. >> i agree with missioner karshmer it's really about post acute care and skilled nursing systems inion rate. i hear stories about like %uñ?ñ?ñ cultural competency. when patients being placed into community skilled nursing facilities that theywrñ?ñ felt discriminated. they just felt uncomfortable because of where they were placed. i don't have an answer. those other stories i hear is different from something within san francisco and we have checks and balances in place to assure that we have best and most culturally competent provider to staff these settings. we're placing people outside, i'm not sure what's in place. ññ?ñ? when we talk about the babyx÷ñ?ñ? boomer generation we all get older. what will be our first presenceu÷ñ?ñ?ñ? to get care at home or get care in a hospital setting. these are really things that we have toañ?ñ? find out before we-zñ?ñ can actually haveyñ?ñ? a more in-depth conversation, i think. commissioner pa -- pating mentioned we're looking into all healthcare partners to make sure we meet the needs. like changing demographics. i think this is something that we

commissioner karshmer. >> thank you st. mary's for this. it does raise a reallyezñ?ñ?be talking about short term and long term care. it's about the services that the patients and the familyñ?ñ? needs to recover or get to their highest level. what we've learned is this notion of lowest level of carry is what we want. missioner singer and pating comments were about this as well. it's about the services. i think we should be very worried in san francisco about the availability of skilled nursing care. not beds as much. i think that gets us confused that somehow the end point. as we think this through, we need to be very committed with doss, with this care group. what are the -- businesses is not as usual. it's not about sniff beds. what is the long term and short term care of skilled nursing. we need to put our thinking caps off for creative approaches to say that this is going to be the model as opposed to reaction to numbers. >> commissioner chung has the floor next.eñ?ñ? >> first off, i want to say2wñ?ñ? that we really appreciate them as a partner in providing the pass

. >> karshmer >> present. >> the meeting is june 2, 2015 we have one public comment. >> public comment please? >> good afternoon commissioner the minutes he lied too much of what transpyred of may 19th. item seven. page seven omits this commission has had authority since 1988 to hold prop qharic. it began in 200719 years after prop two passed. as reported in this extract in my new article there is no motion of april 29th. memo documenting the loss of 200 hospital beds between 2002 and 2020 with old two prop two harings with a total of 150 beds how did you lose the other 136 sniff beds without public front q hearing santa monica the minutes under report d hp failed to provide needs analysis that you requested eight years ago there is no mention of what turned out to be the secret city attorney advice to you gutting prop two by aborting issuing a single finding prop two requires you to issue. the minutes say nothing about the second and third resolve clauses rs and failed to report you have imposed a six month deadline to dph to provide you with eight year passed due sniff needs analysis

. >> i'm sympathy to what commissioner chung and karshmer raised. >> thank you.sioner chung. >> i think that's a good suggestion to keep out short term and long term skilled nursing facility beds. if we say something like what we really considering is whether this is detrimental impact on the continuity of post acute care. that would make better sense. >> thank you. >> part of that deals with the language of the prop q to which we need to find whether it is or is not detrimental. we can modify it as we wish. we to need to come out with one or another with this. commissioner pating may have a solution to8%ñ? that being able to discuss this on a short term basis versus long term base. also from the discussion that we want to encourage that we are really wanting to look at total post acute care and téxñ?ñ?he entire continuum of care. we would encourage to be further explicit, encourage working together at a hospital for the citywide needs. not of sniff beds but of the whole issue of post acute care. >> we appreciate the comments by the commissioner. i think all of y

. >> commissioner karshmer >> let me get this rite every time somebody opens a door there is an alarm to the -- >> operation center >> okay because we want to encourage people to take the stairs it's a good thing. >> it is a good thing at the same time given the history we also want to be alert to the random patrolses in the stairwell operation center we want to be alert any time the stairwell doors are opened then given certain times of the day those alarms are able to be programmed we realized during business hour they're constant alarms what we're more concerns about is the stairwells to be closed when they come through >> this is not alarm that most people hear? >> no it goes to the operation center. >> commissioner singer? >> thanks for that report as i think you know when we had the consultanting firm come on after the unfortunate spaulding incident the first recommendation was you need to put one person in charge of this whole thing which we didn't have before so it good to have you stuck to this challenge i appreciate that. i have three questions. one is a cost issue versus wh

. >> commissioner karshmer >> let me get this rite every time somebody opens a door there

. >> karshmer >> present. >> the meeting is june 2, 2015 we have one public comment. >> public comment