Missouri

Residential assisted living licensing rules and official state resources

Licensure term: Assisted Living Facilities and Residential Care Facilities
Resident capacity: No maximum. Additional requirements past 12 residents (dishwasher)
Staff ratios: Assisted Living - Minimum staff-to-resident ratios are 1:15 during the day shift; 1:20 during the evening shift; and 1:25 during the night shift. The required staff must be in the facility awake, dressed, and prepared to assist residents in case of emergency. The administrator may count toward staffing when physically present in the facility. A licensed nurse must be employed a minimum number of hours per week based on the number of residents: 8 hours a week for 3-30 residents; 16 hours a week for 31-60 residents; 24 hours a week for 61-90 residents; and 40 hours a week for more than 90 residents.
Cost of licensing: $100 application fee (up to 25 residents)
Bedroom square footage: The total floor space area in common space areas designated as living and dining rooms shall be at least forty (40) square feet per resident
Memory care: Any facility that provides care to any resident that has Alzheimer's disease or related dementia shall provide orientation training regarding mentally confused resident's such as those with Alzheimer's disease and related dementia as follows:

Full requirements

Regulatory Agency: Missouri Department of Health & Senior Services - Long Term Care Regulation Division
Contact Phone Number: 573-526-8524
Licensure Term(s): Assisted Living Facilities and Residential Care Facilities Assisted living Facility means any residence, other than a RCF, intermediate care facility, or skilled nursing facility, that provides 24-hour care and services and protective oversight to three or more adults who need assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs); storage, distribution, or administration of medications; and/or supervision of health care under the direction of a licensed physician. Residential Care Facility means any residence, other than an ALF, intermediate care facility, or skilled nursing facility, that provides 24-hour care to three or more adults who need or are provided with shelter, board, and with protective oversight, which may include storage and distribution or administration of medications and care during short-term illness or recuperation.
Census Requirements: No maximum. Additional requirements past 12 residents (dishwasher)
Qualifications for Caregivers: In both facility types, all staff must receive at least 1 hour of fire safety training and orientation appropriate to job function and responsibilities, including information about preservation of resident dignity, abuse/neglect, and working with residents with mental illness. Any facility that provides care to any resident having Alzheimer's disease or other dementia must provide orientation to all staff. For employees providing direct care to such residents, the orientation training must include at least 3 hours of training, including at a minimum an overview of mentally confused residents; communicating with persons with dementia; behavior management; promoting independence in ADLs; techniques for creating a safe, secure, and socially oriented environment; provision of structure, stability, and a sense of routine for residents based on their needs; and understanding and dealing with family issues. For other employees who do not provide direct care but may have daily contact with such residents, the orientation training must include at least 1 hour of training, including at a minimum an overview of mentally confused residents, such as those having dementias, as well as communicating with persons with dementia. Dementia-specific training must be incorporated into ongoing in-service curricula. Orientation and training must be conducted, presented, or provided by an individual who is qualified by education, experience, or knowledge in the care of individuals with Alzheimer's disease or other dementia. In addition to the requirements listed above, all staff in an ALF must receive a minimum of 2 hours of initial training on transfer assistance (e.g., wheelchair to bed, bed to dining room chair); instruction regarding person-centered care and the social model of care; and techniques that are effective in enhancing residents' choice and control over their environment; and 24 hours of additional training, approved by the Department, consisting of definition and assessment of ADLs; assessment of cognitive ability; service planning; and interview skills.
Staff Ratios: Assisted Living - Minimum staff-to-resident ratios are 1:15 during the day shift; 1:20 during the evening shift; and 1:25 during the night shift. The required staff must be in the facility awake, dressed, and prepared to assist residents in case of emergency. The administrator may count toward staffing when physically present in the facility. A licensed nurse must be employed a minimum number of hours per week based on the number of residents: 8 hours a week for 3-30 residents; 16 hours a week for 31-60 residents; 24 hours a week for 61-90 residents; and 40 hours a week for more than 90 residents. Residential Care Facility - At minimum, there must be one staff person for every 40 residents. Facilities operated in conjunction with and contiguous to another licensed facility may not be required to have staff on-site 24 hours daily based on specified exceptions (e.g., a call system or the number of staff in the other building). Facilities with fewer than 12 residents are not required to have overnight awake staff unless any of those residents are blind or use mobility aids, in which case awake staff are required.
Cost of Licensing: $100 application fee (up to 25 residents)
Square Footage Requirements: The total floor space area in common space areas designated as living and dining rooms shall be at least forty (40) square feet per resident Bedrooms shall have at least 70 square feet per resident
Bathrooms Required: One toilet, bathtub and sink for every six (6) residents
Memory Care Requirements: Any facility that provides care to any resident that has Alzheimer's disease or related dementia shall provide orientation training regarding mentally confused resident's such as those with Alzheimer's disease and related dementia as follows: a) for employees providing direct care there is 3 hours required orientation training including at a minimum an overview of mentally confused residents such as those with Alzheimer's disease and related dementia, communicating with persons with dementia, behavior management, promoting independence in activities of daily living, etc. b) for all employees who do not provide direct care for but may have daily contact with, a minimum of one (1) hour training is required on an overview of mentally confused residents and how to communicate with persons with dementia. c) for all employees involved with care of residents with dementia, dementia specific training shall be incorporated into annual ongoing inservice-training