City report: 2024 hospital discharges show most San Francisco residents sent to nearby skilled nursing facilities; data gaps persist

Claire Altman, senior health program planner with the Department of Public Health, presented the calendar-year 2024 Skilled Nursing and Subacute Care Transfer Data Report, saying the report is “required by local ordinance.”

The report found that hospitals reported more than 7,000 discharges to skilled nursing facilities in 2024, about 5,500 of which were San Francisco residents, and that more than 75 percent of San Francisco resident discharges to skilled nursing facilities were located in San Francisco. Altman also reported that fewer than 30 discharges to out‑of‑county subacute skilled nursing facilities were recorded across reporting hospitals in 2024.

Why it matters: the Board of Supervisors’ May 2022 ordinance asked hospitals to provide discharge and demographic information to better understand whether residents needing skilled or subacute nursing care are being placed in‑county. Commissioners and public commenters said the findings inform whether the city should pursue changes in capacity or policy.

Altman emphasized persistent methodological limits. “This data continues to be challenging for facilities to collect and it is not obtainable for all reporting health facilities,” she said, noting differences in electronic health records and referral systems among hospitals and manual chart review at some sites. The report excludes some data details because facilities either could not supply them or reported them in separate referral datasets that lack demographic fields.

The report also highlights cross‑hospital variation. For example, some hospitals had to manually check receiving facility addresses to decide whether a placement was in San Francisco; others used referral systems. California Pacific Medical Center (CPMC) told DPH it could not differentiate San Francisco residents from nonresidents in its primary discharge dataset, though Altman said the hospital’s referral data shows most of its discharges go to in‑county facilities.

On distance and placement patterns, Altman said more than 95 percent of San Francisco residents transferred to skilled nursing facilities went to locations in San Francisco or within 30 miles; among out‑of‑county placements, more than half were under 15 miles from the reporting hospital. San Mateo and Alameda counties were the most common out‑of‑county destinations.

Public commenters pressed for stronger follow‑up. Geriatrician Teresa Palmer told the commission she reviewed CPMC records and said the hospital should be able to provide the requested data. Benson Adele of the ombudsman program said discharge notices they receive from skilled nursing facilities are another source of downstream information but hard to aggregate.

Altman and commissioners agreed that the data improvements over three years are useful but incomplete. Altman said DPH will follow up with hospitals — including CPMC — and that Chinese Hospital is progressing on Medicare and Medi‑Cal certification to provide subacute services at a 23‑bed unit.

Next steps noted in the presentation include DPH follow‑up with Laguna Honda on hospital referrals to that facility and additional data verification for statewide bed counts. Altman cautioned the report cannot determine whether out‑of‑county placements reflected family preference, bed availability, or payer status; hospitals generally provided payer and residency only in aggregate form per the ordinance.

Ending: Commissioners asked DPH to pursue more granular tracking where possible, especially concerning Medi‑Cal–only patients and whether payer status affects out‑of‑county placement; DPH said it would continue to refine methods and follow up with reporting facilities.