Patients exiting surgery or other intensive care who need more support than an in-home health care worker can provide typically stay in “skilled nursing facility,” or SNF, beds.
Beginning next year, hospital officials say there’s scheduled to be more patients requiring these beds than are available in San Francisco. And demand is projected to rise even further, at the same time as California Pacific Medical Center, whose hospitals are undergoing seismic retrofits, are doing away with these beds.
The City’s skilled nursing beds usage is projected to be at 115 percent of capacity next year, after CPMC removes several dozen of the nursing beds from The City’s supply, according to data presented to the Health Commission.
Neither CPMC’s new Cathedral Hill hospital – currently under construction – nor an overhauled St. Luke’s in the Mission district will have skilled nursing beds, according to CPMC, which will have the skilled nursing beds at its Davies campus only.
About four nurses will be laid off as a result of the bed removal, the healthcare company said, though union representatives said that closer to 19 people will lose their jobs.
The overall trend in American health care is towards “managed care,” including at-home visits to a recovering patient, rather than long-term skilled care in hospitals, a 2009 report commissioned by the Department of Public Health found.
However, there’s still local demand for skilled nursing services, statistics show. After exceeding bed capacity next year, The City is projected to be at 130 percent of capacity in 2020 and 702 beds short of its skilled nursing facility need by 2050, according to the DPH.
This trend creates “a capacity risk for San Francisco” that “may have a detrimental effect on the community,” said Colleen Chawla, DPH’s deputy director of health.
One reason for the declination is that Medicare and Medicaid have been less-willing to reimburse for such care. Without government subsidies to cover the care, private hospitals are less willing to provide it.
“If someone doesn’t make money off of something, they want to stop,” said DPH Director Barbara Garcia, who noted that such moves by CPMC put a strain on The City’s publicly-funded health care networks “because we don’t have that choice.”
The department wants to hold CPMC “more accountable” for cutting the services, Garcia said. “We want them to be a better partner.”
Craig Vercruysse, CPMC’s chief operating officer, noted that there are “35 years” until the 2050 shortage, and pledged to work with DPH “to meet those needs.”