COLUMBUS, Ohio- James Bragg visited his wife at a nursing home in Columbus every day for more than two years until the COVID-19 outbreak arrived in Ohio, and nursing homes were required to suspend visits. After 42 days of isolation, his wife, Elizabeth, died from Alzheimer's, all alone.

On Monday, when the state lifts a restriction that has been unimaginably challenging for countless families, Ohio nursing homes will be allowed to resume outdoor visits with masks and social distancing.

Facilities should consider the number of COVID-19 cases at their facility and case numbers in the surrounding community when making the decision to allow visits, Gov. Mike DeWine said when he made the announcement last month.

The lifting of the restriction brings excitement for nursing home residents and families who have experienced separation and loneliness for months. But with the COVID-19 outbreak worsening in Ohio, the development also brings fear for some who worry that family members may unknowingly spread COVID-19 into nursing homes, where the virus is often fast-spreading and deadly.

Nursing homes have tried to keep residents and their families connected during the separation period with window visits and Zoom calls. But it's not the same as seeing a loved one in person, and those types of visits can present challenges depending on the condition of the resident's health.

Bragg's Alzheimer's was deteriorating. She had gone blind and experienced severe memory loss. She only knew her husband was with her when she could register the sound of his voice, so window visits were basically pointless, he said.

"At the end, we just couldn't communicate with her or nothing, so it was 42 days of isolation, and she passed. It wasn't no use going to the window because she wouldn't know I was there," he said. "It was the hardest thing in the world."

Ohio's nursing homes have been hit particularly hard by COVID-19. More than 2,100 residents of long-term care facilities have died, accounting for about two-thirds of all of the state's COVID-19 deaths.

Columbus Public Health Commissioner Mysheika Roberts said COVID-19 cases have entered the facilities from nursing home staff.

She stressed that DeWine lifting this requirement does not mean every nursing home will be allowing visits right away. Nursing homes should think critically about whether they can safely accommodate visits, she said.

Roberts' staff has been working with local nursing homes to make sure they have isolation units, where all COVID-19 patients are cared for by staff members who do not interact with other residents. They have also been working with nursing homes to ensure staff are educated on safe practices for their interactions with others outside of work.

She does not blame the state's reopening of sectors of the economy or careless behavior from the general public for nursing home outbreaks so much as she does particular instances of staff members unknowingly introducing the virus into their workplaces.

"I don't know if everyone in the community should have to carry the responsibility of protecting the nursing homes if they have no connection to a nursing home staff," she said. "To me, it's taking a look at the education and the guidance that's given to nursing home staff on their practices and their families' practices to try to limit their exposure so they won't bring it into the nursing home."

Ree Hodge, who works as a nursing assistant at Majestic Care of Columbus, which has recorded 73 resident cases and 15 staff cases, said she has concerns about nursing homes resuming visits. She said there is a risk of the virus entering a facility but also the possibility of cases leaving the facility and spreading in the community.

"I don't think they should start visiting yet at any facility until they know it's affecting less than 5% until you only have like a little small corner of the place with it," she said. "These are people who may or may not be sick in some way."

Bragg said the staff at the nursing home where his wife resided seemed to have too much on their plate during the COVID-19 outbreak. All the "extra stuff" like coordinating virtual visits was overwhelming them.

When visits resume, Hodge said family members will be tempted to get close to their loved ones whom they have not seen in months, requiring staff to closely monitor the outdoor visits to enforce distancing.

"If I hadn't seen my significant other in months, and then they put me right there next to them, I'm touching them! I'm hugging them," she said. "When we were doing the visits with them between the glass, it kind of felt prison-y to me, but it felt safe. Now they're going to need at least three people out there to make sure that they don't touch people."

As challenging as it was to work through the outbreak, Hodge said she at least knew who had it and who did not because of the frequent testing. When the outbreak arrived at her workplace, she buckled up, never took off her mask, and kept at it to provide care for her residents, she said.

DeWine has said there is a real need for people, especially after months of isolation, to see loved ones in-person. Visits "add value to life," he says.

At the nursing home where Hodge works, she did not usually see many visitors before the COVID-19 outbreak. But she said lots of family members might come out to visit when the restriction is lifted. Because visiting privileges were taken away, families might value it more, she said.

"I hope a lot of them appreciate that time that was taken away from them. I hope that a lot more of them think about it like, 'Damn, I really need to go see such and such!'" she said.