On Tuesday, the Board of Supervisors unanimously passed protections aimed at San Francisco’s rapidly disappearing residential care facilities.
Residential care facilities provide housing to seniors and the disabled. They often include mental health and substance abuse services for clients, and advocates argue they’re a means of keeping vulnerable individuals off the streets.
But their prevalence in the city is plummeting; the number of facilities has dropped by 30 percent between 2012 and 2018, according to a 2019 report by the city’s Long-term Care Coordinating Council Assisted Living Workgroup.
As of 2021, there are 55 facilities with a total of 2,309 beds, according to the San Francisco Human Services Agency.
“These are pretty critical elements of our system of care,” said District 8 Supervisor Rafael Mandelman, who authored the legislation. “The need is growing. You can walk around San Francisco and see some folks who are out in the streets who probably ought to be getting care.”
The ordinance, sponsored by Mandelman and District 9 Supervisor Hillary Ronen, makes it easier for residential care facilities to open and creates barriers for those seeking to close. Tuesday’s vote was on a first reading of the ordinance, and a final vote will take place at another meeting.
The first part of the ordinance originated as part of interim controls in 2019, which delayed closures of residential care facilities through zoning laws. The legislation ensures that before an applicant shuts down a facility or changes its zoning use, they must acquire special permission from the Planning Department.
This may also discourage property owners who seek to abandon a facility for a more profitable option, such as market-rate housing, Mandelman said.
Additionally, if a facility does receive special permission to close, the Planning Commission must consider whether other licensed residential care facility providers or agencies, like the Department of Public Health, want to take over instead.
Already, a few residential care facilities have benefitted from the interim protections. A facility at 628 Shotwell St. in the Mission evacuated its residents following a 2015 fire, causing them to relocate and the building to lay vacant for years. The property was eventually sold to another buyer seeking to convert the space to two units of housing, which drummed up opposition from community advocates and organizing groups, including the Mission Economic Development Agency and Calle 24 Latino Cultural District.
The owners refused to continue residential care operations, citing its lack of a proper license and resources, and that it was not a “financially viable” location. However, they offered it to the community for $2 million. Though no deals have been struck yet, the ordinance was a useful tool, said Sara Shortt, Director of Policy and Community Organizing at Community Housing Partnership, another community group in support.
“It helped slow down the whole process, so there wasn’t a sudden conversion of housing,” Shortt said. “Instead, we could have conversations with the owner and look for potential community-based purchasers.”
The second protection eases the rules for opening facilites. Previously, facilities seeking seven or more beds needed special authorization from the Planning Department in certain residential districts. Mandelman’s ordinance eradicates that, easing facility openings.
This ability — which applied to some residential districts before the ordinance — ushered in more than a dozen beds at the facility on 658 Shotwell St. In 2017, the facility had 29 beds and plans on offering 46 after renovations. Eliminating the extra step sped the process along.
Yet while the protections were applauded by both the Planning Commission and the supervisors in the Land Use and Transportation Committee, advocates emphasize that it’s a short-term solution to a stubborn problem: costs.
Providers, such as the one at 628 Shotwell St., no longer find the industry to be financially viable. Even though board and care facilities get reimbursed by the state, payments come slowly and at low rates. Some clients at private facilities may not qualify for reimbursement through MediCal or Medicaid, either, since it’s not technically medical care.
It’s worse for smaller facilities, some of which are run by families. “Part of what some of this is, is there’s lots of rapidly rising property values and costs of living,” Mandelman said, making it harder to maintain. “My hope is that they would then sell to another operator.”
Sue Diamond, a Planning Commissioner who supported the measures at a hearing in July, summed it up at the meeting: “It is really important that we not rely on this land-use regulatory solution as the end all be all,” Diamond said, who advocated for more funding via the budget. “Because in the absence of that, I suspect that many of these facilities will continue to close.”
Mayor London Breed’s budget outlined $11.4 million annually for bed capacity to add 196 beds, which includes Board and Care beds among other types of treatment and co-op beds. About $76.8 million is also proposed for the fiscal year 2021-22 for acquiring and rehabilitating new facilities.
Mandelman said the city should explore funding options at the state and local levels and resolve looming financial issues. But, in the meantime, “we don’t want to lose a bunch before we do.”