PMMA’s (Presbyterian Manors of Mid-America’s) 15 communities are reopening to visitors cautiously in the wake of new guidance from the Centers for Medicare and Medicaid Services issued September 17.

“We know how important it is to begin reopening our communities and providing our residents with a sense of normalcy,” said Bruce Shogren, PMMA president and CEO. “Reopening to visitors and reuniting our residents and their families is one of the most important things we can do to ensure the mental health of our residents.”

The new guidance from CMS is aimed at balancing the need for residents and their family members to reunite with the dangers inherent in permitting visitation in the middle of a global pandemic. The guidelines outline a process for both outdoor and indoor visits, as well as identifying triggers that would require a senior living community to return to more restrictive visitation policies. Communities are required to continue offering virtual visitation in addition to in-person options.

PMMA has adopted CMS’ core principles outlined in the September 17 memorandum, “Nursing Home Visitation – COVID-19.” All PMMA communities will allow visitation through various means based on the community’s structure and residents’ needs, including but not limited to resident rooms, dedicated visitation spaces both outdoors and indoors, and compassionate care situations.

“The bottom line is, we need to commit to allowing visitors while still minimizing the risk of infection to our residents,” Shogren said in a letter dated October 9, 2020. “We have to be especially diligent in paying close attention to the details when opening our campuses to visitation. This is especially important as we approach the traditional flu season.”

Communities will continue to follow CMS guidance regarding screening and surveillance testing for employees. CMS issued guidance in late August requiring senior living communities with skilled nursing to conduct regular testing of employees, volunteers, and other service providers on a frequency based on county positivity rates. PMMA implemented this guidance in early September and continues to conduct surveillance testing at its 14 campuses that offer skilled nursing. Fort Scott Presbyterian Village in Fort Scott, Kan., is licensed for assisted living and is not required to test at this time.


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.