The doors are still open at the Lore Malsch Protestant care home in Munich, albeit to the surprise of some visitors.

"Now we're getting phone calls — lots of calls," says the home's manager, Jan Steinbach. People are asking whether they are still allowed to visit loved ones as the nationwide caseload in Germany ticks upwards.

Whether to limit visitors during the pandemic is a real quandary, with no correct answers for care homes. Let visitors in, and risk bringing COVID-19 into a facility full of at-risk people. Keep them out, and deny residents contact with their loved ones, potentially damaging their health through isolation itself.

During the first wave in March and April, regional governments in most of Germany either stopped visits entirely or severely limited them.

"In the first wave facilities had hygiene strategies, but they were suitable mainly for a flu wave not the kind of pandemic we have now, including in terms of protective gear," Bernd Tews, managing director of the German federation of private care homes (BPA), told DW. "That meant that in a very short time the situation across homes in Germany became difficult: We had no masks, we had no disinfectant, we had no gloves. All the protective equipment we needed was not available and not for sale on the world market either."

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The BPA publicly criticized the shortages earlier in the year, but Tews said facilities are now markedly better equipped for a second wave. This, coupled with the promise of rapid, 20-minute antigen tests being made available to check visitors, makes him confident that most facilities would be able to keep letting visitors in.

He noted two probable exceptions — a particularly serious local situation, or coronavirus cases inside a home itself.

'Long haul' until the end of winter

Jan Steinbach implemented changes in the spring when forced to drastically limit visits at Lore Malsch in Munich. As well as facilitating video calls, the home now boasts a secure visiting room where residents and guests can meet, separated by plexiglass. Guests disinfect their hands and check their temperatures on entry; masks are required at all times, even in private rooms, difficult as that is for Steinbach and his team to control or enforce. Steinbach also lets his staff take a free standard coronavirus test each Monday if they wish, for their peace of mind and for his when filling the roster.

"Understandably as winter starts, everybody who gets a sniffle is now worrying about whether it might be a COVID sniffle," says Steinbach. "And it could well be that it becomes difficult to maintain our usual staffing. At the moment, it's still alright here. But it will be a long haul until next March, until the winter's done."

Limits on numbers commonplace

In the western city of Koblenz, the St. Elisabeth Caritas Haus allows each resident to receive two visitors per day — but not more. The visitors can come together and stay as long as they like. Two visitors might not sound like much, but facility director Raphael Kloeppel says that with 164 residents, the traffic can pile up quickly.

The lockdown in March and April meant considerable changes for residents. They would spend much of the day in their rooms, albeit with staff visiting them, with reduced group activities and no communal meals — only those unable to eat alone in their rooms would eat in small groups instead.

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Even though Kloeppel stresses how hardy residents were, some joking that they'd survived the war and would cope just fine in their bedrooms for a few weeks, he also noticed the two months taking a toll.

"What did strike me during the lockdown, which lasted rather a long time, was that some residents did deteriorate somewhat, physically. As we'd say locally, they seemed reduced, having lacked conversation and stimulus — this rather passive existence many of them endured accelerated the aging process," Kloeppel said.

'Anything else would be unethical'

Whether it's Kloeppel's Catholic Church-supported home in Koblenz, or Steinbach's Protestant one in Munich, both men are insistent that no matter what the visiting rules, one exception was always made.

"It does upset me to read salacious reports in the press about many people dying in homes, unable to even see their loved ones," says Steinbach. "That was not the case here. In palliative phases people could always visit, and will always be allowed in ... Anything else would be unethical in my view."

In Koblenz, patients with COVID-19 would be isolated from the rest of the home to enable them to receive visitors. These guests would admittedly be kitted out head-to-toe in personal protective equipment, "from the hood cover to the smock, shoes, gloves and mask," Kloeppel says. One woman died in these conditions, but with her children present.

"I think it has to be that way. Coronavirus or not, the human side must be respected. The facility has the means to protect itself, and we will continue to use them."