Some 44 patients may be forced as far away as Sacramento and 72 healthcare workers could lose their jobs since Sutter Health decided to abolish sub-acute care at St. Luke’s Hospital in the Mission.
The news has raised concerns regarding the health care needs of seniors as the city is already struggling to provide post-acute care. Patients who are admitted to post-acute care units often need very long-term or even lifetime care and are among the most vulnerable patients in the community.
More than half of St. Luke’s nursing home residents receive sub-acute care, requiring round-the-clock monitoring, with some on ventilators.
Sutter says it is working with the families of those affected to find them better placements in other facilities. But due to lack of available spaces in San Francisco patients will need to be relocated as far as Sacramento.
The skilled nursing and sub-acute units — which provide comprehensive inpatient care designed for adults with high needs, such as ventilator care — are scheduled to be closed in October as part of hospital’s transition into a new $600 million campus that will likely open in early 2019.
St. Luke’s was taken over by Sutter Health in 1999 and in recent years, Sutter says, the facility has accumulated $30 million in annual losses. However, Sutter agreed to keep St. Luke’s open as a full-service hospital as part of the deal that gave the $4 billion nonprofit the right to build a new hospital on Van Ness.
“With regard to our subacute patients, we anticipate that positions will be eliminated gradually over time as the subacute patients’ transition to other facilities. The precise timing will depend on staffing needs as patient census gradually decreases,” Battista wrote.
Jobs with Justice Executive Director Gordon Mar says the announcement caught everyone off guard: “This was somewhat known that they (Sutter CPMC) had intended to do that because they had communicated this to the health department back in 2011 but it was the community’s understanding that it wasn’t going to happen until the new St.Luke’s hospital was opened,” he said, the new facility will not have skilled nursing units.
According to a 2016 comprehensive report prepared by the Department of Public Health, the city faces several challenges when it comes to post-acute care: “San Francisco’s growing older population coupled with the high-cost of doing business in the city and low reimbursement rates for long-term skilled nursing care may result in a bed capacity problem in the future.”
St.Luke’s closure is part of a larger issue around lack of sub-acute care in the city. The San Francisco Health Commission under Proposition Q recently reviewed the closure of two acute care hospitals: In 2014, California Pacific Medical Center (CPMC) closed 101 of its licensed skilled nursing beds at its California Campus. Shortly after, in 2015, St. Mary’s Medical Center closed 32 licensed beds.
Contrast this with increasing demands: According to the 2014 American Community Survey, San Francisco’s population age 65 and older currently comprises 14% of the city’s population (approximately 113,000). California Department of Finance 2014 population projections indicate that San Francisco’s population 65 and older will comprise 20% of the population by 2030 (approximately 192,000).
Age isn’t the only factor determining the need for sub-acute care two key factors predict short and long-term skilled nursing care need: difficulty with daily life activities like bathing, dressing, and suffering from dementia.
Currently, 38% of San Francisco seniors 65 and older and 7% of adults ages 18 to 64, approximately 80,000 people, report disabilities. Among the most common difficulties reported are cognitive, walking, and independent living. In addition to that, 13.3% of San Francisco Medicare seniors (65 and older) are diagnosed with dementia. According to the DPH, “Assuming these rates stay the same, the number of seniors 65+ with disabilities and/or dementia will increase significantly by 2030.”
The report projects that San Francisco will need to increase the current supply of skilled nursing beds by nearly 70% to meet future needs. But with the closures of various sub-acute facilities, the future of health care for seniors in the city remains in limbo.
“This is a good example of what’s wrong with our healthcare system where health care decisions and indecisions are being made from a business perspective rather than based on healthcare needs of the community” Mar said.