Board hears emergency measures after cityofficials report steep loss of residential care beds; supervisors seek action on city-run ARF

Supervisor Rafael Mandelman introduced a resolution and accompanying interim zoning controls on Sept. 3 aimed at slowing the loss of San Franciscoresidential care facilities and to require conditional use authorization for changes of use from a residential care facility to other uses.

Mandelman said the controls are intended as an 18-month stopgap while the city develops longer-term solutions. He told colleagues the city has 21 fewer residential care facilities than in 2012 — a roughly 26 percent decline that equates to the loss of about 112 beds — and that the Department of Public Health had identified three additional planned closures. "The intent of these interim controls is to discourage further closures and conversions of our scarce residential care facilities, slow their loss, and give the city additional time to address this challenge," Mandelman said.

The resolution asks the Planning Commission to weigh Department of Public Health, Human Services Agency, Department of Aging and Adult Services, and Long Term Care Coordinating Council findings when evaluating a proposed conversion, including the capacity and the nature of services provided, neighborhood impacts, the availability of licensed residential care beds within a one-mile radius, and whether the use would be relocated or replaced.

Mandelman also said he had requested the city attorney draft legislation requiring the Department of Public Health (DPH) to open and staff all 55 city-operated long-term residential treatment beds at San Francisco GeneralHospitalAdult Residential Facility (ARF) by no later than June 30, 2021. He asked DPH to report within three months on barriers to operating at full capacity and to provide a plan and annual updates showing how the beds will be returned to service.

Supervisor Hillary Ronan and Supervisor Matt Haney both pressed DPH on recent bed suspensions at the ARF. Ronan said she was informed by a psychiatric nurse and facility staff that DPH had placed 41 of 55 long-term beds into indefinite suspension and had not been admitting new residents since September 2018, even as people waited in locked wards. Ronan called for an urgent public hearing with DPH and the Department of Human Resources to explain the timeline, staffing efforts, budget and operational decisions, and communications with frontline staff and families.

Haney, who said he had visited San Francisco General and met with ARF residents and staff during the recess, described residents as "extremely vulnerable" and said the reduction of long-term beds by roughly 75 percent was "irresponsible and illogical." He joined Ronan in requesting a hearing by the end of the month and said the board must ensure residents have access to nursing, medication management, and activities of daily living supports.

Both supervisors and Mandelman framed the controls and the DPH directive as urgent responses to an immediate service shortfall. Multiple supervisors said they will seek public hearings and document requests to determine when decisions were made to keep beds empty and what alternatives DPH considered. Mandelman and Ronan said workers and union members (SEIU Local 1021 and others) helped surface the issue and pushed for transparency.

Ending: The board did not adopt final legislation on Sept. 3 but heard the proposals, directed further inquiry, and several supervisors asked staff to schedule hearings and prepare ordinance language requiring DPH to restore the ARF beds to service by mid-2021. The matter was positioned for follow-up committee hearings and ordinance drafting.