Challenges, changes, and the commitment to continuing to serve our community at the highest level
Dear Friend,
 On March 31, 2011, I had the opportunity to conduct town hall meetings that brought together between 500 and 600 people, made up of residents, family members, staff, volunteers, and key external stakeholders.
However, before I share with you the issues and changes the Jewish Home needs to make, it seems appropriate that, as we approach the holy days of Passover, to encapsulate what makes this Jewish holiday unique – and what change can achieve. It could be said that the Jewish people were ‘born’ the moment Moses parted the Red Sea and followed him from slavery to freedom. Over 400 years of oppression in Egypt changed the biblical tribes of Israel into the people who carried the Ten Commandments from Sinai to Jerusalem – and beyond.
Discussing the immediate and midterm issues facing the Home, our challenges and responses to today’s fiscal and operating realities, and the steps approved by the Jewish Home’s board of trustees to best address these matters, was complex and intense. But it also proved to be a meaningful occasion for the Jewish Home to promise a profoundly positive future, one that will enable us to continue serving our community, albeit in new and diversified ways, for generations to come.
The issues facing the Jewish Home of San Francisco
1. California’s proposed 2012 budget: In an attempt to narrow its $26.6 billion dollar deficit, the state of California’s proposed 2012 budget includes a 10 percent reduction in Medi-Cal reimbursement to certain provider groups, which includes the Jewish Home. However, these cuts are far more significant to the Home than 10 percent. The actual cut amounts to 23 percent, because it is based on older 2008-09 Medi-Cal rates of reimbursement.
The state’s proposed budget will compound the Jewish Home’s existing $6.5 million operating deficit by $11 million-plus. When one factors in capital equipment replacement, maintenance of the physical plant to ensure life-safety compliance, second-year impact of the labor contract, and health care and regular inflation, the devastating bottom-line impact to the Home balloons into a cash deficit in excess of $20 million in 2012. As the second-largest distinct part nursing facility (DPNF) in California, with 86 percent of our residents Medi-Cal beneficiaries, this is an untenable threshold for the Home and, more significantly, unsustainable in our near and long term.
2. Outdated buildings and buildings’ systems:
Constructed in 1923, the Jewish Home’s oldest residential wing, 1West and 2West, was not designed for the people we are serving today. As a Centers for Medicare & Medicaid Services five-star rated facility (the highest rating given), we take pride in providing high-quality, cost-effective care and services. In fact, the Home provides care at a cost rate that is, on average, $54 a day less than other similar DPNFs in California. But we are hard-pressed to apply this level of cost-effectiveness on 1West and 2West; because of its outdated configuration, we actually overstaff. Additionally, by 2013, all nursing homes across the U.S. must be sprinklered. A current bid for this undertaking is in excess of $1 million. It does not make sense to sink such a significant amount of money into a building that, as per our site master plan, is not part of the Home’s future.
3. Health care reform: Federal/state health care reform initiatives will change the way health care is delivered in the future. For example, health care will be delivered in people’s own homes, in independent or assisted living environments, or via community-based services. Fewer people will be the recipients of long-term care. As a 430-bed nursing facility, the Jewish Home is misaligned with these initiatives.
4. Changing health care consumer expectations/interests and needs: The baby boomers have come of age. This huge influx of seniors is growing exponentially and they have different needs and expectations when it comes to health care delivery systems. Couple this with health care reform initiatives – more emphasis on home care, outpatient services, and residential care – and it is clear we are looking at a very different senior care model to what has been traditionally available.
Changes being made by the Jewish Home of San Francisco
1. Shifting from predominantly long-term Medi-Cal stays to the provision of short-stay rehabilitation, hospice, and acute geriatric psychiatric care: The Jewish Home is changing its current care model to be more aligned with the future of health care reform. Current planning will result in the transformation of the Jewish Home to recognize and respond to the extraordinary growth in the number of seniors, and enable the Home to offer multiple levels of care with less reliance on government funding.
Thus, in addition to long-term care and short-stay rehabilitation, hospice, and acute geriatric psychiatric care, the Jewish Home is moving toward serving a greater number of seniors than are currently being served today by means of a continuum of care and housing options. This will range from independent living, assisted living, and memory support units, to the utilization of the Jewish Home’s on-site clinics and community-based health care services to help people remain in their own homes in the community for as long as possible.
As a nonprofit organization, the Jewish Home will continue to provide significant levels of subsidized charitable care to an even wider spectrum of older adults.
The Jewish Home continues to actively accept referrals for short-stay rehabilitative care, as well as for short-stay acute psychiatric care. However, on March 31, 2011, we suspended accepting applications for all long-term care admissions for an indefinite period. With admission to our short-stay programs open to older adults of all faiths, ethnicities, and racial backgrounds, we are one of the city’s and county’s most significant resources for this type of specialized care. This shift in focus represents an important part of the Home's future, given pending health care reform initiatives and the state of California’s changing Medi-Cal priorities/emphasis.
2. Closure of 1West and 2West by December 31, 2012: The Jewish Home is committed to supporting older adults in the most thoughtful, cost-effective way. It is not committed to buildings that, as a result of government regulations and requirements, require significant capital investment. Therefore, the Jewish Home is closing its 1923 building, which houses 1West and 2West, to resident care by December 31, 2012. As vacancies open up in other buildings, with the exception of the Friedman Pavilion (the site of our short-term and rehabilitation program) and the Home’s acute geriatric psychiatry hospital, existing 1West and 2West residents will be able to transfer to these locations.
3. Personnel reductions:
We realize that we cannot continue to serve the same number of Medi-Cal recipients as we have to date. Notwithstanding the devastating impact reduction in the Home’s Medi-Cal reimbursement rate has on our bottom line and what we need to do to address the effects thereof at all levels of our organization, as the population we serve reduces, it means we undoubtedly have to make the extremely difficult but necessary decision to reduce some of our contractual and non-contractual staffing complement. Out of respect for all our staff, but specifically related to our contractual staff and the unions that represent them, we will continue to work with SEIU-UHW and Local 2 consistent and in compliance with our legal obligations and collective bargaining agreements. The Jewish Home has a legacy of being committed to high-quality care and we will maintain this standard. Therefore, there will
not be any change to the current ratios of nursing hours provided to each resident per day.
4. Additional organizational changes: We continue to examine the essence, the core, of what constitutes the Jewish Home, and we have determined that additional measures need to be initiated. For example, looking at offering both kosher and kosher-style cuisine; reducing our research program; and with respect to our medical staff model, implementing a framework congruent with a more traditional skilled nursing model of physician reimbursement, whereby the Home’s physicians will be paid directly from the state of California on a fee-for-service basis.
As we effectuate this difficult yet principled process of transforming ourselves, it cannot be emphasized enough that the Jewish Home of San Francisco honors and values its mission and traditions. We pay homage to our origins, serving the most frail and vulnerable in our community. We will continue to do so by strategically repositioning ourselves while remaining responsive and responsible community stewards. This necessitates being financially viable so that future generations will benefit from the care and services provided.
Although the information conveyed at the town hall meetings has an impact on people’s current sense of comfort and stability, it was heartening to see the extent to which the reasoning behind the Jewish Home’s course of action was understood. In a way akin to the Passover seder meal reminding us of where we came from, who we are, and what kind of people we want to be, the Jewish Home’s vision will have us realizing what kind of positive future we have.
Lastly, allow me to speak for all those involved in long-term care when I say that none of us, when we initially entered this field, envisaged having to confront such issues as these today. The Jewish Home of San Francisco is a microcosm of the broader community and therefore is not immune to what our society has to deal with. The Home is also a mission-driven organization with a 140-year legacy. As such, we have a responsibility, an obligation, to prevail over these unexpected and unprecedented challenges so that we will be here to support older adults for generations to come.
I look forward to continuing to communicate with you about our ongoing efforts to develop and implement solutions that will meet current and future needs.
Daniel Ruth
President & Chief Executive Officer
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