Jacquelyn Smith Clarke

As the pandemic progresses, we have become used to the constant upending of what we thought we once knew. 

From PPE guidance to testing and vaccines, the amount of information and how quickly it changes has been daunting, unpredictable, and inconsistent. 

Attorneys regularly give the advice, “Document it,” but in the realm of COVID-19 Infection Control surveys and appeals, this advice is more important than ever. 

For example, as recently as Jan. 4, 2022, the Centers for Disease Control and Prevention updated its COVID-19 Isolation Guidance for the general population, shortening the isolation period to five days for asymptomatic and mildly ill people positive for the virus. The CDC specifically stated that the updated recommendations “facilitate individual social and well-being needs, return to work, and maintenance of critical infrastructure.” 

This update prompted responses from a myriad of news outlets emphasizing the changing guidance and a series of internet jokes about what the CDC might recommend next. 

But, when guidance evolves, facilities are charged with keeping up. Whether to prepare for a surveyor, draft an appeal, or defend a potential lawsuit, a thorough, well-maintained library of resources is important. 

Below are tips for maintaining your resource library over time: 

Be comprehensive 

Staff of long-term care facilities across the nation have spent countless hours keeping up with the changing guidance from multiple sources to provide the best care for their residents. Outbreaks have occurred despite heroic efforts and facilities have been cited (and sued) despite their best efforts. Documenting these efforts as comprehensively as possible is key. Facility policies and procedures are a great starting place, but the addition of outside guidance that is saved over time is even better.

Infection Preventionists are experts at knowing the sources they can rely on to provide the most up-to-date information. Consider providing your IP the resources and administrative assistance to document their research and decision-making. Did your IP reach out to the local health department? Is there new CDC guidance on mask-wearing? What is CMS saying? Does the medical director have any thoughts? 

Many of these resources do not archive their advice at points in time where it is easy or possible to know what the prior guidance was at a specific point in time. Documenting it now as decisions are being made is the best practice. 

Document local happenings and guidance 

Local changes and issues can easily become lost over time. That news story about an outbreak at a local gathering? Save it. The local or state department of health updating their graphs to show a new variant spreading in your zip code? Download it. Shortages of PPE, test kits, lab delays? Keep a diary. Information from a local industry meeting on what other facilities are doing? Note it. 

If an infection-related complaint or issue arises and you have contemporaneous and reliable notes on these issues, it will be much easier to demonstrate your reasonableness. If you do not, you are left guessing with a vague notion that things at that time were more challenging, but without evidence showing why. 

We also know that COVID-19 spread has changed over time and affected populations differently. Some variants are less reliably tested for and have shorter incubation periods. Community spread is a primary factor in the susceptibility of a facility to an outbreak. Knowing the status of the virus and variants in the community and the resources available and guidance provided locally is of course helpful contemporaneously, but is also helpful if you need to provide a history later. 

Stay organized 

Often those who are great doers are not great organizers. And even if you are, when crises hit, the challenge increases. Have a good system in place beforehand. This could look like a shelf with folders that are updated regularly for various resources: CDC, CMS, Corporate, etc. This could be a file on the server. It could be a hard copy timeline of knowledge and resources.  It is likely a combination of all these things. 

Boy, are we used to the adage, “If it is not documented, it did not happen,” but if it is documented but impossible to find, you are in a similar situation. When I interview staff to prepare statements for appeals and investigate citations, a well-organized and user-friendly library of materials showing changes over time provides an excellent roadmap. It provides consistency of knowledge and reliable evidence to use in support of the care.  

I hope you and your facility are not in the position of having to rely on these materials later, but if you are, you will not regret being comprehensive, documenting local occurrences and keeping your library of COVID-19 resources organized so that they can be as helpful as possible. 

Jacquelyn Smith Clarke is an Atlanta-based partner at Hall Booth Smith, P.C. She can be contacted at [email protected]

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.