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PMMA offers suggestions for holiday celebrations (November 16, 2020)

PMMA’s (Presbyterian Manors of Mid-America’s) president and CEO, Bruce Shogren issued a letter November 16 offering advice for the upcoming holiday season.

“We understand that 2020 has been a difficult year for everyone. Separation for loved ones is never easy, and as we approach the Thanksgiving and holiday seasons, the desire to spend time with our families becomes even stronger,” Shogren wrote. “Even in a difficult year, we have much to be thankful for and it is understandable that we want to celebrate with our families.”

The COVID-19 positivity and death rates continue to climb in Kansas and Missouri and across the nation. Despite all our preventive measures, we have seen significant increases in our own communities as we head into the holiday season. Infectious disease experts across the country believe the nation is beginning to experience the long-feared second wave of COVID-19.

The national statistics are sobering. As of November 13, 2020:

  • 10,614,420 known cases in the United States
  • 180,0257 newly reported COVID-19 cases
  • 241,331 deaths, with 1,430 newly reported deaths on November 13

These statistics underscore that now is not the time for us to forget what happened in long-term care communities in March, April and May. This has been a long battle, with too many casualties. We must not and cannot let our guard down. It will take all of us to ensure our seniors are protected against the second wave of the COVID-19 virus.

Holidays will look different this year in PMMA’s 15 senior living communities. As of November 17, only two PMMA communities are in counties where the COVID-19 positivity rate is below 10 percent, with numbers continuing to rise. With positivity rates so high, visitation is restricted and traditional holiday gatherings and activities will be getting a socially distanced face-lift.

Decorations are going up early. Life enrichment and dining services teams are working overtime to find special ways to celebrate the holidays in safe, socially distanced ways, within the walls of our campuses. The staff are working on ways to help families virtually connect with their loved ones in meaningful ways throughout the holiday season.

PMMA is strongly urging residents to shelter in place and remain on campus this holiday season.

“It will be difficult to forgo Thanksgiving and holiday gatherings this year, but it is the safe and right thing to do,” Shogren wrote.

According to the Centers for Disease Control and Prevention (CDC), small inside gatherings of people who are not wearing masks and socially distancing has been a significant contributing factor in recent COVID-19 outbreaks. The CDC is warning everyone that even small holiday gatherings could be a potential source for spreading the COVID-19 virus. The CDC issued guidance stating “the safest way to celebrate Thanksgiving this year is to celebrate only with people living in your household.” For our residents, this means remaining on your PMMA campus.

As you discuss your upcoming holiday plans, we encourage you to follow the advice of health officials, infectious disease experts and the CDC. If you make the decision to attend an in-person gathering, please follow the CDC guidelines for small gatherings. These guidelines are available at the websites below:

Check the CDC website, as well as the local and state health departments, for the most current guidance. It is likely to be updated as we move through the holiday season.

Residents who choose to leave the campus for holiday gatherings are at an increased risk for contracting COVID-19, and may be putting other PMMA residents, friends and employees at risk of infection upon returning to your PMMA campus. For these reasons, you will be asked to do the following before you will be permitted to return to your PMMA community:

  • Undergo a rapid point-of-care COVID-19 test
  • Receive a screening for signs and symptoms of COVID-19 (including a check of your temperature), and answer certain questions related to your potential exposure to COVID-19 while off campus
  • Quarantine in your room in the community for up to 14 days

If a resident does test positive upon their return to campus or during the quarantine period after returning, the resident will be required to move to the community’s appropriate COVID-19 isolation area and remain there until discharge is appropriate in accordance with the resident’s primary care physician and CDC and state guidelines.

These precautions are necessary to reduce the threat of a potential outbreak in any of our PMMA communities during the upcoming holiday season.


A community’s visitation status is also dependent on the county’s COVID-19 testing positivity rate. Indoor visitation will not be allowed when county positivity rates are above 10% or the campus has had a positive case of COVID-19 in a resident or employee. A positivity rate above 10% is considered high risk and only outdoor visitation is allowed per the CMS guidelines. If visitation is paused for a positive test in the community, the campus must have no new positive cases for 14 days before visitation can begin again.

When county positivity rates are between 5% and 10%, visitation is considered medium risk. During medium risk periods, outdoor visitation will be allowed, weather permitting, with strict adherence to the outlined safety protocols. A negative COVID-19 test is not required for outdoor visitors. Indoor visits may also be scheduled, however, anyone wishing to have an indoor visit are required to provide proof of a negative COVID-19 test no more than 2-3 days in advance of the visit. Indoor visitors also have to adhere to the mandatory safety protocols.

A county positivity rate of less than 5% is considered low risk for visitation. Both outdoor and indoor visitation is permitted, depending on weather, and indoor visitors will not need to provide proof of a recent negative COVID-19 test. Visitors will be required to adhere to the mandatory safety protocols.


CMS and state guidelines allow communities to establish protocols and reasonable limitations around visitation. View our Visitor Information Card. Outdoor visitation is preferred whenever possible. Reasonable limitations include requiring visitors to schedule visits in advance, limiting the number of visitors each resident may have at one time to 2 people, limiting the total number of visits that may be scheduled during a time period, and screening visitors for entry to the community. Screening includes answering a questionnaire about recent travel, health status and exposure risk, and taking and logging temperatures before they are allowed entry into the community.

Resident safety always comes first. Based on the recommendations from the CDC and CMS, outdoor visitation will be preferred as long as weather permits. Outdoor visitation provides the best ventilation and opportunity to maintain safe social distances during visitation. It also provides the most locations for residents and families to meet together.


When you visit our communities, you are expected to adhere to safety practices and take necessary precautions to protect our residents and employees.

If your visit meets this exception, you should:

  • Schedule your visit in advance with the community’s designated contact.
  • Be respectful of visitor limitations (2 visitors per resident per day) and time limitations. Time limits are set to allow provide as many opportunities as possible for residents to visit with their family and friends. It also provides opportunity for the community to complete cleaning protocols between visits.
  • Provide proof of negative COVID-19 test within 2-3 days in advance your of visit, if required. (Indoor visits when county positivity rates are between 5% and 10%.)
  • Answer screening questions honestly.
  • Have your temperature taken at entry to the community.
  • Adhere to safety measures, including wearing the provided facemask over nose and mouth at all times, washing or sanitizing hands before and after a visit, and maintain physical distance. Hugging, kissing and handshaking is prohibited to protect residents and employees.
  • Follow all instructions given for movement within the community.
  • Report immediately to the community if experiencing any signs or symptoms of COVID-19 or any positive COVID-19 test results occurring within 14 days of visiting any community.


County positivity rates also play a role in the new surveillance testing guidance issued by CMS in late August. The new CMS guidance mandates surveillance testing for all skilled nursing facilities. Surveillance testing requires all employees, agency employees, volunteers, hospice, lab and therapy providers at our campus to be tested on a frequency determined by the local county’s COVID-19 testing positivity rate.

Senior living communities with skilled nursing in counties with a positivity rate below 5% must test at least once a month. Senior living communities offering skilled nursing in counties with a positive rate between 5 and 10% must test weekly. Senior living communities with skilled nursing in counties with a positivity rate above 10% must test twice a week. The frequency is determined based on a 14-day positivity average. If the average goes down, it must sustain that trend for 14 days before the senior living community may reduce testing frequency. If the average goes up during the 14 days, the testing frequency must be increased immediately.

At this time, testing is not required for senior living communities that do not offer skilled nursing, however, PMMA has chosen to test all employees on the campuses that offer skilled nursing. On the Fort Scott, Kan., campus is not conducting surveillance testing because it is licensed for assisted living only.

In addition, CMS is sending point-of-care testing machines to all senior living communities with skilled nursing by the end of September. Some PMMA communities have received the machines and a limited amount of testing supplies, and others have not yet received the machines. The point-of-care antigen testing units form the backbone of the Department of Health and Human Services’ (HHS) plan to curb COVID-19 infections deaths in the nation’s nursing homes.

PCR tests look for pieces of SARS-CoV-2, the virus that causes COVID-19, in the nose, throat, or other areas in the respiratory tract to determine if the person has an active infection. Antigen tests look for pieces of proteins that make up the SARS- CoV-2 virus to determine if the person has an active infection. However, a negative antigen test does not rule out COVID-19 because antigen tests are not as sensitive as PCR tests. In cases where COVID-19 is strongly suspected, a negative antigen test should be confirmed with a more sensitive PCR test.

The point-of-care devices provide the capability to conduct a rapid test at the campus, but are not sufficient for handling mass testing at a community because of the protocols needed to ensure the integrity of the sample and the time needed to process each test.



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