PURPOSE: This rule describes the course of instruction and training that may be prescribed by the board under the authority as set forth in section 344.030.1., RSMo.

1. (1) Applicants who do not otherwise qualify for examination shall complete one of the following courses of instruction and training. The formal instruction shall be coursework qualifying for academic credit, completed with a grade of not less than “C.” A portion of the formal instruction may be from an intensive and comprehensive seminar of at least forty (40) clock hours specific to nursing home administration which has been approved by the board. An applicant who has completed—

   1. (A) A high school education or the equivalent, must complete three hundred fifteen

2. (315) clock hours of formal instruction and a minimum of two thousand (2,000) clock hours of internship;

   1. (B) A licensed practical nurse program, must complete two hundred twenty-five (225) clock hours of formal instruction and a minimum of eight hundred (800) clock hours of internship;
   2. (C) An associate degree, must complete six hundred forty (640) clock hours of internship;
   3. (D) A three (3) year diploma program or a baccalaureate of science (BS)/baccalaureate of arts (BA), must complete five hundred

3. (500) clock hours of internship; or

   1. (E) A masters or beyond, must complete five hundred (500) clock hours of internship.

4. (2) The course of instruction and training shall follow the core of knowledge areas and other subject matter as deemed necessary by the board to properly prepare an applicant for health care administration. The core of knowledge shall include, but shall not be limited to, the following subject areas:

   1. (A) Nursing and Physician Services:

      1. 1. Restorative nursing;
      2. 2. Rehabilitation;
      3. 3. Definition, concept and procedures of

nursing;

1. 4. Skin and wound care;
2. 5. Infection control procedures;
3. 6. Drug administration and drug effects;
4. 7. Disease recognition and process;
5. 8. Quality assurance;
6. 9. Physician’s role in the facility; and
7. 10. Physician/resident relationships;

8. (B) Social Services:

   1. 1. Resident rights;
   2. 2. Living wills and advance directives;
   3. 3. Social, emotional, religious, and

financial needs of the resident;

1. 4. Family counsel and consultation;
2. 5. Grieving process;
3. 6. Death and dying;
4. 7. Communication with the resident;

and

1. 8. Ombudsman program;

2. (C) Food Services:

   1. 1. Proper nutrition;
   2. 2. Therapeutic diets; and
   3. 3. Resident satisfaction;

3. (D) Social and Therapeutic Recreational Activities:

   1. 1. Needs of the resident;
   2. 2. Community resources;
   3. 3. Rehabilitation services;
   4. 4. Volunteers and auxiliaries; and
   5. 5. Chemical dependency of the resident;

4. (E) Medical Record Keeping:

   1. 1. Medical records systems;
   2. 2. Appropriate charting and documenta-

tion; and

1. 3. Evaluation and revision of care plans;

2. (F) Pharmaceutical Services:

   1. 1. Proper drug handling and control;
   2. 2. Proper drug dispensing; and
   3. 3. Drug interactions;

3. (G) Personnel Management:

   1. 1. Maintaining a positive atmosphere; 19 CSR 73-2
   2. 2. Grievance procedures;
   3. 3. Effective communication;
   4. 4. Evaluation procedures;
   5. 5. Recruitment of staff;
   6. 6. Interviewing candidates;
   7. 7. Selecting future employees;
   8. 8. Staff development and training;
   9. 9. Personnel policies and procedures;
   10. 10. Health and safety; 11 Departmental organization and man-

agement;

1. 12. Professional ethics and conduct;
2. 13. Total quality management; and
3. 14. Health care reform;

4. (H) Financial Management:

   1. 1. Budgeting;
   2. 2. Marketing principles;
   3. 3. Asset management; and
   4. 4. Accounting;

5. (I) Marketing and Public Relations:

   1. 1. Public relation principles;
   2. 2. Marketing principles;
   3. 3. Newsletters;
   4. 4. Community and social organizations;

and

1. 5. Working with the media;

2. (J) Physical Resource Management:

   1. 1. Building and grounds management;
   2. 2. Environmental services;
   3. 3. Safety procedures and programs; and
   4. 4. Fire and disaster plans; and

3. (K) Laws, Regulatory Codes and Governing Boards:

   1. 1. Medicare and Medicaid;
   2. 2. Omnibus Budget Reconciliation Act

(OBRA);

1. 3. Occupational Safety and Health

Administration (OSHA);

1. 4. Americans With Disabilities Act

(ADA);

1. 5. Life safety;
2. 6. Legislative process;
3. 7. Board responsibilities; and
4. 8. By-laws.

1. (3) The course of instruction and training shall include instruction in the services which must be provided in nursing homes, the protection of the rights and interests of the residents and the elements of good nursing home administration as well as other subject matter as deemed necessary by the board to properly prepare that applicant for nursing home administration.
2. (4) Instruction and training prescribed by the board shall be recognized as meeting the requirements of this rule only if it is offered by an accredited educational institution or affiliate which has been duly registered with the Missouri Board of Nursing Home Administrators. SENIOR SERVICES

3. (5) Internships as required by section (1) shall be under the direct supervision of a licensed nursing home administrator approved and designated as a preceptor by the Missouri Board of Nursing Home Administrators. An administrator may be approved and designated as a preceptor for a period of two (2) years, if s/he—

   1. (A) Has been licensed and employed as a Missouri nursing home administrator for at least thirty-six (36) months immediately prior to application to become a preceptor;
   2. (B) Is currently serving as the administrator of a duly licensed intermediate care facility (ICF), skilled nursing facility (SNF), assisted living facility (ALF) or any Residential Care Facility (RCF) that was licensed as a residential care II on or before August 27, 2006 that continues to meet the licensure standards for a residential care facility II in effect on August 27, 2006, with sixty (60) or more beds;
   3. (C) Is an administrator of an ICF, SNF, ALF or RCF (as described above) with sixty

4. (60) or more beds which is in substantial compliance with the rules governing nursing homes; and

   1. (D) Has not been the subject of any action by any board of nursing home administrators or licensing authority which resulted in discipline, including but not limited to, formal reprimand, probation, suspension or revocation of license or privileges as a nursing home administrator; and
   2. (E) Has successfully completed a board approved preceptor training program.

5. (6) Designated preceptors shall request in writing board approval to conduct an internship for an applicant who has been found not qualified for licensure by the board, based upon 19 CSR 73-2.020. Approval may be granted by the board if the preceptor—

   1. (A) Is not related to the intern within the fourth degree of consanguinity;
   2. (B) Agrees to give the intern an opportunity to observe and take part in the managerial tasks of the preceptor;
   3. (C) Will acquaint the intern with the organization and operation of all the various departments of the facility by permitting his/her observation and/or participation in department activities;
   4. (D) Will hold an exit interview with the intern upon completion of an internship to point out noted strengths and weaknesses; and
   5. (E) Upon satisfactory completion of the internship will prepare and return to the board office the mandatory form certifying the completion of the required hours of internship.
6. (7) The board, for good cause, may refuse to approve or renew a preceptor designation or may refuse to approve an assignment of an intern to a preceptor.
7. (8) A preceptor may supervise no more than one (1) intern concurrently.
8. (9) Internships shall be completed within eighteen (18) months of completion of classroom or other formal instruction unless approved by the board.

9. (10) A portion of an internship may be completed in a duly licensed ALF or RCF (as described above) with sixty (60) or more beds if the intern desires such experience. The maximum hours of internship that may be served in such an ALF or RCF (as described above) are designated as follows. Applicants may complete up to—

   1. (A) 667 clock hours if 2,000 clock hours are required by the board;
   2. (B) 267 clock hours if 800 clock hours are required by the board;
   3. (C) 214 clock hours if 640 clock hours are required by the board; or
   4. (D) 167 clock hours if 500 clock hours are required by the board.
10. (11) Each day of an internship experience shall include at least one (1) four (4)-hour block of time within the primary working hours of the administrator.

AUTHORITY: section 344.070, RSMo Supp. 2007.* This rule was previously filed as 13 CSR 73-2.031. Original rule filed May 13, 1980, effective Aug. 11, 1980. Amended: Filed April 14, 1983, effective July 11, 1983. Amended: Filed Oct. 16, 1985, effective March 14, 1986. Amended: Filed Oct. 1, 1987, effective Jan. 14, 1988. Amended: Filed Jan. 3, 1992, effective May 14, 1992. Amended: Filed July 14, 1993, effective Jan. 13, 1994. Amended: Filed June 30, 1994, effective Feb. 1, 1995. Amended: Filed May 15, 1995, effective Nov. 30, 1995. Amended: Filed April 30, 1998, effective Oct. 30, 1998. Moved and amended: Filed Jan. 31, 2003, effective Aug. 30, 2003. Amended: Filed Dec. 28, 2007, effective Aug. 30, 2008. *Original authority: 344.070, RSMo 1969, amended 1979, 1993, 1995, 2007.