Impending SNF Closure Compounds San Francisco Shortage

When a San Francisco medical center shutters its skilled nursing and sub-acute care operations this month, the move will put an additional strain on a city facing a care shortage.

Sutter Health California Pacific Medical Center (CPMC) will close its skilled nursing and sub-acute unit at St. Luke’s Hospital as part of a $600 million overhaul, affecting a sizable population of patients in the area needing skilled nursing care, according to a Hoodline article posted Tuesday.

The closing of St. Luke’s will ultimately uproot 44 patients — 25 of whom depend on the center’s skilled nursing services — into facilities in neighboring counties.


Only 11% of California’s sub-acute beds are located in the San Francisco area, Colleen Chawla, deputy director of health and director of policy and planning at the San Francisco Department of Public Health, explained to Skilled Nursing News.

“There are 40 sub-acute beds; 25 are occupied,” said Chawla. “These are the only sub-acute beds in San Francisco.”

This shortage has alarmed industry groups and public officials in the area, including the San Francisco Department of Public Health. Its “Post-Acute Care Project” published a report in 2016, which found that the city only has 22 SNF beds — both short- and long-term — per 1,000 adults aged 65 and older. The study estimates that if the city were to maintain this ratio, it would need 4,287 licensed SNF bed by 2030, an increase of roughly 70% over the current supply.


Time is not on the side of current patients receiving skilled nursing care at St. Luke’s, as many will be relocated sooner than later, according to a letter to employees written by Sutter Health Vice President of Human Resources Edward Battista.

“Those patients receiving skilled nursing care will be discharged more quickly as their average length of stay is much shorter than that of the sub-acute patients,” said Battista. “We anticipate the positions of those caring for patients receiving skilled nursing care will be eliminated effective August 10, 2017.”

Positions for caretakers providing care to sub-acute patients will be “eliminated gradually,” as patients are transitioned to other facilities, according to Battista’s letter.

This pacing concerns Hillary Ronen, San Francisco supervisor, who, along with other city supervisors Jeff Sheehy, Sandra Lee Fewer and Ahsha Safai, vocally oppose the closing of St. Luke’s and its skilled nursing unit, according to Hoodline.

Two new hospitals will be added to Sutter’s CPMC network, one replacing St. Luke’s, and the other roughly four miles north at Van Ness Avenue and Geary Boulevard. Neither facility will have skilled nursing capabilities, according to Chawla.

Ronen and her colleagues, alongside patients, their families and CPMC representatives, met recently to iron out a solution. A long-term ombudsman is also working with patients to find alternative locations, Chawla added.

Skilled Nursing News was unable to obtain any further comments Ronen and from any of the supervisors at the time of press, due to California’s legislative recess.

For Chawla, the shortage of subacute beds is only a minuscule part of larger issue.

“The closure of these beds is problematic. It exacerbates the problem we already have … and we know that we have, but it’s also a problem that we know is happening nationwide, and it’s going to take all the partners to fix,” said Chawla. “It’ll take public agencies, as well as private providers and payers, to help come up with a solution to that problem. It’s not anything that any one of us going to fix alone.”

Written by Carlo Calma

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