Individual Rights and Responsibilities

PURPOSE: This rule specifies the rights and responsibilities of individuals receiving services in a community residential program or day program subject to licensure by the department in accordance with 9 CSR 401.055, including Residential Care Facilities (RCF) and Assisted Living Facilities (ALF) dually licensed by the Department of Health and Senior Services (DHSS). (1) Each individual receiving services is entitled to the following without limitations: (A) To humane care and treatment; (B) To medical care and treatment in accordance with the highest standards accepted in medical practice to the extent available at the community residential program or day program; (C) To safe and sanitary housing; (D) To not participate in nontherapeutic labor; (E) To attend or not to attend religious services; (F) To receive prompt evaluation, care, treatment, and rehabilitation about which he/she is informed insofar as he/she is capable of understanding; (G) To be treated with dignity as a human being; (H) To not be the subject of experimental research without his/her prior written and informed consent or that of his/her parent or guardian, and to decide not to participate or withdraw from any research at any time, for any reason; (I) To have access to consultation with a private physician at his/her own expense; (J) To be evaluated, treated, or habilitated in the least restrictive environment; (K) To not be subjected to any hazardous treatment or surgical procedure unless the individual or his/her parent or guardian consents, or unless such treatment or surgical procedure is ordered by a court of competent jurisdiction; (L) In the case of hazardous treatment or irreversible surgical procedures to have, upon request, an impartial review prior to implementation except in case of emergency procedures required for the preservation of his/her life; (M) To a nourishing, well-balanced, and varied diet; (N) To be free from verbal, physical and sexual abuse, misuse of funds/property, and neglect; and (O) To an impartial review of alleged violations of rights. (2) Each individual served is entitled to the following unless the program director determines it is inconsistent with the individual’s therapeutic care, treatment, habilitation, or rehabilitation and the safety of other individuals in the program and public safety: (A) To wear his/her own clothes and keep and use personal possessions; (B) To keep and be allowed to spend a reasonable amount of his/her own money; (C) To communicate by sealed mail or otherwise with persons, including agencies inside or outside the facility/program; (D) To receive visitors (family, friends, clergy, or other invited person) of his/her choice at reasonable times; (E) To have reasonable access to a telephone to make and receive confidential calls; (F) To have access to his/her mental health and physical health records; (G) To have opportunities for physical exercise and outdoor recreation; and (H) To have reasonable, prompt access to current newspapers, magazines, radio, and television programming. 1. Any limitation(s) imposed by the program director or designee, including the reason(s) for such limitation(s), must be documented in the individual record. (3) In addition to the rights specified in sections (1) and (2) of this rule, residential programs and day programs serving individuals with Intellectual or Developmental Disability (IDD) shall comply with 9 CSR 45-3.030. (4) Policies and procedures shall not be developed that limit the individual rights identified in this rule. (A) Each individual shall be involved in any process that limits his/her rights, and any limitations must be documented in the Individual Support Plan (ISP), Individual Treatment Plan (ITP), or care plan. Documentation shall include the timeframe for each limitation and the process by which the individual’s rights will be restored to him/her. (5) As set out in section 630.760, RSMo, in addition to rights provided for individuals served in residential facilities or day programs licensed by the department, individuals in facilities and programs licensed by the department shall have the same rights as individuals as defined in section 198.088, RSMo. (6) Individuals shall have an absolute right to receive visits from their attorney, physician, clergy, or case manager in private at reasonable times. (7) Notwithstanding any limitations authorized under section (2) of this rule on the right of communication, all individuals shall be entitled to communicate by sealed mail with the department, their legal counsel, and with the court, if any, which has jurisdiction over the individual. (8) As set out in section 630.120, RSMo, no individual, either voluntary or involuntary, shall be presumed to be incompetent, to forfeit any legal right, responsibility, or obligation or to suffer any legal disability as a citizen, unless otherwise prescribed by law, as a consequence of receiving evaluation, care, treatment, habilitation, or rehabilitation for a mental illness, intellectual or developmental disability, or substance use disorder. (9) Each individual shall be informed of the process to make an inquiry, file a complaint, or report a violation of his/her rights to the department. Information shall be readily accessible to individuals at all times with staff assistance provided, if necessary. (10) The individual rights included in this rule shall be readily available in accessible format to all individuals served without undue assistance or effort from program staff. (11) Services shall be provided in a manner and an environment that maintains or enhances each individual’s dignity and respect in full recognition of his/her individuality. Staff shall conduct activities in a manner that assists individuals in maintaining and enhancing their self-esteem and self-worth. (A) Case discussions, consultations, examinations, and treatment are confidential and shall be conducted privately with each individual being served. (B) Privacy shall be respected during toileting, bathing, and other activities of personal hygiene except as needed for safety or assistance. (C) Each individual’s private space and property shall be respected including, but not limited to, obtaining his/her permission before changing a radio or television station, knocking on doors and requesting permission to enter, closing doors as requested, and not moving or inspecting personal possessions without permission unless there is reasonable suspicion of a health or safety concern. (D) Individuals shall be allowed to decorate their personal space to create a homelike environment in accordance with safety regulations of the program. (E) When possible, individuals shall have a choice in their roommate and, based on financial means and availability, be allowed to choose a shared or private room. (F) As appropriate and allowed by the individual served, family members and other natural supports and/or parents/guardian shall be provided with information to promote their participation in relevant services/supports and decisions related to the individual. (12) Information and Orientation. Each individual admitted to a residential program or day program shall receive an orientation about what to expect while receiving services and supports, their role in services/supports, and program policies and procedures. The orientation must be provided within one (1) week of admission, and annually after that, and be documented in the individual record. (A) The orientation shall be provided in verbal and written form and be explained in a manner that is understandable to the individual. The orientation shall include, but is not limited to— 1. Program rules, daily routines, participation requirements, rights, responsibilities, and behavioral expectations; 2. Available services, supports, and activities; 3. Complaint and appeal procedures; 4. Confidentiality policies; 5. Transition and discharge criteria and procedures; 6. Financial obligations, fees, and financial arrangements for services/supports provided by the program; 7. Health and safety policies regarding use of tobacco products, illegal or legal substances brought into the program, prescription medication brought into the program, and weapons and ammunition brought into the program; 8. Layout of the premises, including emergency exits and/or shelters, and review of fire and disaster drill procedures; 9. Visitor policies and procedures; 10. Advance directives, when indicated; and 11. The individual’s role in developing his or her ISP, ITP, or care plan. (13) Social Committee. Residential programs and day programs having a licensed capacity of ten (10) or more individuals shall establish a committee, if one (1) does not currently exist, to review existing and planned social and structured activities for the program. (A) The committee shall regularly review program policies and practices to ensure the for Community Residential Programs and Day Programs legal rights of individuals served are consistently maintained. (B) Membership on the committee shall include, at a minimum, individuals with mental illness and IDD, and program staff familiar with and able to make decisions related to program activities/functions. Family members or other natural supports, service providers, and other community members may participate on the committee. Minutes of committee meetings shall be readily available for review by individuals served, other interested parties, and department staff or its authorized representatives. (14) Guardian. No facility or day program administrator shall be guardian of the individuals in the facility or day program as stipulated in section 475.055, RSMo. AUTHORITY: sections 630.050 and 630.705, RSMo 2016.* Original rule filed May 14, 2020, effective Dec. 30, 2020. *Original authority: 630.050, RSMo 1980, amended 1993, 1995, 2008 and 630.705, RSMo 1980, amended 1982, 1984, 1985, 1990, 2000, 2011, 2014.