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story.lead_photo.caption California Care Center in California, Mo., celebrated National Nursing Home Week in May 2020 with a color theme. Residents participated in black and white day, orange or yellow day, purple or pink day, green day, and ended the week with red, white and blue day. The staff and residents dressed in the color of the day each day. On Thursday of the week, residents played a whack a balloon game down the hallway. (Submitted photo)

Restrictions on many aspects of daily life were lifted Tuesday across Missouri, but it's not so simple for long-term care facilities.

Facilities such as nursing homes and retirement and assisted living communities are full of people who are particularly vulnerable to COVID-19.

"Since the underlying health conditions of residents in these facilities make them more vulnerable to COVID-19, the full reopening of all facilities will occur gradually and in phases," according to a Monday statement from the Missouri Department of Health and Senior Services.

DHSS said its forthcoming guidance on phased-in reopening for long-term care facilities would "take into consideration many factors including the current status of COVID-19 in the community and current status of COVID-19 in the facility. In addition, other facility-specific guidance will likely be included in the reopening plan in line with guidance released from CMS."

CMS refers to the federal Centers for Medicare and Medicaid.

"However, in order to allow facility residents a form of in-person visitation with family members and loved ones until a facility can fully reopen, the state will ease restrictions to allow for outside and window visitation at long-term care facilities, assuming proper social distancing protocols and other criteria are being met," DHSS noted.

Visitors' access to long-term care facilities has basically been prohibited since mid-March.

Missouri Gov. Mike Parson said Tuesday, "People need to be able to go in there to see their loved ones. They need to be able to touch, they need to be able to see them, they need to be able to speak, but we've got to figure out a way to do it safely."

Parson added the approach cannot be "throw the doors open and let everybody go in there, knowing that's high risk."

He said state guidance is also being provided for facilities that want to provide communal dining and group activities, and more information about reopening plans would be shared later this week.

In the meantime, the state Health Department's guidance on outdoor visits and window visitation "for residents who are bedbound or who cannot otherwise leave their room," also issued Monday, leaves final decisions on visits to individual facilities.

"Facilities may want to consider having a policy in place to determine these activities can be expanded without jeopardizing the health of the residents," the department's guidance added — addressed from DHSS Director Dr. Randall Williams to all long-term care facilities.

In allowing visits, Williams said, facilities "may want to consider" whether any staff or residents have had COVID-19 or whether it has been two incubation periods — 28 days total — since the last facility-acquired case; limiting outdoor visits to residents who are free of COVID-19; screening visitors; keeping detailed visitor logs; and sanitizing of surfaces, even outdoors.

Williams' letter noted facilities might want to consider "allowing up to two visitors at one time with social distancing (spaced by at least 6 feet), hand hygiene before and after each visit for both the resident and the visitors, and use of a cloth face covering or face mask for both the resident and the visitors. In the event a resident cannot safely wear a cloth face covering or face mask, a plastic partition or plexiglass barrier may be considered to prevent the spread of virus."

There are further guidelines included for facilities that want to consider allowing outdoor visits for residents who have COVID-19, symptomatic or not.

The full set of guidelines is available at health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/visitation-guidance.pdf.

Staff of Villa Marie in Jefferson City said the facility was awaiting CMS guidance and was currently not open to visitors.

Villa Marie is a StoneBridge Senior Living facility. StoneBridge, based in St. Charles, also operates the Adams Street and Oak Tree homes in Jefferson City, as well as a home in Westphalia, among its other facilities.

St. Louis public relations spokesman Craig Workman, who responded to request for comment on behalf of StoneBridge Vice President of Operations Eric Doerhoff, said: "The new guidelines issued by the State of Missouri are a very welcome development, and we are determining how best to implement them while continuing to follow all coronavirus-related CDC and CMS guidelines to protect the health and safety of all of our residents and staff.

"We anticipate that each of our communities will have slightly different visitation guidelines based on their size, outdoor amenities, available staff and other factors. We will notify our residents and their families of our new visitation guidelines once they are in place. It is our hope that our Mid-Missouri communities can begin opening up to visitors in the coming days. We look forward to seeing our residents visit with their families face-to-face once again," Workman added.

Lutheran Senior Services, which operates Heisinger Bluffs in Jefferson City, posted to its website Monday, "Information specific to each community has been communicated to residents and assisted living, memory care assisted living and care center residents' first emergency contacts. If you have questions specific to your or your loved one's community, please contact the community directly."

LSS noted transportation services — but not group outings — access to wellness centers and exercise rooms, and volunteer activities of independent living residents within their facility were all to resume Monday.

Visitor restrictions for independent living residents — and independent living residents only — were also to be lifted Monday, with specific visiting hours in effect to allow for screening. Visitors are also required to wear a mask while in the community.

Some services and activities for LSS-assisted living residents were to resume Monday.

"With precautionary measures in place, services and activities will look different," the LSS website notes. "Details specific to communities will be shared by the communities closer to these dates. Residents need to wear a mask and follow social distancing guidelines when leaving their residences."

LSS also encourages independent living residents to stay home as much as possible and to monitor any symptoms of COVID-19.

The News Tribune also attempted Tuesday to contact administrators or executive directors of other local long-term care facilities regarding when visitors might be able to return but did not immediately receive responses.

BJ Schaefbauer, president of Primrose Retirement Communities, which operates a community in Jefferson City, posted to the company's website last week: "As we operate in 17 states, there are varying regulations and recommendations from local and state agencies. We have developed a multi-phase approach to be used in each of our communities, though each community's plan will vary in accordance with their specific state and local guidelines. For that reason, we ask that you direct your questions to your local community's executive director."

Administrators or executive directors of Jefferson City Nursing and Rehabilitation Center LLC and Jefferson City Manor also did not immediately return requests for comment.

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