State officials have revised guidance relating to nursing homes, particularly regarding testing and compassionate caregivers.

Secretary of Health Dr. Rachel Levine said the state Department of Health will follow the guidance given by the Centers for Medicare and Medicaid Services by tying testing frequency and procedures in nursing homes to the community's COVID-19 activity level.

When planning to go back to school, guidance was linked to COVID-19 activity levels, the thresholds being low, moderate and substantial.

According to Levine, a facility that does not currently have an outbreak in a county with low activity of COVID-19 will not have to test asymptomatic patients.

“But we are testing all staff members every four weeks,” Levine said.

For nursing homes in counties like Butler, which is in the moderate level, staff and residents will be expected to test asymptomatic staff once per week and any asymptomatic residents who have had outside contact in the past 14 days.

“Residents and staff who appear symptomatic with COVID-19 should and will be tested immediately,” Levine said.

Butler County has added 18 confirmed cases of COVID-19, but its death toll remained at 19, according to Thursday's report by the Pennsylvania Department of Health. Since the beginning of the pandemic, 753 county residents have tested positive for the virus.

As of Tuesday, the county has had COVID-19 in 16 long-term care facilities with 32 cases among residents, 25 cases among employees and three deaths.

Levine said the new antigen testing equipment and supplies being sent to all of the state's nursing homes by the Center for Medicare and Medicaid will help with retesting capacities.“That will improve the ability to do that testing significantly,” she said. “We've heard of no shortages of supplies.”Antigen tests are one of three commonly used tests for COVID-19. Polymerase Chain Reaction tests are still considered the most accurate because they test DNA, but antigen is becoming more heavily developed as a point-of-care test.“They're fast, they're less expensive and they're easier to use,” Levine said.Antibody tests, the third test, are used to detect if a person's immune system has been subjected to the virus.“Three tests, all a little bit different,” she said. “The antibody tests are not as clinically useful at this time.”Frank Skrip, director of public relations at Concordia Lutheran Ministries, said Concordia facilities intend to follow all guidance, but he added that routine testing creates extra stress.“We recognize the state's attempts to keep nursing homes safe,” he said. “We'll do our part, but with that said, we hope they recognize the burden this places on those providers who are on the front lines.”

In June, the department issued revised guidance allowing long-term care facilities to have visitors as long as they adhered to the department's guidance, universally tested at their facility at least once, and have gone 14 days without a new coronavirus case among staff or residents.The second revision revealed by Levine Thursday will allow “compassionate caregivers” the ability to visit a home regardless of COVID-19 activity in their community as long as they perform some prerequisite tasks. “We're separating compassionate caregivers as a separate category at this time,” Levine said.These caregivers, such as family members or loved ones, will have to provide proof of a negative COVID-19 test completed within 10 days of their visit, pass a routine health screening and wear a mask while in the facility.Skrip said he and others at Concordia are glad state officials are addressing a difficult byproduct of social isolation in their communities.“When you haven't touched a loved one in six months at this point, I think everyone is in need of a compassionate caregiver,” Skrip said.Skrip said the issue is there are still limitations, even for compassionate caregivers. He said the caregivers need to be built into the resident's care plan, and the resident must meet certain criteria before access is allowed.“(State officials are) still falling short in our opinion in recognizing how devastating this isolation has been in long-term care residents,” he said.The state's guidance continues to evolve throughout the pandemic and likely will again, especially as the Centers for Disease Control and Prevention announced two possible vaccines that could be developed by October or November.Levine said the department will continue following the work with the vaccine as it proceeds through trial, approvals and distribution.“None of it's official yet, so we will see how that comes out,” she said. “Nothing is simple in a world with COVID-19.”