San Francisco SNF Fight Ends, Subacute Shortage Persists

As hospitals around the country decide to move away from skilled nursing and subacute services, a hotly contested proposed closure in San Francisco has highlighted a growing national issue.

Sutter Health California Pacific Medical Center (CPMC) had plans to close its St. Luke’s campus, including its skilled nursing and subacute care operations.

Following intense pressure from patient advocates and union representatives, CPMC CEO Dr. Warren Browner announced in a statement issued Monday that the hospital system will continue to provide care for the 28 subacute patients currently served at St. Luke’s hospital, even after St. Luke’s eventual closure.


But not all hospital-based SNFs may get such a reprieve as patient attitudes change. Farther east, Northwestern Medicine in Chicago recently made a decision to shut down its SNF to expand its home-based primary care, citing consumer desire to age at home or move into private-pay assisted living.

The subacute unit at St. Luke’s may have been ultimately spared; but the situation further illustrates not only a “regional problem,” but a nationwide strategy shift, as noted in a SF Bay article.

Immense pressure


Since CPMC announced the proposed closure in June, Browner and the hospital had faced blowback from patients’ families who fought the decision.

The families had the support of city supervisors and local groups, including the California Nurses Association (CNA), which formed a broad coalition with other community organizations — including San Franciscans for Health Care, Housing, Jobs and Justice — that advocated for the patients.

Based on its meetings with these groups, Browner announced CPMC’s final decision.

“We hope that this solution will give families peace of mind, knowing that their loved ones will continue to receive the highest quality care here in the city, where they can easily visit and support them,” he said.

CPMC is now working to determine which of the hospital’s three campuses — the new Van Ness and Mission Bernal hospitals, or CPMC Davies — can best accommodate the subacute patients. Browner expects to determine the new location in the next few months, and that patients will likely be transferred only once, preferably at the time of the new Mission Bernal hospital’s opening in August 2018, according to CPMC.

“The current unit at St. Luke’s will eventually close before the new hospital opens,” CPMC media relations manager Dean Fryer told SNN via e-mail. “However, we are committing that the patients currently in the sub-acute unit will remain in the care of CPMC at one of our campuses in San Francisco until they no longer need or desire our care.”

‘Cautiously optimistic’

Browner’s announcement yesterday was the culmination of CNA’s efforts in advocating for St. Luke’s subacute patients, according to Katy Rose, labor representative for CNA and the nurses at St. Luke’s Hospital.

“We were very relieved and happy to hear yesterday that our efforts have succeeded in protecting this group of 28 patients in San Francisco [and keeping them] near their families, their loved ones and their long-term caregivers,” Rose told SNN.

Despite securing the safety of the subacute patients at St. Luke’s, Rose explained that CNA and local groups continue to battle the shortage in subacute and overall SNF beds that the city is currently facing: Currently, the subacute unit at St. Luke’s is licensed for 40 subacute beds, according to Rose. These beds are the last remaining in any subacute unit in San Francisco, she said.

“We’re cautiously optimistic at this point, because while it is extremely important that this group of 28 patients are protected, there is an ongoing and dire shortage of such beds in San Francisco that needs to be addressed in a long-term fashion,” she said. “What we want to see is that these [subacute] services are protected … and that as the current patients are eventually discharged, or as they leave this level of care in the future, that the care remains available to future patients who will need it.”

This issue only magnifies the city’s shortage of subacute beds—a fact that Browner said he realized during initial discussions as he and CPMC weighed their options as to where they might relocate St. Luke’s subacute patients.

“We were committed to finding the best possible situations for each patient, as nearby as possible,” said Browner. “But given the enormous difficulty of securing these alternate beds and the inherent challenges our families face, we decided the best option would be to continue to serve them in the CPMC system, here in San Francisco.”

‘A full participant’

Going forward, Rose explained that CNA and local advocacy groups are setting their sights on working towards a long-term solution for the city’s shortage in subacute beds. CNA and its coalition are currently working to address the issue with the San Francisco Board of Supervisors, she explained.

“We know that the facts show that there is a current and looming shortage of this type of care in the city, and so it’s going to be a priority of the coalition going forward to continue to advocate and push for a real solution to this problem,” said Rose.

CPMC is currently working with the city and state to determine a specific plan for where the new subacute unit will be located, Fryer said.

“We have set up a series of meetings with family members to discuss specifics as they unfold and we will transition patients when details are settled,” said Fryer.

Written by Carlo Calma

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