SLCR has received questions regarding whether or not Skilled Nursing Facilities can be a clinical or on the job training sight for students entering health care fields. The quick answer is YES! Long-term care facilities can use the guidance from CMS memo QSO 20-39-NH and DHSS visitation guidance as a way to say “YES” to hosting schools who are training our next workforce in long-term care. Students can be considered health care workers who are not employees of the facility but provide direct care to the facility’s residents. They can be permitted to come into the facility as long as they are not subject to a work exclusion due to an exposure to COVID-19 or showing signs or symptoms of COVID-19 after being screened. Facilities should work with the schools to ensure they are aware of infection control policies and procedures and to whom questions can be addressed.

The most recent visitation guidance from CMS and DHSS can be accessed on our website:

For questions related to this, please contact

Following recent announcements from the US Food and Drug Administration and the Centers for Disease Control and Prevention, certain immunocompromised individuals can begin receiving third doses of COVID-19 vaccine in Missouri.

A third dose of the PfizerNBioTech or Moderna vaccines may be administered to moderately to severely immunocompromised people due to a medical condition or combination of immunosuppressive medication or treatments including but not limited to the following:

  • Immunocompromised due to solid organ transplant and taking immune suppressing medications
  • Immunocompromised due to active treatment for solid tumor and hematologic malignancies
  • Immune compromised due to Receipt of CAR-T cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate to severe primary immunodeficiency (eg., DiGeorge, Wiskott-Aldrich Syndromes)
  • Immunocompromised due to Advanced or untreated HIV infection
  • Immunocompromised due to “Active treatment with high-dose corticosteroids or other drugs that may suppress immune response: high dose corticosteroids (ie.,≥ 20 mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blocker or other biologic agents that are immunosuppressive or immunomodulatory”

Individuals who do not meet the criteria for “moderately to severely immunocompromised” do not need a third dose at this time.

In line with federal guidelines, Missouri will use a self-attestation model for people who are moderately to severely immunocompromised. Individuals will not be required to provide documentation of their health status, and they can get third doses at all venues where first and second doses are available.

This guidance does not apply to those who received the Janssen/Johnson & Johnson vaccine. For people who received either Pfizer-BioNTech or Moderna’s COVID-19 vaccine series, a third dose of the same mRNA vaccine should be used. A person should not receive more than three mRNA vaccine doses at this time. If the mRNA vaccine product given for the first two doses is not available or is unknown, either mRNA COVID-19 vaccine product may be administered. Individuals should wait at least 28 days between their second and third doses.

Announcements from federal health officials came after the analysis of studies demonstrating that immunosuppressed people are more likely to get severely ill from COVID-19, are at higher risk for prolonged infection, are more likely to transmit the virus, and experience lower vaccine effectiveness.

Additional information regarding this guidance can be found on the CDC website at

Interim clinical considerations for use of COVID-19 vaccines can be found at

Missouri’s revised standing orders can be found at

Due to the recent increase in COVID activity in skilled nursing facilities as well as outbreaks in assisted living communities, here are some resources that may be of interest to your members and ask that you share this material as widely as possible.

Below, you will find a fact sheet and social media graphics that reiterates important infection prevention strategies, including promoting COVID-19 vaccinations and continuing to wear a mask. This factsheet can be emailed to staff or used as a poster to reinforce the urgent actions CDC is asking of all healthcare providers and staff in long-term care facilities.

Additionally, there are also two slide decks that were reviewed on our partner call last week. The first slide deck summarizes the urgent action CDC recommends for protecting residents and staff from COVID infections as well as information about how CDC is working to ensure vaccine access for long-term care facilities. The second slide deck provides additional information about monoclonal antibody treatment.

LTC Infection Control Delta Factsheet
2021-08-11 LTC MAb update Slide Show
NH partner summary_21-08


Finally, below are links to existing web resources. Please share these as well.

The Department of Health and Senior Services has entered into a contract with SLS Health to assist with staffing needs for healthcare facilities, including long-term care facilities. The contract will allow skilled nursing, intermediate care, assisted living or residential care facilities to access the contract to secure healthcare staffing according to a firm, fixed rate. Payment for the staffing costs will be borne by the respective facility. Please see below attachments for additional information about the contract, how to access staffing resources, and applicable rates.

Missouri’s COVID-19 Healthcare Augmentation LTC slides
Attachment B

As of August 13, 2021, any Shanghai Dasheng Health Products Manufacture Co., Ltd. respirator with a NIOSH approval label containing a revoked approval number is no longer NIOSH-approved and cannot be manufactured, assembled, sold, or distributed.

See the link below to find the approval numbers of the respirators that have been de-certified. The approval number starts with TC-84A. If you can’t find this number on the respirator or its packaging, it was never NIOSH approved in the first place and shouldn’t be used, but if it has any of the listed TC numbers in the link below on the respirator itself or its packaging, you should discontinue use immediately and remove from use any that have been distributed.

Changes are underway for CDC’s Weekly NHSN COVID-19 Vaccination Modules. In anticipation of recommendations for additional COVID-19 vaccine series, new questions on COVID-19 vaccine doses will be added to the current data collection forms in August 2021. The main changes to the forms for all three facility types are listed below:

  • Added question #4 for facilities to report on the cumulative number of individuals eligible to receive an additional dose or booster of COVID-19 vaccine.
  • Added question #5 for facilities to report on the cumulative number of individuals who received an additional dose or booster of COVID-19 vaccine (by manufacturer type).

To help facilities prepare for these changes, CDC is conducting listen-only training webinars.

Topic: Changes to the Weekly NHSN COVID-19 Vaccination Data Collection Forms for Long-Term Care Facilities
Date: Wednesday, Aug 25, 2021
Time: 2:30 – 3:30 PM ET

Below is a link to the Missouri Department of Health and Senior Services COVID-19 after action survey. This survey is designed to gather feedback from a variety of healthcare and public health partners and organizations. Please respond by selecting the discipline that reflects your organization and submit one survey per organization, excluding state agency partners. Your responses to this survey should be based on your organizations role and perspective of the COVID response. Receiving input from a variety of stakeholders, at all levels of the response, will help us better identify our strengths and weakness of the public health and medical services emergency Support function.

Please see this FAQs for more information. Thank you in advance for your participation!


We have recently noticed several facilities that have used their fire alarm zones as part of their evacuation plan. The fire alarm zones are the zones on the fire alarm panel used to help staff identify the location of the fire. These are different from smoke zones, which are the zones in the building created to prevent the spread of smoke and fire and allow staff time to complete a full evacuation of the building. Many facilities have fire alarm zones that do not match the smoke zones in the facility. Often times there are more fire zones to help staff identify the location of a fire.

To start a smoke zone evacuation, it may be necessary to evacuate multiple fire alarm zones at the same time. The evacuation plans need to have these smoke zones clearly labeled and all staff need to know where they will move the residents in the event of a fire. The facility cannot base their evacuation plans on the fire alarm zones.

In this example, the facility has eight fire alarm zones (Fire Zones 1-8). The facility has a smoke barrier wall that divides the facility into two smoke zones (Smoke Zones A and B). The facility also has a secured unit, but the controlled egress doors (locked keypad doors) are not a part of the smoke barrier wall, so the secured unit is part of Smoke Zone A.

If a fire occurs in Fire Zone 4, it means that an evacuation of all residents would need to occur throughout Smoke Zone B, which would include all residents in Fire Zones 3, 4, and 5. The evacuation plan may mention things like room number, dining rooms, etc., but should avoid using fire zones to describe the smoke zones. Although it is important to know which smoke zone activated the fire alarm system, staff cannot move the residents from Fire Zone 4 to Fire Zone 5, as they are still within Smoke Zone B. Staff must completely move the residents out of Smoke Zone B.

In addition, it is significant to note if a fire occurred in Smoke Zone A (i.e. Fire Zones 1 or 6), the staff would need to move residents in the secured unit from Smoke Zone A. Staff cannot leave the residents in the secured unit since a smoke barrier wall does not protect the secured unit and it is not its own smoke zone.

The facility must have the evacuation plans posted on at least every floor of the facility [19 CSR 30-85.022 (33)(B)(2)] which directs all staff, residents, and visitors where to go in the event of a facility evacuation. The policy and procedure for evacuations also needs to be in the emergency preparedness manual.

NFPA 99, 2012 edition Where buildings are required to be subdivided into smoke compartments, fire alarm notification zones shall coincide with one or more smoke compartment boundaries or shall be in accordance with the facility fire plan.

August 22-25, 2021: MHCA 73rd Annual Convention & Trade Show
Location: Branson Convention Center, Branson

The long-term care industry faced enormous challenges in 2020 due to the COVID-19 pandemic. Thanks to your hard work and perseverance, along with widespread access to vaccines, we feel comfortable about gathering in person in Branson.

Click HERE to view a message from MHCA Executive Director, Nikki Strong, regarding an update to safety protocols and masking requirements for the MHCA 73rd Annual Convention & Trade Show.

August 26, 2021: Empowering Elder Well-Being with Supportive Technology

Today’s elders have more ways than ever to stay connected with their loved ones, but tech support at Life Plan Communities and other senior living campuses isn’t always geared toward them – and common resources online may not include solutions unique to their needs.

Even though the strict lockdowns at nursing homes and other communal settings have eased considerably, the pandemic revealed the very real need for elders to master technology in order to combat loneliness, provide entertainment, and even stay on top of their health through apps and wearables.

On August 26 at 3 p.m. ET, Join GroovyTek, The Green House Project, and the Pioneer Network for a can’t-miss discussion on empowering elders with technology.

Using the International Council on Active Aging’s Seven Dimensions of Wellness as a guide, we’ll:

  • Explore the current state of older adults’ relationship with technology,
  • Discuss strategies to overcome barriers to adopting common tech tools,
  • Discover how tech can promote elders’ independence, wellbeing, and health,
  • Hear directly from an elder about her personal experience with tech,
  • And much more.

September 22, 2021: Envisioning the Future: Finding Meaning & Purpose

Pioneer Network is proud to present the third in its series of four Symposia for 2021, each based on the theme, Envisioning the Future. In this symposium, the focus is on Finding Meaning & Purpose. Speakers include residents and innovators in the field who will draw on their experiences, including the collective experiences encountered as we all lived through the pandemic. They will explore how to find meaning and purpose for those who live and work in senior living communities as well as how we can move forward in a way that assures that isolation becomes a thing of the past, acknowledging that wherever we may reside, life is lived best in community.

September 22, 2021: Finding and Keeping Great Co-Workers
Presenter: Clint Maun, CSP

Healthcare Providers have taken the needed action to fight a global pandemic and have established the required systems to contain and prevent the spread of the Corona Virus. The never-before-seen challenges we have experienced in 2020 has made it more vital than effort to have superior staff in all roles in 2021. We know healthcare professionals and staff can work together to achieve amazing success at workforce stabilization which will also benefit our customers. Join Clint Maun for an overview of proven teaming strategies during this time of opportunity, including processes to build workforce resilience and reduce burnout.

Join us for this important Virtual meeting.

  • COVID-19 Vaccine Supply Questions

Healthcare personnel and resident COVID-19 vaccination coverage data submitted to NHSN provide critical information to public health officials. These data are used to assess resource needs and enable partner coordination for the deployment of vaccination supply and administration support.

We ask that you pay close attention to the following questions in the Vaccine Supply section of the vaccination coverage forms:

  1. For the current reporting week, please describe the availability of COVID-19 vaccine(s) for your facility’s residents:
    • 1. Is your facility enrolled as a COVID-19 vaccination provider? [Select Yes or No]
    • 2. Did your facility have a sufficient supply of COVID-19 vaccine(s) to offer all residents the opportunity to receive COVID-19 vaccine(s) from your facility in the current reporting week? [Select Yes or No]
    • 3. Did your facility have other arrangements sufficient to offer all residents the opportunity to receive COVID-19 vaccine(s) in the current reporting week (examples of other arrangements include referring to the health department or pharmacies for vaccination)? [Select Yes or No]
    • 4. Please describe any other COVID-19 vaccination supply-related issue(s) at your facility. [Optional]

NHSN strongly encourages users to continually review responses to these questions in the NHSN application to ensure the information reported is up-to-date and accurate. This will give public health officials a better sense of any current COVID-19 vaccine supply needs and issues that facilities may be encountering. Data collection forms for residents and healthcare personnel of long-term care facilities can be found under the “Data Collection Forms and Instructions” heading of the following webpage:

If your facility is experiencing issues with COVID-19 vaccine supply, please contact your state or local jurisdiction for assistance and learn more through this CDC webpage:

For questions related to NHSN and data reporting, please contact us at:


  • Changes to NHSN COVID-19 Vaccination Data Reporting for Healthcare Personnel Coming this Fall!

NHSN COVID-19 Vaccination Data Collection Forms for Healthcare Personnel will be Revised

What are the changes?

  1. Data on the current healthcare personnel categories for question #1 will no longer be collected.

New categories will now include:

    • Employees: Staff on facility payroll
    • Licensed independent practitioners: Contracted physicians, advanced practice nurses, and physician assistants
    • Adult students/trainees and volunteers: Non-employee students/trainees and volunteers aged 18 or older
    • Other contract personnel: Contracted staff who do not fall into any of the other denominator categories
  1. Question #3.2 (offered but declined COVID-19 vaccine) and question #3.3 (unknown COVID-19 vaccination status) will now be required.
  2. Question #4 on COVID-19 Vaccine(s) Supply will now be optional.
  3. Facilities will need to create a monthly reporting plan before entering data into NHSN.

How should I prepare?
Long-term care and non-long-term care facilities should develop or update data tracking mechanisms to collect weekly COVID-19 vaccination data on these new categories of healthcare personnel.

How can I learn more?
CDC will be conducting training webinars this fall. More information on these webinars will be shared later this summer, so stayed tuned!

Who do I contact with questions?
Please send an e-mail to with ‘COVID-19 Vaccination Data Reporting’ in the subject line.

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 4/1/21 through 6/30/21 is due August 14, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

PLEASE NOTE: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline. The Service Center will be unable to assist on the weekend. Therefore, phone and email support will be concluded as of Friday August 13, 2021 at 8:00 p.m. (ET).

More information about PBJ can be found on the following webpages:

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for 1/1/21 through 3/31/21 must be submitted no later than 11:59 p.m. on August 16, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to IRFs, LTCHs, and 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 and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

August 20, 2021: A Beautiful Day in the Neighborhood
Guest: LaVrene Norton, Action Pact Founder & Executive Leader and Megan Hannan, Action Pact Consultant; with Host Carmen Bowman

Need help getting everyone out of the doldrums of COVID? Let free the spirit of joy and love – work together to bring back the simple pleasures of home. Create team on the fly. Let music and laughter rock the halls. Wave!

Think Neighborhood. Have a block party.

We begin again with a short presentation on the Artifacts of Culture Change as they can offer us a measurable road map. We will then head down the path to Neighborhood where culture change begins. Where good neighbors work together to enjoy and share the simple pleasures of daily life.

September 14, 2021: Staffing
Location: Ameristar Hotel, St. Charles

September 15, 2021: Staffing
Location: Oasis Hotel, Springfield

September 28, 2021: Staffing
Location: Stoney Creek Hotel & Conference Center, Independence

September 29, 2021: Staffing
Location: Comfort Inn, Macon

CNA Training Update in Missouri

We have been waiting a long time and finally we see the results coming at us from our efforts to update and improve the training of Missouri CNA’s. The process has changed significantly effective August 31, 2021 “technically”. Administrators, DON’s, RN Instructors, HR Staff and CNA Training Organizations will want to understand how these changes affect them and their programs. The CNA Registry process for verification of employment in the last 24 months has also changed and will be handled through a third party site. You should already be registered as an employer and your CNA’s in the new system. This session will review all the new regulations, the new forms and the new testing/registry process through TMU Headmaster.

Staffing Series 2: Take off on the Journey to Improved Staffing

In Series 1, we explored Staffing Turnover and Retention and formulated a Roadmap to take us on a journey to improve staffing, increasing stability and quality of care, life and service for our residents. In this series we will take off on the journey and concentrate on the areas that Series 1 attendants identified as needing the most work; Recruitment and On-Boarding/Training. We will rethink where we are spending recruiting dollars, share ideas for improving landing quality applications and then build on reducing turnover and improving retention with improved and best practice ideas for Staff on-boarding/Orientation and training. Administrators and HR Staff will benefit from this interactive session. If you missed the first session, you can view it on-line on SDS Training site through MANHA.

October 5, 2021: Trauma Informed Care
Location: Oasis Hotel, Springfield

October 6, 2021: Trauma Informed Care
Location: Comfort Inn, Macon

October 7, 2021: Trauma Informed Care
Location: Ameristar Hotel, St. Charles

October 12, 2021: Trauma Informed Care
Location: Stoney Creek Hotel & Conference Center, Independence

Sponsored by Missouri Health Care Association & Missouri Association of Nursing Home Administrators

We will review the regulatory requirements, available resources and necessary policy and procedure changes to keep your facility on the right side of Trauma Informed Care Compliance.

October 10-12, 2021: MALA 2021 Fall Conference
Location: Margaritaville Hotel and Resort, Osage Beach

The tentative conference agenda is now available and includes several speakers and presentations over a three-day period. The option to attend all or just one day is included on the registration form.

Please see the conference link for further details.

The healthcare continuum is again becoming strained with the number of positive cases across the state. This portal was originally established in November to improve communication across the care continuum to assist in ensuring Missourians have access to the right care in the right setting.

We are renewing our request for long-term care communities to complete a brief survey each day in order to identify available beds for potential admissions. Participation in the bed availability survey is voluntary. The survey may be accessed at

The dashboard was reset on July 15th, so any homes that have not submitted data since the reset occurred will need to submit an initial survey – old update links will no longer work. Homes that have submitted data since the reset can continue to submit using the update link.

 Reminder: After submitting the initial survey, a confirmation email will be provided for a link to update your survey each day (instead of submitting a new survey). Submitting a new survey results in multiple surveys showing on the map with different bed numbers. This makes it difficult to know which totals are current. Please use the link emailed after the initial submission to edit facility bed availability. Please do not submit an “initial” submission more than once. If information does not change from day to day, the submitter can simply update the date and submit – the prior day’s information will populate.

The survey information will populate an accompanying dashboard that will be available to hospitals to use as a tool in finding placement for those patients who would be best served in a long-term care setting. This dashboard may be accessed at To view instructions on utilizing the dashboard, click on ‘Instructions’ under the map for information.

QIPMO has collaborated with the Missouri Department of Health and Senior Services (DHSS) in response to the novel Coronavirus known as COVID-19. In doing so, QIPMO has formed a new Infection Control Assessment and Response (ICAR) team with a primary goal of assisting Missouri Long-Term Care Facilities to navigate the challenges of the COVID-19 pandemic and other infectious diseases.

Please see the flyer or visit the following QIPMO webpage –

August 20-21, 2021: CARING for the OLDER ADULT Across the Continuum (Caring for the Frail Elderly) & 17th Annual Health Ethics Conference
Location: Holiday Inn Executive Center, Columbia, MO – (This is a Hybrid event, attend in-person or virtual)

The conference will provide a forum for updating interdisciplinary health professionals caring for older adults in the community, regardless of living situation, in the ethical care and treatment of older adults including, medical management, interdisciplinary care, research, and system change.

Missouri has limited PPE reserves to assist in filling these critical needs and will prioritize healthcare providers providing direct care to confirmed or suspected COVID patients. Note requests should only be submitted after all normal supply chains, including the Missouri COVID Supply Solution, have been exhausted and providers have a supply of twenty-one days or less on hand.

Please be sure to describe the urgent need for PPE and your situation in the comments on the form.

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2020, which will affect their FY 2022 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into SNFs’ CASPER folders in QIES on July 14, 2021. 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 13, 2021.

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.