>> president commissioner singer. commissioner chung. the second item on the agenda is the approval of minutes on april 21, 2015. there's a revised portion under the item eight with commissioner pating's additional comments. >> commissioner as the minutes are before you for approval commissioner pating already put in his comments. the motion to accept the minutes are in order. commissioner pating you want to make that -- >> make a motion to approve. >> that will be with his comments. is there a second? >> second. >> are there further additions or corrections to the minutes? we're ready for approval. those in favor say aye. >> aye.

>> the minutes have been adopted. our next item please. >> item three is director's report. >> i'm looking for my questions under the director report. i will not be discussing any items. >> the director's report is before you. i guess i'll ask only on the humming bird place and exactly how does it function. people go themselves or they are referred by agencies or officers or what? >> we're looking for referrals that can be the homeless outreach team from psych inpatient. it's a true driven model. we do have over the much of the staff appears. it's a day program. the navigation center just open end. we had two individuals we thought there were 50 people that day. two individuals who we thought might do better in a more calm

place than being with 50 people within a navigation treatment. it is a program that is by referral >> when you have run an evaluation of this, this would be very interesting. this sort of like project because it will have implications. >> it's a fairly new program. it has a model base. we believe this one is the largest one in the country. it is funded through our mental health services act. we will be looking at closely for outcomes. i've gone twice already to the

facility. any of you would like to take a tour of it, it's a very beautiful facility. it was with seneca for young people. they've done at the love renovations and upkeep of the facility. i'll be happy to take any of you on tour for that. >> commissioner is there any other questions to the director? any public comment? >> no public comment on a item. >> item four is general public comment. i'm not receiving any requests from anyone. >> thank you. >> we'll move to item five. >> commissioner chung please. >> good afternoon commissioners. the planning committee met before this commission meeting. there were two contracts that we

looked at today. one is part a, contract to mission neighborhood health center the other one is a contract to my team which is hospice for people living with hiv aids. we have voted and recommended to put both contracts on the consent calendar. also there were an emerging issue that we discussed quite extensively and we are planning to put that on the agenda for further discussion. in terms of what the time line would look like as we got some update from our cfo that we are very likely that we're going to move the time line. we trying to get some of the

information hashed out. >> questions to the chair of the finance committee or any further comments? if not, no public comment? >> item six is a consent calendar. >> so the contract report is before us from the committee and the question would be whether anybody wants to extract any or prepare for the vote on the consent calendar. we'll prepare for the vote. all in favor please say aye. and the consent calendar has been accepted. >> item seven is the resolution authorizing department of public health to recommend to the san

francisco board of supervisors -- >> good afternoon president and dr. chow and vice president singer, director garcia and members of the health commission. i would like to come before you for approval for a generous gift from dr. mivic hirose. last month, she made a generous donation and thoughtful cash gift donation totaling $500,000. for the use of all hospice patients at the hospital. another gift of $100000 to be directed to the laguna employees for quality improvement of hospital staff. i'm here to answer questions. i hope that you can approve the

resolution so that itbtñ?ñ?ñ can move on to the board of supervisors for theirtwñ?ñ? approval for accepting and spendingmñ?ñ? the generous donation. >> like to make that motion. very generous gift. thanks to dr. rose from all of purpose i hope we'll accept this. >> the resolution is before you and has been moved by commissioner pating. is there a second to that before we discuss? >> second. >> okay. discussion and commissioner singer. >> this is terrific for our city that people do this. congratulations. what is spend retroactively mean? >> the check was -- i should have our cfo answer the question, because she has the technical --

>> the check was received couple weeks ago. we need to deposit a check right away so we can start getting interest. we cannot do appropriation for spending until the resolution approved. because the check is deposited into the bank, we're asking for approval retroactively. >> any further discussion on the resolution? this is certainly a very generous gift. is there some way that we can assured that the doctor understands our gratitude for this? >> absolutely.

we could -- her bank representative came here on april 15th. we intend to provide a memory or a sort of book picture capturing the new laguna and present it to her at a future date. i'll be happy through our joint conference committee or through the health commission and health commission convey that message also. >> she would like to come and receive something from either the joint conference committee

or -- it's nice to highlight someone who has been so thoughtful to the generosity to the city and the patients at laguna. it could represent another example for others. >> i will communicate that to her banker. >> thank you. >> any further comments. we're then prepared for the vote. all of those in favor of the resolution, please say aye. >> aye. >> all of those oppose. the resolution is passed unanimously. >> i'll note there's no public comment on that item. we have item eight which is proposition q hearing closing of skilling nursing facility. i will note this is the first hearing of two. you will vote at the may 19th meeting on this issue.

>> good afternoon commissioners. i'm a health planner within the office of policy and planning here at dph. i'm here to provide you with the brief overview with the proposition q hearing regarding the reduction of nursingñ?ñ beds at st. mary's medical center. promise q was passed by voters in 1988. it requires private hospitals to provide public notice before theyútñ?ñ? close inpatient or outpatient facility eliminate or reduce level0÷ñ?ñ?ñ of services provide lease sale or transfer. the health commission is required to hold a public hearing and this is the first of

two hearings. the hospital may present information and respond and the health commission may make findings about whether the services will have a detrimental impact on the healthcare services in san francisco. the health commission received notice from st. mary's medical center earlier in march. they intend to close skilled nursing facility on june 21, 2015. the school nursing unit has 32 licensed bed. majority of patients are covered by medicare and 13% of their patients were covered by private insurance and 7% by med cal. this closure there will be an

elimination of services at st. mary's. st. mary's indicated that changes in healthcare reimbursment and ongoing losses of unit as reasons for their closure. to provide you with background in the memo that you received it contains information about san francisco population. the grass that you see shows the population over the age of 65 in san francisco, california and the united states. you'll notice that the proportion of adults over 65 will increase from 14% of our population to 25% by 2050. you'll also notice that our population of 65 and older is higher than the state and the united states will be significantly higher by 2050.

the shifting demographics indicate an increasing needs for long term care and support services for our aging population. what we typically call long term care services means that we're providing support for people with limitations in their abilities to care for themselves. this means providing assistance with activities of daily living. such as eating bathing grooming, people preparation shopping, transportation. skill nursing facilities is providing long term care. in san francisco we have hospital-based facilities as well as free standing facilities. this can be oriented towards short term stays for people who need rehabilitation after injury or illness. they can be oriented towards patients requiring longer term stays. such as patients that have

permanent disabilities, chronic illness, require ongoing supervision. this graph shows the total number of skilled nursing facility beds in san francisco. which as of 2013 was about 2759. since 2002, the number of hospital bed have fallen about 27%. we know this number has declined further since 2013. free standing facilities, however, have fallen about 15%. i just wonts to point -- i just want to point that the data is the number=yñ?ñ? on $yñ?ñ?6sñ?ñ?licensed beds.

in 2013 san francisco had seven hospital-based skilled nursing units with more than 1500 licensed skilled nursing beds and occupancy rate of about 79%. the average length of stay was about 110 days. as commission knows between 2013 and 2020, san francisco is projected to lose more than 300 hospital based beds. this is due to changes in sniff services that were discussed at the previous hearing as well as reduction of sniff beds at st. luke's hospital. the closure of sniff beds at san

francisco general behavior health center the reduction of licensed beds of jewish home as well as the closure of sniff beds that we're talking about today. i also like to add additional information, chinese committee hospital is planning to open 23 sniff beds post construction in 2016. in 2013, we had 16 free standing skilled nursing facilities in san francisco with 1173 licensed beds. 92% of residents entering these facilities were discharged from the hospital and 85% of the discharges from the sniff are occurring within three months or less. about 50% of these discharges were sending patients to their home and about a quarter were senderring them back -- sending them back to the hospital. seniors between the ages of 75

and 94 represent the highest users in these facilities. for some patients home and community based services can provide care outside of a skilled nursing facility and mount based long term support services can be addressed by the issues that you see listed here on the slide. they can decrease the risk for institutionalization. with the population that's older than california, our long term care bed occupancy rate is higher meaning that air beds more full on average than the state. while our ratio of long term care beds to our population is lower, as of 2013, san francisco

had 3.7 beds per 1000 adults over the and of 24. while california had 4.4 beds per 100 adults. i like to note here that long term beds means any kind of sniff bed, whether they're oriented towards short term stays or long term stays based on the data. this is3iñ?ñ because of the data that we received fromm?ñ?ñ the state. it doesn't distinguish betweenrbñ?ñ? the two. our change in demographics as well as the reduction in skilled nursing beds in san francisco means that any reduction in skilled nursing services will likely create a capacity risk for the city and the reduction that skilled nursing beds is likely to have a detrimental impact on the community. dph is interested in a variety of models that are geared towards managing chronic conditions and these may help

people stay in the community longer. health homes are authorized under the affordable care act and whole person care in support of housing are prominent aspect of california's cal waiver renewal. all three of these models are emphasizing care management and coordinated care. especially for people with high health needs and multiple chronic conditions. these are people who may down the line need skilled nursing care. dph also participates on san francisco's long term care coordinating counsel including the care committee long term care coordinating council. a?ñ?xrñ?ñ?ñ finally the department of aging and adult services conducts a

need assessment every four years to direct resources. doss is currently working on their needs assessment and it's due to release later this year. you have a draft resolution before you that leaves a decision to you to determine the loss of beds will or will not have a detrimental impact. st. mary's medical center has representation here today. i believe they would like to make a statement. >> is there any questions that the point or shall we move on to the presentation from st. m ary's? okay that would be fine.

>> good afternoon president chow, commissioners, director garcia. i'm anna chung, i'm president at st. mary's medical center. i like to share some information kind of to give some background and context to. i request a notification of closure of beds. start off with, i want to give a little bit of information about st. mary's. st. mary's is probably one of the longest working acute care hospitals. we started in 1857 by eight sisters, sisters of mercy came from ireland. really for support of community.

almost from the day they arrived they started attending to the needs of the poor. healthcare needs as well as children's needs. the slide that is in front of you, i just wanted to show some of the history. the work of the sisters attending to those people needed in makeshift tents after the 1906 earthquake and also the original location of the st. mary's on stockton street. today st. mary's is a community hospital with about 1100 employees about 300 physicians about 220 volunteers. we have 371 licensed beds. we to not need to use all 371 licensed beds. we're a community hospital. we provide services such as emergency services orthopedic,

acute medical surgical care, cancer services, well woman's health. probably unique to st. mary's is the provision of an adolescence psychiatric unit. it's a locked unit. it is the only one that is available in san francisco. we provide to a high number of needs that are primarily med cal. this slide here is intended to show you just where our patients are coming from. the darker the area, the more densely is our patients. you can see that st. mary's really serves a lot of the patients in the western side of san francisco. st. mary's challenges. just like many other hospitals, st. mary's has faced unprecedented financial exactlies and -- challenges and

pressure. in order for us to continue and do the best we can to deal with limited resources that are available to the hospital so that we can continue with our mission, which is to take care of the community to advocate for them and also to provide care for everyone including those without the ability to pay. in this slide here i also showed to the hospital, we take care of a pretty high population together of medicare and med cal patients. as i mentioned, about half of our patients are med cal patients. at this point, i will turn it over to abby who will share a bit of the community bents that we provide. >> good afternoon commissioners. as you know st. mary's is long

standing provider of community benefits in san francisco. this was what was reported in fiscal year '14. you'll see this again shortly. closure of the skilled nursely facility at st. mary's as i think you understand has been a long arduous and a discerned commission on the part of st. mary's and sisters of mercy. skilled nursing unit at st. mary's is short term acute unit that provides physical rehab and

rehabilitative care. many hospitals across the united states pulled skilled nursing units within the four walls in their hospital. that has been the experience at st. mary's as well. the expenses for the required hospital based services to the skilled nursing unit is about $2 million on a direct cost bases. that's not charges. that's not including the overhead. as i said the leadership did a valued based decision which is where multiple stakeholders are called into the room to have a very deep thoughtful discussion based on values not necessarily on finances but on the values of the hospital and what the closure means to the hospital in the community and it was a

unanimous decision that this was a necessary step it take. so the plans are under way to close the unit on the 21st of june. the unit is budgeted on a historical average. it's capped because of the budget. in private healthcare most budgets are set based on historical averages. this unit is running average daily census about 70 patients. it is anticipated, since these are sort term patients, those patients will be placed in the community. i think that concludes our presentation. i know there are questions that you may have for us and for the department. >> thank you, commissioners. questions. perhaps from your last comment.

you said that you could place in the community. does that mean the community still has a number of sniff beds? we heard sutter was doing sutter and not taking others. >> right. there's 17 community skilled nursing facilities in san francisco that do take patients. kaiser using them routinely, st. francis uses them routinely. these patients will be discharged home should they be ready to go home or and that's more likely scenario. patients that will be discharged to skilled nursing from st. mary's would go into a community skilled nursing facility. >> commissioners questions? commissioner pating. >> i want to thank our staff for doing a wonderful report. congratulations. wonderful briefing document. i want to thank ms. chung for

involvement in the program. i have four questions and i'll ask them one at a time. the census of your sniff unit has a capacity of 32 can you explain the low utilization? >> if you look at the census, the census actually and the patients have dropped primarily in the last couple of years. it probably is a multifactorial kind of reason. a part of that is the changes in some of the practice of our physician. started about two years ago our program they have