Plan to save S.F. care facilities for mentally ill, seniors is promising | #healthcare | #elderly | #seniors
After a fire tore through a Victorian on Shotwell Street in the Mission, the building — which used to house six seniors in a residential care home — sat empty for six years.
Alex Goosef, 69, stands outside a residential care facility, located at 969 Buena Vista West, in San Francisco, Calif., on Tuesday, September 3, 2019.
Small residential care facilities like the one at 628 Shotwell St. are disappearing at an alarming rate in San Francisco, putting vulnerable seniors and adults with disabilities, mental illness or addiction at risk of homelessness with little access to needed treatment services.
In San Francisco, the number of assisted living facilities for seniors and adults with disabilities dropped 38% since 2012, with beds dropping 17%, according to city reports. Hardest hit were the smallest facilities serving low-income residents. At least 100 people were waiting to get a spot in a facility, according to the most recent count.
Advocates say the shortage means more people are sent out of county, which is hard for families, or end up on the streets.
“If we are serious about ending homelessness for seniors and people with disabilities, we need residential care facilities,” Supervisor Rafael Mandelman said.
Advocates have sounded the alarm for years as high costs and low reimbursement rates shutter these homes. Officials are now trying to cement laws to make it harder to eliminate existing facilities and easier to create new ones as a stopgap while tackling the bigger issues of costs and a shortage of operators.
In October 2019, Mandelman sponsored temporary regulations that required a building owner to apply for special approval from the Planning Commission to demolish or convert an existing residential care facility to another use. Mandelman introduced an ordinance Tuesday to make the rules permanent and add other measures that would put pressure on applicants to check if any entity is interesting in running the building as a residential care facility.
Mandelman also wants to expand the area where no special approval is needed to create or grow a facility.
Advocates believe the regulations have helped block the vacant Shotwell Street site from being converted to a new use.
In December 2019, the owner applied to convert the building into housing, according to city documents. The case is still stuck in the Planning Commission. On April 23, the owner’s lawyer sent a letter to community groups emphasizing the intent to develop but first offering to sell the property so it could be reopened as a residential care facility.
“The property owners are not in the Residential Care Facility business and lack the expertise, licenses, and resources to operate such a facility. It is also not a financially viable use in this location,” the letter read.
The letter gave the groups 25 days to come up with around $2 million. Sara Shortt, director of public policy with Community Housing Partnership, said she and other advocates are creating a plan for a non-profit developer to buy it. The current owner declined to comment.
The economics are often unworkable: For small facilities, the break-even rate per bed is at least $2,000 a month, but that’s more than double the state-set rate for Supplemental Security Income recipients in assisted living. The city subsidized 15% of assisted living beds in 2019 for about $11.2 million per year. Subsidies are still not enough for some to sustain operations, said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.
Non-profit Richmond Area Multi-Services (RAMS) runs a 33-bed facility for people with mental illness and medical needs funded by the Department of Public Health on Broderick Street. Christina Shea, deputy chief and director of clinical services, said costs keep rising, but the contract has not risen at the same rate.
The health department could not respond immediately to a request for comment. The city expressed interest in December in buying the facility, but the owner wasn’t ready to sell yet, a city report said, and the lease was extended. The owner could not be reached for comment.
Advocates believe the new regulations helped protect the property.
“San Francisco doesn’t have nearly enough residential care facilities to house people who are struggling with severe mental health issues,” said Sal Rosselli, president of the National Union of Healthcare Workers, which represents mental health therapists at the Broderick Street facility. “This pilot program is already helping the city preserve these essential facilities and improve conditions by changing the dynamic of power between the city and the property owners.”
As deadline approaches for community groups to make an offer on the Shotwell Street site, Shortt said they are not “married” to it being a residential care facility, but would like it to provide some form of housing or treatment.
“We’ll look at the economics of it for sure, but we think it’s well worth getting people off the streets” who might end up in emergency rooms and cost the city more, she said. “We knew that it was a very precious opportunity to potentially preserve.”
Mallory Moench is a San Francisco Chronicle staff writer. Email: email@example.com Twitter:@mallorymoench