A sign urges people to stay away from Stillwater Health Care nursing home in Bangor to protect people at the facility in this April 21, 2020 photo. Credit: Natalie Williams / BDN

For months, Heather Brown has had to be extra careful at home and at work.

She works at a residential mental health facility and her husband works at a grocery store, which puts them both at elevated risk of getting the coronavirus. Brown also has a chronic illness that could make getting sick more severe. She said she had to leave her prior health care job because the people she worked with were not quarantining, a risk she said she could not afford to take both for health and financial reasons.

Brown received her second COVID-19 vaccine shot last week and will soon be fully immunized against the virus. That status has allowed her to worry a little less.

“I can’t bring it home to me, and I can’t catch it and die and leave my husband to raise three children alone,” she said.

Every resident and workers in Maine nursing homes and assisted living programs covered under a federal program has been offered first doses, with many now onto second and third clinics. But life has still not returned to normal for Brown and those she works with and cares for, since vaccinations are not the deciding factor loosening rules at long-term care facilities.

While Brown no longer has to quarantine if she is exposed to someone who is sick, she cannot travel to see her parents in Massachusetts without quarantining for 10 days under state guidelines. At work, the protocols of screening residents and enforcing distancing and mask wearing remain.

In Maine, more than 33,000 people have gotten shots in these homes under a retail pharmacy program, according to the U.S. Centers for Disease Control and Prevention. More than 22,000 people have gotten their first shots and another 10,000 have gotten both doses. Vaccine acceptance among residents has been high, but staff uptake is lagging in Maine and nationally.

That high concentration of vaccines may be contributing to fewer outbreaks at long-term care facilities, which were hammered over the first seven months of the pandemic here. In Maine, 59 percent of deaths have come in these places, a figure that is sixth-highest among states with all New England states registering high shares, according to Kaiser Family Foundation data.

Family members, workers and administrators say they are relieved the vulnerable population is being protected, but their ability to return to more-or-less normal operations is largely based on how prevalent the virus is in their county, a situation that homes have little control over.

Wendy Hanscom of Newry was able to see her mother staying at Pinnacle Health and Rehab in Canton for 20 minutes in person for the first time in months last weekend. The 113-bed facility was rocked by an outbreak from mid-November to early January that affected 92 residents and 51 staff members.

She had been worried about her mother getting sick since she was hospitalized with an infection before Thanksgiving. Now, with her mother being vaccinated and her father having gotten his first shot at Walmart, she feels less scared that she could inadvertently get them sick.

“Even if we get sick, we’re not going to get them sick,” she said. “We’ll feel much safer with them.”

Mark Jacobs, Pinnacle’s administrator, said Hanscom’s visit did not happen because her mother was vaccinated. State rules allowed for it because Oxford County’s 14-day positivity rate was low and the facility cleared its outbreak, Jacobs said.

Congregate settings such as nursing homes are allowed to have indoor visits if their county’s positivity rate is at least below 10 percent under recently revised state guidelines. Group activities like dining and socialization are allowed depending on the number of residents and whether those once infected with the virus have recovered or are confirmed to not be sick. Distancing measures still apply.

Because indoor visits are time-limited, Jacobs said he has to schedule them out weeks in advance. That could all be upset if the county’s positivity rate changes or another outbreak occurs. New case counts and hospitalizations have been dropping in recent weeks, but public health officials worry the presence of a new, more contagious variant could upend that.

“I can’t quantify if the vaccine is making a difference in our facility,” Jacobs said. “I think vaccination from a general standpoint lowers the risk of an outbreak and lowers the county’s numbers, but we have to keep COVID out of the building.”

That could be difficult as Jacobs said he has new employees who have yet to get vaccinated. The federal retail pharmacy program only requires providers to visit a facility three times — once for an initial shot, a follow-up dose and another chance for anyone who initially waited and a third to give any remaining second doses.

Any facility experiencing similar difficulties should reach out to the state to arrange further clinics, said Robert Long, a spokesperson for the Maine CDC, citing the importance of getting those staff vaccinated to lower the risk of transmission.

It could be a while before life at long-term care facilities returns to normal, said Dr. Jabbar Fazeli, a spokesperson for the Maine Medical Directors Association and a nursing home medical director in Kittery. The vaccination level at a facility does not change visitation rules, which he expected will frustrate family members, residents and staff.

“Some will be saying, ‘What’s the point of vaccinating if we still have to maintain the same protocols and need surveillance testing?’” he said.

Correction: A previous version of this report misspelled Wendy Hanscom’s last name.