State because of the fact of the closure and our patients is our pride and our joy. Its not just a job. And what our concern is is that say like for you and i, its easy for us to get up and relocate and deal with new faces. With our clients its not like that. It can be devastating and can even lead into death possibility, which we pray not, but this is our concern. Our clients have very challenging behaviors that we understand and our first step or recourse is not to medicate. We know how to interact or defuse their behavior and not allow them to get hurt and protect them. Everything that is very, very difficult for a Family Member to do, you need a team like the irene swindel center. We hope the board can review the track record of the center, which we were one of the leading models of the residential facility in the northern california. We had other facilities sending their clients to us. When they came to us, there was a drastic improvement in ways there wasnt at the other facility. I feel this is a facility that really, really needs to stay here in the city and the clients we had had are the state of the art people who build highrise buildings and other things here in the city. Thank you. Im going to call other names while the next speaker comes up. Hi, im teresa palmer, i work with San Francisco for healthcare jobs and justice. One of the things i wanted to point out, its on the c m. P. C california campus, it costs 6500 a month minimum to be there. It is a model facility and under the model of memory care, which is an enhanced form of Residential Care that is expensive to provide. It has increased nursing and staff training than most Residential Care facilities. Most facilities are decidedly non medical and do not do well when seriously ill patients are sent to them. The ombudsman has provided you with a list of Horror Stories that can happen when sick people are discharged to the hospital from an rcfe. And the Hospital Council is basically supporting a narrow focus on short stay acute care because that brings the most revenue. They want to discharge their problem patients to Residential Care because thats the cheapest thing for them to do. Low to moderate income cant find regular longterm care in San Francisco and community sniffs are using beds to provide post hospital rehab, that the hospital used to provide because it is funded by medicare and pays more than medical. Because the hospital industry will no longer provide post hospital sniff, sniff subacute and acute psychiatric care, they dont make enough of a profit on it, even though they dont pay taxes. This is pushing sicker and sicker people to Residential Care. Residential care should only be used for frail and ill people if it truly meets their needs. To meet the needs of a Residential Care patient, you have to have wraparound thank you. Whats your name again . Teresa palmer. Thank you. Im michael lion, also with San Francisco for healthcare housing jobs and justice. Im on the board of the California Alliance for retired americans. Were working very hard to incorporate universal longterm care into the california Single Payer Health bill thats going on right now. As part of that, were working to remove the strong institutional bias and longterm care. But you have to consider whats going to be happening in 2013. Its only 13 years from now. In 2030. Its only 13 years from now this is when the baby boom wave is going to approach 85. So this is the elephant inside the snake is going to move to the point where the beginning of it is 85. Nationally in 2010, there was 11 Million People who were 85 and older. In 2030 it will be 18 million. In 2050, 35 million. In San Francisco 25,000 people in 2030. 50 of the 85 plus are expected to get dementia. The future 85 year olds are going to have much more chronic disease than the past 85 year olds. The future 85 year olds are going to have a lot less money than past 85 year olds. Something must be done to care for them and it cannot be simply Residential Care. There must be a continuum of all levels of care. We must remember that hurting any level of care is going to hurt other care. Thank you. Hello everyone. Im so happy to come here to talk about our residents, which means not like i mean, theyre like our family. Its not im talking about myself, im going to lose my job, its not that. Its our small community, we have high experience and i know how were going to deal with them, its good for our residents to stay the same place and then the same staff its a better place for them. Thank you. Thank you. A few more cards. Annie chung and katie owens. Im kim from the National Union of healthcare workers and i have a privilege of representing the workers at the facility. We have a real problem here. The people at the top of the food chain, the hospitals who are making millions and millions of dollars of profits pay no taxes and are shoving people out the doors. And are not doing their fair share at the other end of the spectrum. They apparently dont like seniors, primarily cpmc, theyre trying to throw out the swindel patients out. What we have here is pure profit and greed going on and we need to do something to change the dynamic. Its time, the hospitals that dont pay taxes, maybe we do some sort of surtax on every hospital bed, that money goes to a pool to try to create more beds. They need to do their fair share. Basically the post acute care, what is it, collaborative or whatever, collaborative was only amongst hospitals primarily. There was no like the people making the most money are not doing their fair share of the healthcare in San Francisco for the Residential Care, for the subacute care and Skilled Nursing beds. Theyre not doing their fair share. We need to come together and perhaps its time to create another dynamic where the Community Members come together and we sit dine and try to hash out a real solution and make them accountable. Make them accountable to the patients, make them accountable to the families, make them accountable to all of San Francisco. This is not fair. Good afternoon. Thank you for calling the hearing. Im katie owens from advanced approach to senior care. Essentially what we do is try to find housing, board and care, assisted living for all counties in northern california. The best way to describe it like a realtor but helping to find assisting care homes. On a daytoday basis i cant explain the stories that i hear, its overwhelming. Theres sadness underneath it. Right now i feel activism, a call to something more and im inspired by everyone here and im very sad to hear that the facility is closing. Even if you can imagine at 6,500, thats not inexpensive and people are paying 50 of that, thats amazing. Above and beyond that, its a specialized facility, so its not like you can say youre closing down, call katie owens and have you 3,000 and what can i find for you. What i can find for you may not be safe and i dont have the list of everything that the ombudsman gave you but if you have a moment ill take you on a tour and you can go into some of those, i guarantee you wouldnt want your Family Members to be living in a lot of those. Nothing about the business owners, thank you, theyre serving a population that needs to be served but not necessarily with frail and vulnerable. I wish i had a solution, i dont. A little bit comes down to money obviously. Were giving a lot of money to research, thats beautiful, but what can we do to solve this problem. Ill leave a thought, i got a call from a gentleman paying 10,000. He has a day in the city named after him that governor ed lee gave him and he cant afford to live where he lives anymore at the age of 99. Im kathy davis, we have no board and cares in our district in 94124 or 94107, the closest is age long and no one can afford to go to it. My concern and i want to thank you for just bringing up the topic supervisor yee. No one has thought about the idea that maybe every senior cant be in independent housing. Maybe we need other solutions and places for people to live. I appreciate the conversation but i think we need to go a step further. Having the discussions about Affordable Housing, we have to think of people aging in place in the Affordable Housing and divert dollars for people to live in and work with nonprofits to provide the services. Im concerned about the population now. We have 120 unit Senior Housing and 3,000 people on the waiting list and as our seniors age in place in independent housing we place them in, where do they go . If you dont have a Family Member in San Francisco or person to advocate, youre not going to be in San Francisco. And its unfair to people who have lived here all their lives not to be able to figure out a solution for them. I feel theres a way to work with the Health Department and department of aging and homelessness and housing to address this issue together. Thanks. Thank you. Good afternoon. Im the president and ceo for the elderly. This is our 51st anniversary being a Community Based organization, mostly for low income and immigrant seniors, particularly asian seniors. We started to operate a small six bed in the Richmond District back in 1990. We accepted only ssi seniors in those days and when they get the ssi check, they take out 100 and the rest comes to operating. When the landlord raised the rent to double, we couldnt do it anymore. We bought a small row and run an 11 i think 12 bed rcfe, accepting half private pay and half ssi. But with all with the healthcare costs and increase of you know like the requirement by the rcfe operators, weve always for 30 years advocated for department of health to provide rcfe with facilities for the elderly, the same patch to Mental Health operators. Ev im here urging the supervisors and thank you for raising the issue and bringing the issue to rcfe. A lot of the seniors have run down their savings. I urge you to find solutions for the residents in the rcfe. Thank you. Any other Public Comments . I didnt hear my name called. I probably wasnt loud enough. Are you phil . Yeah. My wife and i moved here in 1971 and bought our house, really a flat, and decided thats where were going to live and well stay there until were carried out in fine boxes. Unfortunately marian developed alzheimers, i had day services for a while. And then it worked until marian developed a fear of going down stairs and our flat was two flights up. I would have had to have somebody there 24 7 to carry her up and down the stairs in an emergency and that was not practical. I looked around for a suitable place for her to go. I came across swindels for alzheimers patients. We were accepted and its been one of the greatest things thats happened for marian. Shes now totally wheelchair bound, doesnt speak, needs help with feeding her, dressing her, all of this. The wonderful staff, which several are here have taken great care of her. Im concerned if they close the facilities shes been there three years and if they she has become adjusted to the routine. It could be catastrophic if they close that facility. The staff knows her and how to work with her. And anticipate her needs. Thank you. Any other Public Comments . Seeing none, closing Public Comments. Public comments are closed. I guess i have a few questions. I want to thank the public for coming out and you see that the needs are varied and a variety of things we need to find solutions to. A few questions for clarification of staff that came up. How have the rising costs factored into basically the rcfe closures. Whats causing it to close . The rising cost factors . I shouldnt assume that. What are some of the factors causing the the closures . Yes. So part of in all honesty, this is antidotal, from conversations weve had with the various rcfes. In many instances, it is the cost of living in San Francisco is raised and i think annie spoke to it, a lot of these places have mortgages but its the other cost associated. I faux theres been labor costs that go up but also regulations around labor laws. With rcfes when you pray 24 7 care to make sure people have breaks and stuff like that, its been additional staff you have to add. Its those types of things. Theres regulatory requirements within the rcfes as well. They look at the business and its not sustainable anymore. These are things we have heard. Thank you. In the care report of this year, it mentioned the idea of equity and post acute care. It mentions how women and people of color are affected by lower quality of care of unlicensed facilities. How will data be addressed moving forward . Just to clarify, how will disparities be addressed Going Forward in the report or it talks about inequities but not having enough data. Maybe im making an assumption of inequity. Is there discussion of how its going to be addressed . In terms of disparities, the biggest is around affordability and income and being able to afford this level of care, when it comes to racial and ethnic disparities, this is something not looked at closely, especially for Residential Care facilities for the elderly. In general we dont have good data of who is being served in the facilities. Its hard to assess. It also suggested reaching out to the mayor to include rcfes as part of their initiative. Could someone talk about hospital post acute Care Collaborative have engaged with the Mayors Office of housing in this particular discussion so far. Thank you supervisor and thank you for taking the first question. Miss patel served as part of the team. To the advocacy question, that is something the Hospital Council and members are really into, we havent yet engaged the Mayors Office. The timing is perfect introducing the topic and report in draft form should be in the official form by the end of the year, which is coming right up. But we would look to you supervisor and other members of this board on how we can best communicate to the Mayors Office to include in his initiatives this element. I know the need is so great but you have identified where there are other needs and we think it should be included as well. What is the department of Public HealthPatch Program . Can someone explain that to me . Im not an expert but ill take a stab. For patients in our system of care we have Transitions Division to move from acute to lower levels of care. As part of the patient flow, some patients are placed in Residential Care facilities in the county and out of county. And so many of the patients do receive Social Security income benefit. On top of that, they provide an additional subsidy to have access to facilities. I thought it was the reimbursement to some of the rcfes that make up for the revenues they need to operate since ssi its an additional payment on top of an ssi benefit. So that Certain Services can be provided for certain populations. Has that been going up in recent years or i dont have the data but i will follow up. Any other questions . Anybody have remarks . And wrap it up. Supervisor fewer and i are looking at each other and feeling a little depressed as i know many of you are and its hard to find the optimism when these problems are so deeply rooted in a very unjust system we live in in the united states. We are not a system that thinks about care over profit. I just want to thank all who came out, to the worker who came out and spoke about her care for her patients i want to thank you so much and wish we could get some of that passion and attitude into some of the politicians in washington who are currently cutting the taxes that allow us to provide that gap funding and to come up with solutions at the local level for these problems. Its just sitting here as a local politicians knowing the limits on our budget and how every single day as the feds pull away from caring for the majority of us in cities and towns across the country to benefit rich friends and corporations that fund their campaign, it feels helpless. Hearing you gives us more strength to keep fighting and speaking truth and keep telling the stories that make absolutely no sense. We know how to fix these problems. Its called Single Payer Healthcare and its called fair taxation, progressive taxation so we can take care of everybody and make sure were all safe in our communities. They have done it way better than us in europe. This is not rocket science. This is not hard to know how to fix. We just need to have the political will to do it. I want you to know most of us here at the local level have that passion and political will. We just have to keep continuing to fight and in the meantime, well join together supervisor yee, ill join with you, to push our Health Department to push our local Hospital Council, thank you david for being here. We need to see you put some pressure on cpmc to keep open swindel. Theyre closing the subacute unit at saint lukes. Were grateful theyre keeping the current families there,