The loss of skilled nursing beds in San Francisco may surge from 20 percent lost to 25 percent lost, if CPMC’s Cathedral Hill Hospital construction plans are approved.
Between 1992 and October 2007, five San Francisco hospital-based and freestanding skilled nursing facilities (SNF’s) closed 312 SNF beds.
Then, between 2008 and 2009 Laguna Honda Hospital (LHH), Lawton Healthcare Center, and California Pacific Medical Center (CMPC) reduced their licensed SNF capacities by a combined 439 beds, bringing the total number of lost SNF beds since 1992 to 751, a 20.5 percent loss of these beds in San Francisco at the same time San Franciscans are rapidly aging and in need of Alzheimer’s and dementia care 24/7, among other SNF services.
In addition, CMPC has proposed closing 180 of its total SNF beds across two of its campuses by the year 2014 when it builds its new Cathedral Hill Hospital, which will bring the total SNF beds lost to 931, 25.4 percent fewer than existed in San Francisco in 1992 — assuming there are no further closures of other SNF facilities before 2014.
“Medicaid pays nursing homes a lower rate, so there are simply not enough nursing home beds for low income folks in San Francisco. Low income frail elderly and disabled people who qualify for Medicaid (Medi-Cal in California) often simply cannot find a SNF bed in San Francisco. These folks usually cannot afford any kind of ‘assisted living’ arrangement, or are too sick to make it without nursing home level of supervision,” says Dr. Terry Palmer, a noted geriatrician.
The situation for Medi-Cal patients who need SNF level of care worsens.
First, it is thought only 2,046 (approximately) of San Francisco’s currently available 2,911 SNF beds accept Medi-Cal patients, just 70.6 percent of the city’s current total SNF beds.
Second, according to data on the U.S. Center for Medicare and Medicaid Services’ Nursing Home Compare web site, between April 2009 and July 2010 the two freestanding SNF’s in San Francisco that accept only Medi-Cal patients — St. Anne’s Home and Hayes Convalescent Hospital — saw their occupancy rates at the time of their annual inspections shoot up from 89 percent to 95 percent, indicating there are fewer beds open that accept Medi-Cal clients needing SNF care.
Similarly, of an additional 11 San Francisco SNF’s accepting both Medi-Cal and Medicare admissions, their annual inspections show occupancy rates jumped from 90 percent in 2009 to 94 percent in 2010, again indicating fewer SNF beds are available for new patients.
Laguna Honda Hospital’s occupancy rate skyrocketed from 88 percent to 98 percent across the same period, indicating it has fewer beds to admit new patients needing long-term SNF care.
Overall, between freestanding and hospital-based SNF beds, the percentage of occupied beds has inched up from 87 percent to 89 percent in just over a year.
Third, many of the facilities that do accept Medi-Cal patients have admission restrictions for the types of medical conditions they will admit, narrowing the number of available Medi-Cal SNF beds for high-acuity, medically complex patients.
And that’s before CPMC plans to close another 180 SNF beds within the next four years, at a time when San Francisco’s rapidly-aging baby boomers and the expected “silver tsunami” of Alzheimer’s patients in San Francisco will face an increasing need for SNF level of care.
Fourth, many SNFs have already converted from providing long-term care to short-term care, limiting placement options for severely ill patients needing care over the long haul.
“When elderly San Franciscans do break a hip or get a non-healing bedsore, there may be no nursing home bed in San Francisco for them. They may go home, but revolve in and out of emergency rooms and hospitals. They may die in a hospital-based skilled nursing unit, or in an out-of-county nursing home,” Palmer says.
When this Examiner placed a public records request with San Francisco’s Department of Public Health to learn how many patients were being discharged out-of-county, he was told in June by its spokeswoman, Eileen Shields, “There are no documents that respond to this request.”
Given the shortage of SNF beds in San Francisco, surely DPH knows how many of its patients are being dumped out-of-county.
How much more will this shortage worsen, before being addressed?