing indoor visits if the resident or visitor or both are vaccinated.

Neelima resides in the assisted living portion of Rockwood Retirement on the South Hill, while Mike lives independently in a house in the same community. The couple made the decision to live apart after Neelima’s multiple sclerosis worsened in 2019, leaving her requiring a wheelchair and more support than Mike could offer.

Mike would visit her nearly every day, and they would eat meals together, go out to eat or on walks around the campus. Then the pandemic came, and Mike was locked out from seeing his wife.

The couple moved to Spokane from the Chicago area after they retired in 2011, and they do not have children. They are each other’s family, especially in Spokane. The pandemic made them both appreciate that they at least had each other.

How did they make it through 2020?

“Him making me laugh about stupid things,” Neelima said.

“She doesn’t think too much of my humor,” Mike said, laughing.

The couple got used to multiple daily phone calls instead of visits and meals together. They have been together for more than 40 years and will celebrate their 37th wedding anniversary in July. Their companionship has sustained them.

“I haven’t kicked him out yet,” Neelima said, laughing.

The vaccine pushWashington’s change in visitation policy has meant a slight return to normal for many residents in long-term care facilities a year after they had to adapt quickly to a very sudden change: seeing family members through windows and on computer screens.

A big part of what has made visitation possible again is the vaccination campaigns inside long-term care facilities, which began in late December . While vaccine supplies were extremely limited back then, facilities that signed up with CVS or Walgreens got repeated visits for first and second doses until large swaths of staff and residents were vaccinated.

CVS and Walgreens administered doses to more than 84,000 residents and staff at 2,020 long-term care facilities statewide.

An eagerness for vaccines within those communities meant residents and staff quickly created some of the most vaccinated environments in the state, making it safer for families to reunite.

At Rockwood Retirement, 100% of residents receiving assisted or support services in their health care wing, like Neelima June, are vaccinated. 99% of residents living in their own apartments and homes on-campus are vaccinated as well. About 75% of staff there are vaccinated thus far.

At Brookdale Nine Mile, a memory care unit especially for patients with dementia, 86% of residents are vaccinated. That process took some time, as some residents need consent from their medical decision-makers to get vaccinated.

“We had an overwhelming response,” said Aaron Willrich, senior marketing director at Brookdale Nine Mile. “And it’s the reason why we’re now able to slowly open up and invite family members back in.”

Reunited at lastDorothy Maier was cooped up all year in her apartment at Fairwinds in north Spokane. She lives independently, shopping for her own groceries and sharing space with her cat. Originally from Ritzville, her family asked her to move to Spokane in 2017 after her husband died.

The advantage of moving to Spokane was being close to her granddaughter, Ana Espindola, who visited weekly if not more often, sometimes with her oldest son in tow.

The rest of their family is from Ritzville, and Maier grew up on a farm there. While she misses farm life, she’d grown accustomed to the “big city” and shopping trips or an occasional meal out with her granddaughter and her family. The pandemic stopped all that, however, and Maier relied on Espindola for groceries at the beginning of the pandemic.

They could do window visits and a couple of outdoor visits, but the past year was tough. Espindola left an iPad for Maier to FaceTime into family activities.

“This is the first time we’ve visited inside,” Espindola said at Fairwinds on March 26. “(Last summer) we visited outside and made a reservation to sit, and I brought my phone and showed her pictures, and that was it.”

Maier and the majority of residents – about 97% at Fairwinds – got their vaccines right at their facility. So far, 81% of staff at Fairwinds is also vaccinated, and directors there say that’s higher than the industry average. They attribute those high rates to the intense education campaign and the multiple clinics that could continue to vaccinate others who were wary at first.

In February, after Maier was fully vaccinated, she was allowed to leave and visit Espindola and her family at their house without having to quarantine for two weeks when she returned.

On March 27, Maier’s great-grandsons got to hug their grandma, run around the campus searching for Easter eggs and visit her apartment for the first time in more than a year. Maier is excited for visits to resume, and to be able to get out of her apartment more often, especially to see Espindola.

“She and her family were the ones I missed the most,” Maier said.

Embracing a ‘new normal’While visitation is a game-changer for many residents, some safety measures will likely remain in place in long-term care settings.

Willrich, at Brookdale Nine Mile, suspects universal masking and personal protective equipment will be in use at facilities for the foreseeable future, especially as the community slowly becomes fully vaccinated.

“We can’t tomorrow open up and be back to normal,” Willrich said. “It will be a ways out, but the future does look very, very bright.”

At Rockwood, all guests must check in, have their temperature taken and fill out a health questionnaire. There is a mask mandate still in place on the campus.

With 100% of residents vaccinated, visitation restrictions are easy to navigate at Rockwood, since all residents can safely receive visitors. Dan DeBoise, who directs health care services there, said the vaccine has transformed the campus.

“Just today before 3, 23 residents got visits that they wouldn’t have had a week ago,” he said on March 25. “That’s huge, that’s incredibly huge; that’s just in half a day how quickly things have changed.”

After a year of pandemic, long-term care facilities have become accustomed to virus protocols like masking, sanitization and, in some places, weekly testing and surveillance for staff members to detect the virus before it gets to residents. Facilities have learned what works and what doesn’t in these situations, preparing them for what could be ahead.

The threat of outbreaks has not gone away completely.

“We’re prepared and have systems in place,” DeBoise said, “We continue to test our staff every week; if we see those variants or staff testing positive, it would be a setback, but we’d rely on the Department of Health and the CDC for guidance.”

The vaccines, while incredibly effective, are not 100%. Breakthrough cases and outbreaks at long-term care facilities since vaccines have been administered are possible, but rare. And so far, less deadly.

In Washington, with more than 3 million COVID vaccine doses administered so far, there have been only 102 breakthrough cases – people testing positive for the virus two weeks or longer after receiving their last dose – as of last week. Of those, the vast majority had mild or no symptoms. Acting State Health Officer Dr. Scott Lindquist said that asymptomatic breakthrough cases are being found because of testing protocols in long-term care facilities.

“When there are outbreaks at long-term care facilities, they go through and test everybody, and that’s how we’re finding these folks,” he told reporters last week.

Even still, the return of some normal activities is welcome for many people. Neelima June can’t wait to go outside and explore the grounds of Rockwood with her husband when it warms up. The couple’s days are slow, but they are grateful to be together.

“We just want to enjoy just being able to see each other more than we have been in the past, and we don’t have to worry about inconveniencing someone else,” Mike June said. “When we were meeting outside the patio at the fireside, that was as far as I could go – someone else had to get her ready and wheel her all the way over there.”

Maier can’t wait to go browsing and shop at department stores or eat out and get a nice burger. Until then, takeout with her family in her apartment is just as welcome, a sign of hope and a slight return to normal.

She might be able to celebrate her 92nd birthday surrounded by family this year, but she knows some things will need to be different.

“I hope I live long enough to see the new normal because I loved the old normal, but I know we’ll never be the same,” she said.