Missouri nursing home responsiveness requirements

Any administrator or employee with reasonable cause to believe a resident has been abused or neglected must immediately report to DHSS, and must report to both DHSS and the Department of Mental Health when the person is a vulnerable person.

If the administrator or other employee of a long-term care facility has reasonable cause to believe that a resident of the facility has been abused or neglected, the administrator or employee shall immediately report or cause a report to be made to the department.

The facility must adopt and implement written policies prohibiting mistreatment, neglect, abuse, and misappropriation of resident property, and policies requiring a report to DHSS (and to the Department of Mental Health for vulnerable persons).

The facility shall develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of any resident and misappropriation of resident property and funds, and develop and implement policies that require a report to be made to the department

Missouri's mandated-reporter statute requires long-term care facility administrators and employees, nurses, physicians, and other listed professionals to immediately report suspected resident abuse or neglect to DHSS, with knowing failure to report punishable as a class A misdemeanor.

has reasonable cause to believe that a resident of a facility has been abused or neglected, he or she shall immediately report or cause a report to be made to the department

Every facility must have a supervising physician available to help coordinate the facility's overall program of medical care.

A supervising physician shall be available to assist the facility in coordinating the overall program of medical care offered in the facility. II

Each resident must be under the medical supervision of a Missouri-licensed physician who has been informed of the facility's emergency medical procedures and is kept current on treatments and medications ordered by other prescribers.

Each facility resident shall be under the medical supervision of a Missouri-licensed physician who has been informed of the facility's emergency medical procedures and is kept informed of treatments or medications prescribed by any other professional lawfully authorized to prescribe medications. I/II

On any accident, injury, or significant change in a resident's condition, staff must notify the resident's physician following emergency treatment policies that the supervising physician has approved.

In the event of accident, injury, or significant change in the resident's condition, facility staff shall notify the resident's physician in accordance with the facility's emergency treatment policies which have been approved by the supervising physician. I/II

As a condition of granting a nurse staffing waiver, the state must have assurance that an RN or physician will respond immediately to telephone calls from the facility whenever licensed nursing services are not on site.

There is assurance that a registered nurse or physician is available to respond immediately to telephone calls from the facility for periods of time in which licensed nursing services are not available

In a skilled nursing facility the director of nursing must be an RN, an RN must be on duty on the day shift, an LPN or RN on the evening and night shifts, and an RN must be on call whenever only an LPN is on duty.

(B) A registered nurse shall be on duty in the facility on the day shift. Either a licensed practical nurse (LPN) or a registered professional nurse (RN) shall be on duty in the facility on both the evening and night shifts. II (C) A registered nurse shall be on call during the time when only an LPN is on duty. II

In an intermediate care facility an LPN or RN must be on call around the clock, every day of the week.

An LPN or RN shall be on call twenty-four (24) hours a day, seven (7) days a week. I/II

Telephones suited to residents' needs must be accessible at all times and must let every resident both place and receive calls in private.

Telephones appropriate to the residents' needs shall be accessible at all times. Telephones available for residents' use shall enable all residents to make and receive calls privately. II/III

The facility must let a resident meet alone with anyone of the resident's choosing and must supply a space that actually assures privacy.

The facility shall permit a resident to meet alone with a person or persons of his or her choice and provide an area which assures privacy. II/III

Facilities must maintain a written emergency and disaster plan, give a current copy to the local emergency management director, and include in it staff instructions to call the fire department or other outside emergency services and to call alternative resources for housing residents.

All facilities shall have a written plan to meet potential emergencies or disasters and shall request consultation and assistance annually from a local fire unit for review of fire and evacuation plans. ... 7. Instructions for staff to call the fire department or other outside emergency services; 8. Instructions for staff to call alternative resource(s) for housing residents, if necessary;

All authorized personnel must have access to each resident's legal name plus the name and telephone number of the resident's physician and next of kin or responsible party to contact in an emergency.

All authorized personnel shall have access to the legal name of each resident, name and telephone number of physician and next of kin or responsible party of each resident to contact in the event of emergency. II/III

Applies to new AND existing facilities: a call system (electrical intercom, wireless pager, buzzer, or hand bells) is required at every resident bed, toilet room, and bathroom, and must be audible in the attendant's work area.

The facility shall be equipped with a call system that consists of an electrical intercommunication system, a wireless pager system, a buzzer system, or hand bells for each resident bed, toilet room, and bathroom. The call system shall be audible in the attendant's work area and be in compliance with 19 CSR 30-85.012(124). II/III

Construction standard for new facilities: an electrically-powered nurses' call system with corridor indicator lights at each bedroom, audible signals and indicating panels at every nurses' station and utility room, and signal buttons at each bed and in each toilet and bathroom.

Facilities shall provide an electrically-powered nurses' call system with indicator lights at the corridor entrance of each bedroom. Audible signals and indicating panels shall be located in each nurses' station and utility room. Facilities shall provide signal buttons at the head of each resident bed, in each toilet room and in each bathroom. III

Missouri has no standalone state QAPI rule; it reaches 42 CFR 483.75 only indirectly, by requiring SNF/NF operators seeking Medicare or Medicaid certification to comply with all of 42 CFR part 483, subpart B (which contains 483.75).

shall submit application materials to the department as required by federal law and shall comply with standards set forth in the Code of Federal Regulations (CFR) of the United States Department of Health and Human Services in 42 CFR chapter IV, part 483, subpart B for nursing homes

DHSS conducts federal surveys of SNFs and NFs using 42 CFR part 483, subpart B and the CMS State Operations Manual, which is the enforcement path by which QAPI is actually surveyed in Missouri.

The department shall conduct federal surveys in SNFs, NFs and ICF/MR facilities, utilizing regulations and procedures contained in— (A) The State Operations Manual (SOM) (HCFA Publication 7); ... (C) For SNFs and NFs, federal regulation 42 CFR chapter IV, part 483, subpart B;