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Report: San Francisco faces skilled-nursing bed shortage

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A San Francisco Department of Pubic Health report states a growing need for post acute nursing beds like San Francisco’s Laguna Honda Hospital and Rehabilitation Center. (Emma Chiang/Special to S.F. Examiner)

San Francisco is suffering from a shortage of post-acute health care beds, and the problem is only projected to worsen as the senior population increases, according to a new Public Health Department report.

The number of skilled nursing beds is decreasing in San Francisco while the demand for them is increasing. That has forced San Francisco’s health officials to confront the issue to ensure thousands of residents have access to these specialized health services.

Skilled nursing beds are in various facilities, from hospitals to nursing homes, designed for short-term or long-term stays for those recovering from surgery, suffering from mental illnesses like dementia, or in need of assistance to perform basic functions like bathing or dressing.

The report, “Framing San Francisco’s Post-Acute Care Challenge,” presented this week to the Health Commission, provides a rare look into the complexities of health care demands for those needing skilled nurses and warns of a bed shortage.

“San Francisco is at risk for an inadequate supply of skilled nursing beds in the future,” Sneha Patil, a Public Health Department official, told the commission this week.

“At current rates of use, demand for San Francisco’s skilled nursing facilities would exceed supply by 2020 and patients age 65 and older would represent the greatest increase in growth,” the report said.

San Francisco has 2,542 skilled nursing beds, according to the report — a combination of hospitals and other facilities, like nursing homes. There are currently about 22 skilled nursing beds per 1,000 seniors in The City. Just to keep that rate between now and the year 2030, the bed supply would need to increase by 70 percent for a total of 4,287 beds.

Driving that need is an aging population. Today, seniors, those aged 65 and older, comprise 14 percent of the population, or 113,000 residents. By 2030, seniors will comprise 20 percent of the population, or 192,000 residents.

Exacerbating the issue is that the supply of beds has decreased in recent years — a trend health officials are attempting to reverse by working with hospital officials and other health care service providers.

In hospitals alone, skilled nursing beds have decreased by 43 percent since 2001 for a total of 1,319 beds today.

Skilled nursing beds outside of hospitals have also declined by 9 percent during the same time period and are operating at “near capacity.”

“The high cost of land and construction in San Francisco has been reported as a substantial barrier to maintaining, as well as increasing the number of [skilled nursing] facilities and providers,” the report said.

Health Commissioner David Pating said San Francisco has “a gap here that is looking to be solved.”

“It’s just not clear to me if we are going to need 500 or 1,000 — whatever the number that we are going to have enough room in The City to build these number of beds,” Pating said, noting that Mayor Ed Lee has a goal of building 30,000 housing units by 2020 in addition to housing more of the homeless population. “I hope we will consider out-of-city and maybe even
multicounty options,” Pating said.

The report found the existing capacity is already showing signs of being strained beyond its limits. On Oct. 1, 2015, Laguna Honda Hospital reported 11 people on its wait-list for long-term care, while the Jewish Home reported 100 people. On Oct. 21, 10 acute care hospitals in San Francisco were having trouble placing 67 patients in skilled nursing situations.

Patil said hospital officials have a difficulty in placing patients in sub-acute care beds. “There are a handful of facilities in the greater Bay Area. But some discharge planners have reported having to send patients as far as LA County due to a lack of beds in just the Bay Area,” Patil said.

Abbie Yant, vice president of community health programs at St. Francis Memorial Hospital, said the report represents the first time The City is addressing post-acute care at large. “We need to protect what we have now,” Yant said. “The problem is here today. We do have some urgency around that.”

The report makes seven recommendations to address the issue, including establishing a panel to create a more detailed plan, explore incentives or funding options to encourage the creation of skilled nursing beds and expand community programs to care for post-acute care patients.