Regulatory Review of Adult Day Services: Final Report - Section 2. Missouri

08/26/2005

Overview

Missouri regulates adult day care by licensure through the Department of Health and Senior Services. Adult day health care is provided through the Medicaid Aged and Disabled Waiver with additional provider requirements.

Licensure and Certification Requirements

Licensure and Certification Requirements
Licensure Only  ☒ 
Certification Only  ☐ 
Both Required  ☐ 
Other  ☐ 

Definitions

An adult day care program is a group program designed to provide care and supervision to meet the needs of five or more functionally impaired adults for periods of less than 24 hours but more than 2 hours per day in a place other than the adult's own home.

Parameters for Who Can Be Served

Providers may serve functionally impaired adult age 18 or older who, by reason of age or infirmity, require care and supervision. No provider shall knowingly admit participants whose needs cannot be met by the program. No parameters for retaining or discharging participants were identified.

Inspection and Monitoring

Inspection and Monitoring
Yes  ☒ 
No  ☐ 

The Director of the Department of Social Services or his authorized representative shall have the right to enter the premises of an applicant for or holder of a license at any time during the hours of operation of a center to determine compliance with the provisions of the license. Entry shall also be granted for investigative purposes involving complaints regarding the operations of a program. The division of aging shall make at least two inspections per year, at least one of which shall be unannounced to the operator or provider. The division may make other inspections, announced or unannounced, as it deems necessary.

Required and Optional Services

  Adult Day Care Adult Day Health Care
Required Optional Required Optional
Activities of Daily Living (ADL) Assistance  ☒   ☐   ☒   ☐ 
Health Education and Counseling  ☐   ☒   ☒   ☐ 
Health Monitoring/Health-Related Services  ☒   ☐   ☒   ☐ 
Medication Administration  ☐   ☒   ☒   ☐ 
Nursing Services  ☐   ☒   ☒   ☐ 
Physical Therapy, Occupational Therapy, or Speech Therapy  ☐   ☒   ☒   ☐ 
Skilled Nursing Services  ☐   ☒   ☒   ☐ 
Social Services  ☐   ☐   ☒   ☐ 
Transportation  ☐   ☒   ☒   ☐ 

Provisions Regarding Medications

Participants who are responsible for taking their own medication at home shall be permitted and encouraged to continue to be responsible for taking their own medication during the hours spent in the center. If a participant is unable to self-administer medication, then the adult day care provider may assume responsibility. The licensed nurse shall be the only individual authorized to receive, control, and manage the medication and drug program. The licensed nurse shall be responsible for the administration of medications and treatments.

Provisions for Groups with Special Needs

Provisions for Groups with Special Needs
Dementia  ☒ 
Mental Retardation/Developmental Disabilities  ☐ 
Other  ☐ 

Staffing Requirements

Type of staff. The adult day care program shall have a director. Direct care paid staff shall be at least 18 years old and they and any volunteer staff shall be qualified by education and experience to perform the duties in the written job description.

Staffing ratios. The adult day care provider shall provide a sufficient number of direct care staff on duty at all times to meet the needs of each participant and assure that participants are never left unattended. At a minimum, there shall be at least two direct care staff persons when 2-16 participants are present and one additional direct care staff person for any portion of eight additional participants present.

The director shall not be counted to meet the required staff ratio if there are nine or more participants present unless he or she is providing direct care to participants. Trained volunteers at least 18 years of age may be counted in the direct care staff-to-participant ratio provided a volunteer program description, including the volunteer training to be provided and the system for assuring the presence of volunteer help as scheduled, has been submitted to and approved by the Division of Aging. Secretaries, cooks, accountants and other non-direct care staff members shall not be considered in calculating the staffing ratio. Direct care staff shall not be counted simultaneously to meet the required staffing ratios for both the long-term care or medical care facility and the associated adult day care program.

Training Requirements

All staff, including non-direct care, direct care, and volunteers, shall be given a general orientation to the program, its policies, and its fire, safety, and emergency procedures prior to performing job responsibilities.

In-service training shall be provided at least quarterly to staff, as appropriate to their job function and participant care needs. At a minimum, in-service training shall address participant care needs, both general and individualized; participants' rights; program policies; and specialized care needs, such as Alzheimer's disease or related dementias, appropriate to the needs of participants. For employees providing care to persons with Alzheimer's disease or related dementia, the training shall include the following: an overview of Alzheimer's disease or related dementia, communicating with persons with dementia, behavior management, promoting independence in ADL, and understanding and dealing with family issues.

Relevant Medicaid Contracting Requirements for Adult Day Services Providers

Missouri provides adult day health care through its Aged and Disabled Waiver.

Adult day health care is a program of organized therapeutic, rehabilitative, and social activities provided outside the home for periods of time under 24 hours per date of service. The adult day care program is designed to provide care for part of the day to persons who are physically, mentally, socially, or emotionally impaired and who need daytime supervision and services to maintain or improve their level of functioning. It is a program of organized therapeutic, rehabilitative, and social activities provided outside the home for a period of less than 24 hours to persons with functional impairments requiring at least an ICF level of care.

Admission criteria. The recipient must be assessed to have certain impairments and unmet needs which would require admission to a hospital or a long-term care facility if adult day care services were not provided. The program shall develop its own written admission criteria specific enough that the program does not accept persons whose needs it cannot reasonably expect to meet.

Persons who reside in a long-term residential or intermediate care facility licensed by the Division of Senior Services and Regulation or any group home or residential type facility licensed by the Department of Mental health are not eligible for the Medicaid adult day health care program.

Staffing requirements. At least one staff member trained in first aid and cardiopulmonary resuscitation (CPR) shall be on the premises at all times.

registered nurse (RN) or licensed practical nurse (LPN) must be available at all times during the program's daily operating hours. The RN or LPN must be available by being a staff member of the adult day health care program or located in the same building provided that a formalized agreement is executed that outlines the responsibilities of the RN or LPN to the adult day health care program. Part of each day must be committed by the RN or LPN to the adult day health care program.

There shall be one full-time person in charge of the adult day health care program who is responsible for day-to-day operations, either a director or the director's designee. If an adult day health care program is associated with another facility, it shall have its own full-time director and designated full and/or part-time direct care staff. If a facility has an associated adult day health care program with a daily participant census under five, the adult day health care director may also be responsible for other sections of the facility.

Staffing ratios. Direct care staff-to-recipient ratio shall be no less than one-to-eight. Direct care staff shall be sufficiently qualified and in sufficient number to meet the needs of the adult day health care program recipients. Trained volunteers may be counted in the staff ratio provided a volunteer program description is submitted and approved by the department specifying the formal training and regular work scheduling of such volunteers. Secretaries, cooks, accountants, and other non-direct care staff members must not be considered in calculating this one-to-eight ratio. It is required that in any case there should always be at least one person besides the director or the director's designee on the premises so that recipients are never left unattended. A long-term care facility is not to use the adult day health care direct care staff to meet the required staff ratio for the licensing of its long-term care facility and vice versa.

Training. All personnel, paid and volunteer, shall be given a general orientation to the facility, its normal routine, fire and safety measures, and policies and regulations.

Location of Licensing, Certification, or Other Requirements

  1. http://www.sos.mo.gov/adrules/csr/current/19csr/19c30-90.pdf
  2. http://www.medicaid.state.mo.us/lpBin22/lpext.dll?f=templates&fn=main-j.htm&2.0
  3. http://www.moga.mo.gov/STATUTES/C660.HTM

Citations

  1. Adult Day Care Program Licensure, Missouri Code of State Regulations. Rules of Department of Health and Senior Services, Division 30, Division of Health Standards and Licensure Chapter 90. [11/30/01]
  2. Missouri Medicaid Adult Day Health Care Provider Manual. Missouri Department of Social Services. [Undated]
  3. Missouri Revised Statutes, Chapter 660, Sections 400-420, Department of Social Services. [August 28, 2004]

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