Missouri Assisted Living Facilities, Essay Example

Pertaining to Missouri’s State Assisted Living Facilities specifically: What are the requirements for admission, what are the mandated staff requirements, what training is mandated?

Though Missouri Assisted Living facilities are in general the same to the other states’ assisted living facilities, there are some certain aspects that are specific to Missouri. In order to find out the peculiarities of the Assisted Living in Missouri let’s consult the Code of State Regulations, Title 19 – Department of Health and Senior Services, Division 30 – Division of  Regulation and Licensure, Chapter 86 – Residential Care Facilities and Assisted Living Facilities.

Code of State Regulations specifies clearly what is necessary for an appropriately trained and qualified individual. It means that an individual is “licensed or registered with the state of Missouri in a health care related field” or it is an individual “with a degree in a health care related field” or an individual “with a degree in a health care, social services, or human services field” or an “individual licensed under Chapter 344, RSMo, and who has received facility orientation training”, “and dementia training, and twenty-four hours of additional training, approved by the department, consisting of definition and assessment of activities of daily living, assessment of cognitive ability, service planning, and interview skills” (CSR, 2009). Exact staff requirements depend on staff position, be it aide, nurse or administrator. For positions that require certification or licensure it is obligatory to provide documents evidencing – “copies of current licenses, transcripts when applicable, or for those individuals requiring certification, such as certified medication technicians, level I medication aides and insulin administration aides” (CSR, 2009).  CNA, CMT and Insulin Registry contain information about latter positions and possible training, which includes many points necessary for all staff.

For employees of Assisted Living facilities it is necessary to have criminal background checked prior to working with residents. In case of “Class A or B felony violation of Chapter 565, 566, or 569, RSMo or any violation of subsection 198.070.3, RSMo or of section 568.020, RSMo” (CSR, 2009) the employee has no right to contact residents. In case of criminal records or any offences related to controlled substances an employee should not be allowed to handle controlled substances (CSR, 2009).

Staffing requirements are: one staff person for every fifteen residents during the day shift; one person for every twenty evening shift; one person for every twenty-five during the night shift.

There must also be a licensed nurse working at least 8 hours per week at the facility for every thirty residents (CSR, 2009).

Kind of training that is necessary for mandated staff can be taken from U.S. Department of Health and Human Services, “High Service or High Privacy Assisted Living Facilities, Their Residents and Staff: Results from a National Survey” (Hawes, Phillips, 2000). One of the chapters of this work is devoted to staff working in Assisted Living facilities. General principles and requirements for their work and training are common for all states.

Out of 100 percent of staff there were 19.5 percent of licensed professionals, 51.4 percent of nursing/resident assistants, 14.9 percent of medication technicians, and other (Hawes, Phillips, 2000). Most personnel were unlicensed; 75 percent of them were required to take pre-service training.

The training included number of topics that were expected to occur in the given circumstances. The training covered the next topics: first aid (79%), how to provide personal care (92), information about Alzheimer’s disease (80%), information about dealing with challenging behaviors (83%), residents’ rights (96%), and medication management (67%) (Hawes, Phillips, 2000). Authors of the review claim that “the staff also reported that they received training on or orientation to the philosophy of assisted living and how that philosophy differs from traditional care in nursing homes or other residential settings” (2000); this is an important part of training and is required for those who are licensed professionals. It is important to learn about what is normal for aging person and what is not, how to manage medications, how to deal with memory loss, and how to deal with unforeseen situations. This knowledge enables staff to recognize disturbing but curable conditions and not to mistake them for elderly behaviors.

When it comes to admission of residents there are few specific features about it. Code of State Regulation provides the next information. The facility must take care of licensed number of residents and not exceed this number. Residents must be mentally and physically capable of negotiating a normal path to safety, using assistive devices or aides when necessary. Medicaid reimbursement is available for personal care services. Residents under sixteen years must not be admitted (2009).

“The facility shall ensure that each resident being admitted or readmitted to the facility receives an admission physical examination by a licensed physician”, the documentation of the physical examination should be requested by the facility prior to admission and received on file within 10 days after admission (CSR, 2009).

“The physical examination shall contain documentation regarding the individual’s current medical status and any special orders or procedures to be followed. If the resident is admitted directly from an acute care or another long-term care facility and is accompanied on admission by a report that reflects his or her current medical status, an admission physical shall not be required” (CSR, 2009).

Code of State Regulations expresses directly what kind of person can be called the qualified and trained individual when it comes to licensure and verification. Skills that are necessary for the Missouri Assisted Living staff include dealing with Alzheimer’s disease, dementia, memory loss, knowledge of residents’ rights, first aid basics and psychological issues. Licensure and certification details are regulated by corresponding laws. In general, Missouri’s assisted living staff requirements differ slightly from federal ones.

Why do Home Health aides need different training than skilled nursing facilities aides?

Sometimes work of aide is considered to be simple and aide’s duties seem identical irrespective of her specialty. In this case there can be defined three different directions of aide work – home health aides, nursing aides and psychiatric aides. They have different duties and thus their training should also differ.

Occupational Outlook Handbook in the article “Nursing, Psychiatric, and Home Health Aides” gives description and brief comparison of the aides’ work. According to it, nursing aides duties include mainly helping patients to eat, dress, and bathe. They can also “answer calls for help, deliver messages, serve meals, make beds, and tidy up rooms” (OOH, 2007). Nursing activities like taking a “patient’s temperature, pulse rate, respiration rate, or blood pressure” (OOH, 1007) can be also attributed to rare aide’s tasks. Nursing aide’s work can include helping patients to get in and out of bed, to walk, to guide them anywhere they need; sometimes it includes helping other medical staff to set up the equipment, to store and move supplies, or to assist with some procedures. Nursing aides also “observe patients’ physical, mental, and emotional conditions and report any change to the nursing or medical staff” (OOH, 2007). Nursing aides have more contact with patients than any other medical staff. They may create friendly atmosphere when caring for residents who stay in the nursing facilities for the long time.

Home health aides usually help elderly, convalescent, or disabled persons to live in their own homes instead of health care facilities (OOH, 2007). They are directed by medical or nursing stuff and thus they provide health-related services. They have common duties with nursing aides as they may take patients’ pulse rate, temperature, or respiration rate; provide help with simplest therapeutic exercises; and help patients to get in and out of bed, to bathe, to dress, or to groom (OOH, 2007). Specially trained home health aides may assist with medical equipment (ventilators which help patients to breathe).

Most home health aides provide help with elderly or disabled people because they need more extensive care than their general caregivers (family, friends) can provide. Occupational Outlook Handbook gives the next peculiarities of the home health aide:

“In home health agencies, a registered nurse, physical therapist, or social worker usually assigns specific duties to and supervises home health aides, who keep records of the services they perform and record each patient’s condition and progress. The aides report changes in a patient’s condition to the supervisor or case manager. Home health aides generally work alone, with periodic visits from their supervisor. They receive detailed instructions explaining when to visit patients and what services to perform.” (OOH, 2007)

When it comes to work with patients in their homes aides have more responsibilities than nursing aides. First of all, they must arrive on time and they are individually responsible for it; they have no supervisors that can help them in emergency situations. They can face situations when their clients may need physical help. Home health aides are different from health facilities aides in the way they take care and in their responsibilities.

“Nursing aide training is offered in high schools, vocational-technical centers, some nursing care facilities, and some community colleges. Courses cover body mechanics, nutrition, anatomy and physiology, infection control, communication skills, and resident rights. Personal care skills, such as how to help patients to bathe, eat, and groom themselves, also are taught” (OOH, 2007). Though the training gives the base for the work of nursing aides, there are usually many things that they learn within the process of work from other aides or nurses.

Home health aides work usually does not require high school diploma. The home health aides frequently are trained by registered nurses, licensed practical nurses, or experienced aides. Home health care includes not only nursing care, but also physical and occupational therapy, speech-language therapy services, etc. Services provided by home health aide can also include medical social services or assistance from a home health aide (when needed by people also receiving skilled care) (OOH, 2007).

Occupational Outlook Handbook suggests that every time the home health aide visits your home he or she should check what client is eating and drinking; check client’s blood pressure, temperature, heart rate, and breathing rate; ensure that client is taking your medicines correctly; check client’s safety; teach client so as he can take care of himself (2007). All their aforementioned duties imply frequent and regular communication with the client, his doctor or any other caregiver.

In your opinion, what is the most important component of Hospice care and why?

For those who choose hospice care it is a hard decision. Being with the beloved person to the end of his or her life may seem a grim but solemn mission. But sometimes it is hard both for dying person and for his or her family to withstand the terminal illness with all its difficulties and complications. Then hospice care is the solution, as it “addresses two big fears a dying person may have — the fear of pain and the fear of being alone” (Mayoclinic). It provides an ease of pain, stress, and loneliness of the beloved but ill people.

Hospice care includes several points that are supposed to provide relief and help to those who need it. It includes the next components (Mayoclinic): palliative care, which implies medications provision and care of the doctor; therapies if necessary, provided to the dying person; respite care, which implies residential or home care in order to help the family (caregivers) the rest; help with daily needs provided to dying people; religious services, which imply visits of chaplain, etc.; counseling in order to ease the solution of legal issues; and bereavement care, which implies work with the relatives and family. All of these features nowadays are indivisible and integral parts of hospice care.

In my opinion it is hard to choose the most important component of hospice care out of these, but several components give the most important things. I think that the most important component of hospice care is palliative care along with help with daily needs and caregivers’ visits. I can explain my point of view.

Hospice care is an expensive service for those who have no Medicare reimbursements. High prices make hospices a kind of elite places for those who seek for calmness and comfort. And it is the chance for dying people to enjoy their last days and to come to terms with the thought of death. Hospice may help them to solve their lifetime problems, find peace and opportunity to communicate with chaplain, lawyer, etc.

When the person knows that the death is close then he or she thinks of eternal values: family, friendship, inner serenity and harmony. And pain relief can make the death less intimidating, less stressful. Thus it gives room for the thoughts about life, reminiscences and meetings with dear people. The last care – help with daily routine – makes people feel that they are cared of and beloved. Then, sometimes terminally ill people may have dreams and may want them to come true; support of family and staff, as well as proper medication, may even make their last days happy.

Of course, the death of the close relative or friend is bereavement. But mere thought that there are people in the hospice who can help, support, relieve and calm your beloved person is calming and gives hope.

Why was “Palliative Care” added to the provision of Hospice Care?

Hospice care is a complex care that is intended to ease the time before death, provide relief and serenity. As it was said above, fear of pain is one of the most important problems of the dying person. And palliative care is a solution of this problem.

Palliative care is a kind of medical care that is focused on pain relief, managing of stress or other symptoms of serious and terminal illnesses. It is not necessarily a hospice care, as it can be provided at the same time as disease treatment.

In hospice care palliative care has a special meaning. Because of hospice care main purpose, palliative care is an important and sometimes key element. What is so special about palliative care? Why it is not enough to meet religious needs and help with daily needs?

For dying person it may be not enough to receive casual daily care and love of the relatives. People that resort to hospice care want to take stock of their lives, to think and to do what they want to. Dealing with stresses related to close death is a main target of hospice care. When residents come to terms with the thought of forthcoming death, they need something to be important to them. Casual duties and daily problems are not parts of their life any more. If so, pain and discomfort may distract them from their thoughts and make the last days gloomy and excruciating. That is not what hospice care strives for.

Palliative care approaches pain and stress relief in a delicate way. It is not simple analgesia; it is a customer-oriented approach to relief and serenity. Palliative care is now an indivisible part of modern hospice care, either residential or home for it eases last days, helps to concentrate on other issues, enjoy attention and love of people one hold dear and in the long run to go to the one’s last home peacefully and calmly.

Works Cited

Hawes, Catherine, Phillips, Charles D. “High Service or High Privacy Assisted Living Facilities, Their Residents and Staff: Results from a National Survey” Texas A&M University System Health Science Center. November 2000. July 23, 2009 <http://aspe.hhs.gov/daltcp/reports/hshp.htm#chap4>

“Code of State Regulations, Title 19 – Department of Health and Senior Services, Division 30 – Division of  Regulation and Licensure, Chapter 86 – Residential Care Facilities and Assisted Living Facilities” Missouri  Secretary of State Robin Carnahan. June 30, 2009. July 23, 2009 < http://www.sos.mo.gov/adrules/csr/current/19csr/19csr.asp>

“Hospice care: An option when confronting terminal illness” MayoClinic.com July 23, 2009 < http://www.mayoclinic.com/health/hospice-care/HQ00860/NSECTIONGROUP=2>

“Nursing, Psychiatric, and Home Health Aides” Occupational Outlook Handbook 2007. July 23, 2009 <http://www.bls.gov/oco/ocos165.htm>