Missouri Code of State Regulations › Title 19 - DEPARTMENT OF HEALTH AND SENIOR SERVICES › Division 30 - Division of Regulation and Licensure › Chapter 88 - Resident's Rights and Handling Resident Funds and Property in Long-Term Care Facilities › Section 19 CSR 30-88.010 - Resident Rights

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes requirements for
				  protection of resident rights in all types of licensed long-term care
				  facilities.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
AGENCY NOTE: All rules relating to long-term care
				  facilities licensed by the department are followed by a Roman Numeral notation
				  which refers to the class (either Class I, II or III) of standard as designated
				  in section 198.085.1, RSMo.
(1) The facility shall retain and make
				available for public inspection at the facility to facility personnel,
				residents, their next of kin, legal representatives or designees and the
				general public, a list of names, addresses and occupations of all individuals
				who have a property interest in the facility as well as a complete copy of each
				official notification from the Department of Health and Senior Services (the
				department) of violations, deficiencies, licensure approval, disapprovals, or a
				combination of these, and responses. This includes, as a minimum, statements of
				deficiencies, copies of plan(s) of correction, acceptance or rejection notice
				regarding the plan(s) of corrections and revisit inspection report.
				II/III
(2) Any notice of
				noncompliance shall be posted in a conspicuous location along with a copy of
				the most recent inspection reports, as required by section
				198.026(6),
				RSMo. II/III
(3) A copy of the most
				current department rules governing the facility shall be kept available and
				easily accessible in the facility for review by residents, their next of kin,
				legally authorized representatives or designees, and the public.
				II/III
(4) Each resident admitted
				to the facility, or his or her next of kin, legally authorized representative
				or designee, shall be fully informed of the individual's rights and
				responsibilities as a resident. These rights shall be reviewed annually with
				each resident, and/or his or her next of kin, legally authorized representative
				or designee, either in a group session or individually. II/III
(5) All incoming and present residents, or
				their next of kin, legally authorized representatives or designees in a
				facility shall be provided statements of resident rights and a copy of any
				facility policies which relate to resident conduct and responsibilities. Such
				information shall be provided in a manner which effectively communicates, in
				terms the resident can reasonably be expected to understand, those rights and
				responsibilities. II/III
(6) The
				facility shall document the disclosure of resident's rights information as
				required in sections (4) and (5). III
(7) Information regarding resident rights and
				facility rules shall be posted in a conspicuous location in the facility and
				copies shall be provided to anyone requesting this information. Informational
				documents which contain, but are not limited to, updated information on
				selecting an Alzheimer's special care unit or program shall be given by a
				facility offering to provide or providing these services to any person seeking
				information about or placement in an Alzheimer's special care unit or program.
				III
(8) Prior to or at the time of
				admission and during his or her stay in the facility, each resident and/or his
				or her next of kin, legally authorized representative or designee shall be
				fully informed, in writing, of services available in the facility and of
				related charges, including any charges for services not covered by the
				facility's basic per diem rate or federal or state programs. Information shall
				include procedures to be followed by the facility in cases of medical
				emergency, including transfer agreements and costs. All residents who receive
				treatment in an Alzheimer's special care program or unit and their next of kin,
				legally authorized representatives or designees shall be given a copy of the
				Alzheimer's Special Care Services Disclosure Form at the time of admission.
				Residents also shall be informed of services outside the facility which may
				reasonably be made available to the resident and of any reasonable estimate of
				any foreseeable costs connected with those services. II/III
(9) Prior to or upon admission, each
				prospective resident or each resident, or his or her next of kin, legally
				authorized representative or designee shall be informed of the home and
				community based services available in this state by providing such resident a
				copy of Missouri's Guide to Home and Community Based Services (Revised 4/4/05),
				incorporated by reference, provided by the Missouri Department of Health and
				Senior Services, PO Box 570, Jefferson City, MO 65102-0570 and which is
				available to long-term care facilities at
www.ged.oa.mo.gov/PICServices/
Pamphlet/index.shtml or by telephone at 1-800-235-5503. This rule does not
				incorporate any subsequent amendments or additions. III
(10) Prior to or upon admission and at least
				annually after that, each resident or his or her next of kin, legally
				authorized representatives or designees shall be informed of facility policies
				regarding provision of emergency and life-sustaining care, of an individual's
				right to make treatment decisions for himself or herself and of state laws
				related to advance directives for health-care decision making. The annual
				discussion may be handled either on a group or on an individual basis.
				Residents' next of kin, legally authorized representatives or designees shall
				be informed, upon request, regarding state laws related to advance directives
				for health-care decision making as well as the facility's policies regarding
				the provision of emergency or life-sustaining medical care or treatment. If a
				resident has a written advance health-care directive, a copy shall be placed in
				the resident's medical record and reviewed annually with the resident unless,
				in the interval, he or she has been determined incapacitated, in accordance
				with section
				475.075
				or
				404.825,
				RSMo. Residents' next of kin, legally authorized representatives or designees
				shall be contacted annually to assure their accessibility and understanding of
				the facility policies regarding emergency and life-sustaining care.
				II/III
(11) A physician shall fully
				inform each resident of his or her health and medical condition unless
				medically contraindicated. If the physician determines the resident's medical
				condition contraindicates the resident being fully informed of his or her
				diagnosis, treatment or any known prognosis, the medical record shall contain
				documentation and justification of this signed by the physician. If there is a
				legally authorized representative to make health-care decisions, or the
				resident has designated any individual to have access, that person shall be
				fully informed of the resident's medical condition and shall have free access
				to the resident's medical records for that purpose, subject to the limitations
				provided by a power of attorney, duly-executed authorization or any federal
				law. I/II
(12) If the facility has
				a policy which requires that residents' medications be bubble packed or
				otherwise individual dose packaged, the facility shall, prior to each
				resident's admission, make such information available to the resident and/or
				his or her next of kin, legally authorized representatives, designees or
				placement authority. II/III
(13)
				Each resident shall be afforded the opportunity to participate in the planning
				of his or her total care and medical treatment, to refuse treatment and to
				participate in experimental research only upon his or her informed written
				consent. If a resident refuses treatment, this refusal shall be documented in
				the resident's record and the resident, his or her legally authorized
				representatives or designees, or both, shall be informed of possible
				consequences of not receiving treatment. II
(14) Each resident shall have the privilege
				of selecting his or her own physician who will be responsible for the
				resident's total care. II
(15) No
				resident shall be transferred or discharged except in the case of an emergency
				discharge unless the resident, and the next of kin, or a legally authorized
				representative or designee, and the resident's attending physician and the
				responsible agency, if any, are notified at least thirty (30) days in advance
				of the transfer or discharge, and casework services or other means are utilized
				to assure that adequate arrangements exist for meeting the resident's needs. In
				the event that there is no next of kin, legally authorized representative or
				designee known to the facility, the facility shall notify the appropriate
				regional coordinator of the Missouri State Ombudsman's office. II
(16) A resident may be transferred or
				discharged only for medical reasons or for his or her welfare or that of other
				residents, or for nonpayment for his or her stay. II
(17) No resident may be discharged without
				full and adequate notice of his or her right to a hearing before the
				department's Administrative Hearings Unit and an opportunity to be heard on the
				issue of whether his or her discharge is necessary. Such notice shall be given
				in writing no less than thirty (30) days in advance of the discharge except in
				the case of an emergency discharge and must comply with the requirements set
				forth in
				19 CSR
				30-82.050. II/III
(18) In emergency discharge situations the
				facility shall submit to the resident and his or her next of kin, legally
				authorized representative or designee a written notice of discharge. The
				written notice of discharge shall be given as soon as practicable and advise
				the resident of the right to request an expedited hearing. In the event that
				there is no next of kin, legally authorized representative or designee known to
				the facility, the facility shall send a copy of the notice to the appropriate
				regional coordinator of the Missouri State Ombudsman's office. II/III
(19) A room transfer of a resident within a
				facility, except in an emergency situation, requires consultation with the
				resident as far ahead of time as possible and shall not be permitted where this
				transfer would result in any avoidable detriment to the resident's physical,
				mental or emotional condition. II/III
(20) Each resident shall be encouraged and
				assisted, throughout his or her period of stay, to exercise his or her rights
				as a resident and as a citizen and to this end a resident may voice grievances
				and recommend changes in policies and services to facility personnel or to
				outside representatives of his or her choice. A staff person shall be
				designated to receive grievances and the residents shall be free to voice their
				complaints and recommendations to the staff designee, an ombudsman or to any
				person outside the facility. Residents shall be informed of and provided a
				viable format for recommending changes in policy and services. The facility
				shall assist residents in exercising their rights to vote. II/III
(21) The exercise of resident rights shall be
				free from restraint, interference, coercion, discrimination or reprisal.
				II/III
(22) Each resident shall be
				free from abuse. Abuse is the infliction of physical, sexual, or emotional
				injury or harm and includes verbal abuse, corporal punishment, and involuntary
				seclusion. I
(23) The facility
				shall develop and implement written policies and procedures that prohibit
				mistreatment, neglect, and abuse of any resident and misappropriation of
				resident property and funds, and develop and implement policies that require a
				report to be made to the department for any resident or to both the department
				and the Department of Mental Health for any vulnerable person whom the
				administrator or employee has reasonable cause to believe has been abused or
				neglected. II/III
(24) The facility
				shall ensure all staff are trained on the applicable laws and rules regarding
				reporting of suspected abuse and neglect of any resident. II
(25) If the administrator or other employee
				of a long-term care facility has reasonable cause to believe that a resident of
				the facility has been abused or neglected, the administrator or employee shall
				immediately report or cause a report to be made to the department. Any
				administrator or other employee of a long-term care facility having reasonable
				cause to suspect that a vulnerable person has been subjected to abuse or
				neglect or observes such a person being subjected to conditions or
				circumstances that would reasonably result in abuse or neglect shall
				immediately report or cause a report to be made to the department and to the
				Department of Mental Health. I/II
(26) The resident has the right to be free
				from any physical or chemical restraint except as follows:
(A) When used to treat a specified medical
				symptom as a part of a total program of care to assist the resident to attain
				or maintain the highest practicable level of physical, mental, or psychosocial
				well-being. The use of restraints must be authorized in writing by a physician
				for a specified period of time; or
(B) When necessary in an emergency to protect
				the resident from injury to himself or herself or to others, in which case
				restraints may be authorized by professional personnel so designated by the
				facility. The action taken shall be reported immediately to the resident's
				physician and an order obtained which shall include the reason for the
				restraint, when the restraint may be removed, the type of restraint, and any
				other actions required. When restraints are indicated, only devices that are
				the least restrictive for the resident and consistent with the resident's total
				treatment program shall be used. I/II