PURPOSE: This rule establishes up-to-date construction standards for new long-term care units in hospitals to help ensure accessible, functional, fire-safe and sanitary facilities.

1. (1) New Long-Term Care General Requirements.

   1. (A) A new long-term care unit is one for which plans are submitted to the Department of Health for review and approval after the effective date of this rule for the construction, expansion or renovation of a unit or the conversion of an existing unit not previously and continuously utilized as a long-term care unit. New long-term care units and additions to and major alterations of existing licensed long-term care units shall be designed to provide all of the facilities required by this rule. Those facilities shall be arranged to accommodate with maximum convenience all of the functions required by this rule; and to provide comfortable, sanitary, fire-safe, secure and durable facilities for the patients. In any major alteration project or addition to an existing long-term care unit, only those parts of a unit affected by the project or addition are subject to this rule.
   2. (B) The minimum requirements of this rule are not intended in any way to restrict innovations and improvements in design, construction or operating techniques. Plans and specifications and operational procedures which contain deviations from these requirements may be approved if it is determined that the purposes of the minimum requirements have been fulfilled. Some facilities may be subject to the requirements of more than one (1) regulating agency. While every effort has been made to ensure coordination, facilities making requests for changes in services and requests for new construction or renovations are cautioned to verify requirements of other agencies involved.
   3. (C) Requests for deviations from the requirements of this rule shall be in writing to the Department of Health. Approvals for deviations shall be in writing and both requests and approvals shall become a part of the permanent Department of Health records for the facility.
   4. (D) Alterations or additions to existing units shall be programmed so construction will minimize disruptions of existing functions. Access to exits and fire protection shall be maintained so the safety of the occupants will not be jeopardized during construction.
   5. (E) The owner of each new unit or the owner of an existing unit being added to or undergoing major alterations shall provide a program, scope of services, which describes space requirements, staffing patterns, departmental relationships and other basic information relating to the objectives of the unit. The program may be general but it shall include a description of each function to be performed, approximate space needed for those functions and the interrelationship of various functions and spaces. The program also shall describe how essential services can be expanded in the future as the demand increases. Appropriate modifications or deletions in space requirements may be made when services are shared or purchased provided the program indicates where the services are available and how they are to be provided.
   6. (F) Swing beds located in the acute part of the hospital which may be used intermittently for long-term care patients are exempt from the requirements of this rule.

2. (2) Planning and Construction Procedures.

   1. (A) Plans and specifications shall be prepared for the construction of all new longterm care units in hospitals and additions to and major remodeling of existing long-term care units. The plans and specifications shall be prepared by an architect or a professional engineer licensed to practice in Missouri.
   2. (B) Construction shall be in conformance with plans and specifications approved by the Department of Health. The Department of Health shall be notified within five (5) days after construction begins. If construction of the project is not started within one (1) year after the date of approval of the plans and specifications, the plans and specifications shall be resubmitted to the Department of Health for its approval and shall be amended, if necessary, to comply with the then current rules before construction work commences.

3. (3) General Design of Long-term Care Units.

   1. (A) All new long-term care units shall comply with 19 CSR 30-20.030(3)(B)5. and 6.

      1. 1. Grab bars or handrails shall be pro-

vided adjacent to all bathtubs, within all showers, on at least one (1) side of all water closets and located in proper positions to facilitate the bodily movements of residents.

1. 2. Lavatories shall be positioned to be

accessible to wheelchair residents and shall not have cabinets underneath or any other unnecessary obstruction to the maneuverability of wheelchairs.

1. 3. Mirrors shall be provided in each res-

ident room or adjoining toilet room. Mirrors shall be a least three feet (3') high and located with the bottom edge no more than three feet four inches (3'4") above the floor or framed tilting mirrors may be used.

1. (B) All new long-term care units shall comply with 19 CSR 30-20.030(4)(A)–(J) with one (1) exception: intermediate-care units and residential-care units are not required to comply with subsection (4)(J).
2. (C) All new long-term care units shall comply with 19 CSR 30-20.030(5)(A)–(I).
3. (D) A separate public area for a long-term care unit shall be provided and shall include a waiting room, public toilets for each sex and a public telephone.
4. (E) An office shall be provided for the licensed nurse supervisor of the unit.
5. (F) Recreation, occupational therapy, activity and residents’ dining space shall be provided at a ratio of at least thirty (30) square feet for each resident.
6. (G) A personal care room with barber and beauty shop facilities shall be provided.
7. (H) General storage rooms shall be provided as follows: ten (10) square feet per bed for the first fifty (50) beds; plus eight (8) square feet per bed for the next twenty-five (25) beds; plus five (5) square feet per bed for any additional beds. No storage room shall have less than one hundred (100) square feet of floor space. Storage space for residents’ clothes and for outdoor equipment is required but may be undivided in the minimum area required for general storage.
8. (I) If the long-term care unit is designed to have its own dietary facilities, the dietary facilities shall comply with 19 CSR 30- 20.030(14).
9. (J) If elevators are located in the long-term care unit, they shall comply with 19 CSR 30- 20.030(21).
10. (K) Handrails shall be provided on both sides of all corridors, aisles and stairways. Corridor handrails shall have ends returned to the wall.

1. (4) Fire Prevention and Protection. All new and existing facilities shall comply with 19 CSR 30-20.030(24)(A) and (B).
2. (5) All new units, additions to existing units and major alterations to existing units shall comply with the life safety requirements in 19 CSR 30-20.030(24)(C).
3. (6) All new units, additions to existing units and major alterations to existing units shall comply with the construction requirements in 19 CSR 30-20.030(25).
4. (7) All new units, additions to existing units and major alterations to existing units except residential-care units shall comply with the electrical requirements in 19 CSR 30- 20.030(26)(E)5. and 6.; (F)1.; (G)1., 3. and 4.; (H)1.A. and 2.A.; and (I).
5. (8) All new units, additions to existing units and major alterations to existing units except residential-care units shall comply with mechanical requirements in 19 CSR 30- 20.030(27).

AUTHORITY: sections 192.005.2 and 197.080, RSMo 1986.* This rule was previously filed as 13 CSR 50-20.060 and 19 CSR 10-20.060. Original rule filed Nov. 29, 1982, effective March 11, 1983.

*Original authority: 192.005.2, RSMo 1985 and 197.080, RSMo 1953.