The covid-19 pandemic changed the rules – repeatedly and almost daily.

Nursing and residential care homes were among the hardest hit.

“The biggest challenges have been dealing with the rule and regulation change,” Kelli Sullivan of law firm Turner Padget told Melinda Waldrop of scbiznews.

Guidance from the CDC, DHEC and Medicare changed literally every week.

When you make a change in procedure and policy, it may change days later.

“It’s like turning the Titanic,” she said.

Nursing and residential care homes were locked down in the early months.

South Carolina began allowing limited visits last September and eased the lockdown in March.

During those months, families were limited in checking on loved ones.

“Everything that stinks about getting older was made worse,” said Sarah St. Onge, at Millender Elder Law.

“If you’re living at home and you’re independent and you get covid, you might end up in assisted living.

“If you’re in assisted living, you might end up in a nursing home.

“If you’re in a nursing home, you might end up in a hospital.

“The isolation is terrible.”

Nursing homes must benefit from covid’s lessons, Sullivan said.

They may yet face legal challenges from infections and deaths.

The best practices include:

• Revised disaster planning.

• Improved staffing through networking and temp agencies.

• A commitment to “document, document, document.”

Sullivan said. “Let’s say you contacted supplier A, B and C and you can’t get any N95 masks. It’s great you’ve done that. You’re doing your best to comply.

“But 4 years from now when you’re sued about this, you’ve got to be able to say, here’s the evidence that I couldn’t get it. Our next best step was to do X.

“If you don’t document those things, memories fade.”

Measuring a nursing home’s liability if a resident got sick or died could also prove tricky.

“You have to look at what did we know and when did we know it,” Sullivan said. “Let’s say it was April last year. Things were a lot less clear in April than they were in September.

“What was the CDC advice? What was the Medicare advice? What was the general infectious disease advice?

“What were we doing to comply?

“Proving covid caused the death of an elderly patient with health complications could be difficult.

“If a resident has underlying kidney disease and they get sick, covid doesn’t have a lot of known implications on kidneys.

“Did they die of acute renal failure or did they die of covid?”

Lawmakers are considering a bill to give nursing homes limited immunity.

“I don’t think it provides a whole lot of protection,” Sullivan said.

“Given the makeup of our legislature and the way our laws are written, I certainly don’t think there’s going to be any blanket immunity,” she said.

“There might be some immunity for simple as opposed to gross negligence.

“There might be some caps on the dollar recoveries. But I think in terms of some blanket protection, you’re not going to see that in South Carolina.”