Prop Q: CPMC St. Luke’s Skilled Nursing Facility & Subacute Unit Closure San Francisco Department of Public Health August 15, 2017 Office of Policy & Planning
Prop Q - Overview • Proposition Q (1988) requires private hospitals in San Francisco to provide public notice prior to closing a hospital inpatient or outpatient facility, eliminating or reducing the level of services provided , or prior to the leasing, selling or transfer of management • CPMC’s plans to close its Skilled Nursing Facility (SNF) and subacute unit at the St. Luke’s campus on October 31, 2017 • In recent years, the Health Commission has reviewed two Proposition Q closures/reductions related to SNFs in San Francisco. • CPMC California Campus (2014) • St. Mary’s Medical Center (2015) 8/15/2017 Office of Policy and Planning 2
Prop Q – CPMC St. Luke’s CPMC St. Luke's Skilled Nursing and Subacute Unit closure will: 1) Decrease the total number of skilled nursing beds in San Francisco by 79 (39 skilled nursing and 40 subacute skilled nursing) 2) Eliminate subacute SNF beds in San Francisco 8/15/2017 Office of Policy and Planning 3
Skilled Nursing Facility Overview 1) Level of Service 2) Facility Setting • Hospital-based GENERAL SUBACUTE CHARACTERISTIC • Freestanding 2,478 40 Licensed beds in San Francisco 24/7 Supervision Physical therapy, occupational therapy, speech therapy 3) Patient Length of Stay Wound care, intravenous therapy, injections, monitoring of vital signs • Short-term patients Assistance with bathing, eating, dressing, feeding, transferring, toilet hygiene • Long-term patients Ventilator care, complex wound management, intravenous tube feeding * Subacute patients are medically fragile and require more intensive care 8/15/2017 Office of Policy and Planning 4
CPMC Skilled Nursing Beds Skilled nursing beds across all CPMC • Campus Licensed Skilled Nursing Beds hospitals have declined by 83% since 2013 2013 2014 2017 Health Commission Resolution 02-10 California 101 0 0 • includes an agreement between CPMC and the Health Commission to provide a total of Davies 38 38 38 100 skilled nursing beds Pacific 0 0 0 This resolution became the foundation for St. Luke’s 79 79 0 • (40 subacute) (40 subacute) early drafts of the Development Agreement (DA), however the final DA is TOTAL 218 117 38 silent with regard to the provision of SNF beds 8/15/2017 Office of Policy and Planning 5
St. Luke’s SNF Unit – Subacute Patient Demographics San Francisco 80% St. Luke’s Subacute Patients Residence Outside City 20% • Most are long-term patients Female 63% Gender • 24 patients remaining in the unit Male 37% Age ≤65 60% Age Age 65+ 40% Since the Closure Announcement: Medicare 70% Payer Medi-Cal 27% • 1 transferred to Kaiser Other <1% • 1 passed away 3 months or less 0% • 1 was weaned off a ventilator and 3 months to 1 20% year discharged home 1 year to 2 years 27% • 1 transferred to O’Connor Hospital Length of Stay 2 years to 5 years 23% Subacute Unit in San Jose, CA 5 years to 8 years 17% 8+ years 13% 8/15/2017 Office of Policy and Planning 6
St. Luke’s SNF Unit – General SNF Patients St. Luke’s General SNF Patients • CPMC’s general SNF beds (n=39) are primarily for short-term stays, with an average length of stay of two to four weeks • Most patients are recovering from a surgery, wound, or condition that required an acute care stay but are not yet able to go home Patients In Unit At Time Of Closure • CPMC reported 15 patients at the closure announcement in June 2017 • Since the closure announcement, 10 patients were discharged to home, leaving the current census at 5 patients 8/15/2017 Office of Policy and Planning 7
San Francisco Skilled Nursing Facility Bed Rate % Beds Per With a static bed supply, San Francisco’s Number of SNF County Population 1,000 65+ Facilities Capacity total skilled nursing bed rate would 65+ Population Alameda 68 5,352 12% 28 decrease from 20 to 12 beds per 1,000 5,148 Santa Clara 52 12% 23 adults 65+ by 2030 1,038 Marin 14 19% 21 1,660 Sonoma 20 16% 21 Contra Costa 32 3,000 14% 20 If San Francisco were to maintain its 2,439 San Francisco 21 14% 20 current bed rate as the population ages, 368 Napa 4 16% 16 the city would need 4,083 licensed SNF 846 Solano 9 13% 15 1,582 San Mateo 13 14% 15 beds by 2030—an increase of 1,644 California 2,002 113,608 12% 24 beds over the current supply 8
Declining Skilled Nursing Bed Capacity in SF Licensed Skilled Nursing Beds in San Francisco, Since 2003, there has been a 30 2003-2017 • percent decline in SNF beds in San 4,000 3,502 Francisco 3,500 3,000 2,439 This decline is largely due to the • 2,500 2,128 reduction of hospital-based beds (43 2,000 percent decline) 1,319 1,374 1,216 1,500 1,000 1,223 As in San Francisco, nationally, the • 500 number of hospital-based skilled 0 nursing facilities has fallen (63 percent decline from 1999 to 2013) Hospital-based Freestanding All SNF 8/15/2017 Office of Policy and Planning 9
General SNF Capacity in San Francisco • While payer data suggest that most SNF beds are occupied by long-term patients, facilities Facility Total Short-Term Bed Long-term are shifting practice towards short-term care Licensed Estimate Bed Beds Estimate Hospital-based SNFs • When hospitals close SNF units, they ZSFG 30 30 0 increasingly rely on community skilled nursing CPMC Davies 38 38 0 Jewish Home 379 100 279* facilities to provide short-term care Laguna Honda 769 100 669* Hospital Freestanding SNFs • Increased demand for short-term care in the 16 Facilities 1,223 583 640** community coupled with higher reimbursement TOTAL 2,439 851 1,588 for short-term stays, may limit availability for *As reported by the facility in 2017 short and long-term Medi-Cal patients **The number of reported Medi-Cal Fee for Service patients in freestanding SNFs on December 31 st , 2015. 10
Subacute Care Capacity in San Francisco • Regionally, subacute facilities have limited County Number of Beds Number of Facilities Los Angeles 2,193 56 capacity - 11% of subacute beds (523) are Orange 532 16 located in the Bay Area and operate at or San Diego 423 11 San Bernardino 384 8 near capacity Santa Clara 223 5 Alameda 149 5 Riverside 139 4 • Subacute discharges in the county are Ventura 114 3 Fresno 83 2 relatively small, and some patients receive San Joaquin 72 2 Tulare 67 2 short-term subacute care in Long-Term Acute Contra Costa 58 2 Care Hospitals. Sacramento 52 2 Kern 51 1 San Mateo 44 1 Yolo 44 1 • San Francisco patients needing long-term San Francisco* 40 1 subacute care are discharged out-of-county Monterey 32 1 Sonoma 17 1 Glenn 10 1 TOTAL 4,727 125 11 * Estimated closure date October 2017
Ongoing Efforts & Considerations • The San Francisco Post-Acute Care Collaborative is developing solutions for high risk individuals needing post-acute care • The Health Care Services Master Plan update will highlight the need for skilled nursing care and explore related land use policy recommendations • The Department of Public Health has initiated regional conversations regarding post-acute care 8/15/2017 Office of Policy and Planning 12
Conclusion • Access to skilled nursing care, including subacute care, is a citywide and regional challenge • Any reduction of skilled nursing care services will limit patient access to this level of care • For these reasons, the Department of Public Health recommends that the closure CPMC St. Luke’s subacute and SNF unit will have a detrimental impact on the health care services in the community 8/15/2017 Office of Policy and Planning 13
Recommend
More recommend
