The City is preparing to close dozens of permanent, residential treatment beds at Zuckerberg San Francisco General Hospital in order to increase capacity in a short-term psychiatric respite program also operated at the hospital.
On Monday, at least 18 patients received 60-day relocation notices informing them that they will soon have to vacate the hospital’s Adult Residential Facility — where some have been living for more than a decade — and move to another part of the facility.
The proposed closure of 41 beds in the unit, which currently operates 55 residential beds reserved for patients with severe mental health challenges who are unable to live independently, would reduce its bed count to 14.
The closure is being protested by nurses who work at the hospital and as of Tuesday, a petition opposing it had garnered over 560 signatures.
The nurses plan to officially oppose the ARF bed cuts at a rally at the Behavioral Health Center at 887 Potrero Ave. on Thursday.
“People have lived in the ARF for 15 years — this is their home. They are stable, and they are being incredibly jarred by this,” said Jennifer Esteen, a registered psychiatric nurse who called the plan “outrageous” and added that the center’s staff were initially told by The City to keep the plan “a secret.”
“You have permanent housing that you will turn into temporary shelter beds — its bad math,” added Esteen. “Because we are having a homelessness crisis I know we need to come up with creative solutions but closing permanent beds could never be a solution when you are having a permanent crisis.”
Citing Mayor London Breed’s decision in September 2018 to declare a state of emergency in San Francisco’s struggle with homelessness, the notices received by ARF patients state that the unit has been “asked to support response efforts” and that a majority of the beds within it “will be placed in suspension.”
While the ARF unit is licensed for 55 patients, only 32 beds are currently occupied. Fourteen beds will remain at ARF, although it is unclear if all 14 beds will be occupied.
At least 18 current patients will either be relocated to the hospital’s Residential Care Facility for the Elderly (RCFE) — a unit in the same building that operates 59 beds for seniors, 37 of which are currently occupied — or must find accomodation elsewhere.
Esteen said that beds have been kept empty pending the reconfiguration of the building’s units despite the hospital’s psychiatric in-patient unit being at capacity. She said the most recent admission to the ARF took place nearly one year ago.
None of the patients currently living in the ARF will lose their homes, stressed Department of Public Health Spokesperson Rachael Kagan, who said that the beds are being “redistributed” to allow for a 27-bed expansion at the hospital’s Hummingbird Place, a low-barrier homeless shelter, called Navigation Center, that specifically serves clients struggling with mental health and substance use issues.
Kagan described the model as both successful and “popular” at the hospital.
In February, 14 new substance use and stabilization beds were added at Hummingbird Place, bringing the number of total beds to 29. At the time, Breed announced plans to open an additional 86 new substance use and behavioral health stabilization beds in San Francisco with funding from the Educational Revenue Augmentation Fund windfall appropriation earlier this year.
According to a ZSFGH Behavioral Health Center spokesperson, the average length of clients’ stays at Hummingbird Place is about 19 days.
“Hummingbird Place has been used by Psychiatric Emergency Services [PES] to discharge people to …and we found its beneficial to patients who are not taking on the next round of voluntary services available to them but do need a place to rest and regroup and consider their options,” said Kagan. “It’s popular and fills a gap in the system in which people [who] leave PES … often go back to the street.”
But the nurses behind the petition criticized the plan to expand temporary Navigation Center beds in exchange for cutting much needed, long-term assisted living beds as an “unequal exchange.”
Esteen condemned the proposal as a reactive solution to addressing an increasingly visible population of homeless individuals struggling with substance use and mental health issues on San Francisco’s streets, at the cost of preventative services and beds that protect The City’s most behaviorally challenged from becoming homeless.
“Permanent lasts longer than temporary,” said Esteen, who works in the Behavioral Health Center’s transitions placement division, and is among other things tasked with identifying placements for clients who are discharged from the hospital’s locked facility and other units.
“One of the problems we have been having is that there are no beds for our clients who will never live alone — they typically live in board and cares, and we have been having a crisis in board and care closures,” Esteen said.
Assisted living facilities, or board and cares, offer assistance with basic daily living tasks, provide around-the-clock supervision, and support medication adherence. To meet the current need for long-term care for adults and seniors, San Francisco contracts with a number of small board and care providers that operate in the community but are disappearing at alarming rates, a 2018 report found.
At the time of the report, The City was subsidizing some 16 percent of San Francisco’s assisted living facility beds and had 131 fewer ARF beds than in 2012.
This year, San Francisco is set to lose some 30 more assisted living beds, according to Esteen. Those patients could be absorbed by ZSFGH’s ARF unit, where some two dozen beds are currently empty.
Among the board and cares set to close is a six-bed facility operated by Aurora Concepcion, who once operated five board and cares in San Francisco, but has shuttered two over the past two year and is poised to close a third this year. Concepcion blames a lack of investment in board and cares by The City.
“We have been underpaid for so many years by The City. We are regulated like a big business, with minimum wage and worker’s compensation — this is not a mom and pop business anymore,” said Concepcion. “The only reason why I’m still around is because we have patients who have been here for 25, 28 years. They will be lost.”
The ZSFGH nurses are calling for all of the beds within the Behavioral Health Center to be filled to capacity as more patients from the board and care facilities set to shutter will need placements.
The nurses are also calling for the public to have an opportunity to weigh in on the proposed ARF bed reduction at the hospital.