S.F. hospital phasing out Alzheimer’s care center
Families seek affordable alternative by end of year
One of San Francisco’s only subsidized residential care centers for Alzheimer’s patients will shut down by the end of 2018, prompting worry among family members, caregivers and officials about the dwindling availability of affordable care for dementia patients in an aging city.
The Irene Swindells Alzheimer’s Residential Care Program, operated by California Pacific Medical Center in the city’s Presidio Heights neighborhood, will close as part of the hospital’s plan to move its campus on California Street to a newly constructed center at the corner of Van Ness Avenue and Geary Street. The new facility is scheduled to open in 2020.
The Alzheimer’s care center, which opened in 1997 and houses 18 elderly patients, is the only service that will be discontinued after the move. Other medical services, such as emergency medicine, pediatrics and oncology, will continue at the new campus.
A spokesman for Sutter Health, which owns the medical center, said the Alzheimer’s program will be phased out because the health
system is focusing on acute care. He said CPMC is in talks with privately owned facilities in the city about potentially moving the residents as a group but declined to name the institutions.
The soon-to-be-closed campus will be sold to TMG Partners, a San Francisco developer that plans to construct up to 250 townhomes and apartments and nearly 400 parking spaces on the property, according to documents filed with the City Planning Department.
A separate Swindells day program for dementia patients, which is run out of the same building as residential care, will be relocated to the San Francisco campus of the Institute of Aging, which runs the program, on Geary Boulevard. The institute hopes to move the program — which offers cognitive exercises, therapy animals, music performers and other activities — into a larger space nearby, and is seeking to raise $2 million in philanthropic support to do so.
Family members and caregivers of the Swindells residents — some of whom have severe dementia and are incontinent — worry they may not be able to find an affordable alternative for their loved ones in San Francisco. Other residential care centers in the city have waiting lists, cost thousands of dollars more each month, or are primarily for patients whose incomes are low enough to qualify for MediCal, the insurance program for the poor. But Medi-Cal covers only skilled nursing centers, which are not always the best environment for patients with dementia, medical experts said.
“None of us can afford the payments that are out there now, it’s all private pay,” said Linda Rosario, whose mother, Penny Fong, 103, has Alzheimer’s and has lived at Swindells since 2015. Rosario pays about $1,800 out of pocket each month for her mother’s care — after subsidies, her mother’s Social Security payments and other supplements.
The number of residential care centers for the elderly in San Francisco has declined 20 percent since 2012, from 96 to 77, according to a 2017 report by the San Francisco Department Public Health, Department of Aging and Adult Services and the Hospital Council of Northern and Central California. The number of beds, however, has declined less dramatically during the same period, from 3,225 to 3,153, or 2 percent.
Meanwhile, the proportion of the city’s population older than 60 is growing. This population has increased 18 percent since 2000 — far faster than the 4 percent rate of growth for the city overall, according to a 2016 assessment by the Department of Aging. This growth is anticipated to continue as the Baby Boomer generation ages.
The average cost per month to live in a skilled nursing home in San Francisco is $11,700 to $14,200, according to the city’s 2017 report. The average cost to live in a residential care center in San Francisco is $4,300 a month.
Skilled nursing facilities have registered nurses on duty 24 hours a day, whereas residential care centers have certified nurse assistants and some registered nurses, and are typically less expensive because residents do not need round-the-clock medical care but still require help with daily activities.
At Swindells, which is considered a residential care center, residents pay between $3,000 and $9,000, according to relatives of several residents. Many pay on the lower end of that spectrum because their fees are subsidized as much as 50 percent with the help of philanthropic contributions to the California Pacific Medical Center foundation.
“Our fear in the broader sense is that it’s going to be harder and harder for aging San Franciscans to live in San Francisco as their needs require residential care,” said Ann Ludwig, whose husband, Karl, 79, has dementia and has lived at Swindells for three years. “Swindells is a model institution, and they should be using it to expand services, which we know are going to be increasingly needed in the city, instead of closing it up.”
Vacancies at residential and long-term care centers in the city, especially those that are affordable for middle-income families, are scarce.
“There’s not a huge availability of beds,” said Cindy Barton, a geriatric nurse practitioner at UCSF’s Memory Center who sees patients with dementia and cognitive problems. “The good ones tend to have a waiting list . ... I know Swindells has been a really wonderful alternative for some of our families.”
Most long-term care and residential care centers are not covered by private insurance or Medicare, leaving many families to pay the cost of care on their own. The exception is if patients are on Medi-Cal, which covers stays at skilled nursing homes. Most residents at other major long-term care facilities in the city, Laguna Honda and the San Francisco Campus for Jewish Living — formerly known as the Jewish Home — are on Medi-Cal.
Supervisor Norman Yee said he plans to monitor whether CPMC arranges comparable care for Swindells residents elsewhere in the city.
“They have promised to do that, and we’ll follow up to make sure that happens,” he said.
Yee said he is considering proposing legislation that would encourage operators of residential care centers to remain in the city by allocating supplemental funding to help pay for staff salaries. Such a program already exists, but the amount allocated for assistance has not been increased in several years, Yee said.