San Francisco health officials have reversed a controversial plan to uproot 82 long-term residents with severe mental illness from two units at a hospital-based care center. All occupants in one unit will remain in place, while those in another have been promised protections when they are relocated.
“Today we won!” said Elizabeth Travelslight of Service Employees International Union Local 1021, which represents the residents’ care workers, in a message to supporters Thursday.
Travelslight said the union secured an agreement with the Department of Public Health to halt the city’s plan to convert two residential units at Zuckerberg San Francisco General Hospital’s Behavioral Health Center into a fully locked psychiatric facility.
According to the agreement, 38 residents in the Adult Residential Facility will remain permanently at the hospital’s campus in the southeastern Mission District. The 44 residents of the Residential Care Facility for the Elderly will move to a new city-run site on Laguna Street in Hayes Valley, with new assurances that all care there will remain city operated rather than privately outsourced — a prospect that had concerned some residents and families.
Daniel Tsai, San Francisco’s director of public health, has not publicly announced changes to the plan, and his department did not respond to a request for comment before publication.
Travelslight said the impetus for the reversal may have been the case of an elderly resident who voluntarily moved into a city-recommended facility after receiving Department of Public Health notices that residents must relocate, only to experience a dramatic deterioration in her health followed by eviction from her new residence.
“The courage of this family coming forward provided an important reality check,” Travelslight wrote.
At an October meeting of the San Francisco Health Commission, the elderly resident’s sister, Yvonne Chan, spoke of the effects on the entire family after her sister received letters in May and June from the Department of Public Health stating that “you, or your loved one, will move to a new home.”
Yvonne Chan, left, spoke about her sister’s housing insecurity at an Oct. 20 Health Commission meeting, with the help of an interpreter.
Audio clip of translated testimony from Yvonne Chan.
“You will only move when a new home that meets your needs is identified,” stated a June letter signed by Angelica Almeida, chief integrative officer at San Francisco General.
But staff at the new city-recommended residence could not care for her sister, Chan said, and the operators moved swiftly to evict her, plunging the family into crisis.
“We trusted this recommendation,” said an interpreter reading a statement written by Chan. “This eviction is devastating to my sister’s health and our family stability.”
In response to an earlier request for comment, the Department of Public Health said it evaluates residents’ needs individually and works with them to identify appropriate placement within the city’s system of care. “Our highest priority is to ensure the continuity of their care and stability as they move into a new setting,” the statement read.
Nevertheless, at several charged Health Commission meetings in May, June, October and November, residents and families said they were afraid of ending up in a private board-and-care home that was violent or unsanitary.
“The place was so filthy. It was full of rats,” said Antoinette Conde, recounting her brother’s time in a Mission District board-and-care home. “Staff were so mean and so degrading to these clients, and the staff were so unskilled, so unprofessional in dealing with his type of mental health. To move him to these contractual residential facilities, which he has been before, will create fear and anxiety and even confusion. Please, please, please listen to us.”
Debbie Gish had the same fears. In an interview, Gish said her 66-year-old sister, Donna, has severe mental illness and had never remained in one place for more than a few months until moving to the Residential Care Facility for the Elderly, where she has lived for nearly two decades.
“In my experience of all those years, when it’s a private subcontractor, their capacity to de-escalate, to redirect, to deal with really chronically difficult people is much lower,” Gish said. She said she was relieved by the city’s assurances that her sister would remain under city workers’ care once she moved to the Laguna Street facility.
Care services inadequate
San Francisco faces a critical shortage of locked mental health beds, which the department said was contributing to overtaxed psychiatric emergency services, long hospital stays, repeated psychiatric crises inside the hospital and people with mental illness returning to homelessness.
The hospital’s behavioral health center was the only building the city could convert within a year, using $21 million in Proposition 1 funding already secured through the state’s Behavioral Health Continuum Infrastructure Program, according to city planning documents.
Last spring, the department announced its intention to rapidly double the city’s capacity to house patients in mental health crisis by converting the two behavioral health residential units at San Francisco General into a fully locked Mental Health Rehabilitation Center.
The department then sent letters to residents and family members explaining the plan to convert their units into a locked psychiatric facility.
“We will plan with you — not for you,” stated the June letter. “You and your care team, family, loved ones or decision-maker will be partners in deciding the best place for you to live.”
Benson Nadell, the ombudsman for San Francisco’s long-term care program, monitors conditions in public and private care settings. He warned the Health Commission that despite these assurances, the relocation process was stripping residents of basic rights.
“This had removed their due process rights in terms of being told they have to move,” he told commissioners. Nadell added that residents “feel that they have less value than ordinary people” when they are shuttled from one facility to another.
Gish said the many months of uncertainty had taken a toll on her and her sister. “She definitely has been living more in the depressed zone in this whole time,” Gish said. “Her situation feels very overwhelming to me, too. It’s probably one of the biggest stressors in my life.”
She said the only individual planning meeting she had was with public health staff who appeared “not bought into this plan at all.”
“The person who met with us knew absolutely freaking nothing,” Gish said. “They handed me a brochure — ‘These are your options. Don’t know anything about any of them. Can’t recommend any of them.’”
She added that she had been told officials held group meetings with residents that did not allow families or advocates to attend.
“These are mentally disabled people,” she said. “There aren’t people there to ask the tough questions to the system. It can be twisted to be ‘This is a very controllable population that we can just steer to where we need them and want them to go.’”
The Department of Public Health defended its process in a written response to questions.
“Residents are encouraged to include whoever they would like into conversations about their next placement, such as a treatment provider, an advocate, family member, friend or someone else who can offer support,” officials wrote.
Before the decision reversal last week, the health department would have had to contend with legal barriers, including a 2019 ordinance to protect the Adult Residential Facility location. City officials would also have to answer for the political pressure of growing public outcry over the fate of residents ahead of a Board of Supervisors vote for consideration of the $21 million state funding. The board must approve the grant by Jan. 9 to remain eligible for the funds, or risk losing the money.
By November, the union began to suspect that city officials were rethinking plans to remove the behavioral health residents from their units.
“DPH has gone notably quiet,” Travelslight wrote in a November update to residents and supporters. “Unclear what they have in mind.”
Jennifer Esteen, a psychiatric nurse who serves as vice president of organizing for SEIU Local 1021, called the outcome “a huge victory.”
“They gave up the push to privatize the work and will not be contracting out work currently being performed by city staff, which is a very big deal,” Esteen said. But she noted that the union remains vigilant as patients are moved to the new Laguna Street facility.
According to the union, the city will need roughly a year to renovate the facility into what public health planning materials describe as a “welcoming and therapeutic home environment” featuring “community areas, beautiful outdoor spaces, patios and a rooftop deck” and round-the-clock health care staff. “It remains to be seen how this facility’s operations will take shape,” Esteen said.
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