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.

**Winter Weather Planning**

Snow and ice are a mainstay of Missouri winter weather. Because of the variety of weather conditions as well as other events, facilities must have an emergency preparedness plan and be ready to act in an emergency to ensure they are to adequately prepared to meet the needs of patients, clients, residents, and participants during disasters and emergency situations.

If your facility experiences a loss of a necessary service (electricity, water, gas, phone, etc.), contact SLCR via the Regional Office emergency phone line and keep them informed of their status. If, for some reason, the facility cannot contact SLCR staff through the regional office phone number, you should contact the hotline. The emergency protocol is located here.

 When you call, be prepared to answer to the following:

 Facility name

    • Census, including staff assessment of current needs of the residents and monitoring of the ill.
    • Contact person and emergency contact number that is not the facility main line.
    • Has the facility called the fire department and central monitoring company if phones, alarm systems are down?
    • Generator: Y/N
      • If yes, what equipment does the generator serve (fire alarm, HVAC systems)?
      • If yes, amount of fuel onsite and/or system for delivery? How long will fuel last?
      • If no, what is fire watch plan?
      • If no, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner?
        • Obtain generator- is the home set up to receive generator power once delivered? Estimated time for delivery? Estimated time when generator power will be established.
        • Evacuation- Where is facility relocating to, distance from facility, transportation to get there, staffing, sufficient supplies/medications, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner (does the location have a functional emergency generator?) If relocating to a SNF – will the home be over capacity? Is there sufficient beds/space in the receiving facility to house the extra residents?
      • Documentation may be requested, including:
        • If evacuated, a list of residents and were they went
        • Room temperature logs
        • Fire watch documentation


Here are a few things to consider in examining your emergency preparedness plan, specifically as it relates to snow, ice, and power outages.

  • If there is a loss of the primary power, how will the facility ensure adequate temperatures of the facility will be maintained during the emergency situation?
  • Is the plan feasible?
    • Plan for the worst. Most events do not occur on a sunny Tuesday afternoon and the plan should account for things such as poor weather, road conditions, weekends/holidays, evenings, staff ability to travel to work, and other obstacles that may cause issue during the actual emergency.
  • Are staff knowledgeable of the plan and have access to what is needed in order to implement the plan?
    • Phone numbers, contact persons, contracts.
  • Do staff know what to do during an emergency and know who is in charge? If the administrator is not onsite, who is in charge and does that person know all their duties?
    • This may be the DON, but it may also be a charge nurse (or another designated onsite staff)if the event happens in the “middle of the night”. Depending on when the administrator or someone higher up on the order of succession can arrive at the facility, that person (i.e. night charge nurse) may be in charge for an extended amount of time.
  • Is the plan detailed enough?
    • Is there a detailed plan that describes when the residents will evacuate during an emergency? If loss of power, does the plan instruct the staff to start the evacuation prior to the point when the facility is below appropriate air temperatures and to maximize their safety during travel? What is the distance to the emergency evacuation site? What types of roads do they have to traverse, such as “side roads”, bridges, or interstates; all of these roads can have their challenges. Does the facility have more than one contracted emergency site?
      • Is it likely that emergency events will also impact the surrounding areas? It is also possible that the evacuation site may be so far away, residents may not be able to get there when road conditions are less than optimal. Does the contracted site meet all the criteria to allow the residents to shelter in place at that location?
    • Is there a contract for transportation and will that transportation be able to get the residents to and from their current location to the contracted emergency location in a snow/ice storm? If the services have other contracted uses, such as school buses, will they be available at 3:00 P.M. on a school day or can they get drivers at 3:00 A.M. on a Wednesday?
  • Does the facility have a generator?
    • Is there enough fuel, a contract to get more fuel, and a list of what it does and does not operate?
      • Facilities (and the staff in charge) need to know in advance, what their generator will operate. At a minimum, this listing must include whether it runs: Life safety equipment (such as E-lights and fire alarm system(s)), magnetic door locks/door alarms (where applicable for safety), HVAC systems, cooking systems, what outlets residents and staff will be able to be use, and computer equipment/Wi-Fi (if electronic medical records (EMR) are utilized).
      • This list needs to be detailed so staff will know specifically what items will and will not work during a power outage. Many generators will run every second or third ceiling light for emergency lighting, but not all lights in the facility will work during a power outage. This needs to be listed so all staff will know that information.
    • If a facility does not have a generator, what are the plans when it may not be easily able to evacuate due to poor road conditions or other factors that may prohibit a smooth transition from a facility to another location?
      • If the facility plans to have a generator delivered during a loss of power, does the facility have a contract with the generator company to deliver one to them? This contract should include the size of the generator that the facility will need in order to ensure the safety and care needs of the residents are met during the emergency.
        • The building will need to be wired and ready to accept the generator in advance. The facility will not be able to install a generator during the emergency event unless the wiring for the generator has already been completed.
      • Facilities must maintain at least their fire safety equipment (E-lights, fire alarm, sprinkler system, range hood (if any cooking occurs), food, water, heating and cooling, and sewage disposal to shelter in place.
        • There must be a plan of how this will be achieved, emergency supplies, the detailed list of what the generator will run, and any contracts that will be needed during the emergency to ensure these services can continue during the emergency event.
          • Sometimes trucks will not be able to run regular schedules and it may take several days before the facility can get their first delivery after an emergency starts; depending on the extent and severity of the disaster.
        • A power outage may be as simple as a blip, may last for hours, or may last for days – depending on the extent of the power grid damage and when the crews can access the problem(s).
          • The facility needs a plan of when, how, and where they will evacuate if they cannot provide at least the components of the previous bullet point.

During a disaster is the least ideal time to learn an emergency plan will not work or to search for a contracted service. All contracted services including, but not limited to, transportation, fuel needs, evacuation location, food, and water needs to be in the emergency plan. The emergency preparedness team needs to consider and plan all services and contract prior to an actual emergency. During an emergency, it may be very difficult or impossible to get a contracted service due to volume of request, road conditions, and/or other factors.

Thank you for preparing in advance and keeping us informed!

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.

From Inside Out: Gardens Meet Unmet Needs – Free Webinar

March 25, 2014:  Focusing on specific case studies, Jack Carman of Design for Generations will discuss how communities have worked together to create exciting outdoor gardens that involve both a person-directed process and excellent outcomes.  Please visit The Eden Alternative website at www.edenalt.org/component/option,com_registrationpro/Itemid,25/view,events/, or click here to register.

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 http://sema.dps.mo.gov/.

New Generations Quarterly Newsletter – Winter 2014

The Section for Long-Term Care has published New Generations – Volume 12, Issue 1, Winter 2014.  This issue is now available on our website, along with an archive of previous newsletters.  Please visit http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

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 joan.brundick@health.mo.gov.

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: http://health.mo.gov/emergencies/ert/alertsadvisories/index.php.

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 www.cdc.gov/flu/index.htm.

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 http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

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 www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.html.

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 www.usfa.fema.gov/citizens/home_fire_prev/holiday-seasonal/holiday.shtm.

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.

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 http://health.mo.gov/LTCsurvey/

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 http://health.mo.gov/emergencies/readyin3/adultcare.php.

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 http://www.cpsc.gov/Newsroom/Multimedia/?vid=61711.

View the news release here:  www.cpsc.gov/en/Newsroom/News-Releases/2014/CPSC-Urges-Consumers-to-Replace-Batteries-in-Smoke-and-CO-Alarms-When-Turning-Clocks-Back-/.

Carnegie Village to hold Alzheimer’s Fundraiser

September 14, 2013:  Bikes, Bingo & Babybacks in Belton, Missouri
Enjoy a 120-mile scenic tour from Belton to Weston with four bingo stops along the way.  The ride will end with a BBQ lunch at The Farmer’s House.  Pre-registration cost is $30 for rider & $25 for passenger and includes a T-shirt, breakfast, one bingo card and BBQ lunch.  Online registration is available at http://bikesbingoandbabybacks.ezregister.com/

For more information, please contact Gina Hodges, LNHA, Carnegie Village Assisted Living, 103 Bernard Drive, Belton, Missouri, 64012, Telephone 816-322-8444.  

Each year, individuals and organizations such as civic groups, social clubs, restaurants and businesses raise thousands of dollars for the Alzheimer’s Association – Heart of America Chapter.  To learn more about DIY fundraisers, please visit http://www.alz.org/kansascity/in_my_community_13212.asp

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 http://health.mo.gov/seniors/nursinghomes/providerinfo.php.

Governor’s 100 Missouri Miles Challenge

Governor Nixon and the First Lady are encouraging all Missourians to get outside and take advantage of the incredible resources found here in the Show-Me State by joining the Governor’s 100 Missouri Miles Challenge.

Whether you run, walk, bike, paddle, or roll, everyone can participate.  The initiative is an opportunity to promote Missouri’s outdoor heritage, improve your health and have fun with family and friends.

  • Missouri has been named the “Best Trails State” by American Trails, a national, nonprofit organization working on behalf of the nation’s hiking, biking and riding trails.
  • The national award is presented every two years to the state that has made tremendous contributions to promote and improve their trails system.
  • Missouri State Parks offers almost 1,000 miles of managed trails.
  • Missouri is also the home of the Katy Trail, the longest developed rail-trail in the nation.

Starting on June 1, 2013, the Department of Health and Seniors Services and the Governor’s Office are challenging Missourians to complete “100 Missouri Miles” of physical activity by the end of the year.  Just visit the challenge website at www.100missourimiles.com to get started!  The website includes an official registry, a mileage tracker, health tips (including for seniors) a directory of trails (and their length) and an event calendar of upcoming outdoor Missouri events.

Emergency Generator Survey

Does your home have an emergency generator?  Is your home’s electrical system pre-wired to accept a temporary emergency generator?  Knowing your status in advance of an emergency can be vital to responders and to recovery efforts.

Due date extended – if your home has not submitted the survey yet, please support this community emergency preparedness effort by completing the online survey.  This survey will provide quick access to vital information about your home in the event of an emergency.

Click here to complete the Emergency Generator Survey

The Missouri Department of Health & Senior Services (DHSS), Section for Long-Term Care Regulation, is gathering emergency generator information for all licensed long-term care homes in the state as part of our emergency preparedness and planning objectives.  Our intention is to gather information in advance, since communication during a disaster (like the Joplin tornado) may be impossible or could be disruptive to a facility focused on caring for residents.  This data will give DHSS the ability to quickly provide information during an actual emergency to governing bodies and to the DHSS Center for Emergency Response and Terrorism to coordinate with responding agencies so that they may identify the most vulnerable populations first.  Homes that do not complete the survey will be contacted.  If you have any questions regarding the Emergency Generator Survey, please contact Melissa Hope at 573-522-1333 or email:  Melissa.Hope@health.mo.gov.

Extreme Heat Conditions

The Department of Health & Senior Services website contains helpful resources during extreme heat conditions.  Please visit:  http://health.mo.gov/living/healthcondiseases/hyperthermia/index.php

Centers for Disease Control and Prevention (CDC) guidance:  Your best defense against heat-related illness is prevention.  Staying cool and making simple changes in your fluid intake, activities, and clothing during hot weather can help you remain safe and healthy.  Please visit:  http://www.bt.cdc.gov/disasters/extremeheat/

National Institute on Aging Newsroom, NIH provides heat-related illness advice for older people: http://www.nia.nih.gov/newsroom/2012/06/hyperthermia-too-hot-your-health