COVID-19 Long-Term Care Facility
Outbreak Reporting and Response Guidelines
(Epidemiology, Surveillance and Infection Control)
April 22, 2020

Overview: Local health departments are the lead agency for investigating outbreaks of COVID-19 in their
jurisdiction, as they are for outbreaks of other communicable diseases. They serve as the primary point of
contact with long-term care facilities (LTCF) in their jurisdictions and are required to report suspect and
confirmed outbreaks immediately to NJDOH/CDS. CDS will assist LHDs in managing these outbreaks by
providing guidance on surveillance and reporting, infection control and other recommended measures
the facility should take to control the outbreak. The LHD is required to work with the facility to ensure
these recommendations are implemented and to obtain status updates on a daily basis. CDS will work
with LHDs to review outbreak data, identify areas of concern, provide additional guidance to be
communicated by LHDs, and assist the LHD to elevate areas of concern.
Communication and Reporting Expectations
LTCFs, defined collectively as nursing homes, skilled nursing facilities, and assisted living facilities are
required to report suspect outbreaks to the LHD. The LHD should obtain information using the NJDOH
COVID-19 Outbreak Intake Worksheet (https://nj.gov/health/cd/topics/covid2019_professionals.shtml)
and provide initial guidance to the facility on outbreak control
(https://www.state.nj.us/health/cd/topics/covid2019_healthcare.shtml). The LHD should contact CDS by
telephone to report the outbreak, discuss steps that the facility is taking to prevent further transmission,
identify areas of concern, and propose any additional recommendations that should be implemented by
the facility. During this consultation, CDS will work with the LHD to establish timeframes and methods to
obtain updates from the facility and provide them to CDS. If the situation meets interim COVID-19
outbreak criteria, CDS will issue an E# for tracking purposes and to alert internal and external partners of
the outbreak.
In order to streamline and obtain routine outbreak updates:
1. An email will be sent daily by CDS to the facility and LHD with a link to an online survey for the
facility to enter updated outbreak information. Alternately, the LHD can choose to enter the
information in the online survey on behalf of the facility.
2. The LHD is responsible for ensuring that updated information is provided for each facility outbreak
each day.
3. The LHD will email an updated facility line list (example available at:
https://nj.gov/health/cd/topics/covid2019_professionals.shtml) to the CDS epidemiologist(s)
working with them on that outbreak each day where there is a change in the number of ill persons
or deaths associated with the outbreak. If the LHD prefers, they can ask the facility to email the
line list to the LHD and CDS simultaneously. If the LHD doesn’t receive an updated line list, they
should contact the facility and request updated information.

 Note: If a LTCF calls CDS directly to report or discuss an outbreak, CDS will advise them to call the LHD.
LHDs should ensure that all LTCFs in their jurisdiction have their contact information (business hours and
after-hours). If a facility contacts CDS and indicates they can’t reach the LHD, CDS will complete the intake
form and provide initial guidance to the facility. CDS will notify the LHD by telephone and will email the
intake form to the LHD with a cc: to OLPH, with instructions to establish contact with the facility, lead the
outbreak investigation, and ensure daily updates are provided to CDS. CDS expects the LHD to respond
within two hours of when the telephone and email notification is made, to confirm receipt of this
notification.
Outbreak response
The LHD is expected to work directly with the facility to gather needed information about cases via a line
list but to also gather information from the facility to ensure appropriate public health actions are being
implemented and that accurate information for the daily survey is available. LHDs should reach out to CDS
with any concerns/issues/questions which arise as part of the outbreak investigation/response, as it
relates to epidemiology, surveillance and infection control. CDS will provide consultation and assistance to
LHDs as necessary.
CDS will also review incoming line lists and survey data to identify facilities of concern and contact the
LHD to discuss or provide additional guidance.
Reporting timeframes
If updated information is not provided to CDS after 2-3 days, CDS will work directly with the facility to
obtain information needed to control the outbreak. In addition, CDS will report the LHD’s non-compliance
to the OLPH, and enforcement action will be initiated, starting with written notification to the Local Board
of Health.
Other Facility Concerns
PPE Shortages: LTC facilities are to report their PPE inventory on a daily basis, in accordance with
Executive Order 111, to https://report.covid19.nj.gov. Facilities in need of PPE can receive PPE based on
the information included in this daily reporting and working with their county OEM.
Staffing Shortages: Facilities should make every effort to handle staffing internally (i.e., extra shifts, extra
pay, contact staffing agencies, etc.); reach out to sister facilities if owner has more than one LTC facility; or
reach out to county or local OEM for MRC or other possible resources.
If all of these staffing solutions fail, the facility or LHD should contact NJDOH/Licensing
(https://www.nj.gov/health/healthfacilities/file_complaint.shtml or 1-800-792-9770 to determine
operational capacity and compliance of the facility.