La. Admin. Code tit. 48 § I-11507

Current through Register Vol. 50, No. 9, September 20, 2024

Section I-11507 - Psychiatric Beds

A. Description

1. Psychiatric beds are located in general hospitals, psychiatric specialty hospitals, or other medical centers which are set up to provide inpatient medical care to persons with mental illness or disorders.

2. Chemical dependency services may be provided in psychiatric hospitals or in psychiatric units of general hospitals. Refer to the subsequent section of this Chapter for a discussion of Chemical Dependency Services.

3. Admissions to general hospitals for psychiatric reasons are usually for emergencies and acute psychiatric episodes; the patient's length of stay does not ordinarily exceed several weeks. Treatment of chronic and severe mental disorders is usually undertaken at psychiatric specialty hospitals, where the average length of stay may be much longer.

4. The role of inpatient psychiatric facilities is one of increasing importance as more becomes known about effective treatment methods. The availability of short-term beds in community-based facilities is essential for treatment of emergency and acute conditions. Therapeutic intervention at an early stage in mental health deterioration is vital for early recovery. Although it is important to have sufficient beds for the long-term care and treatment of the chronically mentally ill, active treatment and rehabilitation programs are needed to assure that patients do not remain institutionalized longer than necessary. Large patient-to-staff ratios have often been a problem in state-operated psychiatric hospitals and have created an impediment to goals aimed at reducing lengths of stay.

5. In any facility providing more than emergency care for persons with psychiatric disorders, small, discrete treatment units for special segments of the population are needed for the most effective therapy. Preschool and latency age, early and late adolescence, severe handicap and emotional disturbance are some of the variables which indicate a need for specialized treatment in separate units.

6. High quality, appropriate services are essential components of all inpatient mental health care if timely and successful recovery is to occur. The patient's length of stay should be as short as is therapeutically possible, for the humane aspect of brief and successful treatment, and for cost effectiveness. The cost of inpatient psychiatric care ranges from $80 a day at large state mental hospitals to $300 a day in private facilities. Outpatient care usually ranges from $50 to $180 per week.

7. Treatment techniques which have been successful in the rehabilitation of persons with mental illness include various types of therapeutic intervention by trained mental health professionals (psychiatrists, psychologist, social workers, psychiatric nurses and others); recreational, occupational and vocational therapy; group, family and individual therapy; and administration of psychotherapeutic drugs. Outpatient or ambulatory care is preferable to inpatient care when the patient's condition is stable enough to permit functioning in the community without endangering the patient, the community, or the course of recovery.

B. Bed Need

1. As of December, 1984, there are 4,999 licensed and approved psychiatric beds in Louisiana: 1166 are short-term beds (average length of stay less than 30 days); 3,707 are intermediate beds (average length of stay between 30 days and 180 days); 126 are long-term beds (average length of stay 182 + days).

2. Although a need for psychiatric beds has been identified in certain health service areas, the addition of beds to the current supply should be undertaken with caution. With increasing impetus toward outpatient services as a preferable alternative to inpatient care, the utilization of inpatient psychiatric beds will eventually decline. Any addition of psychiatric beds to the existing supply should be made only after analysis of occupancy rates of facilities in the area.

3. Inpatient psychiatric services for which there is a recognized need include, but are not limited to:

a. intermediate and long-term treatment facilities for children and adolescents;

b. small, community-based facilities for short-term and intermediate treatment;

c. emergency and acute care psychiatric units in general hospitals, especially those converted from existing, underutilized medical/surgical beds;

d. facilities offering special programs to assist the chronically mentally ill with the transition from institutionalization to community living;

e. facilities providing special treatment units for persons with mental disorders aggravated by other adaptive disorders, such as emotional disturbance, severe handicap, developmental disability and addiction to alcohol or drugs;

f. facilities offering programs for partial hospitalization and psychiatric foster and/or home care.

C. Service Area. The service area for psychiatric beds is the health planning district in which the facility (or proposed facility) is or will be located.

D. Resource Goals

1. Bed Supply: 104.0 psychiatric beds per 100,000 population.

a. In determining the bed to population ratio for the proposal, DPPE will use population projections for the anticipated opening date (year) of the facility, which in no case shall exceed five years subsequent to the year in which the complete application was declared complete.

b. In determining bed supply, beds which are counted are (1) licensed, but not Section 1122 approved beds which are in use or could be put into use within 24 hours*, (2) 1122 approved beds which are not yet licensed, and (3) 1122 approved and licensed beds which are in use or could be put into use within 24 hours.*

2. Occupancy: Free-standing Psychiatric Hospitals

a. A free-standing psychiatric hospital shall maintain annual occupancy rates relative to the number of beds in the facility:

0- 49-50%

50- 99-60%

100-199-70%

200 + -75%

b. In determining occupancy rates, beds used in the calculations include (1) licensed but not Section 1122 approved beds which are in use or could be put into use within 24 hours*, and (2) 1122 approved and licensed beds which are in use or could be put into use within 24 hours.*

c. *Beds that can be brought into service within 24 hours shall be construed to mean the appropriate number of beds in rooms originally constructed and equipped as hospital rooms that either (1) have not been converted to other uses, or (2) retain all essential nonmovable equipment and connections necessary for patient care in accordance with licensing standards. Nonmovable equipment shall include equipment which can be removed only through reconstruction or renovation.

3. For any additional free-standing psychiatric beds to be approved:

a. the bed to population ratio shall not exceed 104.0 per 100,000 population; and

b. either optimal occupancy must be reached by all free-standing psychiatric hospitals in all bed size categories or a 75 percent occupancy of all psychiatric hospitals in the health planning district must be attained.

4. Occupancy: Psychiatric Units in General Hospitals

a. A psychiatric unit in a general hospital shall maintain annual occupancy rates relative to the number of beds in the facility:

0- 49-50%

50- 99-60%

100-199-70%

200 + -75%

b. In determining occupancy rates, beds used in the calculations include:

(a) licensed but not Section 1122 approved beds which are in use or could be put into use within 24 hours*, and

(b) 1122 approved and licensed beds which are in use or could be put into use within 24 hours*.

c. *Beds that can be brought into service with 24 hours shall be construed to mean the appropriate number of beds in rooms originally constructed and equipped as hospital rooms that either (1) have not been converted to other uses, or (2) retain all essential nonmovable equipment and connections necessary for patient care in accordance with licensing standards. Noranovable equipment shall include equipment which can be removed only through reconstruction or renovation.

5. For any additional psychiatric beds in a general hospital to be approved:

a. the bed to population ration shall not exceed 104.0 psychiatric beds per 100,000 population; and

b. either optimal occupancy must be reached by all psychiatric units of general hospitals in all bed size categories or a 75 percent occupancy of all psychiatric units of all general hospitals in the health planning district must be attained.

6. Adjustment:

a. An existing psychiatric hospital or psychiatric unit of a general hospital which has operated at a level of 10 percent or more above its optimal occupancy, as determined by bed size category, for a period of 12 consecutive months, will be allowed to add a number of beds that would bring its occupancy down to the optimal occupancy level for its bed size. The occupancy rate for the 12 consecutive months shall be determined by DPPE from the four most recent quarters of data due to have been reported by the hospital to the Division of Licensing and Certification.

b. Inpatient services should be provided in small units, with patients grouped according to specific treatment needs.

c. A facility should continually strive to reduce the average length of stay for psychiatric admissions.

La. Admin. Code tit. 48, § I-11507

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).