This week, the state released revised guidance for long-term care facilities in Missouri that choose to establish an Essential Caregiver program and/or resume general visits either inside or outside the facility. Facilities should have a policy in place to determine how contact with loved ones can occur while protecting the health of residents. Each facility will ultimately make the decision as to whether or not to adopt this guidance. “COVID-19 has had a major impact on our most vulnerable citizens and their families,” Governor Mike Parson said. “We have worked hard to strengthen our prevention and mitigation strategies in long-term care facilities, and we understand the importance of spending time in-person with families and caregivers. These visits serve as an important part of  residents’ overall well-being.” When COVID-19 first knowingly entered the United States in January, it was quickly discovered that those living in long-term care facilities were at a higher risk for contracting the virus. Health officials began to see the virus impact Missouri’s long-term care facilities in late March. Since that time, more than 650 Missouri long-term care facilities have reported at least one case among staff or residents. On May 18,  Missouri Department of Health and Senior Services (DHSS) Director Dr. Randall Williams issued an order requiring congregate living facilities, including long-term care, to report to DHSS within 24 hours when a positive test result is received among staff or residents. Additionally, increased testing capacity in Missouri allowed the state to execute new strategies for addressing outbreaks early or before they start and arrange for comprehensive testing. The “boxed in” testing strategy has been implemented in 586 facilities since May 18 and has been effective at decreasing morbidity and mortality. The new guidance, which recommends ways to safely facilitate visits in long-term care facilities, will supplement the state’s guidance issued for facilities in June. In accordance with newly revised federal guidance from the Centers for Medicare and Medicaid Services, facilities must allow visits by outside health care providers and the Ombudsman program. Infection control, screening guidelines, and proper PPE use must be in place. Facilities that have not had any cases of COVID-19 among staff or residents, or those that have not had a facility-acquired case in the past 14 days, are able to allow general indoor visits for residents who do not or are not suspected to have COVID-19 (or who have been released from isolation). Outdoor visits may occur in any facility for residents who do not or are not suspected to have COVID-19 (or who have been released from isolation). The guidelines dictate that five visitors may be designated for each resident, with two allowed to be present at a given time by appointment and with social distancing being practiced. Proper hand hygiene and face coverings should be used.