In Missouri, there are four levels of long-term care licensed by the state: residential care, assisted living, intermediate care and skilled nursing.
I. Residential Care
A residential care setting, often referred to as an RCF (residential care facility), offers the least restrictive environment and minimum level of services in Missouri's long-term care system. While some residential care settings serve older adults, many provide care for a population of younger residents who may have developmental or physical disabilities or both; a history of drug or alcohol abuse or both; or mental illness.
II. Assisted Living
The assisted living level of long-term care, often referred to as an ALF (Assisted Living Facility), generally provides many of the same services as residential care — living space; three meals per day; help with medications; housekeeping and laundry; recreational activities; 24-hour protective oversight from staff—as well as assistance with activities of daily living (e.g. eating, bathing, toileting, etc.).
There are two types of assisted living settings: Assisted Living Option I and Assisted Living Option II. Similar to residential care, residents in Assisted Living Option I must be able to make their own pathway to safety within five minutes. If they are unable to make their own pathway to safety, then a higher level of care— Assisted Living Option II, intermediate care, or skilled nursing—would be a more appropriate setting.
III. Intermediate Care
An intermediate level of long-term care setting has a "nursing home" level state license to provide care to those who need daily 24-hour accommodation, board, personal care and basic health and nursing care services under the daily supervision of a licensed nurse and direction of a licensed physician. This level of long-term care differs from skilled nursing in two ways:
IV. Skilled Nursing
The skilled nursing level of long-term care, often referred to as a SNF (skilled nursing facility), provides residents with 24-hour accommodation, board and skilled nursing care and treatment services. Skilled nursing includes physical, occupational or speech therapy in addition to treatments or procedures commonly performed by or under the supervision of a professional Registered Nurse (RN), as prescribed by a licensed physician. This level of long-term care must have a Licensed Nursing Home Administrator (LNHA) and a full-time Director of Nursing (DON). However, a Certified Nursing Assistant (CNA) usually provides much of the routine care, and a Certified Medication Technician (CMT) can distribute medication.
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