On Sept. 9, the Oklahoma State Department of Health released revised guidance to support the efforts of long-term care facilities to balance the need to safeguard residents from COVID-19 while ensuring social and emotional connections with family and friends.

According to OSDH, "long-term care providers" are residential care and assisted living facilities, adult day cares, nursing and skilled nursing facilities, and intermediate care facilities for individuals with developmental or intellectual disabilities.

Developed by the Oklahoma State Department of Health, members of the National Guard and university partners, the guidance included input from long-term care providers with oversight and approval by Gov. Kevin Stitt and the COVID-19 Task Force, according to a press release.

Local facilities depend on guidance from the state, as well as the Centers for Disease Control and other national organizations.

When the recommended "levels" are met, Cherokee County Nursing and Rehabilitation Center will allow visitors with mandatory screening and mask requirements.

"Because new cases in residents or staff members temporarily suspend options for visitation, we continue to facilitate remote visitation opportunities such as phone and video calls as well as window visits," said Mark Erwin, administrator. "This situation is extremely fluid, and circumstances change on a day-to- day basis. Rest assured that the facility is diligently working to admit visitors as soon as conditions permit."

House Majority Caucus Chair State Rep. Tammy West, R-Oklahoma City, applauded the revised visitation policies, as she had recently held an interim study to examine current and future needs of residents in long-term care facilities related to COVID-19.

"A number of Oklahomans who are residents of long-term care facilities suffered especially devastating effects from the COVID-19 pandemic," West said in a press release. "Not only did these residents suffer higher death rates and illness, but many struggled with isolation factors when quarantine forced them to be shut off from family members and other caregivers."

The full guidance is available on coronavirus.health.ok.gov in the "Resources & Recommendations" section.

OSDH's revised guidance includes changes concerning virtual and in-person visitations. Some main changes include:

• Establishing guidelines for compassionate care visits and essential caregiver visits that go beyond end-of-life care and now include visits for psycho-social needs and assisting with daily care needs.

• Requiring the facility to allow virtual visitation at least twice weekly, or more as may be necessary to ensure resident well-being.

• Ensuring family members are made aware of visitation policies and any changes to them. • Ensuring the state long-term care ombudsmen are allowed into facilities to investigate issues related to quality of care.

Ombudsman Supervisor Scott Harding with EODD Area Agency on Aging said his office has mainly been receiving calls about visitation policies.

"We weren't getting those types of calls before," said Harding. "Overall, the call numbers have decreased. In most cases, we haven't been going into facilities based on guidance from the CDC."

Following state guidelines, facilities were to develop a plan to submit to the state, but Harding said each one had some flexibility, depending on certain conditions, such as the number of positive cases in the building, local resources available to treat patients, and the amount of personal protection equipment on hand.

"Most facilities aren't looking at full reopening due to the county data," said Harding. "Most were looking at short-term plans, but now have to come up with long-term solutions."

While there are overall general concerns about long-term care residents, Harding said many residents are having negative effects from isolation. He said many facilities are doing what they can to keep residents connected to their loved ones, especially by using videoconferencing, such as Facetime.

"Some allow window visits. Some are starting to allow or discussing the possibility of allowing outside visitations," said Harding.

Harding said many residents are suffering from isolation and depression because they haven't seen loved ones for many weeks.

"It's important to try everything to stay connected. It's not always easy," he said. "There's a real concern about depression and deterioration."

He said that most long-term care facilities are doing the best they can to keep residents connected, while keeping staff and residents safe, even as guidelines continue to be updated.

As advocates for the residents, Harding said the ombudsmen try to maintain communications with the facilities.

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