La. Admin. Code tit. 48 § I-11107

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-11107 - Long Term Care

A. Introduction. For the purpose of this planning analysis, long term care services are those direct services needed by persons functionally impaired by advancing age, physical or developmental disability, chronic disease, or recuperating from acute illness. Services are both institutional and non-institutional. Non-institutional long term care services are those which are primarily directed toward preventing or postponing institutionalization. Not included in this analysis are long term care services needed by persons impaired because of mental illness or substance abuse. These are covered in the subsequent area level planning section.

B. New Orleans/Bayou-River Health System Area

1. The percentage of persons 65 + in the New Orleans/Bayou-River health system area is 8.8 percent. The current nursing home bed (SNF, ICF I and II) to population ratio is 36.3 beds per 1,000 population age 65 + . This is significantly fewer beds than are available in the other parts of the state. In 1980, 90.1 percent of patient days were by persons age 65 + ; 3.9 percent were by persons with developmental disability; and 6.0 percent were utilized by other persons. The average occupancy in 1981 was 96 percent in the New Orleans district. The average 1981 occupancy in the Bayou district was 99 percent.

2. There is one intermediate care facility for the mentally retarded (ICF-MR) in the New Orleans/Bayou-River area, Belle Chasse State School, operating 604 beds at 88 percent occupancy. A state school in Thibodaux is under construction and will have a bed capacity of 75.

3. Planning Objectives for Long Term Care for HSA I

a. Through 1985, the proportion of skilled (SNF) beds should be maintained between 15 and 20 percent of the total number of nursing home beds located in the HSA.

b. Through 1987, the ratio of total nursing home beds to the population age 65 and over within the HSA should not exceed 65 beds per 1000 population age 65 and over.

c. Through 1985, the overall annual occupancy rate for nursing homes in HSA I should be maintained at least 95 percent.

d. By 1985, all nursing homes should provide the full range of rehabilitation and supportive services established by the federal guidelines for nursing home care and should be encouraged to seek Joint Commission on Accreditation of Hospitals (JCAH) accreditation.

e. By 1988, the development of small, community-based ICF/MR services should be initiated, in accordance with the goals and standards established in the State Health Plan 1982-87.

f. By 1985, valid and reliable data describing the scope, utilization, and cost of all home health and other community-based services provided to the functionally impaired population residing in the health service area should be accessible to those involved in the development and/or expansion of community-based services.

g. By 1985, accurate and complete information describing the availability of institutional and community-based long term care services should be accessible to the aged residents in the health service area.

h. By 1985, the development and expansion of the array of community-based long term care services including home health services, adult day care, day-hospital, respite care services, and alternative residential settings for the developmentally disabled, should be initiated.

i. 1987, Comprehensive Physical Rehabilitation Facility services should be available and accessible to the population, meeting goals and standards for CPRF services established in the State Health Plan 198287.

j. By 1987, Home Health services should be available and accessible to the population, meeting goals and standards for such services established in the State Health Plan 1982-87.

4. Recommended Actions

a. Existing providers of nursing home care should assess the feasibility of altering their services to include outpatient, mobile, or home-based services.

b. Existing and potential providers of ICF I and II nursing home care should assess the feasibility of conversion to or construction of skilled (SNF) care or day care.

c. General hospital facilities with underutilized medical/surgical beds should assess the feasibility of converting space to medical day care services or skilled nursing beds.

d. The Department of Health and Human Resources should assess the feasibility of securing an appropriation of funds to be used for low interest loans to persons willing to develop currently unavailable community-based services to the functionally impaired to prevent institutionalization.

e. The Department of Health and Human Resources should assess the feasibility of securing a recurring appropriation of funds through 1987 to be used for low interest loans to persons willing to develop small community-based residential services for the developmentally disabled.

f. The Department of Health and Human Resources, the Office of Elderly Affairs and the Legislative Health and Welfare Oversight Committee should assess the feasibility of making at-home services economically accessible to persons not eligible for Medicaid reimbursed at-home services, but having potential eligibility for institutional long term care services. Alternatives to prevent costly institutionalization might be "co-pay" programs through which eligibles pay 25 percent of the cost of services. (Sliding scale payments are not recommended because of the cost of administration.)

C. Mid-Louisiana Health System Area

1. The percentage of persons 65 + in the Mid-Louisiana health system area is 8.7 percent. The current nursing home bed (SNF, ICF I and II) to population ratio is 67.2 beds per 1,000 population 65 + . Although the number of beds is well below the standard 80/1,000 population 65 + which is established as a benchmark for assessing service availability, it is still believed that the bed ratio could be significantly reduced if sufficient alternative services were available. If low-cost and subsidized alternative services are developed over the coming 5-year period, by 1990, a goal of 65 beds/1,000 population age 65 + could be feasible.

2. In 1980, 84.3 percent of patient days in Mid-Louisiana nursing homes were by persons age 65 + ; 4.9 percent were by persons with developmental disabilities; and 10.8 percent were utilized by other persons. The average occupancy in 1981 was 92 percent, which is 3 percent less than the 95 percent standard.

3. There are 3 intermediate care facilities for the mentally retarded (ICF/MR) in the Mid-Louisiana area, with an overall occupancy rate in 1981 of 97 percent for the 924 beds.

4. Planning Objectives for Long Term Care for HSA II

a. Through 1985, SNF beds complements should be encouraged to locate within acute care hospitals.

b. By 1987, the ratio of total nursing home beds to the population age 65 and over within the HSA should not exceed 80 beds per 1000 population age 65 and over.

c. Through 1985, the overall annual occupancy rate for nursing homes in HSA II should be maintained at least 95 percent.

e. Through 1985, the total number of existing and 1122-approved inpatient hospice beds in the Mid-Louisiana HSA should not exceed 41.

f. By 1985, the development of small, community-based ICF/MR services should be initiated, in accordance with the goals and standards established in the State Health Plan 1982-87.

g. By 1985, valid and reliable data describing the scope, utilization, and cost of all home health and other community-based services provided to the functionally impaired population residing in the health service area should be accessible to those involved in the development and/or expansion of community-based services.

h. By 1985, accurate and complete information describing the availability of institutional and community-based long term care services should be accessible to the aged residents in the health service area.

i. By 1985, the development and expansion of the array of community-based long term care services including home health services, adult day care, day-hospital, respite care services, and alternative residential settings for the developmentally disabled, should be initiated.

j. By 1987, Comprehensive Physical Rehabilitation Facility services should be available and accessible to the population, meeting goals and standards for CPRF services established in the State Health Plan 198287.

k. By 1987, Home Health services should be available and accessible to the population, meeting goals and standards for such services established in the State Health Plan 1982-87.

5. Recommended Actions

a. Existing providers of nursing home care should assess the feasibility of altering their services to include outpatient, mobile, or home-based services.

b. Existing and potential providers of ICF I and II nursing home care should assess the feasibility of conversion to or construction of medical day care units.

c. General hospital facilities with underutilized medical/surgical beds should assess the feasibility of converting space to medical day care services or skilled nursing beds.

d. The Department of Health and Human Resources should assess the feasibility of securing an appropriation of funds to be used for low-interest loans to persons willing to develop currently unavailable community-based services to the functionally impaired to prevent institutionalization.

e. The Department of Health and Human Resources should assess the feasibility of securing a recurring appropriation of funds through 1987 to be used to low interest loans to persons willing to develop small community-based residential services for the developmentally disabled.

D. North Louisiana Health Systems Area

1. The percentage of persons 65 + in the North Louisiana health system area is 11.8 percent. The current nursing home bed to population ratio is 80.1/1,000 population age 65 + . Although this is quite near the standard 80 bed/1,000 population 65 + which is established as a benchmark for assessing service availability, it is believed that the bed ratio could be significantly reduced if sufficient alternative services were available. If low-cost and subsidized alternative services, especially mobile and at-home services in rural areas, are developed over the coming 5 year period, by 1990, a goal of 75 beds/1,000 population age 65 + could be feasible.

2. In 1980, 85.2 percent of patient days in North Louisiana nursing homes were by persons age 65 + ; 6.5 percent were by persons with developmental disabilities; and 8.3 percent were utilized by other persons. The average occupancy in 1981 was 96 percent.

3. There are 11 intermediate care facilities for the mentally retarded in North Louisiana. There was a 93 percent occupancy in 1981 for the 2,853 beds.

4. Planning Objectives for Long Term Care for HSA III

a. By 1987, the ratio of total nursing home beds to the population age 65 and over within the HSA should not exceed 80 beds per 1000 population age 65 and over.

b. Through 1985, the overall annual occupancy rate for nursing homes in HSA III should be maintained at least 95 percent.

c. By 1985, all nursing homes should provide the full range of rehabilitation and supportive services established by the federal guidelines for nursing home care and should be encouraged to seek Joint Commission on Accreditation of Hospitals (JCAH) accreditation.

d. By 1987, there should be a reduction in patient days utilized by persons with developmental disability in SNF and ICF I and II beds from 6.5 percent to 4.5 percent.

e. By 1985, valid and reliable data describing the scope, utilization, and cost of all home health and other community-based services provided to the functionally impaired population residing in the health service area should be accessible to those involved in the development and/or expansion of community-based services.

f. By 1985, accurate and complete information describing the availability of institutional and community-based long term care services should be accessible to the aged residents in the health service area.

g. By 1985, the development and expansion of the array of community-based long term care services including home health services, adult day care, day-hospital, respite care services and alternative residential settings for the developmentally disabled should be initiated.

h. By 1987, Comprehensive Physical Rehabilitation Facility services should be available and accessible to the population, meeting goals and standards for CPRF services established in the State Health Plan 198287.

i. By 1987, Home Health services should be available and accessible to the population, meeting goals and standards for such services established in the State Health Plan 1982-87.

j. By 1985, ICF /MR services should be delivered in accordance with the goals and standards established in the State Health Plan 1982-87, with no additional ICF-MR services approved during 1122 review except for facilities with 8 or fewer beds.

5. Recommended Actions

a. Existing providers of nursing home care should assess the feasibility of altering their services to include outpatient, mobile, or home-based services.

b. Existing and potential providers of ICF I and II nursing home care should assess the feasibility of conversion to or construction of medical day care units.

c. General hospital facilities with underutilized medical/surgical beds should assess the feasibility of converting space to medical day care service or skilled nursing beds.

La. Admin. Code tit. 48, § I-11107

Promulgated by the Department of Health and Human Resources, Office of Management and Finance, LR 13:246 (April 1987).

AUTHORITY NOTE: Promulgated in accordance with P.L. 93-641 as amended by P.L. 96-79, and R.S. 36:256(b).