Hurricane Sandy: A Lesson in Survival

Why it is important to have an emergency plan in place.  This article focuses on October 22, 2012 and sometime following, when the largest Atlantic hurricane on record left the East Coast in a state of emergency.  Read and understand what it was like as nursing homes were evacuated.  You also get a description of some challenges crews faced as well as the lessons learned from the experience.

Please see the full article from Long Term Living – July/August 2015 here.

Missouri Severe Weather Awareness Week

March 3 – 7, 2014:  Missouri Severe Weather Awareness Week

March 4, 2014:  Annual Missouri Severe Weather Drill

The annual drill will be held on March 4th, 2014, at 1:30 p.m.  In case of actual severe weather on March 4th, the drill will be postponed until Thursday, March 6th, also at 1:30 p.m.  For more information, visit SEMA at

Health Update: January 31, 2014 Influenza in Missouri

Health Alerts, Advisories and Updates

Health Update:  January 31, 2014

SUBJECT: Influenza in Missouri, 2013-2014

On December 26, 2013, the Missouri Department of Health and Senior Services (DHSS) issued a Health Advisory containing information on the current influenza season as well as recommendations on diagnostic testing and the use of antiviral drugs (

This Health Update summarizes influenza activity in Missouri through late January, and provides information on how medical providers and facilities can access DHSS’ Weekly Influenza Report.  Health Alerts, Advisories, and Updates are available on the DHSS website.  For the most current information, please visit:

Ensure Your Local EMD has a Copy of Your Home’s Current Emergency Plan

Missouri has experienced extreme weather conditions this winter, and there is a chance of more inclement weather in the forecast.  The Section for Long-Term Care Regulation would like to remind you there are emergency preparedness representatives in your community to help you with emergency planning and are there to help in the event of a disaster.

You can find your local emergency management director (EMD) on the State Emergency Management Agency’s (SEMA) website at  Scroll down to Contact Your Local Emergency Management Agency and choose your county.

State regulations require all long-term care homes to provide a copy of their emergency plan to their local EMD.  Please reference the following regulations:

19 CSR 30-85.022 (33) and 19 CSR 30-86.022 (5)(A) 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.  If the consultation cannot be obtained, the facility shall inform the state fire marshal in writing and request assistance in review of the plan.  An up-to-date copy of the facility’s entire plan shall be provided to the local jurisdiction’s emergency management director.

For additional information regarding emergency preparedness, please contact Melissa Hope, Planner II, Division of Regulation and Licensure at

Resources are also available on the Department of Health and Senior Services website,

MDS and Flu Season

CMS posts the public Quality Measures on Nursing Home Compare, and consumers are able to view the percentage data that your nursing home offered and administered the flu vaccine during the current or most recent influenza season.

The 3.0 Resident Assessment Instrument (RAI) manual does not provide specific dates for influenza season.  This has prompted Missouri facilities to ask what dates are considered the influenza season in Missouri, in order to correctly code the MDS, which will be reflected in their Quality Measures.  Seasonal flu monitoring and reporting to the CDC in Missouri begins in early October and extends well in to the month of May.

For MDS coding purposes, if the resident is not in the facility between October 1 and May 31, you should code in Section O:  “Resident not in facility during this year’s flu season.”  For residents who are in the facility from October 1 through the last week of May, the facility is required to offer the flu vaccine as long as it is “reasonably available,” which means that it is still available to be ordered from your local pharmacy or supplier.

If you have any questions, you may contact Joan Brundick, State RAI Coordinator, at 573-751-6308 or email

Health Advisory: pH1N1 Influenza

Health Advisory:  Pandemic pH1N1 Virus-Associated Illnesses and the Influenza Season in Missouri (12.26.13)

CDC Health Advisory:  Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season (12.24.13)

Health Alerts, Advisories, and Updates are available on the Department of Health and Senior Services website.  For the most current information, please visit:

Flu Season is Here

Homes are required to offer the flu vaccine to all of their residents.  Vaccination of your healthcare workers, although not mandated, is also important in preventing the spread of flu in your home.  Encouraging your staff to receive the vaccination can also help reduce absenteeism due to illness and reduce the costs of care associated with ill residents. 

Flu season information is available on the CDC website at

Safety Reminders: Holiday Decorations

It is that time of year when people are decorating their homes and businesses with festive décor and anticipating upcoming holiday celebrations.  Residents and staff in your care home also look forward to festivities and enjoy holiday decorations.  It is important for residents, staff and visitors to carry on traditions and to feel a sense of joy and peace we all want this time of year.

The Section for Long-Term Care Regulation (SLCR) wants to help you and your residents have a safe holiday season by sending out the following safety tips, references and regulatory reminders.

Fires or other accidents are not something anyone wants! 

Safe decorations include:

  • Artificial Christmas trees, and decorations that are non-combustible or flame retardant.
  • UL approved decorative lighting (use in supervised areas and turn off when not in use).
  • UL approved outdoor lighting.
  • Holiday decorations, including evergreen wreaths, ornaments, photos, etc. can be used on resident’s doors, and in hallways, as long as they do not exceed 3 ½” in depth and they are not blocking the entrances or exits.*

*Any combustible decorations hung from doors or walls in corridors may be used with a waiver.  Non-rated combustible decorations cannot exceed 20% of the wall space in an exit egress corridor.

SLCR published an article regarding holiday decorating in the winter 2011 edition of the quarterly newsletter.  Please visit

Although the 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) is the official reference, the 2012 Edition contains some less restrictive requirements.  Please refer to the CMS memo regarding waivers here: CMS Memo S&C 13-58-LSC 2000 Edition National Fire Protection Association (NFPA) 101® Life Safety Code (LSC) Waivers, or visit the CMS website at

Prohibited decorations include displays, hangings, and other decorations that block exits, visibility of exits, or fire protection appliances.  Never hang decorations from fire sprinkler heads or pipes.

NFPA 101, Section  Combustible decorations shall be prohibited in any health care occupancy unless they are flame retardant.

NFPA 101, Section  Means of egress shall be continuously maintained free of all obstructions or impediments to full instant use in the case of fire or other emergency.

NFPA 101, Section  No furnishings, decorations, or other objects shall obstruct exits, access thereto, egress therefrom, or visibility thereof.


Please note, some county or city local ordinances may also require compliance with more restrictive standards, including the International Fire Code (IFC).


  • F323:  Electrical Safety – Any electrical device, whether or not it needs to be plugged into an electric outlet, can become hazardous to the residents through improper use or improper maintenance.  Electrical equipment such as electrical cords can become tripping hazards.  Halogen lamps or heat lamps can cause burns or fires if not properly installed away from combustibles in the resident environment.  The Life Safety Code prohibits the use of portable electrical space heaters in resident areas.



  • Can candles be used in nursing homes under supervision, in sprinklered facilities?

CMS Memo S&C-07-07:  Nursing Home Culture Change Regulatory Compliance Questions and Answers

Answer: Regarding the request to use candles in sprinklered facilities under staff supervision, National Fire Protection Association data shows candles to be the number one cause of fires in dwellings.  Candles cannot be used in resident rooms, but may be used in other locations where they are placed in a substantial candle holder and supervised at all times while they are lighted.  Lighted candles are not to be handled by residents due to the risk of fire and burns.

This holiday season, consider using battery-operated flameless candles.  They look and smell real!  Learn more about candle fire safety from the U.S. Fire Administration at

If you have any questions regarding the Life Safety Code, please contact SLCR at 573-526-8524.  We wish you a wonderful and safe holiday season.

Tuberculin Skin Test Antigen Available – Shortage Resolved

The national shortage of TUBERSOL® used in the administration of PPD tuberculin skin tests appears to be resolved and is now widely available.  Providers should administer PPD tuberculin skin tests that were deferred due to the shortage.  Please make every effort to complete all deferred testing within the next 30 days.  If you are unable to meet this timeframe, please work with your Regional Office to establish an acceptable timeframe to complete your deferred testing.  If you have any questions, you may also contact Joan Brundick at 573-751-6308 or send an email to

posted December 6, 2013


2013 Annual Long-Term Care Emergency Preparedness Survey

The Section for Long-Term Care Regulation (SLCR) is conducting the sixth annual Emergency Preparedness Survey of all licensed long-term care homes in Missouri.  All licensed homes will receive the survey via regular U.S. mail.  Homes may complete the survey online at

Homes are asked to provide information concerning the development and contents of their emergency plans.  The information will be compiled to assist homes and emergency planners in emergency situations.  The survey is anonymous; no identification is required.  Your confidential responses are for planning purposes only and will not be used for regulatory reasons. 

SLCR received 538 responses last year and hopes to increase that number this year.  The section thanks all homes in advance for their participation and welcomes questions at 573-522-1333. 

Emergency preparedness planning resources are also available at

Cardiopulmonary Resuscitation (CPR) in Nursing Homes

CMS Memo S&C: 14-01-NH

The Section for Long-Term Care Regulation wants to make certified providers aware that this Memo requires “certification” of some nursing home staff as part of the nursing home’s compliance with regard to CPR.  CMS’ guidance had previously been that an on-duty staff member be able to perform CPR appropriately at all times.  If a question arose during a federal process regarding whether someone could perform CPR properly, a surveyor may have needed to ask for an explanation of appropriate technique from some available staff member to verify compliance with that requirement, but verifying the certification of a particular staff member typically wasn’t necessary.

One point that remains unaddressed in this new S&C Memo is that many different CPR training agencies offer “certification” of their own, and this Memo doesn’t specify which agency’s certifications are acceptable to CMS and which are not.  SLCR has requested a clarification of this point from the CMS Central Office, and so has the Kansas City Regional CMS office.  Neither of our offices have received a response.  When we receive further guidance, we will provide it to you via this Listserv.  Until then, we will not be altering our current survey practices, but we want to make providers aware that this new S&C Memo has been issued by CMS, and that depending on their answer to our questions, it’s likely that some of your staff may need to obtain CPR certification with very short notice.

Because this memo references the American Heart Association as a standard-setting organization with regard to CPR, it is our belief that provider certification through the AHA will almost certainly be deemed acceptable by CMS.  Whether other certifications will suffice is less clear at this time.  As soon as we have some clarification on this point, we will share it with you.  We apologize that we can’t offer more specific guidance at this time, and appreciate your patience.

View the CMS Memo S&C: 14-01-NH here:  Survey-and-Cert-Letter-14-01 or click here. 



Change Your Clock – Change Your Batteries!

When you change your clocks, do not forget to replace your smoke alarm and CO detector batteries.  Daylight Saving Time ends on Sunday, November 3, 2013.  For more safety tips, visit the U.S. Consumer Product Safety Commission (CPSC) at

View the news release here:

Long-Term Care Emergency Preparedness Report 2012/2013

The Section for Long-Term Care Regulation (SLCR) conducted the fifth annual Emergency Preparedness Survey of all licensed long-term care homes in Missouri.  SLCR received 538 completed surveys and would like to thank the homes that responded.  For the first time, SLCR also conducted an Emergency Generator Survey that asked specific questions regarding a home’s electrical generator capacity.  819 long-term care homes completed this survey.  SLCR welcomes any questions concerning the surveys or emergency preparedness planning at 573-522-1333.  The new report is available on our website, please visit

New Generations – Summer 2013 Quarterly Newsletter

The Section for Long-Term Care has published New Generations – Volume 11, Issue 3, Summer 2013.  This issue is now available on our website, along with an archive of previous newsletters.  Please visit

Missouri’s New Time Critical Diagnosis (TCD) System


Missouri’s emergency medical response system saves thousands of lives every year, and now improvements will assist health care providers in providing quicker, more coordinated responses when victims of medical emergencies dial 911

The new TCD System was developed in partnership with the Missouri Department of Health and Senior Services, the Missouri Foundation for Health and other health-related organizations and health care professionals throughout the state.

To learn more about the improvements, please visit  You may share this life-saving information by distributing the printable publications located here to members of your organization.

Emergency Generator Online Survey

Emergency Generator Survey data collection 80% complete

You may complete the online survey at

In a situation where electricity is disrupted it is helpful for emergency planners to know which nursing homes have back-up generators and perhaps more importantly, which do not have back-up generators.  This web-based survey asks whether you have an emergency generator (or not), its fuel type, your ability to connect a temporary generator and other data helpful in an emergency situation.  This data can be valuable to DHSS and your local emergency planners in their preparedness plans, but the data collection is not yet complete.  If you have not completed the generator survey, please help us by doing so now.  At the end of the survey, you will have an opportunity to “opt out” of sharing this data with other emergency preparedness agencies if you prefer.

Please remember that since different levels of care may be housed in different buildings or may have different electrical service, we need a separate survey for each licensed level of care.  Also, if you have had a significant change in your generator set-up since completing the survey, or if you do not remember if you completed the survey, please contact Melissa Hope, Planner II, at (573) 522-1333 or send an email to

Thank you for your participation in this effort.