Update: On May 1, San Francisco announced that all residents and staff at skilled nursing facilities were required to be tested for Covid-19.
With the San Francisco Campus for Jewish Living continuing to accept Covid-19 patients into its skilled nursing facility, the senior home hosted a virtual town hall to answer questions about its ability to care for infectious patients alongside its vulnerable population of elderly residents.
The April 23 town hall was open only to residents and family members of the SFCJL.
In a Zoom audio recording obtained by J., the SFCJL’s leadership addressed testing, safety procedures and its thinking behind the decision to accept recovering Covid-19 patients, per a state order to help prevent hospitals from becoming overwhelmed in the coming weeks.
The senior facility reported on April 27 that nine Covid-19 patients had been accepted so far. The first was brought to the campus on April 10; the campus currently has enough beds for up to 30. The facility has a dedicated floor and staff to care for them, according to SFCJL spokesperson Marcus Young. There are 374 total beds in the skilled nursing facility and about 300 residents.
Overall, SFCJL has conducted Covid-19 tests on 25 symptomatic staff and residents, director of clinical operations Peggy Cmiel said during the town hall. All of the results were negative, she said.
CEO Daniel Ruth said the facility is following guidelines from county and state health departments, which recommend that only staff, residents and patients with symptoms should be tested.
Those guidelines are currently being challenged by other health officials in the state. Last week, L.A. County Health Director Dr. Barbara Ferrer said nursing homes should be testing all residents and staff, regardless of whether they show symptoms.
“We were wrong,” Ferrer said at a news conference while announcing the shift in her city’s policy.
On April 19, the California Department of Public Health announced it was expanding access to testing, specifically prioritizing facilities like nursing homes and hospitalized patients.
SFCJL spokesperson Young said in an April 27 email to J. that testing every resident and staff member on a consistent basis would not be realistic nor helpful for gauging risk. It would “only give us a snap shot of what today looks like,” he wrote. “The same is true for any facility in the country. We have approximately 600 clinicians and staff who come and go every day — they go back to their own homes, the grocery stores and provide care for their own loved ones as needed.
“So, while the public opinion tide is shifting to testing everyone whenever they want to be tested — symptomatic or not — the reality today is that to achieve a truly accurate on going picture at SFCJL, we would need to be running hundreds of tests every day (not even including residents/patients). Every single day — because you would never know if someone who tested negative yesterday becomes infected a day or two after.”
Young added that if the city’s health department changes its policy, the SFCJL will follow any updated orders.
San Francisco Supervisor Ahsha Safaí, whose district covers the Excelsior neighborhood where the SFCJL is located, said in an April 24 interview with J. that he thinks “testing of all staff should be a requirement,” a capability he believes is coming “very soon.”
Safaí said he’s been in regular contact with the SFCJL’s leadership and described the facility as “state-of-the-art.”
The supervisor also said he understands the concerns of families who have pushed back against the SFCJL’s decision to bring in Covid-19 patients.
“I always put myself in the shoes of the people who have fears,” Safaí said. “If it was my parent, I would have reservations and fears.” But Safaí thinks a larger problem is the city’s lack of sub-acute care units, skilled-nursing facilities that treat patients with complex needs, an issue the supervisor has fought to correct during his tenure.
During the town hall, Ruth sought to bring perspective to the facility’s admittance of Covid-19 patients.
“Not all nursing homes are created equal,” he said. SFCJL is “almost 20 to 30 years ahead of its time” compared with other elder homes around the country, some of which are experiencing widespread outbreaks of coronavirus.
Ruth also said the SFCJL has an adequate supply of personal protective equipment and is continuing to acquire more in “significant” quantities.
The SFCJL’s leadership also spoke to why Covid-19 patients are being admitted now, even though regional hospitals have not yet seen the predicted surge.
Among other reasons, “We feel that our environment would be much better than a hotel,” an option that civic leaders have discussed, Ruth said. “We are able to offer the life enrichment activities — albeit, they are different than what they were, but still significantly better than what one might receive in a hotel.”
A day after the town hall meeting, a second staff member at the SFCJL tested positive for coronavirus. According to Young, the individual had been working from home for three weeks and hasn’t entered the campus since then.
On April 16, a certified nursing assistant at the senior home tested positive for Covid-19.
A relative of a resident receiving care from that nursing assistant said hearing the news of his positive status “felt like someone punched me in my stomach.”
The relative requested to remain anonymous in order to keep lines of communication open with the SFCJL staff.
“It was a shock,” said the relative, who is opposed to the SFCJL bringing Covid-19 patients into the facility. “It’s difficult. It’s emotional. It’s almost like a feeling of hopelessness.”
For his part, Young also praised the early preemptive measures the SFJCL took to protect its staff and residents, including restricting visitors and taking staff temperatures starting in early March. “This decision was not an easy one to implement, especially for the concerned families, but in the end we credit it with the fact that we have, to date, no known positive cases among our resident and patient populations,” he said.