More than one million people aged 65 and over call Missouri home. Those who live there can appreciate an overall cost of living that’s nearly 15% below the national median. Other cost savings include income tax exemptions for older adults who earn less than $85,000 annually and partial exemptions on other senior income sources.

Unfortunately, though, crime rates in the state are high compared to the rest of the country. On a scale of one to 100, where 100 represents high crime, Missouri’s violent crime rate is 6.7 points higher than the national average, while its property crime rate is 6 points higher.

In this guide, older adults and their loved ones can learn about the types of senior care that are available for those living in Missouri and how assisted living is regulated in the state.

Assisted Living Facility (ALF) Definitions

The Missouri Department of Health and Senior Services licenses both assisted living (ALFs) and residential care facilities (RCFs). Both types of facilities follow one set of rules, except that ALFs may admit and retain individuals that require a higher level of assistance to evacuate the building in an emergency than residents in RCFs. The key difference in care between the facility types is that an ALF must have a physician available to supervise care.

An assisted living facility is a residence, an intermediate care facility, or a skilled nursing facility that provides 24-hour care, protective oversight, and services to three or more adults requiring assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). These facilities also provide storage, distribution, or administration of medications and supervision of health care under the direction of a physician.

An RCF is similar to an ALF except that assistance with ADLs and IADLs is limited. These facilities provide shelter, board, and protective oversight for their residents.

Resident Agreements and Disclosures

Resident agreements for both types of facilities must provide residents or their representatives with information regarding the services that will be provided to or coordinated for the resident, their costs, discharge policies, and payment and refund information.

Assisted Living Admission and Retention

There are some key differences in admission requirements and regulations between the two types of facilities. The differences have to do with the level of care the resident would require. ALFs may not admit or retain residents who are bedbound or have behaviors that present a danger to themselves or others, require restraints (either chemical or physical), require skilled nursing services that the facility is unable to provide, or require more than one person to provide help with ADLs or IADLs. Should a resident have a short period of time where they are incapacitated or are recuperating from surgery, they are allowed to remain in the ALF.

Residents can be admitted or retained in RCFs if the individual can independently evacuate the facility in an emergency within five minutes of being alerted.

Assisted Living Services and Service Planning

ALFs must provide 24-hour care and protective oversight, nursing services, assistance with ADLs and IADLs, and storing, distributing, and administering medications as well as recreational activities for its residents.

Before admission, the ALF must screen potential residents to determine if they are eligible for admission. Within five days of admission, an authorized staff member must perform an assessment, and a physician must perform a physical examination. The purpose is to document the resident’s current medical status and to develop a personalized service plan. This service plan describes the services the resident requires, and the resident’s facility evacuation plan should the resident require assistance in an emergency.

RCFs must provide 24-hour care and protective oversight, storing, distributing, and administering medications and care during short-term illness and recuperation. Staff must encourage residents to be active and participate in activities.

Residents in RCFs must have a physical exam performed by a physician to document their current medical status and the need for any special orders or procedures. This exam should be performed before admission but no later than ten days after admission.

Assisted Living Food and Dietary Provisions

All facilities must provide three meals per day. If a physician prescribes a modified diet, the facility is allowed to provide these meals if the resident is monitored on a quarterly basis.

Assisted Living Staffing Requirements

The staffing requirements in the two facilities are different due to the different levels of care they are required to provide. ALFs must employ an administrator to oversee the daily operations of the facility and supervise the staff. The facility must employ a licensed nurse and direct care staff. If the facility administers medication to residents, they must employ either a Level 1 medication aide or certified medication technicians. All ALFs must be supervised by a physician who is informed of treatments or medications prescribed by other providers. The facility must employ adequate staff to provide for residents’ proper care, social well-being, protective oversight, and upkeep of the facility.

The minimum staff ratio for ALFs during the day shift is 1 per 15 residents, 1 per 20 residents on the evening shift, and 1 per 25 residents during the night shift. The staff must be awake, dressed, and prepared to assist residents in an emergency. A nurse must be employed 8 hours per week for 3-30 residents, 16 hours a week for 31-60 residents, 24 hours per week for 61-90 residents, and 40 hours per week for more than 90 residents.

Any ALF that provides physical or cognitive impairment services must have a 1 per 15 resident ratio during both day and evening shifts and a 1 per 20 ratio during the night shift to provide additional assistance for residents during emergencies.

RCFs must employ an administrator or manager to run the daily operations and supervise the staff. The facility must employ direct care staff to provide personal care to residents. If the facility administers medications to residents, the facility must employ a Level 1 medication aide or a certified medication technician. On-duty staff levels must be able to provide for residents’ care and the facility’s upkeep.

The minimum staff ratio is one staff person for every 40 residents. Facilities with fewer than 12 residents are not required to provide overnight, awake staff unless the residents are blind or have mobility issues.

Assisted Living Staff Training Requirements

All facility staff must receive orientation for fire safety training and orientation that is appropriate for their job responsibilities.

Any facility that provides care to any resident with Alzheimer’s or another form of dementia must provide orientation to all staff members. Staff that provides direct care for these residents must receive at least 3 hours of training, including an overview of mentally confused residents, communicating with persons with dementia, behavior management, and techniques for creating a safe, secure environment. Employees not providing direct care must receive one hour of training that includes an overview of mentally confused residents and other related topics.

All ALF staff must receive two hours of training on transfer assistance and 24 hours of training on the definition and assessment of ADLs, assessing cognitive ability, and service planning.

Assisted Living Housing Requirements

Facilities in Missouri are not required to provide apartment-style units. Units can offer single- or multiple-occupancy rooms with a maximum occupancy of four residents. One toilet and sink must be provided for every six residents, and one bathtub or shower must be provided for every 20 residents.

Some ALFs have rules that the facility must be “home-like.” These facilities could include features such as a living room or common room, a kitchen and family-style eating area, a laundry area for residents to use, and an outdoor area for activities and recreation.

What Is Included With Assisted Living Care In Missouri?

There are several requirements that each assisted living community must provide for its residents. The facility must offer both general observations and health supervision to assist in identifying each resident’s health condition and ability to function. The facility must assist residents with all ADLs and medication services and assess the need for medication attention or nursing services.

Medication Provisions

Residents of both ALFs and RCFs can self-administer prescription and non-prescription medications if they can, according to a licensed health provider. Each resident must have their medication regime reviewed by a physician, pharmacist, or RN on a monthly basis. Staff that administers medications must be certified as a Level 1 medication aide or certified medication technician if they are not licensed physicians, nurses, or pharmacists.

Health Care Services

In Missouri, ALFs must provide care and services in the resident’s care plan. This can include coordinating medical care and appointments. Communities may also deliver health services, with 54% of communities providing skilled nursing. Many have health care specialists and on-site services, with 57% of communities offering dental care. In addition, 51% of ALFs have hospice services.

Mental health issues are a growing consideration for communities, and services to address these concerns are becoming more common. In Missouri, 77% of communities conduct depression screenings, and 60% offer mental health counseling. Social work programs are also found in 50% of ALFs. Social workers can provide counseling, conduct assessments, and help ensure residents can access all necessary resources.

State Mental Health Resources

People in Missouri have several options when facing mental health crises or distress. Some options include several statewide mental health hotlines, such as the Disaster Distress Helpline (1-800-985-5990) and the National Suicide Prevention Lifeline (1-800-273-8255). People living in the state can also reach out to their local Area Agency on Aging to connect with local mental health resources and support groups.

Activities of Daily Living (ADLs) Assistance Services

A primary service of assisted living that benefits residents is receiving help with activities of daily living (ADLs). These are fundamental tasks that a person must do regularly to sustain life and general health, including toileting, bathing or showering, dressing, transferring (getting in and out of bed or a chair), ambulating (walking), and eating. Signs that a person may benefit from living in assisted living include increased isolation, loss of mobility, noticeable weight loss or gain, and/or neglecting household chores. 

Residents in Missouri’s assisted living facilities often receive help with their ADLs. In Missouri, 9% of residents need help with eating. Other commonly used services include bed transfer (6%), toileting (17%), and walking (32%). Caregivers in ALFs help 24% of residents dress and 55% of residents bathe.

Cost Of Assisted Living Care In Missouri

The average cost of assisted living care in Missouri is $3,000. This cost is $1500 lower than the monthly national average of $4,500 per month. The cost of living in Missouri is less than the national average by 10.2%, with health care costs less than the national average by 5.4% and housing costs less than the national average by 19.7%.

The level of care a person requires impacts the cost of care, as does where you live. The cost of assisted living ranges from a low of $2,075 in the Jefferson City area to a high of $4,585 per month in the Kansas City area of Missouri.

How Costs Compare In Nearby States

If you live close to one of Missouri’s borders, you may find assisted living in a neighboring state is an affordable option. Despite Missouri bordering eight other states, only three of those states have lower monthly average costs for assisted living. Kentucky’s average monthly cost is the lowest, at $3,448. Arkansas and Oklahoma’s average monthly costs are $3,760 and $3,855, respectively.

How to Pay for Assisted Living

Missouri Assisted Living Oversight

The Department of Health and Senior Services oversees all ALFs in Missouri, inspecting facilities and ensuring compliance with all state regulatory guidelines. Licensed providers must undergo semi-annual inspections.

Quality And Safety Of Assisted Living Facilities In Missouri

Missouri ALFs are subject to a set of rules and regulations provided by the state’s Department of Health & Senior Services (DHSS). These regulations exist to protect the rights, health, and safety of older adults living in ALFs. 

According to these regulations, a licensed physician must oversee assisted living care. The DHSS inspects all long-term care facilities in the state at least twice every fiscal year, from July 1 to June 30. This unannounced inspection includes resident and family interviews, staff interviews, and on-site observations.

If a resident, caregiver, or staff member witnesses a violation of rights, licensing regulations, or an incident involving abuse or neglect, it must be reported to the state’s Adult Abuse and Neglect Hotline, which investigates and resolves complaints involving senior care.

Legal Resources

The term “elder law” is often associated with estate planning, trusts, and help obtaining benefits through Medicare or Medicaid. Unfortunately, the field has grown to include cases involving elder abuse, elder neglect, and exploitation. Skilled attorneys can help older adults affected by these issues. 

The Missouri Senior Legal Helpline is one such service that provides older adults with free advice on civil legal issues, as well as wills, trusts, and estate planning. People can use this service by calling 1-800-235-5503.

Legal Services of Eastern Missouri, Legal Aid of Southwest Missouri, and Legal Aid of Western Missouri also provide free legal advice and services for people aged 60 years and over who are unable to afford legal fees with a private lawyer.