SF is rapidly losing care facilities for the mentally ill and the elderly. But a plan to save them is promising

After a fire ravaged a Victorian building on Shotwell Street in the Mission, the building – which once housed six elderly people in a nursing home – sat empty for six years.

Small residential care facilities like the one at 628 Shotwell St. are disappearing at an alarming rate in San Francisco, putting vulnerable seniors and adults with disabilities, with mental illnesses or addictions at risk of homelessness with limited access to services necessary treatment.

In San Francisco, the number of assisted living facilities for seniors and adults with disabilities has fallen 38% since 2012, with beds down 17%, according to city reports. Smaller facilities serving low-income residents were hit the hardest. At least 100 people were waiting for a place in a facility, according to the most recent count.

Advocates say the shortage means more people are being sent out of the county, making it difficult for families, or ending up on the streets.

“If we are serious about ending homelessness for the elderly and people with disabilities, we need residential care facilities,” said supervisor Rafael Mandelman.

Supporters have sounded the alarm bells for years as high costs and low reimbursement rates lock these homes away. The authorities are now trying to consolidate the laws to make it more difficult to dispose of existing installations and easier to create new ones as a stopgap while tackling larger problems of costs and operator shortages.

In October 2019, Mandelman sponsored temporary regulations that required a building owner to seek special approval from the Planning Commission to demolish or convert an existing residential care facility to another use. Mandelman presented an order on Tuesday to make the rules permanent and add other measures that would pressure applicants to verify whether an entity is interested in running the building as a residential care facility.

Mandelman also wants to expand the area where no special approval is needed to create or expand a facility.

Advocates believe the regulations have helped prevent the vacant Shotwell Street site from being converted to new use.

In December 2019, the owner requested to convert the building into accommodation, according to city documents. The case is still blocked in the Planning Commission. On April 23, the owner’s lawyer sent a letter to community groups outlining the intention to develop, but first offering to sell the property so that it could be reopened as a residential care facility.

“The owners are not part of the residential care facility industry and do not have the expertise, licenses and resources to operate such a facility. It is also not a financially viable use there, ”the letter read.

The letter gave the groups 25 days to find approximately $ 2 million. Sara Shortt, director of public policy at Community Housing Partnership, said she and other advocates were making a plan for a non-profit developer to buy it. The current owner declined to comment.

The economics are often unachievable: for small facilities, the break-even rate per bed is at least $ 2,000 per month, but it is more than double the rate set by the state for security income recipients additional in assisted living. The city subsidized 15% of assisted living beds in 2019 for about $ 11.2 million per year. Grants are still not enough for some to support operations, said Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

The nonprofit Richmond Area Multi-Services (RAMS) operates a 33-bed facility for people with mental illness and medical needs funded by the Department of Public Health on Broderick Street. Christina Shea, deputy chief and director of clinical services, said costs kept rising, but the contract had not grown at the same rate.

The health department could not immediately respond to a request for comment. The city expressed interest in December to buy the facility, but the owner was not yet ready to sell, according to a city report, and the lease has been extended. The owner could not be reached for comment.

Advocates believe the new regulations have helped protect the property.

“San Francisco does not have enough healthcare facilities to house people with serious mental health issues,” said Sal Rosselli, president of the National Union of Healthcare Workers, which represents mental health therapists of the Broderick Street establishment. “This pilot program is already helping the city to preserve these essential amenities and improve conditions by changing the power dynamics between the city and landlords.

As the deadline approaches for community groups to bid on the Shotwell Street site, Shortt said they are not “married” to the fact that it is a care facility. in residence, but would like it to provide some form of accommodation or treatment.

“We’re definitely going to look at the economics of it, but we think it’s worth getting people off the streets” who could end up in emergencies and cost the city more, she said. “We knew this was a very valuable opportunity to preserve.”

Mallory Moench is a writer for the San Francisco Chronicle. Email: [email protected] Twitter: @mallorymoench


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Ethel Nester

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