That they were going to shut down the subacute unit at st. Lukes hospital. I was a bit taken aback and i know many members of the community were as well. And so we came in that week, spoke with my colleagues supervisor ronen, whose district this actually resides in st. Lukes. But, you know, for the residents of my neighborhood, st. Lukes is a lifeline and has always been a lifeline. And will continue to a lifeline. Most recently evidenced by the fire that happen in the our district, just a week ago, where two members of our community passed away from smoke inhalation. So just want to say that this is not an easy conversation and never has been an easy conversation. But one thing that we did note, and i just want to underscore, there were human beings in these beds. And there are currently still human beings in these beds. And so we came in, we asked for an emergency hearing. We had that hearing. We were not satisfied with the answers that we got. And then we asked for a hearing under emergency conditions for the entire board to consider. And thankfully cpmc made the decision to keep the subacute care ongoing. And we transferred those beds to davies hospital, where there have been families and individuals that have been able to access that in an easy way. Just for the context and for individuals that will be watching this and hearing this later, most of the people that are in this care, this 24hour care, theyre often indigent families and not able to access, so their loved ones in a very accessible way. So part of the proposal had been to transfer some of these patients out of county and or into areas that were not accessible. And that was not something that would be accepted by this board of supervisors. So thankfully cpmc made the right decision we believe. Kept the unit open. And we wanted to continue the conversation. We want to talk about some give an opportunity for those in the Health Care Community and others, as well as the Family Members to come up and speak today, to talk about their own personal experiences. But we also want to push the department of Public Health and the Hospital Council. We believe that its incumbent upon us as policymakers to have a longterm solution. Right now San Francisco would be without these last few bed, that cpmc has, the only county in the bay area that would not have subacute care. So weve asked kelly to come up here today. I know theres going to be a presentation by the department of Public Health to talk about the plan. And we think that cpmc is an important part of that plan. We think the Hospital Council is an important part of that plan. I know that there have been some conversations with st. Marys hospital, Chinese Hospital. There are those that want to step up. But we also want cpmc to be part of that solution. And so i know dr. Browner could not be here today. I did have a good conversation with him about that, as well as supervisor peskin had a conversation with him about that, specifically revolving around Chinese Hospitals. So we can come back to that later. But i do want to thank the individuals from the advocates from the community for continuing to make this an issue that we will not let go. As i said, there are live human beings in these beds. Myself and supervisor stefani went last week and visited some of the family and saw the conditions and heard their concerns. What im hoping will come out of this and why we continue to have these conversations here at the board, is we want a longterm plan. A shortterm and a longterm plan presented that will ensure that San Francisco is not without this level of care. This is 24hour, aroundtheclock care, often patients that have trachs and this is expensive. We understand its an important level of care that San Francisco needs to have. So again i want to thank my colleagues for the hardfought work that we did to ensure that these beds would remain open, for remaining engaged. And then we will im going to pass it over to supervisor ronen would like to say some words as well. I just want to quickly go over the run of show today and who is going to present. Were going to do something a little bit out of order, is that okay, chair . Can i do a couple of housekeeping itemness. We have spanishlanguage translation available. Maybe you could come up an make and announcement. [speaking spanish] chair thank you. And then my other housekeeping item, i noticed that the caption for this item is incorrect on the sfgov tv. Maybe we could fix that. Back to you, supervisor safai. Supervisor safai thank you. Were going to call up kelly here in a moment. Shell have an opportunity to speak and play out a plan. We want to allow gloria and raquel, one of the families that are currently in subacute care to come up and speak about their experiences and their conditions their sister. Then we will ask San Francisco for health care housing, jobs and Justice Coalition mark erickson, salini am i saying that right . Salini. And then from the California Nurses Association c. N. A. And then were going to ask benson nadal from the longterm Care Ombudsman Program and well open it up for Public Comment. So again i just want to end with its this is this is gutwrenching. This is heartbreaking to see the conditions, to see the individuals living and trying to survive and again this is something i have never experienced. And i understand that its it is heartwrenching to experience that type of circumstances with the Family Member. And just want to be sensitive to that. And really appreciate the families for inviting us down there to, to let us experience that with them. And know were here to continue to advocate and push and demand the highest level of care in the city and county of San Francisco. So just want to hand it over to i know you want to say something, supervisor ronen. Supervisor ronen yes, thank you, supervisor safai, for calling this hearing. You know, it is a shame that the city of San Francisco, city and county of San Francisco doesnt have, other than the few beds that are left at davies, a single subacute unit in the county. That is wrong and we need to fix that. Having im looking forward to hearing from the department of health about what the concrete plans are to do that. Having said that, i also visited the davies campus, i would say its about a month ago. And i was frankly shocked to see the conditions that i saw when i was there. I immediately called warren browner, the c. E. O. Of cpmcand had a discussion with him. I know he went to the unit shortly after i called him that same day. And i talked to him a couple days ago and he assured me what he told me, let me say it this way was contrary to what i witnessed with my own eyes. So im not sure exactly whats going on. And im also looking forward to hearing from cpmc. When i went to the subacute unit, there were not very many staff on the unit. In fact, i think i saw two people the entire time i was there. When i walked in, there was a light going off, you know, indicating that a patient needed staff, that i didnt see turned off for at least 15 to 20 minutes. When i was in the room visiting a patient, with her family, at one point she wasnt breathing well because her breathing machine was clogged. And she had pressed the button. And there was nobody coming to respond for quite some time to that to that linking button. Eventually the group that i was with, someone went over to the one staffer that we saw in the area and asked him to come help. And he was sort of clueless as to the needs. He said, oh, i didnt see that button. And the light flashing. Oh, im helping this patient, but let me yeah, ill go over there when i can. It was so casual and didnt lack it didnt exhibit sort of the urgency you would expect to make sure at least that the patient wasnt in serious trouble and then maybe multitask to get them the things that needed to be done. It was not the level of care that i would hope for my Family Member, if that was me or my Family Member in that unit. In my subsequent discussions with warren browner, he told me that there is an offsite monitor that monitors the time between when a light goes off and when its responded to by a staffer. And that he didnt find anything unusual in terms of the time that it took. Again i can only attest to what i saw with my own eyes. And it was worrisome. So, you know, this is not a hearing to beat up on cpmc sutter. This is the only hospital currently with any subacute beds. They were hard fought for to keep them at cpmc sutter. But the hospital did make that agreement and that was appreciated. I do want to hear from you and have some concerns about the level of care that is being provided at that facility. But this is more importantly or equally i should say not more importantly, but equally importantly about the fact that we do not have these services in the city and county of San Francisco. And that that is unacceptable. Thats the responsibility of Health Department and the entire medical community to remedy that fact. And so thats why im here. And thats what im interested in talking about today. I want to just say to the Family Members that are here that, you know, thank you for taking me around and showing me the circumstances for myself. I had never been in the subacute unit before. So it was very eyeopening for me. And, you know, i can say from what i witnessed that day, that i understand at another level the concerns that the Family Members have been bringing up in these hearings. And so im looking forward to hopefully getting some of those questions answered today. Thank you. Chair supervisor fewer. Supervisor fewer thank you very much, supervisor safai, for having this hearing. I am also concerned that we dont have a subacute facility in the city and county of San Francisco dedicated just for that care. But i also just want to emphasize that it is not its not a question of whether or not subacute or Skilled Nursing beds, because we need both. And so i am looking forward to the hearing today to find out what our Current Situation is, because i know, through various hearings weve had together, that theres also a shortage of Skilled Nursing beds. And so i dont think that we should be substituting one for the other. Quite frankly there is high need for both. So thank you for calling this hearing. And i hope to learn a lot today and be part of a solution to i i think are this population that is going to need this care, currently needs this care. So they dont have to be pushed out of San Francisco. Thank you. Chair thank you, supervisor fewer. Thats a very good point. Thats a good transition. So i think well call up kelly. Why dont you go over have an opportunity to give your presentation. Okay. Thank you. Good morning, supervisors. My name is kel request. Im a project manager with San Francisco department of Public Health. Im here today to do the introduction for the update on subacute Skilled Nursing care. Just kind of overview. Supervisor safai did a good overview of reminding everyone what this level of care actually is. Subacute Skilled Nursing is provided to medically fragile individuals. And this is to distinguish from some confusion that some folks may have around the beds that we currently have at st. Marys, which is also known as subacute, but it is more for mental health, individuals and not for those having medical compromises. Today were talking about people who need subacute care. And that is a level of their is when youre no longer in an acute crisis, meaning to be in an acute care hospital, but not well enough or stable enough to go back to a community setting, such as a home or an apartment. There are individuals who need ongoing 24hour care, as the supervisor mentioned. These are folks who require very specialty care, Skilled Nursing services, such as inhalation therapy, tracheotomy care, tube feedings, very complex onCare Management, generally are the individuals that youll find in these facilities. Broadly speaking the department recognizes that optimally postacute care would be provided in a home or communitybased setting. Thats most people who enter into hospitals get care and treatment. And then are able to go back home and finish recuperating. But there is the segment of folks that that is not possible. They are people who cannot be discharged home, either because they dont have a home or they dont have a home that can accommodate the specialty equipment. And these are folks that need to go to Skilled Nursing facilities for what we would call subacute care. And what brought us here today, in 2018, cpmc transferred at that time 17 patients from st. Lukes subacute to their davies campus. And the agreement at that time was that these individuals would be cared for, no new patients would be admitted and we are aware that today the census is eight. In the fall of 2018, the department of Public Health began a process to identify a consultant to help conduct an environmental scan to bring it to current the last time we did our environmental scan was several years ago. We also wanted somebody who would help us manage the project selection and implementation, so that we could bring new subacute Skilled Nursing beds online as quickly as possible. And we worked in conjunction with the controllers office. In june of 2019, we selected milliman inc. , they are a health care and finance expert consultant. And weve invited milliman to give an update on the work that theyve done to date. And ill be able to answer questions following. Id like to introduce you said theyre going to present on what theyve done today . They did the environmental scan and theyll update. Yeah. It would be good for you to come back. Exactly. Well follow through. Thank you. Im going to introduce you to the senior principal consultant. Through the chair, what is an environmental scan . Im sorry . Supervisor ronen an environmental scan . How many beds do we have in the community currently. How many we did surveys in 2015, of how many patients are discharging with subacute need. We wanted to update that. Is that number getting more, less, stable. We actually engaged milliman to make the outreaches and conduct those surveys, theyre going to give us a summary of the report. Theyre also going to need an update from the participants were Work Partners were working with and going forward. Welcome. Okay. Good morning, supervisors. My name is susan phillips, Senior HealthCare ManagementHealth Care Consultant with milliman. As kelly mentioned, im here to present today an update of the project to identify and develop opportunities for subacute Care Capacity for the city and county of San Francisco. So, first, just let me briefly introduce myself and milliman. Milliman is an an ak due waral m created in 1947. We have a major office here in San Francisco. Our mission is to serve our clients to protect the health and financial well being of people everywhere. And that is our core mission and we take that mission very seriously. And strive towards that. We involve 3800 employees, including consultants that have extensive experience in supporting Public Sector clients. And i personally have 20 years of experience in working with Public Sector clients and working on various policy initiatives in terms of Analysis Development and supporting and implementation. So as i mentioned why were here today, is to give you a status update. And in terms of the in terms of the purpose, we want to provide you, as i mentioned, a status update. We want to give you an outline of our next steps, in terms of generating options for expanding subacute care options and give you preliminary findings of what we have done so far. Okay. I think supervisor safai did a very good job in providing an overview of what subacute care is. And in terms of the specific population, i did have a few slides to walk through that. In the interest of time, i might go through that fairly quickly. But, you know, i think the main thing that we wanted to highlight here is that, you know, this population again is medically frail, in need of special medical services. And to serve medical beneficiaries, certain licensing requirements sustained by the state. For example, certain nursing staff requirements that have to be met. Ill get into that in a little more detail. So i did think it was important just to lay out again the subacute care is part of the full continuum of postacute care. You know, as a person leaving a hospital, you know, thankfully most patients, you know, dont need postacute care following a hospitalization. Obviously some do. The goal of any discharge from a hospital is to get the patient to the right care at the right time at the right place. And the place and the type of care thats appropriate is highly dependent on the patients condition. And the level of care that they need. So this is, you know, a full continuum of postacute care, you know, from the home to Skilled Nursing and then up to subacute care. So the next slide is really to illustrate the difference between sub