1. Code of State Regulations State Statutes Rules & Regulations
There are a variety of staff positions an in-home services agency is required to maintain. We will discuss the hiring requirements and education/experience requirements that each of these staff members must meet, the training requirements and adequate documentation.

2. Hiring Requirements
If a person qualifies, they can fill several of the staff positions we will be discussing. For instance, if all other hiring requirements are met, a registered nurse can fill the position of the registered nurse and the designated manager.
Or, if all hiring requirements and education/experience requirements are met, a person could qualify to be the designated manager, advanced personal care aide and basic aide.

3. Hiring Requirements Family Care Safety Registry (FCSR)
Employee Disqualification List (EDL)
Reference checks
In addition to meeting experience and education requirements of their specific position, all employees must also be screened and employable with the
Family Care Safety Registry, or FCSR,
the Employee Disqualification List, or EDL
The FCSR and EDL requirements are discussed in the Protective Services/EDL session.
And the final requirement is to have two reference checks. These reference checks must be completed within thirty days of hire and must be former employers or other knowledgeable persons, not family members.
The Family Care Safety Registry and Employee Disqualification List requirements are explained in the Protective Services session.

4. AIDES 19 CSR 15-7.021 (19)(C); 13 CSR 70-91.010(3)(K)
18 years of age; and
Able to read, write, and follow directions; and
Have at least
Six months paid experience as an agency homemaker, nurse aide, maid, or household worker; or
One year experience, paid or unpaid, caring for children or for sick or aged individuals; or
Successful completion of formal training in nursing arts or as a nurse aide or home health aide; and
Not a family member of the recipient for whom services are provided to.
The first position we’ll discuss is an aide. All aides must be 18 years of age and be able to read, write and following directions. Proof of age must be verified. Filling out an application, signing and dating it will adequately document an applicant’s ability to read, write, and follow directions.
Additionally, aides must also meet one of the following requirements:
Have six months paid experience as an agency homemaker, nurse aide, maid or household worker or
One year experience, paid or unpaid, caring for children or for sick or aged individuals; or
Successfully completed formal training in nursing arts or as a nurse aide or home health aide
If the applicant uses previous paid experience to meet the aide requirements, the previous employer must be contacted to verify the employment. This employer can also be used as one of the references.
If the paid or unpaid experience caring for children or sick or aged individuals is used, adequate documentation of the experience must be maintained. The documentation must explain the type of experience, length of time, duties performed, etc.
If formal training is used, a copy of the certificate or license must be maintained and verified.
The final requirement is the aide cannot be a family member of the person they are providing services to. With the in-home services program, staff cannot provide services to their immediate family member. An agency can provide services to an employee’s immediate family member but the services must be provided by a staff other than the immediate family member. An immediate family member is defined as a parent; sibling; child by blood, adoption or marriage; grandparent or grandchild.

5. Advanced Personal Care and Advanced Respite Care Aides 19 CSR 15-7
Advanced Personal Care and Advanced Respite Care Aides 19 CSR (19)(D); 13 CSR (5)(E)
Licensed practical nurse (LPN); or
Certified nurse assistant (CNA); or
Competency evaluated home health aide having completed both written and demonstration portions of test required by DHSS; or
successfully worked for the provider for a minimum of three consecutive months while working at least fifteen hours per week as an in-home aide that has received personal care training.
All aides that will be providing advanced personal care or advanced respite care services must meet one of the following requirements.
They must be a Licensed practical nurse, or
A certified nurse assistant, or
A competency evaluated home health aide having completed both written and demonstration portions of the test required by the Department of Health and Senior Services; or
Worked for the provider for a minimum of three consecutive months as an aide while working at least fifteen hours per week and received the aide training.

6. Supervisor 19 CSR 15-7.021(19)(B) 21 years of age; and
One of the following:
Registered Nurse, or
Possess a baccalaureate degree, or
Licensed practical nurse with one year experience with direct care of elderly, disabled or infirm, or
three years experience with direct care of elderly, disabled or infirm.
Supervisors of the agency must be at least twenty-one years of age and meet one of the following requirements: Be a registered nurse or possess a baccalaureate degree or be a licensed practical nurse with at least one year experience with direct care of the elderly, disabled or infirm or have at least three years experience with the direct care of the elderly, disabled or infirm.
Direct care of the elderly, disabled or infirm means just that. You must have provided direct care. If a person worked in the medical records department of a hospital for the last five years or worked as an office manager for an in-home services agency for ten years, they do not qualify for a supervisor position. The past experience must be directly caring for the client.

7. Supervisor Responsibilities 19 CSR 15-7.021(21)
Monitor provision of services in accordance with the care plan
Documentation of 80% or less of service delivery rate
Evaluating aides’ performance
Communicating with the RN and DSDS case manager regarding clients
Some of the duties of the supervisor include:
Monitoring the provision of services in accordance with the care plan to ensure services are being delivered correctly.
Forward to the Division of Senior and Disability Services regional manager a monthly report of clients whose service delivery rate fell below 80%.
Annually evaluate, in writing, the performance of all aides. The evaluation must be based on at least one on-site visit at a client’s home and the aide must be present during the visit. In addition to evaluating the aide, the supervisor must review the care plan with the client and evaluate the adequacy of the care plan.

8. Designated Manager 19 CSR 15-7.021(14)
Meet supervisor qualifications and
Successfully complete Provider Certification
Training
Annually attend update training
The agency must also employ a designated manager. The designated manager is responsible for the day-to-day- operations of the agency, is a policy maker and directs the agency’s record keeping, service delivery verification, hiring and firing practices and staff training. In addition to meeting the previously stated supervisor requirements, a designated manager must successfully complete Provider Certification Training. This means the test must be passed and a certificate issued.
If an agency’s designated manager quits or is no longer employed by the agency, the agency has six months to hire a replacement and have the replacement successfully complete Provider Certification Training.
The agency can have as many certified managers on staff as they wish. A certified manager is someone that attends Provider Certification Training and takes the test. Any staff person can attend Provider Certification Training and be a certified manager. But, the agency is only required to have one designated manager and report who that designated manager is to the Missouri Medicaid Audit and Compliance Unit.