Increasing costs of care and decreasing services for seniors and adults with behavioral health challenges are emerging as key issues for San Francisco as The City prepares to renew its Healthcare System Master Plan this spring.
The master plan, legislated in 2010 and adopted in 2013, is intended to identify current and projected needs in regard to health care services and facilities, and directs The City to study health trends and disparities in neighborhoods as well as assess medical spaces and land use policies impacting their operations.
Current trends show that emergency room visits are going up due to a lack of preventive services and medical facilities in disenfranchised and immigrant communities like the Bayview or Chinatown. Also noted as a critical issue is the rapid drop in services for aging adults and those struggling with behavioral health issues, according to city planning and health officials who presented an overview of the master plan on Dec. 12.
While approximately 250,000 San Franciscans are estimated to have a behavioral health condition, The City has seen as 47 percent decline in skilled nursing beds to accommodate severe cases since the plan was first enacted.
Addressing this gap is crucial as San Franciscans age in place, said Health Department Senior Program Planner Claire Lindsay.
Since 2013, 2.1 million square feet of hospitals — including 236 beds — have been added, as well as nearly 350,000 square feet of medical outpatient services and some 12,000 jobs in the medical sector since 2010, according to the plan.
Upwards of 775,000 square feet of medical space is currently in the pipeline, including the construction of two new UCSF buildings in Mission Bay, a new Planned Parenthood facility , a new Kaiser facility dedicated to mental health services and a Jewish Home with 210 residential care beds.
Those projects were developed in accordance with the master plan’s guidelines, which apply to projects with 5,000 square feet or more of new or added medical use or 10,000 square feet of projects seeking a change of use to medical use. If approved under the master plan, those developments may be fast tracked by the Planning Department.
The City’s population is expected to grow by another 250,000 people by 2040, and the master plan estimates that between 4.3 million and 4.7 million square feet of additional medical space is needed. However, continued shifts in how medical services are delivered — including a focus on outpatient and preventive care — could impact this estimate.
“It may be that health care system may not have to maintain its current intensity to serve a growing population,” said city planner Sheila Nickolpoulos, who added that a large disparity lies in which populations lack access to care.
“It bums me out [that] in this country health care is profit driven, whether non profit or not. We live in a deeply racially segregated city. Even if we say we have zoning capacity, the truth is if you live in the Bayview, off Silver Avenue, in Visitacion Valley or on Treasure island you don’t have access to health care,” said Planning Commission President Myrna Melgar.
Melgar suggested that changes to the master plan include “real tools to incentivise building health care facilities in neighborhoods where there are disparities in health outcomes because of socio-economic and environmental factors.”
Proposed changes to plan include removing goals around open space and affordable housing and adding guidelines for behavioral health and long term care.
Legislation that will work in tandem with the plan’s implementation includes easing the permitting process for residential care uses and increasing subsidies for residential care providers, many of whom have shuttered due to increasing overhead.
Tom Radulovich, executive director of Livable City San Francisco, urged the commission during public comment to principally permit group homes and residential care facilities operating over multiple stories where current restrictions exist in neighborhood commercial areas.
Commissioner Frank Fung agreed.
“In quite a few of our districts the obstruction is the Conditional Use process and the prohibition of the medical use,” said Fung.
A joint hearing of the planning and health commissions on the master plan update is scheduled for March 2020, after which the plan is expected to move before the Board of Supervisors for approval.