Sponsored by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation

There is no cost to attend any of these meetings. Please see the flyer.

September 4, 2024: Region 2
Location: Drury Plaza Hotel & Convention Center, Cape Girardeau

September 5, 2024: Region 7
Location: Crowne Plaza St. Louis Airport, Bridgeton

September 18, 2024: Region 1
Location: Oasis Hotel & Convention Center, Springfield

September 24, 2024: Region 6
Location: Special Olympics Missouri, Jefferson City

September 26, 2024: Region 5
Location: Moberly Municipal Auditorium, Moberly

October 1, 2024: Region 4
Location: Stoney Creek Hotel, St. Joseph

October 2, 2024: Region 3
Location: Adams Pointe Conference Center, Blue Springs

July 2024

Simple Strategies:
Summer Emergency Preparedness

Emergency preparedness is important in every season, but it is especially important in the summer. Summer storms, tornadoes and hurricanes often come with damaging winds and rain, and have similar preparations even though they occur in different areas of the country.

In This Newsletter:

Learning Opportunities

Extreme Heat
Across the nation we have been experiencing heat waves. Extreme temperatures can negatively affect people, especially populations like nursing home residents. Both staff and residents must take necessary precautions to prevent complications related to excessive heat. Nursing home residents are among the most vulnerable to heat exhaustion and heatstroke.
Some suggested interventions for your facility may include the following:

  • Establish a facility protocol with guidance from the medical director about when outdoor activities can/should occur. If residents must be out, such as for transport to medical appointments, etc. be sure they are dressed appropriately for extreme temperatures and be sure to pack them with hydration materials. 
  • Alert staff to monitor residents for the signs and symptoms of heat exhaustion and heatstroke. Notify the resident’s physician of such observations and obtain medical services as needed.
  • Request clinical pharmacist monthly reviews to highlight potential medications that might create higher risks. Review resident medications and identify those that may cause residents to become more susceptible to harm from heat and sunlight.
  • Assure that facility policies and procedures for heat emergency situations are current, complete and staff are trained.
  • Monitor temperatures in care areas and resident rooms.
  • Monitor residents’ choice of clothing to ensure it is appropriate in extreme temperatures. Loose-fitting, light-colored cotton clothing is best to allow the skin to breathe.
  • Help decrease temperatures by closing window blinds and turning off unneeded lights in the daytime.
  • Assist residents to maintain adequate fluid intake. In addition to water, consider popsicles, Jell-O, sherbet and juices to keep residents hydrated.
  • When outside, encourage residents to sit in shaded areas and to use sunscreen.
  • Close windows, doors and blinds during the daytime and open them at night after the outside temperature cools sufficiently.

Check out the following resources to take proactive steps in ensuring you stay cool, hydrated and recognize signs and symptoms of heat-related illness:

Extreme heat should be treated as a major weather emergency, just like an extreme storm and the possibility of power outages. Now is the time to pull out the facility emergency and disaster plans, ensure they are up to date, and be sure staff are educated about what to do.

Safe Temperatures in Nursing Homes
There are regulations requiring long-term care facilities to maintain safe temperatures.

F-Tag 584 pertains to comfortable and safe temperature levels in nursing homes. According to the regulation, facilities initially certified after October 1, 1990, must maintain an air temperature range of 71°F to 81°F. Ensuring a comfortable environment is crucial for residents’ well-being, minimizing susceptibility to hypothermia or hyperthermia.

Residents with a history of dehydration, cardiovascular disease or pulmonary disease are particularly susceptible to heat-related illnesses and complications. All staff should be aware and monitor for signs, symptoms and consequences of heat exhaustion, heatstroke and heat cramps.

Use this NHICS response guide as a checklist to ensure tasks are addressed and completed regarding severe weather.

Power Outages
Nursing homes across the country may experience power outages for various reasons. Many of these reasons are centered on natural disasters, such as hurricanes and tornadoes. Electrical interruption may also be caused by failing systems, such as electrical grid brownouts or blackouts. When nursing homes lose power, especially for extended periods of time, disaster can strike.

How can nursing homes prepare for the possibility of a power outage? The Federal Emergency Management Agency (FEMA) has published guidelines to facilitate the preparation process.

Among the preparation steps, FEMA recommends:

  • Analyzing risks, particularly those systems and components that can interfere with the ability to deliver care when power outages occur.
  • Identifying specific at-risk residents, such as those receiving temperature-stabilized medications or who may need power-operated support systems.
  • Securing temporary power support, including the use of generators.
  • Setting up redundant cooling systems for food supplies and medications, including off-site or temporary refrigeration facilities.
  • Establishing a maintenance and resupply chain for emergency power systems.
  • Establishing a plan to access resident records during power outages.
  • Establishing communication with organizations like emergency services, local or state health departments, emergency management agencies and evacuation shelter facilities.
  • Enhanced staff training to develop emergency-response skills and to ensure that all staff members understand their specific duties during a power outage.
  • Ensuring that nursing home insurance policies provide coverage for natural disasters that result in loss of electrical service.
  • Identifying shelters that are able to maintain healthcare services for residents if they are forced to evacuate.

By taking these steps in advance of a power outage, nursing homes will be better equipped to provide continuous and safe care to residents, all without subjecting residents and staff to the risks associated with electrical service interruption.

Hurricanes are dangerous and can cause major damage from storm surge, wind damage, rip currents and flooding. They can happen along any U.S. coast or in any territory in the Atlantic or Pacific oceans. Storm surge historically is the leading cause of hurricane-related deaths in the United States.

Hurricane season is here, take time to understand and prepare for how a hurricane could affect you. You can start your hurricane preparedness efforts by downloading FEMA’s Hurricane Hazard Information Sheet.

Visit Ready.gov/hurricanes for more information and tips about hurricanes. You can also download the FEMA app (free of charge) to learn how to prepare for common hazards, receive real-time alerts from the National Weather Service and search for additional disaster preparedness guidance.
Tornadoes are violently rotating columns of air that extend from a thunderstorm to the ground. Tornadoes can destroy buildings, flip cars and create deadly flying debris.

A tornado can:

  • Happen anytime and anywhere.
  • Bring intense winds, over 200 miles per hour.
  • Look like funnels.

The National Weather Service (NWS) provides numerous tornado safety resources. They can be accessed directly at Tornado Safety.


Shelter In Place: A Critical Component of Your Emergency Operations Plan: Updates from an Expert

by HQIN Consulting Subject Matter Expert Jordan Rennie, Owner and Principal of Rennie Consulting

Jordan assists the Health Quality Innovation Network (HQIN) as a subject matter expert working with nursing homes on emergency preparedness plan reviews and emergency preparedness education.

In the face of emergencies, healthcare facilities must be prepared to make quick and informed decisions to protect residents, staff and resources. A well-crafted Shelter in Place (SIP) section within your Emergency Preparedness Plan (EPP) is essential to ensuring operational continuity and safety. Here is a concise guide on key elements your SIP strategy should cover:

1. Preparation and Planning
Risk Assessment: Conduct a thorough risk assessment to identify potential scenarios that may necessitate SIP, such as severe weather, hazardous materials incidents or infrastructure failures. Tailor your SIP plan to these specific threats. This can be done while completing your annual Hazardous Vulnerability Assessment (HVA).

SIP Locations: Identify and designate safe areas within the facility where residents and staff can gather. These areas should be protected from external hazards and have access to necessary resources.

Supplies Inventory: Ensure a robust inventory of emergency supplies, including medications, food, water and medical equipment. Stock enough to sustain operations for at least 72 hours.

Upstaffing: Plan for increased staffing levels in anticipation of an SIP event. Arrange for additional clinical and support staff to be on site to handle increased demands and resident care needs.

Family: Ensure your family is prepared at home with their own shelter in place plan. You will not be able to adequately respond to an emergency at your facility if you are worried about folks at home.

2. Decision-Making: Shelter or Evacuate?
Criteria for SIP vs. Evacuation: Establish clear criteria to guide the decision on whether to shelter in place or evacuate. Consider factors such as the nature and scope of the threat, the condition of the facility and the safety of evacuation routes.

Decision Authority: Define who has the authority to make the SIP or evacuation decision. Ensure this individual or team is trained and has access to real-time information and communication channels.

Communication Plan: Develop a communication strategy to relay the decision to staff, residents and their families. Ensure everyone understands the protocol and their specific roles during an SIP event.

3. Proactive Measures
Resource Management: Maintain increased levels of critical supplies. Establish relationships with vendors to ensure quick resupply of essentials such as food, water, fuel and medical supplies. In addition, consider having a list of vendors both in your area and outside. This will increase resilience should vendors in your area be impacted as well.

Generator Capacity: Verify that your backup power systems, including generators, are functional and can support critical operations for extended periods. Regularly test these systems and ensure fuel supply arrangements are in place. Consider installation of generator “quick connects” that allow easy deployment of external generators.

Environmental Controls: Ensure that HVAC systems and other environmental controls can be managed during an SIP to maintain safe and comfortable conditions for residents and staff.

4. Communication with External Entities
Local Emergency Management: Establish and maintain open lines of communication with local emergency management agencies. Share your SIP plans and seek alignment with community emergency response strategies. Local emergency management leaders can assist you in making the decision to shelter in place or facilitate evacuation.

Vendor Coordination: Develop agreements with vendors for emergency delivery of essential supplies, including fuel, water, food and medical goods. Ensure contact information is current and establish protocols for rapid response.

Information Sharing: Implement mechanisms to share and receive information with external partners during an SIP event. This includes updating local authorities on your facility’s status and needs and receiving critical updates from emergency management agencies.

5. Training and Drills
Regular Training: Conduct regular training sessions for all staff on SIP procedures. Ensure everyone understands their roles and responsibilities during an SIP event.

Drills and Exercises: Perform regular SIP drills to test your facility’s preparedness. Use these exercises to identify gaps in your plan and refine your strategies.

6. Regulatory Requirements and Resources
Planning and preparation are great practices. They can assist in creating a more resilient and safer environment for staff and residents. However, it is also important to keep regulatory requirements in mind. The following E-Tags are covered by the CMS Emergency Preparedness Rule relating to SIP and Evacuation.

Regulatory E-Tags: E0018, E0020, E0022, E0015, E0041

For more information, refer to the CMS Emergency Preparedness Rule Webpage.

A comprehensive SIP plan is vital to the resilience of healthcare facilities during emergencies. By focusing on preparation, clear decision-making processes, proactive measures and robust communication with external entities, you can ensure that your facility is ready to protect and care for residents and staff when the unexpected occurs.

Training and Education Importance
Emergency Preparedness Plan training and education is crucial for both staff and residents in nursing homes.

You want your staff to be prepared and you want your residents to feel safe.
You can accomplish this by providing staff with:

  • Knowledge and Skills: Staff need to be well trained in emergency procedures, including evacuation, communication and response protocols. Training ensures they know what to do during various emergencies.
  • Drills and Exercises: Regular drills and exercises help staff practice their roles, understand evacuation routes and learn how to handle different scenarios.

Trained staff can respond efficiently, minimizing risks to residents and themselves.

For resident safety, providing residents with:

  • Awareness: Residents should be informed about emergency plans, evacuation routes and safety measures. Training helps them understand what to expect during emergencies.
  • Shelter In Place and Evacuation Readiness: Residents need to know how to safely shelter in place, evacuate safely and how to follow instructions from staff.
  • Reducing Panic: Proper training reduces panic and confusion during emergencies, ensuring residents can follow procedures calmly.

Remember, ongoing training, exercises and evaluation are essential to ensure staff and residents respond appropriately during emergencies.

Is Your Emergency Preparedness Plan Survey Ready?

See What People Are Saying About Our EPP Review Assessment Tool:

“I truly appreciate your insights. This was extremely helpful as I get my EPP updated.”
“Thanks for your insight and expertise.”
“I’m so grateful for your help.  This review was exactly what I needed.”
“Time well spent.”

Are You in Need of a Turnkey,
Ready to Implement, Tabletop Exercise?

The team of experts at the Health Quality Innovation Network (HQIN) is offering free support to ensure your facility’s emergency preparedness plan meets all the necessary criteria.
Take our online assessment, which guides you through a series of questions that will quickly identify what could be missing in your current emergency preparedness plan. After you submit your responses, an HQIN quality improvement advisor will review your responses and provide you with tools and resources to help support survey readiness. In addition, we will send you a complete, ready to implement, Tabletop Exercise and After-Action report.

Ready to get started? Scan the QR code or click the button below:

Click HERE to Take the Assessment
After Action Report Improvement Plan Template
Download our After Action Report Improvement Plan Template, which is a tracking form that allows teams to record real emergency events and exercises to document the scenario, capabilities tested, strengths, areas for improvement and more.

Nursing Home Excellence:
Prepare, Prevent, Protect (3P) Top Performer Program
The Health Quality Innovation Network’s (HQIN) Prepare, Prevent, Protect (3P) Top Performer Program recognizes participating nursing homes who are proactive in delivering high quality care to their residents and ensuring a safe environment for residents, staff and visitors.

The 3P Top Performer facilities achieve success in the following three designations:

  • PREPARE: Implement planning, policies and training on emergency preparedness and infection prevention.
  • PREVENT: Prevent avoidable resident emergency department visits, readmissions and hospitalizations.
  • PROTECT: Commit to ongoing, proactive immunization program.

Congratulations on achieving success in all three designations! Share with your staff and recognize them for their contributions.

Download the list of nursing home facilities being recognized.

Emergency Protocol for Long-Term Care Homes
The Emergency Protocol was developed in 2007 for communication between long-term care homes and the Section for Long-Term Care Regulation (SLCR), in the event a disaster occurs resulting in a loss of a necessary service (electricity, water, gas, telephone, etc.). This protocol was established to streamline communication so that homes can focus on what is most important – the safety and well-being of the residents.

This protocol provides the cellular telephone number corresponding to the region in which your home is located if you experience a loss in a necessary service that has the potential to affect resident safety or well-being. You are encouraged to contact the regional office main office telephone number during normal business hours because survey staff carry the cell phone and may be conducting a survey or inspection during working hours and may not answer immediately.

Download the Emergency Protocol Handout for Facilities for the phone number to use in your area.

This protocol is NOT to be used to self-report incidents normally reported to the Elderly Abuse & Neglect Hotline (1-800-392-0210).

If you have any questions about the Emergency Protocol for Long-Term Care Homes, please contact the Section for Long-Term Care Regulation at 573-526-8524.


Learning Opportunities

Facility Assessment: More Than a Regulatory Requirement

Learn CMS Required Regulatory Components Due by August 8!

July 17 at 10 a.m. ET
Join us on July 17 where we will focus on the new facility assessment requirements from the Centers for Medicare & Medicaid Services (CMS). You will not want to miss this opportunity to learn what needs to be done by August 8 to ensure your facility assessment meets all required regulatory components
The facility assessment is referenced 172 times in the 329-page staffing rule and is also the first requirement in preparation for the staffing requirement. F838 has been in play since 2016 but is taking on a new shape and focus with less than a month to make the required updates by August 8.
At the end of the session, you will:

  • Understand the revised facility assessment requirements and regulatory updates.
  • Understand how to complete the facility assessment process with your team.
  • Understand how to identify resources that are necessary to care for residents competently during normal day-to-day operations and emergencies.
  • Understand how to link the facility assessment to your emergency preparedness plan (EPP) and QAPI program.

Learn how the Health Quality Innovation Network (HQIN), as your Quality Improvement Organization, can provide assistance.

Register Here

Learning Modules for Nursing Home Staff, Visitors and Residents Teach Infection Prevention

Infections can be deadly in nursing homes. Solid infection prevention practices, coupled with the COVID-19 vaccine, are key to protecting those who live and work there.

Download our flyer and post it in your nursing home to encourage staff, visitors and residents to learn how to prevent infections. The brief learning modules, which are accessible through a link on the flyer or by scanning the QR code, review the dangers of infections and how to prevent them.


Newly Updated CMS Training for Frontline Nursing Home Staff and Management – Modules 5 and 8

Learn about the impact of dementia in caring for nursing home residents with COVID-19 and how to protect the emotional health of nursing home staff through this no-cost, updated Quality, Safety & Education Portal (QSEP) online training developed by the Centers for Medicare & Medicaid Services (CMS).

View scenarios In Module 5: Caring for Residents with Dementia to gain more understanding of the special needs that residents with dementia have and how to best care for them. Master content at your own pace, learning anytime and anywhere, even on your mobile devices.

While many concerns rest on the physical health and well-being of nursing home staff and residents, emotional health is also important. Module 8: Emotional Health, is designed for nursing home managers to learn how to develop creative strategies to promote and support emotional health for staff and residents.


New Learning Modules on Diabetes Available Now!

We are pleased to announce the release of our comprehensive new learning modules on diabetes. These modules are designed to enhance your knowledge and skills in identifying, treating and managing diabetes, providing you with the latest best practices for optimal resident care. To access these modules, and others on a variety of topics, visit HQI Academy, our online learning management system.  
New to HQI Academy? After you follow the link, click “SIGNUP” in the upper right. Fill out the short form to create your account. Once logged in, you’ll have access to a variety of courses on the main dashboard. Simply click on the cover of any course to start learning.
Access HQI Academy
About the Health Quality Innovation Network
Led by Health Quality Innovators and its quality improvement partners, Constellation Quality Health, KFMC Health Improvement Partners and the Kansas Healthcare Collaborative, HQIN is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Kansas, Missouri, South Carolina and Virginia. To learn more about HQIN visit https://www.hqin.org.

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2023, which will affect their FY 2025 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into facilities’ My Reports folders in the Internet Quality Improvement and Evaluation System (iQIES) for SNFs on July 03, 2024. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 14, 2024.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

Memorandum Summary

  • Update Nursing Home Guides Posted on the Medicare.gov Care Compare website: CMS will post new guides for consumers on the Medicare.gov Nursing Home Care Compare website to further support consumers choosing a nursing home and those already admitted to a nursing home.
  • Implement the New Staffing Level Case-Mix Methodology: CMS will implement the new staffing level case-mix adjustment methodology, announced in September 2023 (QSO-23-21-NH), for staffing measures reported on Nursing Home Care Compare.
  • Revise the Staffing Turnover Methodology: CMS will revise the nursing home staffing turnover methodology so that employees who are on leave for 90 days or less are not counted as staff turnover.
  • Post Facility Data: To increase transparency CMS, will post data on characteristics of nursing homes and their residents on cms.gov.

We are currently testing enhancements to the COMRU online submission system which will result in some newer applications being reviewed ahead of older applications. These enhancements are aimed at reducing the number of returned applications for corrections, resulting in faster processing times. Please do not reach out to COMRU staff if you have a newer application reviewed and have older applications that have not been reviewed – this will only slow down processing times.

Some of the enhancements made to the system include:

  • The “Submit” button will be removed from the online application once COMRU has done a preliminary review to determine if the application is a Level 1 or Level 2.
  • On the Level 1 form, Section D, if one of the diagnoses are marked, an error message will populate if the question is not answered YES.
  • A reminder message will populate if the application has a point count under the mandated 18-point requirement for SNF placement.
  • On the Level of Care form, Section D, the comment area below the “Treatment” section will be required to be answered if 6 points is indicated.

In order to assist COMRU with decreasing the amount of time to process submitted applications, please review the online training posted on the COMRU webpage https://health.mo.gov/seniors/nursinghomes/pasrr.php.

In 2023, 34 Missourians died due to heat-related illnesses. Heat is the number one cause of weather-related deaths in the United States.

The Missouri Department of Health and Senior Services (DHSS) urges Missourians to take precautions as heat and humidity rise to dangerous levels. In 2023, 34 Missouri residents, ranging in age from 11 months to 96 years, died due to heat-related illness.

“Heat and humidity can place a lot of stress on the body,” said DHSS Director Paula F. Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

This early wave of extended extreme heat may not have given Missourians the time to adjust to higher temperatures. This is especially true for some groups like pregnant women, very young children or older adults.

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online.

People who are working or exercising outside in the heat or have certain chronic health conditions such as heart disease, lung disease or diabetes may need to take extra care in the heat. Medications, as well as those with substance use disorder, can impair a body’s response to heat, making one more vulnerable to the heat. Additionally, those experiencing homelessness are at a greater risk of experiencing heat-related illness.

Never leave a child or pet alone in a vehicle. Even on a cooler day, the temperature inside a vehicle can rise by 20 degrees in 10 minutes and is life threating to anyone left inside.

Heat-related illness can affect anyone. Take steps to stay cool in the hottest hours of the day:

  • Prepare your home—Use air conditioning and change air conditioner filters; cover windows that receive morning or afternoon sun with drapes or shades.
  • Stay indoors—Stay in air-conditioned places as much as possible. At home, take a cool bath or shower, use stoves and ovens less often, and keep window blinds and curtains closed to help maintain cooler temperatures. During prolonged periods of high temperatures, use air conditioning – either at home or by seeking shelter in a local cooling center. Don’t rely on fans to keep you cool. Fans are generally okay for providing comfort in temperatures less than 90° F. But at temperatures over 90° F, a fan can make body temperature rise.
  • Schedule activities carefully—Plan outdoor activities for morning or evening hours when the temperatures are cooler.
  • Wear appropriate clothing—Do not over-dress. Good choices are lightweight, light-colored, loose-fitting clothing.
  • Pace yourself—Reduce exercise or physical activity as much as possible during the hottest part of the day and take frequent breaks in the shade or in an air-conditioned place.

Take steps to stay hydrated:

  • Drink plenty of fluids—Take a drink break every 20-30 minutes regardless of your activity level, and do not wait until you are thirsty. Water or hydrating sports drinks are best. Avoid sugary, caffeinated and alcoholic beverages, which actually cause you to lose body fluids.
  • Wear sunscreen—Sunburn affects your body’s ability to cool down and can cause you to become dehydrated.

Take steps to stay informed:

  • Check on friends and neighbors—Especially older adults and individuals with a disability or chronic health conditions, as heat is more likely to affect their health. If you find an emergency situation – call 911. In a non-emergency situation, if a senior or disabled adult is suspected of being in need of assistance due to warm weather, make a call. Make a difference. Call the toll-free Missouri Adult Abuse and Neglect Hotline at 1-800-392-0210
  • Know the signs and symptoms of heat-related illnessWhat to do matters, depending on type of illness occurring. Signs of heat exhaustion may include heavy sweating; cold, pale and clammy skin; dizziness; headache; muscle cramps; tiredness or weakness; nausea or vomiting; or fainting (passing out). If you think you or others are experiencing heat exhaustion, you should stop physical activity and move to a cool place that is preferably air-conditioned, loosen clothing, and sip cool water.

Seek medical attention immediately if you or others are throwing up, your symptoms get worse or symptoms last longer than one hour. Heat stroke is life-threatening and occurs when the body is unable to control its temperature or cool down. Signs of heat stroke may include extremely high body temperature (103°F or higher); hot, red, dry skin with no sweat; fast, strong pulse; throbbing headache; dizziness; nausea; confusion; or loss of consciousness (passing out). You should call 911 right away, as heat stroke is a medical emergency. Then, if you are able, move to a cool place that is preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

  • Pay attention to weather forecasts and heat advisories- CDC’s HeatRisk map is one tool that provides local heat risk information to keep you and others safe.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

National Nursing Assistants Week was celebrated June 13-19, 2024. Join CDC’s Project Firstline to recognize Certified Nursing Assistants (CNAs) across the nation who show an unwavering commitment to providing quality care to their patients and residents.

CNAs are skilled, vital members of the healthcare team, and we express our gratitude for their commitment to serving on the frontlines each day. CNAs dedicate themselves to infection prevention and control and help maintain safe and healthy environments for all patients and residents.

Show your Support

Support CNAs in your facility by saying “thank you” and acknowledging their contributions, which enhance infection control knowledge and make a significant impact in people’s lives.

Build their Knowledge

Utilize these important resources with CNAs in your facility to continue to build knowledge and strengthen infection control practices:

  • Interactive infection control activities: CNA’s can test their knowledge in real time and learn how to apply infection control solutions to stop the spread of germs.
  • Infection Control training toolkits: View ready-made materials and resources to host facilitated training sessions on a variety of infection control topics.
  • Micro-learn series: Use a series of guided discussions to help your staff recognize common infection risks and stop the spread of germs.
  • Enhanced Barrier Precautions resources: If you work in a nursing home, share these resources to help support your staff in understanding and effectively using Enhanced Barrier Precautions to protect residents and themselves.

Frequently asked questions
Pocket card
Overview video

The SLCR Health Education Unit will be conducting Instructor Information Meet Ups.

July 11, 2024: Online Programs
August 8, 2024: Certified vs. Licensed Facility
September 12, 2024: Scheduling a Test & Students
October 10, 2024: Clarifying 17 hours orientation vs. 16 hours OTJ hours
November 14, 2024: Train the Trainer Info
December 12, 2024: Discuss CMT Process

Please see the CNA Registry webpage for past meetings and more information.

If you have questions, please call our office at 573-526-5686.

Help improve the health of your residents by participating in a dental health pilot program!

The Missouri Department of Health and Senior Services Office of Dental Health (ODH) has developed a pilot program to deliver on-site interventional care to long-term care residents to reduce adverse health risks to residents in a cost-effective manner. Oral infections in older adults significantly increase the risk of pneumonia, acute diabetic problems, cardiovascular events and acute rheumatic arthritis episodes. This highlights the need for good oral health care for long-term care facilities (LTCF) residents.

Please see this flyer for more information.

CNA Training Reimbursement Opportunity for Skilled Facilities

Please join us as the Health Education Units hosts an informative webinar with MO HealthNet on July 10, 2024.

You will not want to miss this!! We welcome Carl Meyer and Lee Gerloff from MO HealthNet to be our guest and provide helpful information on what, when and how to submit for reimbursement. HEU will also be available for information regarding regulatory requirements and information related to the training reimbursement.

July 10, 2024: CNA Reimbursement Webinar

Please stay tuned to our CNA Registry webpage for more info and registration to come.

Please contact the Health Education Unit for any questions at the CNARegistry@health.mo.gov.

The Healthcare-Associated Infections/Antimicrobial Resistance Program is currently packing and shipping the Infection Prevention books to Long Term Care facilities across the state. However, due to the large number of facilities it will take some time for all books to be shipped. These books are being mailed via UPS to each facility and you will be receiving them soon.

Original Message

Missouri currently has 975 CNA’s that have not renewed as of June 1, 2024.

Please check the registry for your status at MO TMU.

All CNAs are required to renew their certification every 24 months. Each renewal requires 8 hours of nursing services to be provided for every 24-month period. Proof of the nursing service can include a W2 or paystub from your employer.

All renewals are now electronic through our online registry (TMU) and a $20.00 fee is required.

If you have never logged into TMU Registry to setup your profile, then you will first need to contact the Health Education Unit at 573-526-5686 or CNARegistry@health.mo.gov for assistance. After your profile is setup, a text message and email will be sent to you 60 days prior to your inactive date, during your renewal period. This notification will prevent any delay in keeping your certification active.

If you already have setup your profile, then please see the renewal instructions at https://health.mo.gov/safety/cnaregistry/pdf/how-renew-cna-certification.pdf.

If you have any questions, please contact the Health Education Unit at 573-526-5686 or CNARegistry@health.mo.gov.

Effective July 1, 2024, the Resource Limit/Spenddown Amount will increase from $5,726.00 to the new amount of $5,909.25. Facilities are required to notify the resident/financial guardian of the need to spend down when the resident reaches $200 less that amount to ensure Medicaid will not be affected.

For more information, please visit https://dssmanuals.mo.gov/wp-content/uploads/2022/07/mhabd-appendix-j.pdf.

Feel free to contact Lynn Gilmore, Lead Auditor, at 573-508-4150 if you have any questions.

Help us make the State of Missouri a great place to live and age with dignity!

On June 13, we will be launching the State of Missouri 2024 Needs Assessment Survey on Polco, our online civic engagement platform. Randomly selected households will receive mailed survey invitations around that time. If you receive an invite and meet the criteria listed, please follow the instructions to participate!

If you aren’t selected for this initial survey effort, stay tuned: in July, the survey will be open to all adults age 50+, adults (age 18+) with disabilities, and unpaid caregivers (adults 18+ who provide care for another adult).

To receive an email notification when this survey is available, click the link below, select “Follow” next to Missouri Association of Area Agencies on Aging, and set up a Polco account.

Thank you for helping to create a better community for all!

Set Up a Polco Account

Thanks to all of our champions who work tirelessly to create communities in Missouri where we can all age well.

Your Voice Matters!

Saturday, June 15th, marks a very special day – World Elder Abuse Awareness Day (WEAAD). This is a global awareness day officially introduced by the International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations on this day in 2006. This important day is in support of the United Nations International Plan of Action which recognizes the significance of elder abuse as a public health and human rights issue. It is observed every year to provide an opportunity for communities around the world to promote a better understanding and increased awareness of the cultural, social, economic, and demographic processes affecting elder abuse and neglect. We know that no community or country in the world is immune from the mistreatment of older adults. In Missouri, the Department of Health and Senior Services (DHSS) receives and investigates reports of abuse, neglect, bullying and exploitation of the elderly and disabled. Last year, DHSS received and investigated 43,862 reports, an average of about 120 each day. The National Center on Elder Abuse estimates for every case of elder abuse or neglect reported to the authorities, as many as 23 cases go unreported.

Missouri’s Department of Health and Senior Services (DHSS) invites you to wear purple anytime throughout the month of June to commemorate this important event and raise awareness of elder abuse, neglect, bullying, and exploitation in later life. The color purple has been adopted as the symbol to raise awareness of elder abuse and the effects of abuse, neglect, bullying, and exploitation in later life.

For more information, please visit https://health.mo.gov/seniors/weaad.php.

The Section for Long-Term Care Regulation is again seeking input from providers we work with. We are asking for your help in identifying areas in our Section where excellent customer service is provided and areas where we need to focus on improving our customer service experience.

Please take a couple minutes to complete our 2024 Provider Feedback Survey by June 25, 2024 at https://www.surveymonkey.com/r/KZXSKB7.

The Healthcare-Associated Infections/Antimicrobial Resistance Program is providing copies of Infection Prevention Guide to Long-Term Care, 2nd edition, and The Infection Preventionist’s Guide to the Lab free of charge to all Missouri Skilled Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities and Residential Care Facilities. Please utilize these free resources for Infection Prevention in your facility. These books are being mailed via UPS to each facility and you should be receiving them soon.

If there are any questions please contact the Healthcare-Associated Infections/Antimicrobial Resistance Program at (573) 751-6113.

CNA Testing

Headmaster D & S is now offering the knowledge portion of the CNA exam in Spanish.

This change is effective for those scheduling after 5/22/24. Please stay tuned for the updated Candidate Handbook to be added to the DHSS CNA Registry webpage.

For questions, please reach out to Headmaster D & S at 800-393-8664 or the DHSS Health Education Unit at 573-526-5686.

Attention Missouri Nursing Homes!

Register for a Free In-Person Health Ambassador Training

Sessions Will Be Held in Jackson/Cape Girardeau, Saint Louis and Springfield

Don’t miss this opportunity to register two individuals from your nursing home for a free regional in-person Health Ambassador Training in Missouri being presented by the Health Quality Innovation Network (HQIN) and Johns Hopkins University.

This training uses the Be REAL framework which focuses on building trust by forming relationships, targeting resources responsive to a facility’s population, and always keeping the door open for interactions to improve health outcomes such as immunizations and infection prevention.

Two people may register per facility and a maximum of 40 participants will be allowed for each session. Recommended participants include all staff, such as:

  • Nurses
  • Infection Prevention Nurses
  • Nursing assistants
  • Social services
  • Dietary
  • Environmental services
  • Also, please consider sending a resident, family member or volunteer.

These sessions will be interactive and include group discussion, small-group activities, games, and an opportunity to practice what has been learned. 

MO Health Ambassador Trainings

For questions, please contact us at ltc@hqi.solutions.

These trainings have been made available by the Health Quality Innovation Network (HQIN) and the Institute for Vaccine Safety – Johns Hopkins Bloomberg School of Public Health.

Please note this portal refers to the number of beds available for admission-not the number of licensed beds.

The Long-Term Care Ombudsman Program Bed and Service Availability dashboard can now be accessed. Facilities and the public can now view how many beds facilities have available, and which residents they can serve, i.e., memory care, behavioral health, bariatric, etc. This information is beneficial to facilities, families, hospital discharge planners and the general public to determine bed availability and services throughout the State. The dashboard can be accessed at this link dashboard. For information regarding how to navigate the dashboard, access this link training video.

If you have any questions about the survey, please contact the Long-Term Care Ombudsman Program via email LTCOmbudsman@health.mo.gov or call 800-309-3282.

The Board of Nursing Home Administrators has been notified of administrators receiving spam emails. The subject line contains the name BNHA and the emails are from an AOL email account. Please do not open the emails and notify your IT staff at once.

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 1/1/24 through 3/31/24 is due May 15, 2024. Please submit PBJ data as soon as possible to avoid delays.


SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. The following data must be submitted no later than 11:59 p.m. on May 15, 2024:

  • MDS data for 10/1/23 through 12/31/23;
  • NHSN data for COVID-19 Vaccination Coverage Among Healthcare Personnel for 10/1/23 through 12/31/23;
  • NHSN data for Influenza Vaccination Coverage Among Healthcare Personnel for 10/1/23 through 3/31/24.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.