City says it’s expanding board-and-cares, but data shows otherwise

In response to an alarming rate of San Francisco board-and-care facilities closing,  Mayor London Breed has publicly vowed, over the past three years, to protect long-term beds for seniors and residents suffering with mental health issues. New ones would open, and the city would purchase some that threatened to close, she promised.   

By July, 2021, Breed upped the ante and declared her office would open 400 new mental health beds in the coming years, in part guided by a 2020 Department of Public Health report. Of those hundreds of beds, 69 would be residential-care facilities, or types of institutions where seniors and others with mental-health issues receive round-the-clock care, beds and meals. 

“If we are going to address the challenges we see every day on our streets, we need facilities, so we have safe and stable places for people to go,” Breed said in a recent press release about a board-and-care opening.  

A statement from the Department of Public Health last week boasted that the department had already met the goal of 69 new beds. Victoria’s House, a board-and-care on Shotwell Street earmarked for those with mental health issues, opened in August and added 46 beds to the city’s stock. Another “23 beds [were] contracted to meet our board-and-care goal” at Sky Park Gardens and County Place Assisted Living, the health department wrote in an email to Mission Local. 

But that goal has not been met. Not by a long shot.

While the rosy Victoria’s House press release is technically true — the property is new, and offers 46 beds — the mayor’s office left out the fact that most of the beds were preserved, and only 15 are new stock. Back in 2018, the same property ran as a board-and-care under a different ownership that had 29 beds. So, in actuality, the new beds brought the total to 38, not 69. 

“The opening on Shotwell is encouraging, depending on how you count it,” said Supervisor Rafael Mandelman, another vocal advocate for reversing board-and-care closures in 2019. “We didn’t lose a facility that we were going to lose. Fifteen beds is a modest move in the right direction.” 

And no press release mentioned that, in that same week that Victoria’s House added 15 beds, a former board-and-care facility that Breed intended to buy in 2020 was sold to Las Verse LLC. The property went for $3.33 million, about $1 million less than the original asking price. 

No press release announced the mayor’s decision to go back on the deal, which could have re-activated some 27 beds.  “Change of plans,” Breed’s press secretary wrote to Mission Local a few weeks ago. The Health Department said the facility would “not meet clinical needs” as a board and care, despite the property being licensed as a convalescent home and previously operating as one. It’s unclear what the property, South Van Ness Manor, will be used for now. However, legislation penned by Mandelman and approved by the full board in 2021 makes it somewhat more difficult for the new owners to completely change its use. 

The situation of disappearing beds, or beds counted twice, is not a one-off. A Mission Local analysis of state databases for two main types of residential care facilities — adult residential facilities and residential care facilities for the elderly — show that, despite congratulatory press releases during facility openings, the city has lost scores of beds since the mayor announced her 2021 goal of 400 new beds, one that included 69 new beds in residential care facilities. 

Adult residential facilities

Adult residential facilities provide care for those with mental, physical or developmental disabilities. From July, 2021, to March, 2022, the latest date available, San Francisco closed six adult residential facilities and opened just one. In total, 106 beds vanished, and 5 opened, for a net loss of 101 beds. 

“It suggests that a trend is continuing, a trend we’ve known about for many years. I think it’s a huge problem,” Mandelman said. 

Residential care facilities for the elderly

From July, 2021, to March, 2022, San Francisco closed a 12-bed residential care facility for the elderly, and one opened: Coterie Cathedral Hill, with some 260 beds. Coterie Cathedral Hill, however, is unlikely the kind the city is trying to save and recover. It is “senior luxury housing,” where two-bedroom units go for $27,000 per month and a studio costs $7,700 a month.

So, excluding Coterie Cathedral Hill, the city lost 12 beds for residential care facilities for the elderly. 

This means that, in two major categories of residential care facilities, the city has lost 118 beds as of March, 2022, the most recent figures in the state database, and opened just 43 as of July, 2022. Assuming no more beds were lost in the period between March and August, the city has experienced a net loss of 75 beds, not a net gain of 69 new beds. 

When Mission Local inquired with the mayor’s press office about the continued closures, the question was punted to the Department of Public Health. 

“We have been doing our best and working hard prevent closures [sic] of Adult Residential Facilities (ARF) and Residential Care Facilities for the Elderly (RCFE). However, most owners of these facilities are retiring, and their families are not interested in the business,” the emailed statement said. 

“They prefer selling their properties at a highest price [sic] as quickly as possible and putting their homes in the competitive market, instead of offering their homes and services to other providers,” it continued.

The department added that the state gave San Francisco $5.5 million to support adult residential- and senior-care facilities. “We’re currently developing a funding distribution implementation plan,” the Health Department wrote in the email.  

Yet the department continues to pass on opportunities. Properties like South Van Ness Manor sold for a price lower than when Mayor Breed submitted a Letter of Intent of Purchase to buy it. 

Earlier this year, the city also had the opportunity to buy the nearby 628 Shotwell St. facility to preserve it as a board-and-care. A nonprofit expressed interest in purchasing the property for $2 million, if the city chipped in. The city demurred, and the property is en route to becoming a duplex. 

The 400-bed goal 

According to press releases from this summer, 179 beds opened with 70 more to come, “which will get us to nearly 250 of the 400 bed goal.” As another release put it: Some two-thirds of the goal had been met. 

But if the 400-bed goal counted board-and-care losses too — i.e. the 118 bed loss from July, 2021, to March, 2022 — that whittles the overall bed progress to 136 beds, or just a little over one-third of the goal. 

How did the Health Department and Breed get to 400 new mental health beds as a goal? 

It was guided, in part, by a 2020 Department of Public Health Behavioral Health Bed Optimization report, which set the city’s necessary bed increases to properly combat facility scarcity. The Health Department continues to use it as a metric of progress, ignoring the fact that facility openings and closures are “dynamic,” Mandelman said. “You are losing beds, while you are adding them.”

In addition to the 69 board and care facilities, the 400-bed goal includes psychological respite centers, sobering centers, locked subacute treatment facilities and more. 

The department is falling short in five of the categories, according to the department’s chart and an email. 

“SDPH opens our beds gradually, so although we make announcements with beds capacity it may take time to fill,” a Health Department email stated to explain vacancies. “For example, we opened beds gradually to accommodate for residents and social services’ needs.” 

The department continued some bed openings may lag or be “reduced to due [sic] to many possible reasons (e.g. smaller property, social distance, etc.).”

Mandelman is calling for a new and extensive report on the status of all mental health beds in San Francisco; the 2020 Health Department report is not cutting it as an adequate metric for city bed expansion, he said. 

“I have been dissatisfied with the 400-bed framework, and I’ve expressed that in a number of hearings,” Mandelman said. “It was not a master plan, and was not intended to be. I don’t think there is a plan.”

Empty beds 

The more perplexing number is that, at a time when facilities are closing and the city’s homeless population is experiencing a mental health crisis, some existing beds remain vacant. 

Some vacancies are natural turnover. But at some facilities, employees credit empty beds to understaffing. 

Tucked away in a secluded corner of the San Francisco General Hospital campus are several residential care facility floors. The first floor of the Behavioral Health Center is an adult residential facility, and the second is a residential care facility for the elderly. In total, the state registry lists 55 beds for residential care use. 

However, as Mission Local wrote in 2019, upper management came under fire for withholding the fact that 23 beds were vacant at the adult residential facility, and 22 at the residential care facility for the elderly. That situation hasn’t significantly improved, sources at the hospital told Mission Local recently; at least a dozen beds remain unused. 

Additionally, a quarter of the adult residential facility’s beds are being used for another purpose. A few years ago, the adult residential facility floor shunted 14 of its beds to the Potrero psychological respite center Hummingbird, which is used for temporary stays. (That meant the mayor and health department willingly exchanged permanent, residential care beds for temporary psychological respite beds. In short: Housing was traded for shelter.)  It was said it would be a temporary fix. 

“But we are guaranteed to get them back,” Amy Wong, a mental health treatment specialist on-site, told Mission Local in 2019. 

Three years later, however, sources at San Francisco General Hospital said the beds are still Hummingbird’s to use, even after the city opened an additional Hummingbird psychological respite center at 1156 Valencia St. last year.

A client, who asked not to be named, moved into Hummingbird Valencia a few weeks ago from San Francisco County Jail. So far, the service is “nice and clean” overall. The clients get three meals a day, like cereal and fruit for breakfast and donated boxed food for dinner. On a recent morning, a small group discussion with everyone took place, and the client is getting referred to a service program.

This particular client likes it, and hopes to stay “a while.”