Can San Francisco cease the extinction of small assisted dwelling amenities?

For San Franciscans seeking assisted living in their hometown, the options are bleak and the outcome can be life-threatening.

In the past decade, the number of residential care facilities across San Francisco has plummeted. According to city reports, between 2012 and 2018 the city lost 186 beds in nursing homes for elderly people who care for fewer than 15 people. More than two dozen of these small facilities were closed during that time, while only 74 beds were added in larger facilities.

“The effects are dramatic. These are the people who built this city, and now the options are homelessness, ”said Laura Slade Chiera, San Francisco’s executive director of mutual legal assistance to the elderly.

Small changes have started to slow the alarming trend, but only to a certain extent. Between 2018 and 2021, almost 460 beds were added in assisted living facilities for the elderly. But these beds were almost entirely in large facilities that serve more than 100 people, including the San Francisco Campus for Jewish Living and Portola Gardens.

Smaller assisted living facilities that offer a more homely environment are now falling out of the structure of the city’s health and housing networks, creating a gap in the care continuum as the population ages.

People looking for assisted living are often faced with long waiting lists, are driven out of the district or end up on the street. In January 2019, 103 people were waiting to be placed in an assisted living facility, according to a report by the San Francisco Human Services Agency.

“We lost a lot of boarding facilities and that contributed to the homelessness crisis,” said Jennifer Friedenbach, director of the Coalition on Homelessness. In the past, “people could use their handicap check and received accommodation, food and support. Then over time the boarding school care was lost and the disability check was not enough to cover rent and health insurance alone. “

The city guides are now investigating possible policy changes to contain the trend. This month the Supervisory Board passed a regulation that requires a change in the use of an existing care facility in order to prevent additional losses.

The regulation also makes it easier to open new nursing homes by removing the requirement for a permit for facilities with seven or more beds in all residential areas.

The regulation will come into force on October 31, but has already been tested by a pilot version of the directive, which came into force in 2019 and should expire in October.

The transition policy helped slow the renovation of a 33-bed facility on Broderick Street operated by the nonprofit Richmond Area Multi-Services. The owner of the building tried not to renew the lease and sold the building, which was leased from the Ministry of Health. And proponents say the rule provided leverage in negotiating with the owner, who agreed to extend the lease for an additional three years.

“These residents we are caring for are very stable right now, but in the past they have been homeless, hospitalized and so they are staying with us so they can continue to live in the community,” said Christina Shea, director of clinical services at Richmond Area Multi-Services.

But even those who support the policy change fear that it is just a patch.

“My legislation is not the solution to this problem. It’s a very small effort to slow the bleeding and open the door to new operators trying to get into space, ”said Rafael Mandelman, San Francisco supervisor who supported the legislation. “But as a city, we need much more aggressive efforts and strategies to provide beds for people who need a higher level of care than is possible in a permanent hose unit.”

In particular, advocates of housing and health care say an increase in funding for grants to cover bed costs is needed to make these facilities financially viable for both residents and caregivers.

The monthly break-even rate for assisted living beds is over $ 2,000 for small facilities, according to the 2019 report, which is more than double the additional safety income for assisted living residents in California. This has made it nearly impossible for some centers to remain financially viable while serving low-income residents without external funding.

“There have been shifts in recent budgets, but not nearly the magnitude we need,” Mandelman said, referring to the health department’s goal of adding 400 treatment beds overnight. Only 73 of these beds are intended for inpatient care, and there is still no date when they might be available.

Another kind of care

San Francisco was once home to a much larger network of assisted living home centers. Much like small daycare centers that can be run and operated as small in-home businesses, families and small businesses would operate these facilities at home across the city.

“We had a thriving mental health system in San Francisco in the 1970s, and a big part of that was all of these Victorian homes that families could buy cheaply and convert into boarding and care,” Friedenbach said.

But over time, inflated rents in San Francisco have displaced these small businesses, and it has become more economical to invest in beds in facilities that are already financially stable. At the same time, the minimum wage has increased by 46%, while the rate of additional safety income for assisted living residents has only increased by 8%, making it increasingly difficult to keep employees and businesses afloat.

In some cases, condominium centers have been sold or the children of the families who run them have lost interest in continuing the business.

“Ultimately, it just doesn’t fit in a lot of places,” said Susie Smith, assistant director of policy and planning at the San Francisco Human Services Agency. “We have a growing older population and have to offer different levels of care.”

Keeping these types of facilities open is also a commitment under the Gov Aging Master Plan. Gavin Newsom, who directs health systems to avoid unnecessary institutionalization and isolation.

Chiera, from Legal Aid for the Elderly, hopes the recently codified directive can resolve a harmful pattern she keeps seeing. “Anything that increases the number of inpatient care beds in San Francisco is great. We focus very much on supportive living and individual living, which is necessary, but it is important that we keep this topic in mind well into old age. It’s really hard to move that far. “

sjohnson@sfexaminer.com