Supervisors, advocates call for action as San Francisco loses residential care beds and Swindells faces closure

The Public Safety & Neighborhood Services Committee spent much of its Dec. 7 meeting on a citywide shortage of residential care facilities for the elderly (RCFEs) and other long‑term care options.

Supervisor Yee opened the hearing with demographics and capacity figures, saying San Francisco had roughly 29 RCFE beds for every 1,000 residents aged 65+, compared with about 48 beds per 1,000 in neighboring counties. “Housing is a health care issue,” he said, linking bed shortages to hospital discharges and rising costs for seniors on fixed incomes.

Departmental presenters outlined the system and possible interventions. Sneha Patel of the Department of Public Health explained long‑term care categories and noted many patients waiting for skilled nursing could be safely supported at lower care levels. Cindy Kaufman of the Department of Aging and Adult Services said the city had lost 19 facilities since 2012, cited rising rents, labor and regulatory costs as drivers of closures, and described DAAS programs such as Support at Home and the Community Living Fund (CLF). David Serrano Sewell of the Hospital Council reviewed draft collaborative recommendations including a standardized post‑acute assessment tool and a citywide roving placement team.

Public testimony was extensive and emotional. A hospice physician, Ken Barnes, said the situation was urgent: “We are at a point that cries out for action, not more study.” Family members and caregivers urged the board to prevent the planned shutdown of Swindells (a memory‑care unit at CPMC/Sutter), describing residents’ dependency on consistent staff and the clinical harms of disruptive moves. Anne Ludwig, speaking for family members at Swindells, called the unit a “model facility” meeting dementia care needs and said its planned closure would be devastating for residents.

Supervisors pressed staff for more data on the causes of closures and on demographic disparities in access. Board members called for a cross‑agency effort — together with the Hospital Council and the mayor’s housing initiative — to identify short‑term measures (subsidies, bed purchases or targeted funding) and long‑term strategies (integrating RCFE needs into housing plans and exploring hospital accountability mechanisms). The committee continued the item to the call of the chair to allow departments and the collaborative to return with additional data and proposed next steps.

The testimony and departmental analysis underscored gaps across the care continuum: closures of small, often family‑run RCFEs; limited reimbursement for assisted living; and pressures that push medically fragile patients into unsuitable settings. Supervisors signaled they would pursue coordinated policy options and mayoral engagement to preserve and expand options for frail seniors.