Sub-acute patients at St. Luke’s find no place to go

Sandy Rivera, center, is visited by her sisters in the sub-acute facility at St. Luke's Hospital

Halfway to the closure date of the sub-acute unit at St. Luke’s Hospital, many of its patients still don’t know where they’ll be going.

Families told representatives from California Pacific Medical Foundation on Thursday that the list of Bay Area facilities they had been given by hospital staff to choose from failed to offer real alternatives nearby.

“You’re supposed to be working with families, finding sub-acute care. Is there a list of anything that is available?” one person asked. “My sister looked into it, and says nothing is available in the Bay Area.”

Liz Cong, California Pacific’s clinical manager, said patients had been given two lists, one with facilities within 25 miles and one with facilities outside that range. 

“You’re correct, a lot of them, at the time, didn’t have any capacity,” she said.

Some families have been offered placements at a facility in San Jose.

California Pacific runs St. Luke’s, and patients in sub-acute care there were notified in early June that the facility would close Oct. 31. Equivalent care will not be provided at the new hospital being built next door, which is due to be completed sometime in 2018. 24 of St. Luke’s 40 sub-acute beds are still occupied.

Since June, families, doctors and advocates have voiced outrage at the prospect of moving these medically fragile patients, many of whom cannot walk, speak or care for themselves. CPMC representatives have repeatedly stated that they would not be endangering patients by moving them.

Sub-acute patients are particularly tricky to place because they need round-the-clock care and specific services — like attending to tracheotomies — that many hospitals don’t offer. California Pacific has, for years, operated the only sub-acute facility in San Francisco.

CPMC’s CEO, Dr. Warren Browner, said the new St. Luke’s won’t include a sub-acute facility because of a reduction in the nonprofit’s beds — part of a 2013 agreement with the city that dramatically downsized a new hospital being built at Van Ness Avenue and Geary Boulevard.

Browner pushed back on the notion that the closure of sub-acute care was due to cost-cutting.

“One issue that comes up frequently is that this is somehow about money. It’s not about money, it’s about beds,” he said.

“If you knew that you were gonna close six [sic] years ago … why weren’t we told that when our loved ones were brought here?” asked Rick Vallejo. “Instead of dropping this bombshell on me all of a sudden? Why weren’t we informed the day that they were brought down here that this place was going to close?”

“It has been a privilege to be able to care for your loved ones for that period of time. I think all of you realize there are no other subacute facilities in San Francisco,” Browner responded. “For the past many years, you and your families have enjoyed the privilege of being in San Francisco. So I’m not really sure you would have made a different decision, even back then.”

He added that state regulations restricted California Pacific from announcing the closure sooner.

That did not sit well with patients and their families.

“You didn’t do me a favor by letting her be here. I made the mistake of bringing her here, and now she’s been here for six years, and now you want to put her out?” Vallejo said.

Beyond frustrations that the hospital will close, families are also upset that hospital staff didn’t do more research on the options available.

“My understanding of talking to the families, there were many places listed that are not sub-acute, that did not do that level of care,” said Terry Palmer, a geriatric doctor who has been advocating for the St. Luke’s patients. “Why was that done?”

“Any questions you have with facilities on the list, we’ve got a team that’s very capable to sit down with you answer questions about what those facilities can and can’t provide,” responded Susan Bumatay, another CPMC administrator.

But with the October closure date looming, families are becoming antsy.

“If we don’t find anything that is a good fit in time, what is your plan?” someone asked.

“Come Oct. 31, if we haven’t found appropriate facilities, we’re going to continue working with families,” Cong said.

“No one is going to get kicked out. We will work responsibly with every patient,” Browner said.

Raquel Rivera, whose sister has been in the sub-acute unit for seven years, asked if CPMC would postpone the closure date.

“As soon as I can come up with a plan I know will work, I’m happy to postpone it. … It would be irresponsible for me to make believe that postponing will solve the problem,” Browner replied.

Keeping the facility open indefinitely, however, does not appear to be an option — Browner said the hospital license from the old building will need to be transferred to the new one for it to operate.

The Health Commission will hold the second of two public hearings, the first of which drew hours of testimony, to evaluate the impact of the facility’s closure, on Tuesday, Sept. 5.

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11 Comments

  1. goask

    “many of whom cannot walk, speak, or care for themselves and have been there for years” THIS is the nub of the problem. The Sub-Acute unit has turned into a de facto retirement home for a couple of dozen patients who are never going to improve significantly. They are paid for by State and Federal Funds, i.e. OUR taxes, and the per-capita cost is multiple times higher than putting these people in are homes. But the patients and their families think they have a right to pick and choose, even though they are actually not paying for the care. This was the case when I worked there 15-20 years ago. Yes it’s hard on patients to be far from families, but a hospital is a hospital, not a care home. Legally it’s all but impossible to move people out, so they are a massive drain on an already impoverished facility. SOMETHING has to be sorted out, and expecting the hospital to take the financial loss somehow without impacting the other patients is unrealistic.

    • Patrick Monette-Shaw

      Ha ha! Hahahahahaha! Ha ha! (Can I pick myself up of the floor now from uncontrollable laughter?)

      Really? St. Luke’s — or CPMC — an “impoverished” hospital or hospital chain?

      The charity care report for FY 2015 noted CPMC had $1.2 billion in net patient revenue and spent just $7.7 million on charity care — (a 0.65%) ratio. For its part, St. Luke’s had $108 million in net patient revenue and spent just $1.3 million on charity care (a somewhat improved 1.2% ratio). How can any hospital or hospital chain claim to be “impoverished” sitting on those millions or billions in net patient revenue and despicable levels of charity care?

      “Goask” should just go jump in a lake, or the Gulf of Mexico! Goask is spouting media spin control, alternatively called corporate propaganda! More “Fake News” from corporate America ??? … Impoverished? Really?

      Can I have a cut of that $1.2 billion in patient revenue, so I’m not impoverished, too?

    • So what is the solution, smartass?

      • Kenneth Parker

        Start by cutting the salaries of non-medical administration by 25%, then, use that money to guarantee patient care for the remaining patients. Any left over(and thhere willbe) can be used to increase nursing heaccount (hire more nurses) thus improving patient care. Withhold final approval for any and all city and county approvals for CPMC until they guarantee full support for all existing patients and patients impacted by the move.And someone really should take that “privileged to be in SF” quote and engrave it on a bronze plate and give it to the CEO as a suppository.

  2. Patrick Monette-Shaw

    When are hospital administrator clowns like Browner going to get it that healthcare is a “right,” not a “privilege,” and that patients have a right to remain in-county and at the appropriate level of care?

    Unbelievable!

    • housyhousy

      I agree healthcare is a right- but 6- YEARS in a hospital? really? skilled nursing facilities can handle tracheostomy care. These patients should be in nursing homes, not hospitals.

  3. Jerry F Schimmel

    When the new hospital is finished are they going to keep the same administrative fools on the payroll?

  4. Sally Hansen

    everyone wants to be in subacute care in SF, they can’t it’s too expensive, the drs who work there can’t eve afford to live there. Head to Antioch, Concord, its a half an hour drive, you can do it, or, here’s another solution, pay-for-it-yourself, then you can get treatment anywhere you want.

    • Ligia Ivette Montano

      Wow! I feel sorry for you, when people cannot see beyond what they’ve been presented by the system, they end up loosing their humanity. Good luck on becoming a senior, or a person with disability that needs extra care, even if you have the money you will struggle to find compassion because you have NONE.

      • Patrick Monette-Shaw

        Great response, Ligia.

        What Ms. Hansen and other heartless and incompassionate people who have posted comments about this sad story don’t understand is, regardless of how much money you have if St. Luke’s closes it’s sub-acute unit there will be ZERO other locations in San Francisco to pay for that level of care, regardless of how wealthy they might be. So take any one of the 50 billionaires in the Bay Area, and they will not be able to purchase sub-acute care in San Francisco — because there will be no facility offering that level of care.

        Skilled nursing facilities (SNF) are not licensed to provide sub-acute care in run-of-the-mill SNF’s. Sally doesn’t get it: No other facilities have a sub-acute care license. And St. Luke’s patients are facing being dumped out-of-county to … wait for it … Los Angeles, not a half-hour drive from here in Antioch!

  5. Ummmm… Where does it say in law that health care is a right @Patrick? That citizens can expect unending care without cost or consequences? Even the government itself rations care and charges for it. As a 100% disabled veteran my care is rationed and wait times are long. I have been waiting for four months to see an eye specialist for a bubble in my retina over the optic nerve head due to compressive concussion. I have been waiting six months to see a civilian nephrologist as the VA doesn’t have any of them, apparently. If I eventually require subacute care, I will be handed over to a nursing/recovery facility then to a veteran’s home to die, quietly, and stop bothering the government – and I got my disability in counter terrorism operations. I earned what medical care the government deigns to provide me (such as it is) the hard way.

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