1. Registered Nurse 19 CSR 15-7.021(19)(A)
Registered nurse (RN) licensed to practice in the State of Missouri or
Licensed practical nurse (LPN) licensed to practice in the State of Missouri and under the supervisor of an RN.
All in-home services agencies are required to have a registered nurse on staff. We are often asked if a registered nurse is required even if skilled services will not be provided. It does not matter what services will be provided. All agencies must employ a registered nurse. The registered nurse must be licensed to practice in the State of Missouri.
A licensed practical nurse can perform certain nursing duties but must be supervised by a Registered Nurse.

2. Employee Training Requirements
Once it has been determined an applicant meets the hiring requirements, the necessary screenings have been completed, the person is found to be employable and the decision has been made to hire the applicant, they must now be trained.
All agencies must have a written training plan for ensuring staff are properly trained. The plan should include what will be trained, who will do the training, when the training will be provided and when training can be waived. Documentation of all training provided or waived must be maintained.

3. Orientation Training 19 CSR 15-7. 021(22); 13 CSR 70. 91
Orientation Training 19 CSR (22); 13 CSR (3); Medicaid Manual
The in-home service provider shall have a written plan for providing training for new aides, respite care workers and homemakers.
20 hours of training within 30 days of hire
8 hours prior to client contact, including 2 hours orientation/handling emergencies
12 additional hours
The plan must include 20 hours of orientation training that must be completed within 30 days of hire for new aides, respite care workers and homemakers. 8 hours of the training must be provided prior to any contact with a client and must be classroom training. The first date the aide has contact with a client must be documented and maintained. The training must also include 2 hours of orientation to the agency and protocols for handling emergencies.
The remaining 12 hours of the 20 hours of training must be provided within 30 days of hire. The Medicaid Personal Care Provider Manual requires 4 of these 12 hours be on-the-job training. On-the-job training must be completed in sessions no longer than 2 hours. The method of training for the remaining 8 hours can be any method you choose such as classroom, reading material or more on-the-job training. Reading material must be limited to only two hours.

4. Required Topics 19 CSR 15-7.021; 13 CSR 70-91.010; Medicaid Manual
Required topics include but are not limited to:
Client Bill of Rights
Code of Ethics
Confidentiality policy
Alzheimer’s Disease
Communicable disease policy
There are a variety of topics that are required to be included in this 20 hours of training. Some of these are the Client Bill of Rights, the Code of Ethics, confidentiality policy, Alzheimer’s Disease and communicable disease policy. Refer to the Medicaid Provider Manuals, the code of state regulations and state statutes for all topics that are required to be included in the training.

5. Alzheimer’s Training 19 CSR 15-7.021(22)(A); 660.050 8, RSMo
New employee orientation curricula shall include an overview of Alzheimer’s disease and related dementias and methods of communicating with persons with dementia pursuant to the requirements of section , RSMo.
of the Missouri Revised Statutes requires an overview of Alzheimer’s disease and related dementias and methods of communicating with persons with dementia be included in training.

6. Alzheimer’s Training Cont.
Employees to be trained:
Direct care staff: Employees providing direct care to persons with AD or related dementias. (aides, nurses, supervisors, etc.).
Non-direct care staff: Employees who do not provide direct care but have daily contact with persons with AD or related dementias (receptionists, billing clerks, schedulers, etc.).
Employees providing direct care to clients, such as aides, nurses and supervisors, must receive training in communicating with persons with dementia, behavior management, promoting independence in activities of daily living and understanding and dealing with family issues.
For non-direct care staff that do not provide direct care to clients but may have daily contact with them, they must receive an overview of dementias and communicating with persons with dementia. This includes staff such as receptionists, billing clerks, schedulers, etc.

7. Communicable Disease Training 19 CSR 15-7. 021(20); 13 CSR 70-91
Communicable Disease Training 19 CSR (20); 13 CSR (3); 19 CSR
Staff who have direct contact with client must have training which includes:
Agency’s policy which prohibits staff contact with clients when the employee has a communicable condition.
Reporting requirements governing communicable diseases as set by the Missouri Department of Health and Senior Services,
Communicable Disease is also a required topic. Communicable diseases include colds, flu, measles, mumps, tuberculosis, hepatitis, etc. The training must include the symptoms of communicable diseases. Employees cannot have contact with clients while they have a communicable condition.
Additionally, all Department of Health and Senior Services reporting requirements must be met.

8. Waiver of AideTraining 19 CSR 15-7.021(22)(A); 13 CSR 70-91.010(3)(E)
2 hours orientation and protocols for handling emergencies never waived
Aide with at least 6 months experience
12 hours of additional training may be waived with adequate documentation
Portions of the required 20 hours of aide training can be waived in certain circumstances.
The 2 hours of orientation to the provider and the agency’s protocols for handling emergencies can never be waived. All employees are required to have this 2 hours of training.
The 12 hours of additional training within 30 days of hire can be waived if the aide received similar training during the current or preceding year or has been employed as an aide at least half-time for six months or more within the current or preceding year.
This means the person must still receive the 8 hours of classroom training, including the 2 hours of orientation, prior to the first client contact.
The prior experience must be verified and documented. We will discuss this process a little later.

9. Waiver for Licensed Staff 19 CSR 15-7.021(22)
All orientation may be waived except 2 hours orientation to the provider agency with documentation placed in the personnel file that the aide is a licensed nurse or certified nurses aide in good standing in the state of Missouri.
If a person is a licensed nurse or certified nurses aide, all but the 2 hours or orientation to the provider agency and the agency’s protocols for handling emergencies can be waived. You must verify and maintain documentation that the license or certification is in good standing in the State of Missouri.