programs that do very well. and c.b.o.s similar ly, so i do think it's hard to say that this is one compared to the other. and again, it was looking at a very specific year that they highlighted all of the outcome measures. so -- but this is an area that we're looking at. we monitor -- again, this is more recent that we're monitoring our civil service clinics and looking at it on the same standard that we have across our system. >> so taking advantage of the fact that you, of course, came from one of the more successfully, you know, rated c.b.o.s, this -- do you believe that it is a fair assessment that most of the civil service areas can certainly have a greater level of improvement, and you're expecting that? >> i definitely believe that there are areas of improvement

for our civil service clinics. but the way to compare it is a little bit challenging because there are many things that are expected from civil service clinics that we don't expect from c.b.o.s, certain responses that we have to do when it comes to crisis, certain things that we have to engage in that we don't expect our c.b.o.s to are involved, and there are certain levels of staffing that are different. so it's sort of hard to compare it that way and to say or judge basically because of this you're doing worse, but definitely, there are areas that we can make improvements, and that's why we're looking at metrics, and this real-time data could help us. but i think now, it's very good. there's two sides of every story. being on this i had zoo, i can see the challenges and also the demands and requirements that are different. for example, when we had the fire situation, when we had the -- we deploy staff, we

deploy staff for a variety of things, and for things that is not necessarily as equal to expect a c.b.o. to respond to, but i would definitely say there are strengths within civil service clinics, but there are areas of improvements, and there are strengths within c.b.o. overall, and improvements, but maybe not exactly the same ones. >> earlier, you thought epic would be of help, so there had been, of course, currently, the mental health programs are on a different platform. is it the intent, then, that epic also be able for the mental health program? >> that would be our goal and aspiration. >> is it a goal or is it in the -- >> no, it is the phase three and the first phase of hospital. even though it's the first phase of hospital, many are in

the psychiatric services or behavioral health that is part of wave one. the outpatient services are on the wave three. >> and if i may, on that epic issue, there is no model for behavioral health systems with the epic. it's something that's in development, and you have to have state approval because the avatar is the state approved system. we can interact and do interruptability, so it is the phase three. we are committed to that. it's not the phase that we've achieved today because we still are exploring that and we still are needing state agreement with that and also development from our systems, particularly epic and any other system. we've been working on this for over ten years, trying to find a system that would work, and it's just not in the -- 'cause

many of them are setup just for hospital, medical systems. but as our director from behavioral health talked about is p.e.s. will be on epic, and the psychiatric service will be on epic, and that would be a big help for us in terms of operablity of our systems today. >> yeah. right. i think it would be useful if we kind of continue to remember that under the epic side, because that's been an -- a long, ongoing question. avatar was a great advancement, although maybe on your side, you didn't think so when it came in. but i think we need to keep an eye on how that is developing. but you're right, a good number of the clients that have been on the epic do offer the interoperablity that will be an opportunity. but on that one, i think we

should continue to use our monitoring to make sure you get what you need there if it's possible. >> and we are also aware that before epic, potentially rolls out for wave three, between those periods there would be a web link that we would be able to access, looking at the data. although we would not be charting there, we could look at the data and identify or clientele that have been in the hospital or been receiving other services in order to coordinate better. >> now i think i've awakened the commissioners who have some questions. i'll just go from right to left, starting with commissioner bernal and we'll just go down the line. >> i had had a similar question about e pic. it seems when you're looking at the civil service clinics, that mainly what they've identified is the billing. do you believe that it actually

is better than it looks, it's just not being do wanted correctly? >> keep in mind that this report was going back for seven years. if we look at what's happening 17-18 and also looking at how the improvement has been, we will see something very different. and also, there are times the services are provided but maybe not documented, or it's not documented in the best way, so that's why all our trainings and doing -- our compliance department going in and doing technical assistance and working with each clinic, training each clinic and the staff has really been helpful. we hire documentation specialists specifically to address these sort of needs. >> and then, my second question, it appears many times in this audit the need for increased staffing for intensive case management and to utilize data in order to assess what the need is. is there a sense now of how much increase staffing will be needed and what the cost might

be? >> yeah. i feel like that's a little bit too early because what my hope is that one, with the first wave of utilization management, we can look at what we currently have and what we currently offer, but the second wave, which was the next fiscal year, when we're looking at all our i.c.m. levels and looking at all our levels, our full service partnerships or sort of wraparound services, once we look at that, okay, then we can identify what's the number of people we need to serve, what's the staffing required, what would be the best caseload, and what would be the best requirement, again, services to be provided in the field. that's really what intensive case management is, the majority should be in the field. so i think we can better identify the staffing structure and the caseload after this initial phase. so i felt like it was premature to say we need additional staff because i'm trying to actually look at what we currently have

and is this the right level of care for the people that are in it right now, and if we open that up, could that actually address a lot of the need. but then, in the process, we actually need to see how we can keep that going because we really should not have a wait list for i.c.m. our system should not have a wait list, and that's the goal. >> and just a final comment, about having a centralized or coordinated wait list, so you have an idea of how many are on there. >> we will be looking at how many people are coming in because we'll have an authorization process. and if for a larger -- if we're a larger system of care, we don't have a wait list, however we could work with people if we find out there's a challenge about when somebody needs the service and they're not able to access. how have we met our goals and services within the time frame as required. so it's hard to say we should create a wait list for our

services -- we shouldn't have a wait list and we're not having a wait list. but for the i.c.m., we should not have a wait list, but in the process we are right now, we're going to be tracking who's coming in, what are they need, and how long are they waiting? >> thank you. >> commissioner carreon? >> my questions were answered. >> commissioner chung? >> i'm actually very interested in your -- in your -- your, like, introductions to peer based services. that's not billable, am i correct? >> so when it comes to peer services, there are multiple ways that we approach it. so this grant that we received through mhsa, which was $750,000 for three years specifically to support people who are in intensive case management and hand off to a

lower level of care, that is not supported. we have many programs that are peer based services that are funded through mhsa. however we do have programs where peer services can provide rehabilitative services and we actually have that as part of our billable grid, that what peers can provide and whether they are billable or not. it depends which program they're in, and whether -- how is it funded. but many of our peer based programs are funded through the mental health services act, but some, we have the funding, and we -- we don't have the funding but we still -- we have the funding and we actually have that supported.

>> i remember you were introducing that concept. >> correct. >> not that long ago. >> correct. >> the other questions i have with that is do all the patients -- do all the clients have peer services or some do, some don't. >> so peer services are available to all dps clients. we have for example peer center on market street that is available to every b.h.s. client that is part of the b.h.s. or someone who comes in and says i need services. we have peers who are hired by various programs, and they're providing services. and the goal is really to have

peers across our system. we make sure that peer based services are embedded in the foundation and culture of the programs 6789 so i would say the majority of the programs either have peers under staff or in their program or they're accessing it through the services provided within our system. so for example, this i.c.m. flow that we're talking about, they would not be just for one clinic, they would be available to any of the intensive case management programs. and that peer could be available to them. so it's provided throughout, but i would say we started years ago. i'm thinking about six or seven years ago, a much smaller number. now we have

. >> every r.f.p. that comes out, that is sort of embedded into it. >> so -- so i -- another question i have it, like, were -- are there any indicators that show that peer services are actually beneficial to clients, and if so, like, like, what -- what are you actually measuring? >> so for our mental health

services act programs and especially if they are peer-based programs, there are specific objectives that follow it to make sure that the services provided are actually meeting the expectations and the goal. so those are all part of our mhsa contract goals, and those are being monitored. in the other programs, what we can look at is basically the success and improvement of the client and as well as the support they get. we also have peers that help with getting people on medicare, for example, helping people with that navigation. there are multiple ways that we can look at. there's not one lens that i can look at and say well, through that one, they're successful. there are many lenses. in a partnership in the community, the way we work with them. we -- there's without a doubt that there's peers are enhancing and actually

improving our system of care, our engagement, our credibility with our community. and are also resources when certain programs may not be able to provide certain service or may not have the demographics and reflectivity of the community they serve and the peers bring that. so it happens on multiple levels, but certain services have those metrics to show that reflected in the sort of outium. >> thank you. i have no more questions. >> commissioner green? >> i'll leave it for -- >> of course. >> commissioner green? >> this is an incredible report. thank you so much. it's rich, and i want to read more. i'm very curious to understand a little bit more about your process versus your out come metrics. i notice, like, on page 20, some of these civil service clinics have been underperforming since 2013. but i wonder, number one, whether your out come metrics

with going to be uniform across the system or whether they're mandated to you or whether you're going to develop your own. and also, i anticipate if you improve documentation that in fact there'll be more money coming from medi-cal which would allow you to hire more staff and answer some of the questions about availability of services. correct. >> so two issues. so one is on performance measures, out come versus process. so were you not -- one is the performance measures we have across the system, and that's become pertinent to sort of the our delivery of our services. we have -- as a result of this, we have actually always have had out comes, and we have multiple metrics such as our cans or ansa, tools -- for example, we are a cans county, for children's services, the assessment and out come we use

to see how our children are doing, or the family and the household is doing, and this is so successful, the state adopted the cans and is requiring it across all the county, and we already were doing cans, and we are already a cans county, so we already do have measures and many out comes that we're monitoring, so that is something that we wanted to put in place. secondly, we recognize we need to have many recovery memory out come measures. so this year, we look at all the measures what are in compliance, what are out comes, and out of that, we are adding new objectives based on having it be out come measures, but some are process that links to out come directly. so for example, let's say having services delivered post hospitalization. so that's a process.

you know, we want you to provide a certain number of services, but then, the goal would be that out of that, we have another objective to make sure this person doesn't go into the hospital. so some are process, but they're embedded together, and pulling them apart and saying this process doesn't relate to out come is not the best way to align them. so that's something we're doing this year, and this year, that's the focus of performance objectives. and then, during this year or next year, we're really trying to add more compliance -- out come and plug it into the compliance, so that's theest that's happening now. -- so that's the -- what's happening now. i certainly believe -- sorry, the evidence shows, the more we do document our services -- obviously, results, more revenue, but the more we document properly and document it in a way that we can

minimize the error rates, that would really also help. and ultimately, that results in being able to generate more revenue and medi-cal, which ultimately again will help the system of our. and our utilization could look at that more and more. so we're looking at the error rate which is just basically compliance and then there's a quality of care. we want to make sure that we meet all the standards when it comes to the quality of care. a significant is missing, something needs to be there, but then, we need to look at quality of care. so the documentation is sort of connected to quality of care, fiscal improvement, and that's looking at a lot of it before this audit happened, and we're going to continue doing that. >> director garcia. >> just i really appreciate all the questions from the commission. i did want to acknowledge drochlt bocere and his -- director bocere and his work.

it's kprikted performance and all of the multiple audits that he had. under the grand jury because that was the newest one that came to us most recently, about a month ago, i want to acknowledge that the director has worked with me on a question that mayor lee asked us, which is how could we predict issues of safety for the police when they've identified them as 5150 many times, so we've worked with the police and b.a.r.t. police. just want to acknowledge everyone who is working closely with him in trying to provide the best care to an individual that could be at risk directly involved with the police, so that has worked, and it's something we should probably share with the grand jury, as well. i also -- unless there's any other questions, i see a lot of

our behavioral health staff in the room, so we they could standup and we could acknowledge them. [applause] >> and we don't get to see them at the commission much, so i want to acknowledge them personally as well. i think our director has the system well understood, and i do want to acknowledge his leadership. >> i think i skipped commissioner sanchez, i'm sorry. >> yeah. no, that's okay. i've -- i think all of our colleagues have asked, you know, the substantial questions, and whatever i -- i'm glad that our director garcia just stated, 'cause that's exactly what i was going to focus both on her and the whole team that has been involved. i have never seen a response that was submitted from our thing from 123 on, the director garcia sent to the director campbell, utilizing all of the

data pertaining to all the issues raised, etcetera. i mean, each one was answered significantly, with up-to-date data in progress. we degree, we partially agree, we disagree, we've implemented. each one of these added was unbelievable in reference to methodology and out come and how in fact a response should be, given the nature of this department of public health and how we're trying to and are establishing a comprehensive baseline which ensures that we have a radar system that will take a look at all the variables that not only have come before but have come past that. i just want to acknowledge everybody for a job well done and really an exceptional report. >> thank you, commissioner sanchez. i'll also note that the last recommendation that the department was agreeing with was to bring a report to the

board of supervisors as part of the budget presentation, and i will assume that that report will come here first as part of the proposals for the budget. so commissioners, any further questions? if not, then thank you, and we thank the department for the comprehensive review of the performance audit. thank you. >> and i want to thank director garcia for all her support and all the directors and managers here who just make it happen. >> we thank all the directors who came and the work that they're doing for the city. thank you. we'll move onto our kmex item, please. >> clerk: yes, commissioners. item 8 is a commissioner q hearing. the new location of program is to be determined.

>> commissioners, as you know, cpmc has presented several items from prop q and we have divided them into topics so that each of the topics could be discussed separately and item 8, 9, and 10, then will be presented by the department. >> good afternoon, commissioners. my name is neha bhatia, and i'm with the department of policy and planning with the department of public health. so today as doctor chou mentioned will be the prop q hearing related to the first of several items that have been raised by cpmc in answer to expects changes that they're expected to make. the second date for this hearing will be august 21.

so in april of 2018, california pacific medical center notified the health department of upcoming changes that are anticipated to occur this year. you received a memo that has more detailed information about each of these issues, so today, i will just be providing a brief summary. and so i'm going to begin with an overview of prop q, and then, the first item on the agenda which is the change in licensure. additionally, we have representatives from the institute on ageing, the c.e.o. as well as a representative from sutter pacific medical

foundation. so proposition q requires that any time a private hospital in san francisco makes any changes such as a closure of an hospital, inpatient or outpatient facility, eliminates or reduces a level of services provided or prior to leasing, selling or transferring management, that they notify the san francisco health commission. in recent years, the health commission has reviewed four proposition q closures. three of these closures have been cpmc skills nursing center, st. lukes, and st. mary's medical center. at these hearings, the health commission typically makes a determination about whether these changes will or will not have a detrimental impact on health care services in the community. so in april of 2018, cpmc notified the health commission of three changes. the first is the change in

licenin >> so i'm going to begin with the first item that we have on the agenda, which is item number one. so the swindell's alzheimer's program service apz estimated 70 residents who have mild to moderate dementia and approximately 30 patients on any given day. this program is located at cpmc's california campus. it is currently jointly licensed by the cpmc and the institute on age, you about the the program will be independently licensed by the institute on ageing in 2018 and 2019, and cpmc has related this

was related to the closure of its campus in march of 2019. so just a little bit about adult day programs. generally, these programs provide a range of nonmedical support services, including psychological and physiological support that promote the quality of life for older adults. programs are typically designed to provide care and companionship for older adults who might be assistance or supervision during the day. generally these services are provided less than 24 hours. participants attend a certain number of days, and generally participants also payout of pocket as this level of care is not reimbursed by health insurance. these levels of care also offer recess piet for families and their caregivers, and they're licensed by the california department of health and social services. the program on the rite indicates adult day programs in san francisco. there are ten programs in

total. three who serve adults with did he shen shall or alzheimers, and one that serves adults who are vehemently disabled. in addition the department of ageing and adult services provide some assistance for adults with dementia or alzheimer's. so while cpmc has been working together with the institute on ageing on this planned change, currently, the institute on ageing has not identified a new location for the day program, and so the impact of this change is uncertain? we know there are a limited number of adult day programs in san francisco that serve adults with dementia or alzheimers, and they are an important resource for keeping the adults in the community and out of institutional, long-term care. if this program were to close then it would result in a loss of services and would have a detrimental impact for residents in san francisco. and with that, that concludes my comments on this item?

i'm happy to answer any questions. >> okay. and so what we will be doing is taking testimony on each of the items as we proceed. i -- and several people have asked to speak to each of the items, and some people have spoken to only asking for one. so -- but the public is encouraged, if they wish, to testify on each of the items as we go through each one. and trying to focus, then, on the subject of that item, which we believe will be the clearest. following the presentation of the three, we will then have the overall discussion of the commission, hoping they have kept each of the three separately because that would then allow us to then ask the

institutions what they want -- i mean, the understandings of how the institutions are seeing these moves in a strategic fashion, if that meets with your approval. so we'll go through each of the presentations, have the public testimony on each of the three items, and then, we'll have a commission discussion on each -- on 8, 9, and 10 together. the resolutions will be voted on after the usual period of time for further comment on the part of the public in august as is currently scheduled. so i will call for those speakers who have first indicated that they would like to speak on item number 8, which is the licensure change. ken barnes please, is that

correct? the medical foundation, that would be a different number. okay. we'll get that correct. then, kim tavanglion. >> national union of health care workers. i'm here once again to talk about and to support the resolution as put forth by the department. it is a travesty of justice that cpmc continues to close programs affecting our seniors. this is one of the fastest growing segments of the population in san francisco. alzheimer's is devastating our communities. they are closing yet another

program that affects these seniors and -- and u.h.w. cannot speak out strongly enough that this is just devastating. there are limited services in san francisco without having any proposed side -- site where this can go into, we know that the service is lost. we know that the rcfe's can't afford the land in san francisco. where are these programs going to go? the nonprofits are suffering from the real estate crisis in san francisco. we know that housing is expensive, but for these nonprofits to operate in san francisco, it's equally expensive. and without this -- without a location where this can go, it's not going to automatically pop up. and cpmc is one more time deciding to hurt this population. you know, i see their

commercials. it's like here, have a baby. here, i guess let grandma and grandpa have to go out of county. they have no problem shipping people to fresno, they have no problem telling people they have to leave the county. this is yet one more time where a very profitable organization is shirking their responsibility to every family in this county. and i hope that every commissioner will speak loudly about this, 'cause cpmc has had more prop q hearings in the past two years. i feel i know you all intimately because i've spoken so many times about this. you know, they are making tons of money. this isn't like a tiny community hospital. millions, hundreds of millions of dollars, and they're sending these people -- they don't care. no referrals. other programs are impacted. where are these families going to find support for their loved ones, their seniors?

the heads of their family, the way we would all want to take care of our grandparents or parents. this is not what san francisco's about, and i would encourage you all to vote yes on this resolution. thank you. >> thank you. the next speaker on this item is dr. teresa palmer. >> hi. i'm a san francisco geriatrician, and i work with kim at san francisco's for health care housing jobs and justice. and i urge you to say that the closing of swindell's is detrimental to the people of san francisco. this was done purely to preserve revenue and not because these services are not

needed. the swindell 1ed family founding this foundation, founded this with their foundation money, and unfortunately, now they're all dead, and so cpmc is closing it. and it's not acceptable, and it's just one of the many closures, including the subacute and the snf units at st. luke's. this is not because the people of san francisco don't need the services. the people of san francisco need the services, but cpmc wants to do the higher revenue acute short stay, and they don't really care what the people of san francisco need. so please pass a resolution that this is detrimental. thank you. >> thank you. if there are no other speakers, did you place in -- i mean, that's fine. why don't you announce your name. >> i'm michael lyon.

i'm also with the san franciscos for housing, health care, jobs, and justice. so kim had talked earlier about cpmc shirking its responsibilities for supplying a kind of health care to san francisco, although it make -- this nonprofit makes millions upon millions of dollars from getting rid of less reimbursed services such as swindell. i want to talk a little bit -- i want to shift the focus a little bit on the question of shirking the focus of responsibility, because i think the focus really lies with you and the board of supervisors to not let this continue to happen again and again and again, of these services being closed. the -- the groups that are

supposed to -- supposed to have been setup to deal with these programs, like the hospital council, that long-term care council, really is dominated by private hospitals, particularly cpmc. and it's no wonder that nothing has happened on these up to now. you have to reassert yourself. >> thank you. remember, the first item is on the licensure change. we'll now go onto the next item, which is on the potential closure. >> clerk: yes. item nine is the potential closure of cpmc alzheimer's residential care facility. >> great. so the second change we are discussing today is the closure of swindell's residential care facility. this is a 24 bed residential care facility for the elderly, which is how it's licensed by

the california department of social services that's located at california cpmc's campus. this campus provides 24-7 care and memory care services for patients living with moderate to severe dementia, including assistance with activities of daily living, such as eating, feeding, dressing or bathing. cpmc plans to close this facility by the end of 2018? and they have collaborated with elder kara lines, which is a nonprofit organization -- care alliance, which is a nonprofit organization. as a result of this collaboration, there will be 14 new beds available at residential care case alliance's campus at alma villa. as i mentioned, they provide 24-7 supervision and assistance with activities of daily living. residents are typically private

pay as this level of care is not reimbursed by health insurance? and some facilities offer what is called memory care, which is a special kind of care that's provided to adults with dementia or alzheimer's. memory care services can include activities to stimulate the memory of residents, security to prevent patients from wandering, which is common among those with more advanced stages of dementia, and these facilities typically have higher staffing ratios and staffing specifically trained to care for those patients. so given that our older adult population is growing, we know that our population 65 and older will grow from 14% of our population to 20% by 2030, and the alzheimer's foundation has estimated that san francisco's population with alzheimers will grow by 69% by 2030. we know that residential facilities for the elderly are

a critical level of care and long-term option of care for our residents? so how many do we have in san francisco? approximately we have about 66 facilities that provide 3,070 beds. unfortunately, there's not a good data source or publicly available information to learn more about these facilities, but we were able to determine that there are at least 13 facilities in san francisco that advertise memory care and they have designated around 322 beds for that type of service? i'll just note that this is likely an underestimate since we were only able to collect information on what we could find. so a little bit about the residents who are currently at swindell. as of june 2018, cpmc reported that there were 15 residents remaining at swindells. at of july 2018 about 12

residents have moved to the eller care alliance alma villa, and another resident chose to move to a different facility, and two residents are planning to move to cpmc's coming home pos miss. cpmc wihas reported that about6 staff will be impacted by this change and that they will be placed in comparable positions within the system. and the graph on the right just provides a little bit of demograph demographic about the residents who are at swindell's in june of 2018. so we know that our senior population and our population with dementia and alzheimer's is growing? and so whole cpmc has provided a viable and cost neutral solution for its current

residents which will ensure that patients have families have a similar level of care with no additional costs, the closure of the facility will ultimately result in a loss of ten residential care facility beds for the elderly in san francisco which will potentially limit access to this type of care in the city, so for those reasons, we recommend that the closure of this facility will have a detrimental impact on health care services in the city. that concludes my presentation on this item. >> thank you. we have one testimony again, kim tavanglioni. >> regarding the residential care facility, we do represent members who actually work in this -- on this unit.

not everybody has been placed in a comparable position, i want to make that crystal clear. some people have wound up with reduced schedules, etcetera, so we are not completely happy with that. once again, cpmc is shirking its responsibility. the loss of these ten beds is detrimental to the entire community. alzheimer's, issues with ageing, it's a very specific type of care that requires the workers to develop deep relationships with the clients, and closing the sliding scale service puts a lot of san franciscans out of county. san franciscans are being

forced to find care outside of county. this makes it worse. cpmc is making enough to actually provide this level of care. they're choosing not to. they're choosing their own bonuses over the care of san franciscans, so i urge you to vote that this is detrimental to the community. thank you. >> you it. dr. conor, i also recognized that you had put yourself down for this item. are you okay with your prior testimony? [inaudible] >> thank you. [inaudible] >> right. [inaudible] >> right. and commissioners, i recognize that the first two items

actually do speak about swindell's and the residential care facility. the third item is actually quite separate which is the change from services from the hospital to the foundation. if it's okay with you, i think we should discuss the first two items first, and then, we'll go onto the third or the subjects may well get mixed up. so let's discuss swindell. first, a change of license and the closure. those are the two separate items that dr. bronner has presented. dr. bronner, thank you for coming, and would you like to make some comments, please. and if there is someone who would like to make some comments from the institute of ageing, that would also help us to understand what the i.o.a. is considering in regards to these two topics. >> so good afternoon,

commissioners, and that's tom briode from the institute on ageing who will make comments after i conclude mine. i'm warren bronner. i'm the c.e.o. from cpmc, and i'm happy to answer any questions that you have with regard to the swindell's residential care program. we expect no negative impacts from the change in licenseure. we're working with the agency to secure an alternate location for the program in san francisco. i want to point out that i.o.a. already manages the program in its entirety and have been a spectacular job. we simply been providing space on the cal campus, and when the cal campus close is by

necessarily, the program will thrive at its new home. in terms of the residential closure, that provides 24-7 care for patients with severe category anitive dysfunction, and while we understand and appreciate the staff recommendations, i would like to emphasize how pleased we are and i believe the families with the residents are with the solution that we've developed with elder care alliance to create 14 more beds in san francisco so they can move into a brand-new assisted living facility at alma villa which is in parkmerced. i would like to say that almost all of our patients have transferred and that the swindell's residential facility

is actually already officially closed. you have already heard that we've arranged for the residents at swindell's to pay the current rates that they pay us. this solution allows the residents to stay together in san francisco and not worry about any increase in costs. we think this is about as good of a solution as we could possibly come up with. we're also supporting the alzheimer's free community. finally, i want to add prop q hearings are about all the locations we're closing, but i would like the opportunity sometime during this hearing to tell you all the new things that we're doing with alzheimer's and geriatric patients here in san francisco. and we support ageing in place here in san francisco. tom, you want to say a few

words? >> good afternoon, commissioners. i'm tom briode, c.e.o. of the foundation. we've had a wonderful partnership with cpmc, and we are very invested in continuing this program into the future. cpmc gave us a significant advanced notice of the closure of the california campus, but as you can well appreciate in this wonderful community of ours, finding alternative space is a significant challenge. finding space is a problem, and then being able to afford it is a second year problem, so we have been in the market for almost two years, looking for appropriate space to transition that day program. i am happy to say that there is a glimmer of hope. we have found a wonderful piece of property in the presidio. it is a freestanding building, about 7,000 square feet. it will allow us to double the number of people that we're

able to serve in that program. and in fact, we're looking at building a much more robust ecosystem around families and individuals with dementia. the challenge continues to be how do we pay for it? the presidio property is class a priced space, and for the last 16 years, cpmc has allowed us to operate on their property on california without any rent charges, so we are going from a rent-free operation to one where we're paying premium rent. we are -- so that comes out to somewhere in the neighborhood of $450,000 a year, year one. we are currently in dialogue with some major donors to help us to fund that rent. we're doing -- the presidio is very interested in having us. they've come up with some creative ways for us to be able

to fund that rent obligation from an up front payment from a donor, so that is not a fait accompli. we should know or have some decision from the donor that we're speaking to by the end of august. so we are aggressively marketing the donor opportunity to multiple people, but there's one donor that's in front of that line, and so we are working very diligently. we're committed to serving the families and individuals with dementia. it's a part of our core work in serving older adults and adults with disability. we serve about 20,000 people every year through the institute here in san francisco, san mateo, santa clara, marin, and now in southern california as of january of this year. so serving this population is our sole purpose for existing. i'd be happy to answer any questions. >> thank you. commissioners, questions to any of our presenters and to our

guests? commission commissioner bernal? >> hi. specifically with your comments with regards to the presidio, are there protocols in place, and in addition, would something -- would occupying a space there require any kind of build out, seismic upgrades, etcetera? >> i'm happy to say that all of those issues have been resolved. the architectural drawings have been approved by the historic preservation staff at the presidio. there's parking available, so easy access for family. there's a transportation within the park for employees to get to our site. it really meets all of our requirements. if we can come up with the rent, we'll be doing quite well, for all of our families

and being able to serve a much larger population. >> i'm familiar with the systems. so there's the presidio go system. are you saying you'd be utilizing that specific system in the presidio for the families. >> four our employees. we provide all of the transportation for our clients. >> commissioner sanchez? >> yeah. yeah, hi. i wondered if -- cpmc has been involved in a multitude of explorations, and i didn't realize that you've been linked with them since 2002. this is the same program that dave badigar has been involved it. >> dave is my predecessor. >> i'm sorry. i haven't kept up on the shift of personnel, etcetera. >> okay. >> the second question -- okay. as -- okay.

because it's all interrelated, there is a crisis pertaining to providing the quality of care, number one, with actual physicians available or part of the protocols. and then, secondly, the fact that part of the st. luke's effort, and we're still looking at that, is that there would be a senior center of excellence there to provide multitude of service -- at least this is part of the hearings we heard many years ago, etcetera, and we still hear it. and yet my question is, and some of the community, how come all of the senior projects or programs are not really being looked at areas around st. luke's whereby we have a number of -- of projects for housing, even for seniors,

which they want to put eight stories, ten stories, and seniors don't want that. they would like, maybe four stories at the most, along with certain specialty units. some are being done in los angeles, seattle, etcetera, but somehow it's not happening around this fantastic facility that is going to be opened up next month, and we're still looking for some of these programs to house patients such as you have been working with. and i guess i'm sort of wondering, like, right across the street, and this is going to come up again, but it's interrelated. they just built new huge condos on valencia where the chevron station used to be on -- whatever. those are going from 1 million to 3 million. two blocks down, you have the foundation, which cpmc now -- i don't know if they own, rent,

whatever, but that's there. and a number of folks are trying to say, you know, as we take a look at this growing need for seniors -- and you take a look at the data, who are we serving? they're saying about how families moving out, a lot of the families are not only being moved out, they're being picked up and sent out, not only within the counties, but back to -- back to countries that they came 40 years ago under agreements with the u.s. so all i'm saying is all these things are happening today, and -- and when you take a look at the data of who's being served in a multitude of these programs, i didn't see one native american or latino family in a number of these programs. at the same time, many of these services have a high number of veterans who are native american and latino, and they're asking and being serviced now in the mission

district. and yet, we're not getting any creative thinking even though we have these new facilities. the presidio is fine, but nobody, or very few families could even afford to go to the hotels there, veterans -- $600 a night, or to rent out a space? don't get me wrong. the presidio is a great space, but all of a sudden, there's a big differential pertaining to costs, and as you said. 7,000 square feet, $450,000? more power to you. if we could find money like that, but to sustain you, but look at other parts of the city which the institute on ageing has access to, and instead of sending people out to santa clara or whatever, let's do some creative thinking which

would reflect the contributions of cpmc, institute on ageing and others, which you've been providing for a number of years. that's all i'm asking. it's a real challenge, and it gets more frustrating as we see more fragmentation and alienation -- not alienation, but -- yeah, alienation of services because of -- of some of the particular political focus that looks at immigrants again and immigrants that have, quote, owned this land in the 1840's, and families are still being deported, and that includes some from even the city and county of san francisco. so what i'm saying is all of these movements pertaining to moving families out, and again respect for the elderly in many

cultures. and having folks some their families be cast out or saying there's no way we can afford to put you in these places because it's too expensive really does a disserve to what these institutions and these places have been to the city over the years. maybe it's type to think what is our mission here in the city of st. francis? we still need the quality -- the quality of care and dignity, respect that these elderlies and families have that have helped built this city and this nation. end of comment. >> just a comment relative to the day program. that's the only thing i can address. but the location in the presidio is ideal because the catchman area of the program the people it's currently serving is right there.