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In early November, after an employee at the Bozeman Lodge was diagnosed with COVID-19, the assisted and independent living facility canceled group activities, closed the dining hall and asked most residents to remain in their rooms. Only staff and essential health care workers were allowed inside the main building.

The restrictions on activities and visitors are among the many safety protocols the Bozeman Lodge and other senior living facilities in Gallatin County have used to keep the virus at bay. Even with strict rules, the virus has spread through many facilities, disrupting the lives of residents, staff and their families.

Countywide, 158 residents of long-term care facilities and 136 staff members have contracted the disease. While this is a small fraction of Gallatin County’s 8,400 cases, the facilities are linked to a majority of the county’s virus deaths. As of Friday, 19 of the county’s 30 COVID-19 deaths had been tied to long-term care facilities.

The county has declined to provide case data on specific facilities. But some facilities, like Bozeman Lodge, are releasing it on their own.

As part of the effort to reduce the impact of COVID-19 on long-term care facilities, the Gallatin City-County Health Department hired a senior services prevention manager, Joe Sexton, to work directly with the county’s 19 senior living facilities.

Sexton has helped them wade through the local, state and federal regulations that have been enacted in the last 10 months and worked with them to implement new protocols, such as screening all those entering the facility, using proper personal protective equipment and regularly testing employees.

These protocols and the willingness of local facilities to follow them have kept Gallatin County from experiencing larger outbreaks, Sexton said.

“In Gallatin County, because the high level of community infection arrived later, there was time to prepare,” he said. “We were able to obtain personal protective equipment and get testing and other protocols in place, so as the level of community infection ramped up, we had these safety routines up and running.”

However, the protocols, particularly the restrictions on personal interactions, have come at a cost.

For months, senior living facilities were largely closed to the outside world. Inside, communal dining was limited, activities were restricted to small groups and residents were asked to stay in their rooms as much as possible.

“That was very difficult on the residents,” Sexton said. “There were a lot of unintended consequences to these restrictions. It impacted people’s health. They experienced side effects of isolation like depression and lack of appetite.”

In late August, the Gallatin City-County Health Board decided to allow visits from family members so long as they wore masks and practiced social distancing.

However, shortly after the health board permitted in-person visits, the number of COVID-19 cases countywide began climbing. Many facilities once again closed to outside visitors as staff and residents tested positive.

“There’s a direct correlation between our recent significant increase in cases and our high positivity rate and what’s happening in long-term care facilities,” Sexton said. “We have been seeing a lot more cases inside the facilities as we see more cases in the community.”

The Gallatin Rest Home is among the facilities that have experienced an increase in cases in recent months.

In late October, the first staff member tested positive, said administrator Darcel Vaughn. A week later, a resident tested positive. To date, the Rest Home has had 23 COVID-19 cases — 15 staff members and eight residents, one of whom was hospitalized and later died in hospice care at home.

Due to the outbreak, residents were largely confined to their rooms and visits were canceled for more than a month.

Routine staff and resident testing haven’t identified any new cases since late November, so the Rest Home was able to resume some activities on Tuesday, Vaughn said.

On Wednesday morning, eight residents gathered to listen to music and exercise.

“This means a lot,” Vaughn said. “For more than a month, residents were confined to their rooms. They can now see other residents, their friends, and talk, even if it’s from 6 feet away.”

Vaughn said she’s relieved the rest home made it through the outbreak, but said she’s worried there could be another.

“You can’t help but look at other places like Billings and Butte and the number of deaths they’ve had,” she said. “That’s the stress we live with every day.”

Despite the uncertainty, long-term care facilities are working hard to return to normal.

Hillcrest, an independent and assisted living facility, held its annual Thanksgiving dinner and recently put up Christmas decorations.

“We’re holding on to the things that we can to still try to make this holiday season as special as possible,” said Rachel Clemens, senior services director.

It has been difficult to decide what things can be done safely and what can’t, she said. Hillcrest has allowed limited use of the fitness center with robust sanitizing practices but has shut down communal dining. The facility has also stopped most non-essential visits, including those from an exercise specialist and a hairdresser.

“We do go back and forth on it,” Clemens said. “It’s looking at what the residents’ needs are to remain healthy and make sure they’re well-being is really looked after. It’s a fine balance.”

Hyalite Country Care, a 12-resident assisted living facility, has also tried to maintain as much of its regular routine as it can, said owner and administrator LeAnn Bunn.

Because the facility is small, Bunn said she’s been able to keep a handle on the virus, enabling the facility to welcome visitors since the fall. She is also letting residents visit their families for the holidays.

Group activities like bingo are continuing but have been modified for social distancing. Bunn has also started taking small groups on drives around the area.

“Their health and well-being is extremely important to me, but I also believe their emotional health is just as important,” she said. “Being separated from their families and not being able to engage as much is so challenging.”

Among facility administrators, there’s no sense of when long-term care facilities will be able to return to their pre-pandemic ways.

Even though the first doses of a vaccine could arrive in Montana in the coming weeks, it could be months before enough people are vaccinated for transmission of the virus to slow significantly.

As a result, in the short term, long-term care facilities are hoping for the level of the virus in the county to decline, so residents and staff will be less likely to contract the disease.

At the Bozeman Lodge, there have been no new cases since late November, but executive director Rita Christensen said she recognizes that could change any time.

For now, the facility has resumed communal dining and some group activities. It will reopen to visitors on Tuesday.

“Everybody wants their lives back and some sense of normalcy,” Christensen said. “These folks don’t ask for a lot. They are generally wonderful people who have lived through some things you and I couldn’t even imagine. They want to enjoy life, their retirement. They’ve earned it.”

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Perrin Stein can be reached at pstein@dailychronicle.com or at 582-2648.

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