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Health Commission reviews post-acute care report as public urges action to halt decline in subacute beds
Summary
The commission heard a Post Acute Care Collaborative report identifying 117 patients waiting for post-acute placement and recommending a standardized assessment (LOCUS), a citywide roving placement team, and expanded supported-living alternatives; public commenters and commissioners pressed hospitals — especially CPMC/Sutter — to keep subacute and SNF beds in San Francisco.
The San Francisco Health Commission received a point-in-time report from the Post Acute Care Collaborative (PACC) and a department briefing outlining a multi-part strategy to address shrinking post-acute capacity and delays in placing medically fragile patients.
Sneha Patel, from the Department of Public Health's Office of Policy and Planning, summarized background trends including closures of hospital-based skilled nursing and the limits these shifts place on discharge options. Daniel Ruth, co-chair of the PACC, said the collaborative completed interviews, site visits and a point-in-time survey that found 117 patients waiting for post-acute placement across the city—s hospitals.
Kelly Hiramoto described the PACC—s three primary recommendations: adopt a standardized post-acute care assessment tool (the LOCUS instrument for level-of-care determination in behavioral health), establish a citywide roving placement team to assess and match patients to appropriate settings, and increase access to supported living or board-and-care alternatives by facilitating subsidies or wraparound services.
Why it matters: public commenters and several commissioners said the report does not change the immediate reality: hospital-based subacute and skilled nursing beds are disappearing and families are being affected. Ken Barnes, a physician formerly in St. Luke's subacute unit, urged the commission to push hospitals to keep beds open and proposed siting a new unit at a planned Mission Bernal medical building.
CPMC/Sutter Health responded to questions about transfers. Emily Webb, Bay Area director of community benefit for Sutter Health, said Davies campus had 38 SNF beds; converting 17 to subacute to keep existing St. Luke's patients in-system would leave 17 subacute beds and 21 SNF beds at Davies. "Those are the last SNF beds in any acute facility in San Francisco," she said, and added CPMC will discuss Prop Q and staffing with department staff.
Public commenters and union representatives urged more immediate and enforceable commitments. Kim Tabaloni of the National Union of Healthcare Workers described the situation as a crisis and called for hospitals to "pony up" beds. Benson Nadel, the county ombudsman, flagged what he described as inconsistent bed counts in the PACC report and highlighted unsafe discharges and data gaps.
Next steps: Commissioners asked staff to quantify projected need and to draft a resolution capturing the department—s next steps and commitments for the commission to consider at the next meeting. The department agreed to return with measurable proposals and to include community voices in implementation planning.
