Missouri Nursing Home Regulations

Missouri skilled nursing facilities fall under the stand-alone long-term care facility classification. All skilled nursing facilities in Missouri must have a license to operate. The Long Term Care Regulation Section of the Department of Health and Senior Services (DHSS) has the authority to issue this license. Prior to license issuance, the DHSS conducts inspection of these facilities and processing of application. The DHSS also certifies nursing facilities to offer services to beneficiaries of the Medicare and Medicaid programs.

Construction Requirements

• Nursing home facilities must submit a basic layout of the nursing home building, including construction type and phases, and mechanical and electrical systems. The DHSS Division of Regulation and Licensure approves this layout and makes corrections, when necessary. The facility must be in a location that is accessible for transportation and local fire protection. Nursing homes are required to provide public areas such as an administrator's office, business office and director of nurses' office; lobby and waiting room; and public restrooms for each sex. In addition, the nursing facility must have areas for recreation and occupational therapy, and adequate dining space.

Administrator

• A nursing home facility's owner or operator is required to designate a full-time administrator. The nursing facility administrator must hold a valid license, also issued by the DHSS. The administrator is given the authority to oversee the overall operation and the staff of the nursing home. Administrators must also make sure that all residents receive the proper nursing care and services. If an administrator needs to leave the nursing facility premises, he must delegate his responsibilities to a responsible employee. This temporary transfer of authority has to be in writing.

Resident Admission

• Nursing homes are prohibited to admit a prospective resident whose care and medical needs cannot be met directly or with the help of external resources. In addition, nursing facilities can only keep residents who need skilled nursing care if they have an adequate number of licensed nurses to perform this duty. When the facility decides to seek the help of external resources, the two parties must execute a written agreement. Nursing facilities must be licensed to care for residents under 17 years of age. Missouri DHSS regulations also mandate that nursing facilities only admit the number of residents specified in their license.

Policies

• Nursing homes are required to establish policies and procedures governing the facility's daily activities. The nursing home administration must produce policies focusing on protecting the residents' safety and health. Examples of basic policies include admission, discharge, treatment procedures, residents' rights and staff practices. Furthermore, the administration needs to implement policies informing employees of their duties and responsibilities regarding the residents and facility.

Continuing Education

• Nursing homes in Missouri must create a continuing education program, including in-service orientation. This continuing education program aims to develop and improve specific employees' skills and knowledge on nursing. The program has to be in line with the employees' job function. An orientation program on the first day of employment is needed so that health care professionals are aware of the facility's policies. Topics to address in an orientation include job responsibilities, infection control and prevention, emergency procedures, information confidentiality and residents' rights.