HS HCS HB 454 -- Residential Care Facilities (Stokan)

Current law stipulates that Residential Care Facilities I and II
may admit and care for only those persons who are mentally and
physically capable of negotiating a path to safety and who do
not require hospitalization or skilled nursing care.  This bill
allows these facilities to admit and care for persons who are
physically capable but mentally incapable of negotiating a path
to safety if certain requirements are met.  These requirements
include the following:

(1) The residential care facility is equipped with an automatic
sprinkler system approved by the Division of Aging;

(2) The facility's automatic fire alarm system and smoke
barriers meet the life safety code for existing intermediate
care and skilled nursing facilities;

(3) Residents are housed only on the ground floor in multi-level
facilities, unless certain safety standards are met;

(4) Personal warning devices are used to protect these
residents; and

(5) Facility staff are awake, dressed, and prepared to assist
residents in case of an emergency.

The bill also:

(1)  Establishes minimal staffing patterns, which are one staff
for every 15 residents during the day shift, one staff for every
20 residents during the evening shift, and one staff for every
25 residents during the night shift.  For residents mentally
incapable of negotiating a pathway to safety, the facilities are
required to provide 3 times the minimum number of staff;

(2) Requires assessment by a licensed health care professional
upon admission, at least semiannually, and when there is a
significant change in condition, for residents mentally
incapable of negotiating a pathway to safety.  An individualized
plan is to be developed, based on the assessment, to meet the
specific needs of the resident; and

(3) Specifies the minimum amount of orientation and training
that newly hired staff are required to receive, and the amount
of ongoing staff training which must be provided.

FISCAL NOTE:  Estimated Net Increase to General Revenue Fund of
$711,750 in FY 1998, $2,325,009 in FY 1999, & $2,380,416 in FY
2000.

HCS HB 454 -- RESIDENTIAL CARE FACILITIES

SPONSORS:  Gunn (Stokan)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Social
Services, Medicaid and the Elderly˙by a vote of 15 to 0.

Current law stipulates that Residential Care Facilities I and II
may admit and care for only those persons who are mentally and
physically capable of negotiating a path to safety and who do
not require hospitalization or skilled nursing care.  This bill
allows these facilities to admit and care for persons who are
physically capable but mentally incapable of negotiating a path
to safety if certain requirements are met.  These requirements
include the following:

(1) The residential care facility is equipped with an automatic
sprinkler system approved by the Division of Aging;

(2) The facility's automatic fire alarm system and smoke
barriers meet the life safety code for existing intermediate
care and skilled nursing facilities;

(3) Residents are housed only on the ground floor in multi-level
facilities, unless certain safety standards are met;

(4) Personal warning devices are used to protect these residents;

(5) Minimal staffing patterns are established, which are one
staff for every 15 residents during the day shift, one staff for
every 20 residents during the evening shift, and one staff for
every 25 residents during the night shift.  For residents
mentally incapable of negotiating a pathway to safety, the
facilities are required to provide 3 times the minimum number of
staff;

(6) Requires periodic assessment of the residents, including an
assessment when a plan of care is developed for any resident
mentally incapable of negotiating a path to safety; and

(7) Specifies the minimum amount of orientation and training
that newly hired staff are required to receive, and the amount
of ongoing staff training which must be provided.

FISCAL NOTE:  No impact on state funds.

PROPONENTS:  Supporters say that allowing dementia patients to
remain in residential care facilities is sound policy because
(1) it avoids the emotional and physical upset caused when these
patients must move to a skilled nursing facility; and (2) it
results in great cost savings to the state and to families.

Testifying for the bill were Representatives Stokan and Murphy;
Missouri Association of Homes for the Aging; Missouri
Residential Care Association; Lutheran Retirement Home,
Jefferson City; and JoAnn Kiesling.

OPPONENTS:  Those who oppose the bill say that the substitute
would require facilities, at great cost, to increase their
staffing levels in order to ensure the safety and care of
dementia patients.

Testifying against the bill were Tiffany Care Centers; and

Missouri Health Care Association.

Debra Cheshier, Research Analyst

HB 454 -- Residential Care Facilities

Co-Sponsor:  Stokan, Murphy

Current law stipulates that Residential Care Facilities I and II
may admit and care for only those persons who are mentally and
physically capable of negotiating a path to safety and who do
not require hospitalization or skilled nursing care.  This bill
allows these facilities to admit and care for persons who are
physically capable but mentally incapable of negotiating a path
to safety if certain requirements are met.  These requirements
include the following:

(1) The residential care facility meets or exceeds the fire
safety standards for intermediate and skilled facilities in the
areas of automated sprinkler systems; fire alarm systems; fire
exits; and smoke barriers;

(2) The facility provides additional staff training, including
training on the care and safety of residents with dementia;

(3) For these residents, the facility provides twice the number
of personnel needed for meeting fire safety staffing
requirements; and

(4) No more than 50% of the facility's population includes such
residents.