19 CSR 30-88.010 - Resident Rights
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
(27) In a residential care facility or an
assisted living facility, if it is ever necessary to use a restraint in case of
emergency, the resident shall be reevaluated immediately for appropriateness of
placement and transferred if necessary. II/III
(28) All information contained in a
resident's medical, personal or financial record and information concerning
source of payment shall be held confidential. Facility personnel shall not
discuss aspects of the resident's record or care in front of persons not
involved in the resident's care or in front of other residents. Written consent
of the resident or his or her legally authorized representative shall be
required for the release of information to persons not otherwise authorized by
law to receive it. II/III
(29) Each
resident shall be treated with consideration, respect, and full recognition of
his or her dignity and individuality, including privacy in treatment and care
of his or her personal needs. All persons, other than the attending physician,
the facility personnel necessary for any treatment or personal care, or the
department or Department of Mental Health staff, as appropriate, shall be
excluded from observing the resident during any time of examination, treatment,
or care unless consent has been given by the resident. II/III
(30) No resident shall be required to perform
services for the facility. If the resident desires and it is not
contraindicated by his or her physician, the resident may perform tasks or
services for himself or herself or others. II/III
(31) Each resident shall be permitted to
communicate, associate, and meet privately with persons of his or her choice
whether on the resident's initiative or the other person's initiative, unless
to do so would infringe upon the rights of other residents. The person(s) may
visit, talk with, and make personal, social, or legal services available,
inform residents of their rights and entitlements by means of distributing
educational materials or discussions, assisting residents in asserting their
legal rights regarding claims for public assistance, medical assistance and
Social Security benefits, and engaging in any other methods of assisting,
advising, and representing residents so as to extend to them the full enjoyment
of their rights. The facility, however, may place reasonable limitations on
solicitations. II/III
(32) The
facility shall permit a resident to meet alone with a person or persons of his
or her choice and provide an area which assures privacy. II/III
(33) Telephones appropriate to the residents'
needs shall be accessible at all times. Telephones available for residents' use
shall enable all residents to make and receive calls privately.
II/III
(34) If the resident cannot
open mail, written consent by the resident or his or her legally authorized
representative shall be obtained to have all mail opened and read to the
resident. II/III
(35) Each resident
shall be permitted to participate, as well as not participate, in activities of
social, religious, or community groups at his/her discretion, both within the
facility, as well as outside the facility, unless con-traindicated for reasons
documented by physician in the resident's medical record. II/III
(36) Each resident shall be permitted to
retain and use personal clothing and possessions as space permits. Personal
possessions may include furniture and decorations in accordance with the
facility's policies and shall not create a fire hazard. The facility shall
maintain a record of any personal items accompanying the resident upon
admission to the facility, or which are brought to the resident during his or
her stay in the facility, which are to be returned to the resident or
responsible party upon discharge, transfer, or death. II/III
(37) Each married resident shall be assured
privacy for visits by his or her spouse. II/III
(38) If both husband and wife are residents,
they shall be allowed the choice of sharing or not sharing a room.
III
(39) If siblings and/or a
parent and his or her child are both residents, the facility shall allow the
family members the choice of sharing or not sharing a room upon availability of
room(s) appropriate to accommodate the residents. III
(40) Each resident shall be allowed the
option of purchasing or renting goods or services not included in the per diem
or monthly rate from a supplier of his or her own choice, provided the quality
of goods or services meets the reasonable standards of the facility. Each
resident shall be allowed the option of purchasing his or her medications from
a pharmacy of his or her choice, provided the quality of the medications and
packaging meets reasonable standards of the facility.
(41) Residents shall not have their personal
lives regulated or controlled beyond reasonable adherence to meal schedules and
other written policies which may be necessary for the orderly management of the
facility and the personal safety of the residents. II
(42) All written accounts of the resident's
funds shall be brought current monthly and a written statement showing the
current balance and all transactions shall be given to the resident, or his or
her next of kin, legally authorized representative, or designee on a quarterly
basis and upon request. The facility shall keep written receipts of all
personal possessions and all funds received by or deposited with the facility
and all disbursements made to or on behalf of the resident and shall disclose
such receipts to the resident, and/or his or her next of kin, legally
authorized representative, or designee upon request. II/III
(43) The resident, or his or her next of kin,
legally authorized representative, or designee shall receive an itemized bill
for all goods and services actually rendered. No later than thirty (30) days
after the discharge or death of a resident, the operator of the facility shall
submit a final itemized bill for all goods and services rendered, showing any
credit balances accruing on the date of discharge or death of the resident, and
a complete account of the resident's remaining funds with the facility, in any
account, with whatever title the account(s) may be known, to the resident's
guardian, conservator, fiduciary of the resident's estate, or the individual
who was designated to receive the quarterly accounting of all financial
transactions made. II/III
Notes
*Original authority: 198.009, RSMo 1979, amended 1993, 1995; 198.073, RSMo 1979, amended 1984, 1992, 1999, 2006, 2007; 198.076, RSMo 1979, amended 1984, 2007; 198.079, RSMo 1979, amended 2007; 198.088, RSMo 1979, amended 1988, 1989, 1994; and 660.050, RSMo 1984, amended 1988, 1992, 1993, 1994, 1995, 2001 .
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.