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 subacute beds. Again as i mentioned, the key difference here as you see is services of subacute care can offer our ventilator care, complex wound Care Management, intravenous tube feeding. Now as you mentioned back in 2018, cpmc had a 17 subacute care patients transferred to davies. And now the remaining eight patients, based on cpmcs report of current bed census. And based on 2018 data, the total count of general sniff beds is 2,227. And this does include freestanding facilities, as well as hospitalbased facilities. So its the total general sniff bed count. Excuse me. Do you have a breakdown of that 2,227 freestanding and which hospitals are doing what . Yeah. So we have 901 at freestanding. And 1,326 hospitalbased. Okay. Okay. I did just want to take a second to provide an illustration of people who need subacute care. Again we did speak about this. But i thought it was important to take a second to kind of walk through a couple of patient profiles of two different people. You know, we have one patient who is older, another one thats younger. Both of these individuals here have had serious medical crisis. And theyre both in need of ventilator care for a long time. And possibly, you know, for the rest of their lives. On this slide, you know, we see that the 45yearold might, who was in otherwise good health, prior to the medical crisis, may be in need of subacute care for decades. So i think this is just important to keep in mind. Okay. So switching to the project. The project objectives, as we said, are to support d. H. P. , plan for and implement expansion of capacity for subacute care beds in San Francisco. Our approach is to can you go back to that slide for a second. Sure. Sometimes you guys say things and do things that make sense to you. Okay. Yeah. And anyone thats might be in the industry. Sure. But when i read that, the first thing that jumps out to me is why is the medical beneficiaries an important part of that statement . Well, so i think that is a population that has, after longterm, medical is a primary payer. What if someone needs subacute care, thats not medical . So if they have medicare and commercial, there are other payers. But its true in terms of capacity, theyre facing the same issues. And thats where we consider them part of the vulnerable population. Okay. Thank you. So our approach is to try to take although wouldnt the vast majority of people in that situation be on medical, if were talking about yeah. If were talking about over 100 days, yeah. If theyre medicareeligible, if were talking about an older person, over 100 days, medicare does pay for the first 100 days. But then after 100 days, then the primary payer would be medical. Youd have to youd have to be either extraordinarily, incredibly wealthy or youre on medical. Right. Because this is longterm care. And thats a major issue in terms of just covering for longterm care in this country. That was my point. My point was to kind of clarify to the general public, but also for my own etfication since im not in the industry. Great. Thank you. Thanks for that question. Okay. So in terms of our approach, what were trying to do is again take a comprehensive view of the potential needs in the city and identify an array of options to address those needs. You know, our goal is to try to make sure that were bringing as many options as possible for your consideration, as appropriate. And as we mentioned right now, were in the mid of this environmental scan. And what were doing as part of that is to collect information from potential partners and stakeholders in San Francisco. So what we have done is conducted a series of interviews, with Hospital Systems and we have asked for data. And im going to get into, you know, our initial findings, based on that. The next phase is what were calling project selection, which we are starting very soon. Were starting by first identifying potential partners, who are interested in developing capacity in the city. And d. P. H. Is currently working directly to identify proposals. And once those proposals are submitted, we would review those proposals obviously. And then work to synthesize that and facilitate further dialogue among those stakeholders and we are would like to provide a framework for decisionmaking for d. P. H. And the board of supervisors and the city to, you know, consider those proposals. We plan to share our review. Were hoping to do so by november. And once the city and d. P. H. Have thought about this proposal and are thinking about which ones to potentially go with, well begin the process to partner with d. P. H. To further flesh out all of the incredible steps thats needed for implementation. Excuse me. Sure. Supervisor ronen, did you have your name on there . Supervisor ronen i had some questions about that. Chair just one second. Are you almost done with you