San Francisco, CA — Today, Mayor London N. Breed along with Supervisors Sandra Fewer, Rafael Mandelman, and Vallie Brown announced a plan to address the closure crisis impacting San Francisco’s Board and Care Facilities. These residential care facilities, which provide homes and care for people with behavioral health challenges and who need help with daily tasks like dressing and eating, have been closing due to increased operational costs and development pressures from the housing market.  

The plan put forth by the Mayor and the Supervisors will stabilize existing Board and Care facilities by increasing operational funding, seek to purchase sites at risk of closure, and advance strategies that will reduce pressure to convert facilities to residential use. 

“As we reform our mental health system in San Francisco, we know that we must take action to stop Board and Care facilities from continuing to close,” said Mayor Breed. “These facilities treat people who would otherwise be at risk of homelessness, while providing the long-term, stable housing they need. I want to thank Supervisors Fewer, Mandelman, and Brown for stepping up to address this important issue as we work to purchase facilities that are at risk of closing so that they can continue to provide the care that our city so desperately needs.”

“Board and Care facilities are critical to caring for our seniors and play a vital role in ensuring that vulnerable residents receive the service they need while remaining housed,” said Supervisor Fewer. “We need to take action to stop the loss of these beds and I’m happy to support this effort to purchase these sites so that they can continue operating in San Francisco.”

“Housing the growing numbers of vulnerable elderly and disabled San Francisco residents is one of the urgent moral challenges of our time, and one we must meet if we are to reverse the alarming rise in homelessness among these populations. I commend Mayor Breed for her leadership in stabilizing our existing Board and Care facilities and her commitment to advancing housing solutions for the most vulnerable,” said Supervisor Mandelman.  

“Many of San Francisco’s remaining Board and Care facilities are in District 5. Too many across the City have now closed,” said Supervisor Brown. “We need to reverse this trend. By purchasing facilities before they close, we can ensure vulnerable residents remain stable and in their homes, not in crisis on our streets and in our emergency rooms.”

Board and Care facilities, otherwise known as Residential Care Facilities for the Elderly (RCFE) or Adult Residential Facilities (ARFs), provide higher levels of care for individuals to enable them to live in the community. These facilities are typically small—with as few as three or four beds—and are integrated into residential neighborhoods. They provide both short- and long-term placements for people with behavioral health challenges, including individuals who are conserved or have exited conservatorship.

Board and Care beds represent an important piece of the overall portfolio of behavioral health beds in San Francisco, and the loss of these beds poses a significant challenge to our overall ability to respond to the behavioral health challenges in the city. The number of residential care facilities and the total number of beds that contract with the Department of Public Health (DPH), has shown a steady decline over the past five years, and an additional 71 beds will possibly be closing by the end of 2020.

The plan from the Mayor and the Supervisors will do three things:

• Stabilize Existing Board and Care Facilities 
  • One of the primary reasons Board and Care facilities cite for closure is the increased cost of doing business. Today, most residents who occupy a bed receive some sort of supplemental income, and these sources typically provide a reimbursement for each placement. The City subsidizes this reimbursement for providers with an additional patch payment, which will be increased to help providers better afford the cost of services. For this year, costs will be covered using existing sources, and moving forward, this additional cost will be incorporated into the DPH’s budget.
• Authorize City Acquisition of Facilities to Preserve and Expand Beds
  • The City will explore purchasing the buildings of existing providers that are at risk of closure, possibly expanding them to increase capacity, and partnering with a community partner for operation.
• Reduce Pressure to Convert to Residential Use
  • Many of the Board and Care facilities that are closing are selling to parties that aim to convert them to residential uses. By placing interim controls on the conversion of any Board and Care use to residential use, the development incentive to go out of business is reduced. The Mayor supports Supervisor Mandelman’s legislation and thanks him for his leadership.

“Board and care homes are a critical part of the continuum of behavioral health services that San Franciscans need to live in the community,” said Dr. Grant Colfax, Director of Health. “The Department of Public Health is grateful to Mayor Breed and these Supervisors for taking steps to preserve these vital services.”

“Our family has served San Francisco residents with disabilities and behavioral health challenges for almost two decades,” said Joshua Taburaza, United Family Care Home Project Manager. “Our clients have worked in the San Francisco community, some of them are veterans, all of them need a home. We provide assistance with medication administration, nutritious meals and snacks, and coordinate their healthcare. We are thankful for Mayor Breed’s proposal and know that it will absolutely help continue the important work for all the Board and Care providers in the City.”

Ensuring the continued operation of board and care facilities can help prevent homelessness for vulnerable people. This effort is part of Mayor Breed’s broader mental health reform initiative, which includes a plan to help the nearly 4,000 homeless San Franciscans who have serious mental illness and substance use disorders. The initial steps of the new initiative will provide enhanced care coordination, create a multi-agency program to streamline housing and health care for the most vulnerable, and increase access to behavioral health services by expanding hours of the City’s Behavioral Health Access Center.

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