The Jewish Home in San Francisco, reeling from budget cuts and shifting to a new operating model, recently stopped admitting seniors for long-term care.
“[The Home] is actively accepting referrals for short-stay rehabilitative care, as well as for short-stay acute psychiatric care,” Daniel Ruth, president and CEO of the Jewish Home, wrote in an email. “We are one of the city’s and county’s most significant resources for this type of specialized care.”
However, the 140-year-old facility has, in Ruth’s words, “temporarily suspended accepting applications” from those seeking long-term care. Currently 420 people are in long-term care, which lasts an average of 28 months, according to national figures.
“This shift in focus represents an important part of the Home’s future given pending health care reform initiatives and the state’s shifting Medi-Cal priorities/emphasis,” Ruth wrote.
Jewish Home officials, sent into scramble mode in the wake of last week’s budget vote by California legislators, declined to be interviewed for this article, and Ruth responded only by email.
The Home, located in San Francisco’s Excelsior District, is a long-term-care, skilled-nursing facility and an acute geriatric psychiatric hospital. The average age of patients is 87, and 80 percent of them use wheelchairs or walkers, according to the Home.
According to previously published reports, the Home derives around 85 percent of its revenue from Medi-Cal. So when state lawmakers last week approved a 10 percent cut in what some nursing homes get reimbursed for Medi-Cal patients, it sent the Home reeling.
“The cuts are much more significant to the Home than 10 percent,” Ruth wrote. “The actual cut to the Jewish Home is 23 percent … [because the cut] is based on older 2008-09 Medi-Cal rates.”
Ruth noted that the Home, which has an annual operating budget of $70 million, will take an $11.1 million hit, “which is untenable and unsustainable.”
The Home has been fighting through budget issues for several years and has been forced to trim many of its in-house services, such as reducing the hours it offers a creative arts program.
But on an even higher level, the leadership of the Home in 2004 embarked on a huge, community-wide undertaking: developing a new strategic plan for the next 30 years.
Part of that plan calls for shifting the Home from predominantly long-term Medi-Cal stays to a needed-care model, including short-stay rehab, hospice and acute geriatric psychiatric care.
One of the most significant aspects of that shift, so far, has been the Home’s addition of more short-term rehab care. Now comes the decision to cease intake of patients who need long-term care.
“If the [state] budget sets Medi-Cal reimbursement rates for Distinct Part Nursing Facilities at an unworkable rate — and a 23 percent cut is unworkable — many DPNFs [including the Jewish Home] will have no choice but to accept fewer patients, keeping patients hospitalized in already scarce hospital beds,” Ruth wrote.
The Home, which began in 1871 as a residential center for 12 seniors, now has more than 700 employees and five distinct buildings on a nine-acre campus. It is the third-largest nursing home in the state.
Ruth praised the Home for providing care at “a cost-rate that is, on average, $54 per day less than similar” facilities and that has “produced $21 million in savings for the state over the past three years.”
Yet he blasted a proposed state budget that “makes no effort to distinguish among the most efficient, high-quality care providers.”
He concluded: “The state should support the kinds of smart, forward-thinking, cost-reducing changes that are consistent with future health care reform goals/objectives by supporting well-run, cost-effectively operated DPNFs such as the Jewish Home by paying fair Medi-Cal reimbursement rates.”