The 15 PMMA (Presbyterian Manors of Mid-America) communities are working toward reopening their communities to visitors, even as the numbers of COVID-19 cases in Kansas and Missouri continues to climb.
Both states’ guidance relies heavily on recommendations from the Centers for Medicare and Medicaid Services (CMS) issued on May 18. CMS guidance from March 13, 2020, limiting visitation to senior living communities remains in effect, but states have the authority to begin reopening senior living communities as it is deemed safe to do so.
“Our reopening plans for each individual PMMA community includes recommendations from CMS and our state and local government entities because each has requirements that must be addressed before moving into the reopening process at any of our PMMA communities,” said Bruce Shogren, PMMA president and CEO.
Based on the recommendations from the CDC and CMS, access to our communities will be relaxed or tightened, as COVID-19 conditions warrant in the greater area surrounding each campus. Items listed in each phase will not be implemented all at once but throughout a phase to ensure resident safety. Phases will last a minimum of 14 days and may last longer, for example, Missouri’s guidance for the length of Phase 1 is 28 days. These recommendations are in place to ensure the health and safety of our residents.
The three-phase process is complex, but it is necessary for keeping our residents and employees safe. Each community’s reopening plan and timeline depends on their local health department and the greater community’s number of new COVID-19 cases.
In Kansas, communities must submit a phased reopening plan to their local health department for review according to guidance from the Kansas Department of Aging and Disability Services (KDADS) on June 15 and June 16. The plans must include strategies for testing residents and employees for COVID-19, the ability to group residents in separate areas by COVID-19 status, adequate staffing and personal protective equipment (PPE), and local hospital capacity to accept COVID-19 patients. Counties do not approve plans, but they review, recommend and may defer or prevent communities from reopening to outside visitors based on the COVID-19 status in the surrounding community.
Each phase is at least 14 days in length in the Kansas recommendations, and any positive cases for residents and/or employees prevents a community from any forward movement in its re--opening plan.
Many Kansas PMMA communities are beginning to provide limited communal dining and group activities so long as social distancing are maintained. Employees are encouraged to comply with Centers for Disease Control and Prevention (CDC) guidance for infection control and prevention. Residents are encouraged to wear masks outside their residences and whenever employees are present. External providers also are being allowed to come on site to provide vital services such as audiology, podiatry and dentistry.
In Missouri, the Department of Health and Senior Services issued visitation, communal dining and group activity guidance in June, but did not issue reopening guidance until July 10. The DHSS guidance calls for Phase 1 to last a minimum of 28 days and for senior living communities to conduct baseline testing of all residents and employees before moving to Phase 2. The guidance also calls for communities to complete testing of 10-percent of their employees every two weeks. Any positive tests will place the community at the start of Phase 1 again.
Missouri’s guidance also places specific restrictions on when a community can choose to move forward to a less restrictive phase based on the COVID-19 case trend in the surrounding county. Only nursing facilities in counties where the cases are on a 2-week downward trend can move to a less restrictive phase.
Because Missouri’s guidance allows for outdoor visitation during Phase 1 of reopening, Missouri communities are beginning to schedule these visitations for residents and their family members. Visitation remains limited and must be scheduled in advance. Both residents and their visitors must adhere to safety precautions and visitors are screened for temperature, COVID-19 risk factors and symptoms of the disease.
“We remain acutely aware of the need for our residents and family members to be able to reunite,” Shogren said. “We are excited that we are working diligently toward reopening our PMMA communities. However, it is important to understand each community’s reopening timeline depends on their own local health department and the greater community’s COVID-19 positive case statistics. The spikes in Coronavirus cases are the reason CMS and the CDC recommended nursing centers be among the last places to reopen.”
PMMA communities are approaching reopening cautiously. Resident safety always comes first. Based on the recommendations from the CDC and CMS, access to our communities will be relaxed or tightened, as COVID-19 conditions warrant in the greater area surrounding each campus. If cases in the surrounding area are on the rise, a community may restrict visitors for resident safety until the number of cases declines and stabilizes in cooperation with the local health department.
Elements within each phase will not be implemented all at once but in stages throughout a phase to ensure resident safety. Phases will last a minimum of 14 days and may last longer, for example, Missouri’s guidance for the length of Phase 1 is 28 days.
Communities may begin with loosening internal restrictions on group dining and activities where social distancing can be maintained, reopening beauty shops with precautions and opening to non-essential service providers including podiatry, audiology, dentistry and other services. Restrictions on external visitors will be
All communities are accepting hand-delivered care packages and packages shipped through professional carriers include USPS, UPS, DHL and FedEx. Contact your PMMA campus for details. The 3-day quarantine was lifted in June.
Limited access means all visits to the community must be rescheduled except in case of end-of-life situations. Families should communicate with their loved one via telephone, email or other electronic methods. PMMA’s IT department and community staff are working to establish electronic communications options such as Skype or FaceTime. Contact your community for information.
In addition, CMS has recommended temporarily stopping group activities and communal meal service and limiting communities to essential staff only. All residents are encouraged to practice social distance – or remaining 6-feet apart at all times for infection prevention.
Employees are screened at the beginning of each shift at the point of entry to the community building and before employees have any direct contact with residents. These screening measures include taking staff temperatures and asking a set of questions about travel, health status, COVID-19 exposure risks and reviews a list of possible COVID-19 symptoms. Employees who have a fever or report feeling unwell are not allowed to work and are asked to get tested for COVID-19 if they have symptoms of the disease. These measures have been in place since March 13 and continue to be updated as guidance changes. In addition, staff members should continue to wear masks per Centers for Disease Control and Prevention (CDC) recommendations.
If your visit is not absolutely necessary due to end of life, reschedule your visit to the community.
If your visit meets this exception, you should:
Personal protective equipment (PPE), which includes gloves, masks and gowns, are available as necessary.