DHSS Antibiotic Stewardship Survey

The Missouri Antimicrobial Stewardship Educational Collaborative is working with Washington University on an antibiotic stewardship project and are seeking input from Skilled Nursing Facility and other Long Term Care Facilities (Intermediate, Assisted, and Residential Care Facilities), in addition to MO hospitals. Please take a few minutes to complete their survey.

Washington University School of Medicine is performing a survey on behalf of the Missouri Department of Health and Senior Services, Hospital Associated Infections and Antimicrobial Resistance Program.

The survey can be found at the attached link here: Survey Link. It should take approximately 15 minutes to complete.

This survey is intended to evaluate the current state of antimicrobial stewardship activities at Missouri long-term care facilities. Please forwards it to whomever at your facility is most involved with the antimicrobial stewardship and the management of antimicrobial use, or if no such person exists your medical director or pharmacy leadership. We request this survey be completed by March 1, 2024.

For any questions regarding this facility antimicrobial stewardship survey, please submit a new email to mo.stewardship@wustl.edu; use “MO DHSS Antimicrobial Stewardship Survey” in the subject line.

We appreciate the time you take to complete these surveys!

REMINDER! The Long-Term Care Ombudsman Program Bed and Service Availability Portal is now available!

Long-Term Care Facilities (all levels of care) are strongly encouraged to complete an electronic survey weekly to report how many beds they have available, and which residents they can serve, i.e., memory care, behavioral health, bariatric, etc. This information is used to generate a dashboard that is beneficial to facilities, families, hospital discharge planners and the general public to determine bed availability and services throughout the state. Please access the survey at this link: survey. To view the dashboard access this link: dashboard.

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.

This is a great opportunity to share what your facility has to offer!

Director of Food and Nutrition Services Qualifications

We have recently received in influx of questions related to the qualifications for director of food and nutrition services in skilled nursing facilities. The federal regulation (F801) requires one of the following qualifications (if a qualified dietician or other clinically qualified nutrition professional is not employed full-time):

  1. A certified dietary manager; or
  2. A certified food service manager; or
  3. Has similar national certification for food service management and safety from a national certifying body; or
  4. Has an associate’s or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management, from an accredited institution of higher learning; or
  5. Has 2 or more years of experience in the position of director of food and nutrition services in a nursing facility setting and has completed a course of study in food safety and management, by no later than October 1, 2023, that includes topics integral to managing dietary operations including, but not limited to, foodborne illness, sanitation procedures, and food purchasing/receiving.

CMS has noted that the approved certifications and course requirements would be the equivalent of a ServSafe Food Manager certification. Additional food manager courses we have found to meet the requirements include: AAA Food Handler, Learn2Serve, and State Food Safety.

COMRU Update

The online application link (Level 1 form/Level of Care) for applications submitted prior to 07/16/2023 (green link) will no longer be available after 02/01/2024.

Skilled Nursing Facilities will want to ensure they have printed/saved a copy of the processed Level 1 form/Level of Care form and Level 2 screening (if applicable) for resident records as these are required per regulation and may be requested during the state survey process.

  • Additionally, please remember that all processed applications are to be deleted from the COMRU online application system 60 days after completion.

COMRU website: https://health.mo.gov/seniors/nursinghomes/pasrr.php.

Should you have any questions, please contact COMRU via email (COMRU@health.mo.gov).

CDC Health Advisory

Please see the CDC Health Alert, entitled, “Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV Immunizations and Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023 – 2024 Winter Season.”

Missouri healthcare providers please contact your local public health agency or the Missouri Department of Health and Senior Services’ (DHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7) with questions regarding this CDC Health Advisory.

Reminder – Infection Prevention Toolkits

Reminder that the Missouri Department of Health and Senior Services (DHSS) in moving into the next Phase of the COVID Prevention and Response Project. Phase II is an effort to provide iPads, conference video cameras, electronic stethoscope and digital blood pressure unit to all Missouri Skilled Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities and Residential Care Facilities.

The deadline for ordering is December 8, 2023.

These kits are being provided to your facility at no charge by the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project. Should you have any questions regarding this project, please contact Mary Menges, Project Specialist, at mary.menges@health.mo.gov.

Update – Infection Prevention Toolkits

On September 29, 2023, you received information from the LTC List Serve regarding the Infection Prevention Toolkit that would be delivered to your facility later this month as part of the COVID Prevention and Response Project of the Missouri Department of Health and Senior Services (DHSS). DHSS has entered into an agreement with Concordance Healthcare Solutions to deliver this Infection Prevention Toolkit to your facility with costs being paid by the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project.

Contents of this Infection Prevention Toolkit include:

Pulse Oximeter: Fingertip
Digital Non-Contact Thermometer
3M Fit Testing Kit: BITREX
3M Fit Testing Solution: Saccharin 55 mL Fluid Volume
3M Respirator Wipes: Non-Alcohol
Glo Germ Glo Box Kit with 8oz gel

For those facilities who are in need of Respiratory Fit Testing assistance please contact the Healthcare Associated Infections/Antimicrobial Resistance Program at LTCStrikeTeam@health.mo.gov.

We will be using the administrator’s name and facility address as listed on the DHSS Website https://health.mo.gov/seniors/nursinghomes/licensecert.php as well as the information for the eight hospital based skilled nursing facilities for delivery and contact purposes. Shipment of the Toolkits will begin the week of October 23, 2023.

Phase II of the COVID Prevention and Response Project will focus on working with the facilities in hopes of acquiring needed communication equipment to assist in outbreak control, training and real-time communication with healthcare providers and the Strike Team. In the coming weeks you will receive information on how to order these devices.

Please contact Mary Menges, Project Specialist, at mary.menges@health.mo.gov should you have any questions or concerns regarding with project.

CNA Certification Renewals

Please log into TMU and check your CNA status on the registry to ensure you are not inactive or expired.

In January 2023, the registry had 74,443 CNAs active. September 2023, the registry is showing 48,732 CNAs currently active. This shows approximately 25,000 CNA’s did not renew their certification.

Information on how to log into the registry, what documents are required to be uploaded and instructions on how to renew your CNA certification are provided in the links below.

Link to TMU: MO TMU (tmutest.com)
MO Renewal Guide – Instructions
CNA Renewal Documentation

You may call the Health Education Unit at 573-526-5686 or email us at CNARegistry@health.mo.gov for any questions.

Infection Control Resources Coming Your Way!

Message from the Department of Health and Senior Services Strike Team Project

The Department of Health and Senior Services (DHSS) through the use of the Nursing Home & Long-Term Care Facility Strike Team and Infrastructure Project funds is embarking upon a multiphase project to assist in COVID prevention and response. All Missouri Skilled Nursing Facilities, Intermediate Care Facilities, Assisted Living Facilities and Residential Care Facilities will be a part of this project.

Following models from other states, Phase I of this project will be the delivery of an Infection Prevention Toolkit to all of the above mentioned facilities. This Infection Prevention Toolkit will be delivered at no cost to all of the facilities. Later this fall the Healthcare Associated Infections/Anti-microbial Resistance Program will also be sending out two infection control reference books from the Association for Professional Infection Control and Epidemiology to assist the facilities in infection prevention.

Additional information will be coming in early October on the delivery of the Infection Prevention Toolkits as well as outlining the contents of the Infection Prevention Toolkit and expected date of shipping. Again, this Infection Prevention Toolkit will be delivered to your facility at NO Cost.

The next Phase of this project will be working with the facilities in hopes of acquiring needed communication equipment to assist in outbreak control, training and real-time communication with healthcare providers and the Strike Team. Lastly, we hope to offer the facilities the opportunity to order needed infection and prevention supplies.

Thank you all for your continued efforts to care and protect the citizens of our State.

Improving the DHSS Web Experience

The Missouri Department of Health and Senior Services is looking to simplify your online experience. To help us evolve that experience, we need your help. We’d like to invite you to take a short survey to share your thoughts, feedback and reactions about the experiences you have had with the DHSS website.

This survey should take 10 minutes to complete and will be open through October 2, 2023.

Upon completion of this survey, you will be entered into a drawing for one of three $100 gift cards. Click here to start the survey.

We appreciate your continued partnership with DHSS and look forward to hearing from you.

COVID Rise in LTC Facilities

COVID infections are on the rise in Missouri’s long-term care facilities. A few things to remember…

Follow CDC Guidance:

Skilled Nursing Facilities: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Flong-term-care.html

  • Place a patient with suspected (e.g., those with runny nose, cough, sneeze) or confirmed SARS-CoV-2 infection in a single-person room. The door should be kept closed (if safe to do so). Ideally, the patient should have a dedicated bathroom. If cohorting, only patients with the same respiratory pathogen should be housed in the same room.

Residential Care and Assisted Living may follow community guidance – https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html?CDC_AA_refVal=h

Report Positive Cases

Facilities performing their own COVID-19 testing (antigen testing) must report positive results through one of the following portals:

  1. Missouri Disease Reporting Online Portal (MODROP)
  2. In bulk via HL7 or CSV file using the DHSS- Electronic Lab Reporting process
  3. National Healthcare Safety Network (NHSN) or the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) Platform.

Facilities using an external laboratory (PCR testing) must enter positive case information into MODROP.

The Missouri Disease Reporting Online Portal (MODROP). MODROP can be accessed directly from https://modrop.health.mo.gov/ or by using the existing ECD-1 link at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/case-reporting.php and selecting the MODROP button.

NOTE: The recommended browser for use of MODROP is Google Chrome. Other browsers may cause issues with MODROP.

Facilities will need to register for a MODROP account the first time they use the new portal. MODROP allows reporting of only COVID-19 cases. Reports of other reportable conditions may be faxed to 573-751-6417.

If you have any questions or encounter any issues utilizing MODROP or for questions about HL7 or CSV reporting, please reach out to the EpiTrax Help Desk via e-mail at epitrax@health.mo.gov.

Please see the FAQ and thank you for your efforts to provide complete and accurate COVID-19 data to public health.

The ICAR Team Can Help!

QIPMO has formed an Infection Control and Assessment and Response (ICAR) team with a primary goal to assist Missouri Long-Term Care Facilities navigate the challenges of the COVID-19 pandemic and other infectious diseases.

Members of the ICAR Team are available for voluntary, no cost visits (virtual and/or in-person) to any residential care, assisted living, and skilled nursing facility in Missouri. These visits are intended to consultative and collaborative in nature with a non-regulatory focus to evaluate inflection control practices. Visits will consist of:

  • completion of a standardized assessment of infection control processes, focusing on highly-transmittable infectious diseases
  • observations of infection control practices
  • preliminary feedback with supplemental educational resources

See flyer for full details.

FREE Resource! Center of Excellence for Behavioral Health In Nursing Facilities

The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) was established in September 2022 by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with the Centers for Medicare and Medicaid Services (CMS). It provides mental health and substance use training, customized technical assistance and resources to certified Medicare and Medicaid nursing facility staff who care for residents with a variety of behavioral health conditions at absolutely no cost to certified nursing facilities. They help nursing facilities to improve the quality of life and care provided for residents who are experiencing a variety of behavioral health disorders, with a focus on Serious Mental Illness (SMI), Substance Use Disorder (SUD), Co-Occurring Disorders (COD) and Serious Emotional Disturbance (SED).

Online resources are also available free for other providers too! Find out more: Home – COE-NF (nursinghomebehavioralhealth.org)

Administrator Update Information Changes

New Rule Change – effective 06/30/23

19 CSR 73-2.130 – Notice of Change of Contact Information and Missouri Administrator Employment

  1. Each administrator shall notify the board office of his/her current contact information within ten (10) calendar days of change for any of the following:
    1. Personal contact information, which shall include administrator license number, personal mailing address, email, and telephone number(s); and
    2. Missouri administrator employment, which shall include, administrator license number, facility name, mailing address, telephone number(s), and employment dates.

Please visit https://health.mo.gov/bnha/contactupdate.php for the online form for BNHA.

Please note: The Board of Nursing Home Administrators and the Section for Long Term Care Regulation (SLCR) each have requirements for reporting a Change of Administrator/Manager in a Long Term Care Facility. Please be sure to follow the requirements for each Section.

For SLCR, please submit the change of administrator or manager via a letter or by using the online form. Forms/letters can be submitted via email to LTCApplication@health.mo.gov or by mail to Department of Health and Senior Services, Section for Long-Term Care Regulation, Licensure and Certification Unit, PO Box 570, 920 Wildwood, Jefferson City, MO 65102.

COMRU Survey Access Code

COMRU is providing the following guidance regarding the online application entitled “Application started prior to 07-16-2023” (the green link).

COMRU will be providing you with a “Survey Access Code”; please note this is different from the return code.

  • The “Survey Access Code” will allow the submitter to access the application to check the status.
  • If the submitter clicks “Submit- Ready for Processing by COMRU” or “Save and Return Later”, the submitter will be provided with a “Return Code”. At this point, the “Survey Access Code AND the “Return Code” will be needed to access the application in the future.
  • Please do not click the “Start Over” button, as this will DELETE the Entire Application. (COMRU will not be able to retrieve the application if this occurs).

Please do not hesitate to contact COMRU at 573-522-3092 for any questions.

Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity

The Strike Team has made an informative webinar for SNF/LTC and Other facilities describing the Missouri Nursing Facility Strike Team and Infrastructure Reimbursement Opportunity. This webinar reviews; how to get to the site where they can find the application, the Application Guidance and Frequently Asked Questions, steps needed to apply, and other useful information. This webinar has been posted to the Health Care Professionals page on the DHSS website.

COMRU Return Codes

We have some good news and some bad news!

The bad news….due to a required change in the database platform, the COMRU online applications for Level 1/Level 2 (old DA124s) forms will no longer be accessible by your CURRENT RETURN CODES after Friday, July 14, 2023.

The good news…you can still access the online applications and COMRU can continue to process applications you submitted! However, as of MONDAY, JULY 17, a NEW RETURN CODE will be required to access all applications entered prior to July 17, 2023.

Please note – this change will not affect any application initiated after July 17, 2023. You will continue to receive a valid return code for all new applications submitted to COMRU after July 17, 2023.

What do I need to do?!

If you recently submitted the application (before July 17) – a new return code will be provided to you when COMRU reviews your application. Otherwise, if you need to make a change or need to receive the new code for applications initiated prior to July 14, 2023, please email the following to COMRU (COMRU@health.mo.gov):

Name of Individual
Name of Facility
Admission Date (if admitted to SNF)

We appreciate your patience during this transition process and apologize for any inconvenience.

Updated Missouri Nurse Aid Candidate Handbook

The DHSS Health Education Unit and Headmaster D & S would like to announce some revisions to the skills portion of the CNA exam shown in the Candidate Handbook effective July 1, 2023. Please see the new updated version at Missouri Nurse Aide Candidate Handbook (hdmaster.com) for the changes.

Please contact the DHSS Health Education Unit at 573-526-5676 and/or Headmaster D & S at 800-393-8664 for any questions.

Dangerous Heat Warnings for Missouri

The National Weather Service has issued a heat advisory for portions of Missouri for Thursday, June 29 and Friday, June 30. As temperatures rise this summer, it is important to prioritize heat related safety measures. Heat-related illnesses can have serious consequences, but with some precautions and awareness, we can create a safer work environment.

Heat-related illnesses often affect the very young, the elderly and the chronically ill, but summer temperatures can also take a toll on healthy young and middle-aged adults. In 2022, 23 people died from heat exposure in Missouri, ranging in age from 2-83 years.

During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center – is the best preventive measure.

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

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. Medications, as well as use of drugs or alcohol, can impair a body’s response to heat, making one more vulnerable to the heat.

Never leave a child or pet alone in a vehicle. Four of Missouri’s heat-related deaths in 2022 were individuals in vehicles. Even on a cooler day, the temperature inside a vehicle can rise by 20 degrees in 10 minutes and pose a real threat to anyone left inside. Stress, distraction and being out of a normal routine can all contribute to forgetting a child in a car seat. Check the back seat each time you exit your vehicle.

There are a number of steps individuals can take to stay cool including:

  • Stay hydrated. Drink plenty of water regardless of your activity level, and do not wait until you are thirsty to do so. Avoid sugary and alcoholic beverages; these actually cause you to lose body fluids.
  • Wear appropriate clothing. Wear lightweight, breathable, and loose-fitting clothing that allows air circulation. When outside, consider wearing a hat and sunglasses to protect yourself from the sun.
  • Stay cool indoors. Stay in air-conditioned places as much as possible. Find a local cooling center if needed.
  • Schedule outdoor activities carefully. Try to plan outdoor activity for morning or evening hours when the temperature is coolest.
  • Pace yourself. Reduce exercise or physical activity during the hottest part of the day, and take frequent breaks in the shade or in an air-conditioned place.
  • Wear sunscreen. Sunburn affects your body’s ability to cool down and can make you dehydrated.
  • Prepare your home. Change air conditioner filters, and cover windows that receive morning or afternoon sun with drapes or shades.
  • Stay informed. Pay attention to weather forecasts and heat advisories. Stay informed about the local heat index and adjust safety measures accordingly.

Knowing the signs and symptoms of heat related illness and how treat them is also important. Signs of heat exhaustion may include muscle cramps; heavy sweating; cold, pale and clammy skin; dizziness; headache; nausea or vomiting; and fainting or passing out. If you think you or a loved one are experiencing heat exhaustion, you should stop physical activity move to a cool place – preferably air-conditioned, loosen clothing, and sip cool water. Seek medical attention immediately if you are throwing up, your symptoms get worse or symptoms last longer than one hour.

Signs of heat stroke may include high body temperature (103°F or higher); hot, red, dry or damp skin; fast, strong pulse; headache; dizziness; nausea; confusion; or loss of consciousness. If you think you or a loved one are experiencing heat stroke you should call 911 immediately. Heat stroke is a medical emergency. Move the person to a cool place – 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.

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