"B1,” the residents shouted back, as they ran their markers over their playing boards — which only they can handle, to avoid cross contamination of equipment — searching for the lucky

number. "Bingo!” yelled Jo Shackelfurd, 88, collecting the two winner's nickels for herself, then a “neighbor nickel” each for the players to her right and left. "Thank

goodness I'm sitting next to you,” quipped Melva Keever, 89, who hadn't won a game yet, “or I'd be broke.” Residents enjoy the return of bingo, a chance to win some nickels.

“It’s serious business,” said activities director, Meredith Tolley. Emily Paulin Communal activities, which beyond bowling and bingo include gardening, ceramics workshops, manicures and

Meals were eaten bedside. Activities were performed alone. Exercise often fell by the wayside. Loved ones were seen only through windows or phone screens. In mid-September, the CMS — which

regulates the nation's 15,000 nursing homes — recognized that “residents may feel socially isolated, leading to increased risk for depression, anxiety, and other expressions of

distress,” and revised its guidance to allow for communal activities and visitation under certain conditions. But the Manor identified its first COVID-19 cases of the pandemic shortly

afterward. More positive tests followed, with a total of five residents and 15 staff members becoming infected with the virus over the next few months. Two of those residents died from

COVID-19. It wasn't until December, when all of the facility's residents and staff had finally been COVID free for two weeks, that the dining room reopened for the first time in

nine months, only to be shuttered again three days later when a staff member tested positive. When communal events finally returned consistently in January, amid the facility's rollout

of COVID-19 vaccinations, residents rejoiced. "It was wonderful,” said Norma Reman, 87, of the first meal with her fellow residents. “You're all together — kind of,” she said,

gesturing with her hands that residents are spaced apart, “and you can have different things to eat.” "And you don't have to eat on paper,” noted Suzanne Steele, an activities

aide. Reman agreed, enthusiastically. “I didn't like that, having to stay in the room,” she said. “I just hoped that [the virus] would finally go or get to where we were able to do

everything together. Resident Norma Reman paints her pig, “Porky”, in a group ceramics class. Emily Paulin But not all residents are embracing the Manor's return to communal life. One

of the recent challenges for staff here has been persuading residents to come out of their rooms. Increased rates of depression or worsened physical debilities caused by extended isolation

during the lockdown are likely driving decreased engagement, said Carla Perissinotto, M.D., associate chief of clinical programs in geriatrics at the University of California San Francisco.

Shifts in routine, particularly for residents with dementia — who can find change disorienting — could also be a cause, as could lingering fears of catching the virus. But finding ways to

reengage residents is critical, Perissinotto said. Isolation and loneliness are associated with a roughly 50 percent increased risk of developing dementia and a nearly fourfold increased

risk of death among heart failure patients, according to studies. "Be aware of who is lonely as a result of all of [the pandemic] and find out from each person what may help them,”

Perissinotto said she tells nursing homes. “Open up the discussion … acknowledge that this sucks and we're here and we'll get through it, to try and bring some hope.”

'I'M SMILING UNDER THIS, I SWEAR’ Resident Frieda Waterson smiles under her mask during a visit with her family. Emily Paulin In early March, following vaccinations at nearly every

nursing home in the country and plummeting infection and death rates, the federal government revised guidance for facilities again, making it easier for residents to see, hug and hold hands

with visiting loved ones, even indoors. “There is no substitute for physical contact, such as the warm embrace between a resident and their loved one,” the recommendations said, while

noting that precautions, including masks, time limits and number caps, should continue. The very next day, the Manor announced that each resident would be allowed two 30-minute or one

60-minute indoor visit per week with two guests at a time. It was a sunny Sunday morning in April when Frieda Waterson, 95, spotted her granddaughter Keyra Comer and great-grandchildren,

Connor, 17, and Kenna, 19, approaching the Manor's entrance. She gasped as she looked out the window of the main lobby. She hadn't seen them in person in 15 months. Keyra and

Connor entered the building first, following the two-guest limit, while Kenna waited outside in the Manor's gazebo. Connor filled his great-grandmother in on his past year and three

months: high school classes, another growth spurt, a new girlfriend. After 15 minutes, it was time for the great-grandkids to switch places. "Oh, this was the most lovely surprise,”

said Waterson, as Connor crouched down beside her wheelchair to give her a goodbye hug. Waterson grasped her great-grandson's arm as they posed for a photo. “I'm smiling under

this, I swear,” she said, pointing at her cheetah-print mask. Connor Comer shows his great grandmother, Frieda Waterson, a photo of him and his girlfriend. Emily Paulin But for some

families, masks are obstructing more than smiles. When Connie Reimer heard she was now allowed to sit next to her 99-year-old mother, Doris “Dode” Voss, during their visits at the Manor, she

asked the staff to dust off Voss’ family photo album, planning to help her mother flip through the pages. Reimer thought it might trigger memories for her mother, who has dementia. But

Voss, confused and panicked by her mask, wouldn't keep it on. "I couldn't hold her hand or give her a hug because she wouldn't wear the mask,” said Reimer. “She

doesn't understand why that goes together."