San Francisco’s shortage of skilled nursing and beds for people with critical illness or injuries has barely budged since city leaders began pressing hospitals to expand treatment options in 2018.
“I really feel like we are where we were two years ago,” said Supervisor Ahsha Safaí, who sponsored a hearing on Thursday to check the status of efforts underway to create at least 70 in-hospital beds for individuals with a serious disease or injury across The City’s hospital networks and freestanding care centers.
In the meantime, patients have had to continue to relocate to other cities and counties around the state to receive what’s known as subacute care, which includes post-surgical care, pain management, inhalation therapy, intravenous tube feeding and severe wound rehabilitation.
It’s been a heartbreaking pattern to witness for people like Vivian Imperiale, president of the Mental Health Association of San Francisco, who had a close friend moved to a subacute care facility in Sunnyvale after he was unable to access a subacute bed in The City.
“It is very alarming that San Francisco dumped him there and forgot about him. Not only are his social worker and conservator not checking in with him, they are not returning his calls,” she said. “That is totally unacceptable.”
Exacerbating the issue is the fact that city and public health officials do not know exactly how many people are currently impacted by the problem across San Francisco. Hospitals and care centers do not report how many people are discharged and relocated for subacute care.
That could soon change, as Supervisor Gordon Mar said he was interested in crafting legislation that would require such reporting.
“I find it very disturbing that other counties are taking S.F. patients when they should remain here at home. This is where we live and pay taxes, we should be able to be near our family,” San Francisco resident Gloria Rivera Simpson said during a public comment portion of the hearing.
In June 2017, the California Pacific Medical Center, part of the Sutter Health network, announced its plan to close its skilled nursing facility and subacute unit at its former St. Luke’s Hospital campus, then the only subacute facility across The City.
Chinese Hospital and the San Francisco Health and Rehabilitation Center are two locations that are now moving towards adding 23 and 38 beds, respectively. But it could be years before The City reaches its goal of having 70 beds open.
Priorities in The City’s health care system dramatically shifted in 2020 as the coronavirus pandemic became a top concern, causing discussions and momentum around building out acute-care beds to peter off.
“It was hard to have these conversations during COVID, and at the state level, it was hard to get any licensing and certification support because everything was dedicated to COVID,” said Kelly Hiramoto of the San Francisco Public Health Department.
According to Hiramoto, bureaucratic delays for site-specific licensing and certification requirements are standing in the way of The City’s ability to rapidly open new subacute-care beds and skilled nursing facilities.
She anticipates that it could take between nine and 18 months before new patients could access the additional subacute beds that are in the works across The City now.
“That seems like a long period of time,” Mar said. “I am concerned about that given the urgency of patients who really need subacute care and continues to be transferred out of the county.”
Economic trends paint a difficult picture ahead for expanding skilled nursing and subacute care, which generate lower profit margins compared to options such as maternity and orthopedic care that are growing in demand and profitability.
The Board of Supervisors requested to hold a hearing again in the upcoming months with an update on the status of the beds.
“Everyone has been in crisis and response mode and I understand that,” said Safaí. “This is the time to think about the future.”