Of Chinese Hospital. Now we have had the hearing we hope that gives it more traction to move forward. I understand there is leadership change at dph and a bit of turnover and we have gone through a transition period. Respectfully, as you said we had this conversation with doctor garcia. I know that we made some serious progress with dignity, and that got paused because of change in leadership over there. We have gone through a change in leadership in a couple of different places. I want to say myself and supervisor peskin want to invite to sit down. We want to move to get this done. That would be very helpful. We look forward to participating. I want to say for the record. Can you speak a little bit about the kent field. I will ask the chair to continue this so we can come back to say where we are in terms of numbers of subacute. We want to hold the department accountable and ask the Hospital Council to step up so we can come back with concrete numbers. We are continuing to have conversations with dignity. They are currently having conversations internally and with other external partners about what will happen with the st. Marys space. It was our first go to because they have a Space Available that could be converted. Consent field is provide consent field is pro kent field is doing the subacute. The conversations were moving to proposal stage when the leadership change occurred. The message from dignity now is the conversation is on pause and they anticipate coming back to the department in november with the status if they are willing to move forward or pursue other options. Does it mean the department is done with the conversations with dignity . We have conversations about why it would be helpful for the city and county of San Francisco to keep subacute as an option. It would be important to have a timeline. Can you talk about the conversation . There is a conversation between Residential Care versus acute care and hospital care. Can you talk a little bit about that. For the department . Just in general to get to the 50 to 80 subacute beds are these all hospital based . No, because the department doesnt have any authority over hospitals to say you have to put in a subacute. We are currently looking at all options how we could bring it into the city. The next opportunity that we can see happening most quickly would be by talking to freestanding Skilled Nursing facilities as in the report. We had them and the department outreached all providers doing prestanding Skilled Nursing skill in the city about willingness to open new beds or if they have facilities struggling, which will are in the city some Skilled Nursing facilities having issues, whether they could become sniff subacute. In that conversation does the city and county, are we involved in reimbursement, hoping them . Are we doing subsidy for the care . We have just begun having outreach conversations. Initial feedback that was not preferred choice. The choices for hospital based dwindled we opened up lines of communication at the same time so we would be able to explore all options rather than no options. The expectations is likely we will enter Public Private partnership. The structure is open for discussion. We havent had sit downs with those partners yet. I think if we were to say in 90 days, if you were to come back at some point we will continue this at call of the chair. We want an update on that and need to move aggressively with conversations with dignity and Chinese Hospital. The outline was that we want clear proposals to bring back to the board by november and then hopefully have a decision by december to begin implementation. That would be 60 days. October november. We will try to get something to you by november and have Implementation Plan by december. We will try to stay on track. We appreciate how important this is to to city and to the board. Thank you. I wanted to ask you two more questions. Supervisor stephanie, did you have questions . We will wait. We have a couple questions. Just trying to wrap my head around what to do as policymakers to provide subacute beds or ask the hospitals to partner to do that. Why doesnt Southern California have the same shortag shortage e and what are they doing to have this care readily available . I am trying to understand why we have a lack of beds here. One thinks financial, of course, but you can help me understand that, that would be great. I think it is real to state when you look at Southern California, there is a great deal more acreage of land to build these kinds of facilities. The other thing is the bay area has Free StandingSkilled Nursing facilities offering this level of care, but i think that the bay area struggles very much with many competing care vulnerable populations that need support and care and that is true for the department of public health, particularly over the last 11 years that i have been with them. It is selfish who are you going to serve with the limited resources we have available to us, and i think it is a constant struggle to prioritize. We are at a point where it is clear that sniff subacute is one of the population we need to put the time and energy to. What are the implications on the acute bed population if the patients arent able to be discharged to subaccute beds. Do those patients stay longer than necessary in acute care . Absolutely. Have we looked at the cost of that . I think getting cost of care the cost of care in a hospital the hard. We have some sort of projected numbers. We didnt want to put that into a presentation when it was such a soft number. We want to spend time to give it validity. We will be working towards that. Thank you. Thank you, supervisor. My question is what is the plan for the space at davies . It is licensed for smithsub acute now . What is the plan. Well, through the regulatory bodies, those beds are sub acute is a sub designation of sniff so they are licensed for sniff now. They go through a process by which they are termed active Skilled Nursing beds versus subacute. Wwe currently have nine beds remaining for subacute. Holding one available in the event there is a need for one of the patients to develop respiratory infection and needs a room by themselves. The ones not sub acute are just remaining sniff. Correct. That is your longterm plan currently . Yes. The floor is licensed for 17 sniff sub acute or are the rest not licensed as subacute. You said nine are. You converted them back to sniff . Correct. So what i want to ask, and i said this to doctor brown yesterday, i would like at a minimum to reconsider keeping the nine that you have as subacute to be part of the larger conversation to get us to 80 citywide beds. I know there are other hospitals. I am not just asking this today of cpmc. We are asking the entire Hospital Council to step up, st. Marys, Chinese Hospital, dignity, kaiser, everyone in San Francisco needs to be part of this solution. It wouldnt be on cpmcs shoulders at some point we made a decision to move away from it. Now we realize that was a mistake. You are not obligated legally as part of the Development Agreement to maintain these beds, but you are obligated to be part of the solution so we would like you to reconsider that, if you would take that back to your leadership, if you could. Of course. Would you also since you are the only one speaking today, would you commit to being part of this conversation to work with Chinese Hospital and dignity and others to come up with a longer Term Solution . Yes, of course. That is it. Thank you so much for answering the questions today. I will close by saying quickly, chair, thank you for taking the time today to speak about a very important topic. It is something that i felt compelled to be a part of, as i said in my opening statement. St. Lukes is a lifeline for my district and neighborhood. So many people come across like supervisor stephanie with a Family Member with a correction or born in st. Lukes or have a personal relationship with someone working there. I am thankful that cpmc committed to keeping the hospital open. It is important for our community. We then transferred the conversation to cpmc davies. Now this is where we are. We do take responsibility as a city as well because we made mistakes in this conversation, and the decisions made have impacts on peoples lives. We have to figure out a way to get to 80. I am glad she is here to say in 60 days we will get an update. We are looking for dignity, Chinese Hospital, cpmc, kaiser, everyone that is part of this system in San Francisco to be part of the solution to get us to the right number of subacutes beds, and 50 to 80 is a starting point. I am hopeful we will get a better idea what that needs to be in the overall conversation. This was not a comfortable conversation. It was very uncomfortable and personal to visit the families in their current state, and i appreciate the families for inviting us down, and i appreciate all of the folks that come out here from cpmc and add row advocates. We want everyone to be part of this conversation. We think it is that important for our county. Thank you, mr. Chair, for giving me leeway in this conversation. I would continue this to the call of the chair, probably in about 60 days we will come back for an update, not as long of a hearing. We will get a quick update and engage with the different hospitals to move this conversation forward. Thank you. You have made a motion to continue to the call of the chair and we will take that without objection. Mr. Clerk any more items before us today. Clerk no further business. All right, then we are adjourned. Once i got the hang of it a little bit, you know, like the first time, i never left the court. I just fell in love with it and any opportunity i had to get out there, you know, they didnt have to ask twice. You can always find me on the court. [ ] we have been able to participate in 12 athletics wheelchairs. They provide what is an expensive tool to facilitate basketball specifically. Behind me are the amazing golden state road warriors, which are one of the most competitive adaptive basketball teams in the state led by its captain, chuck hill, who was a National Paralympic and, and is now an assistant coach on the national big team. It is great to have this opportunity here in San Francisco. We are the main hub of the bay area, which, you know, we should definitely have resources here. Now that that is happening, you know, i im looking forward to that growing and spreading and helping spread the word that needs that these people are here for everyone. I think it is important for people with disabilities, as well as ablebodied, to be able to see and to try different sports, and to appreciate trying different things. People can come and check out this chairs and use them. But then also friday evening, from 6 00 p. M. Until 8 00 p. M. , it will be wheelchair basketball we will make sure it is available, and that way people can no that people will be coming to play at the same time. We offer a wide variety of adaptive and inclusion programming, but this is the first time we have had our own equipment. [ ] usf donates 100120 pounds of food a night. For the four semesters we have been running here, usf has donated about 18,000 pounds of food to the Food Recovery Network. Im maggie. Im nick. Were coechairs of the national led organization. What food recovery does is recover and redistribute food that would go wasted and redistributing to people in the community. The moment that i became really engaged in the cause of fighting food waste was when i had just taken the food from the usf cafeteria and i saw four pans full size full of food perfectly fine to be eaten and made the day before and that would have gone into the trash that night if we didnt recover it the next day. I want to fight food waste because it hurts the economy, its one of the largest emitters of Greenhouse Gases in the world. If it was a nation, it would be the Third Largest nation behind china and the United States. America wastes about 40 of the food we create every year, 160 billion worth and thats made up in the higher cost of food for consumers. No matter where you view the line, you should be engaged with the issue of food waste. Access edible food that we have throughout our Lunch Program in our center, i go ahead and collect it and ill cool it down and every night i prep it up and the next day ill heat it and ready for delivery. Its really natural for me, i love it, im passionate about it and its just been great. I believe its such a blessing to have the opportunity to actually feed people every day. No food should go wasted. Theres someone who wants to eat, we have food, its definitely hand in hand and it shouldnt be looked at as work or a task, were feeding people and it really means so much to me. I come to work and theyre like nora do you want this, do you want that . And its so great and everyone is truly involved. Every day, every night after every period of food, breakfast, lunch, dinner, i mean, people just throw it away. They dont even think twice about it and i think as a whole, as a community, as any community, if people just put a little effort, we could really help each other out. Thats how it should be. Thats what food is about basically. An organization that meets is the San Francisco knight ministry we work with tuesday and thursdays. By the power of your name i have faith to move mountains because i believe in jesus. I believe its helpful to offer food to people because as you know, theres so much homelessness in San Francisco and california and the United States. I really believe that food is important as well as our faith. The San Francisco knight ministry has been around for 54 years. The core of the ministry, a group of ordain ministers, we go out in the middle of the night every single night of the year, so for 54 years we have never missed a night. I know its difficult to believe maybe in the United States but a lot of our people will say this is the first meal theyve had in two days. I really believe it is a time between life or death because i mean, we could be here and have church, but, you know, i dont know how much we could feed or how many we could feed and this way over 100 people get fed every single thursday out here. Its not solely the food, i tell you, believe me. Theyre extremely grateful. Its super awesome how welcoming they are. After one or two times theyre like i recognize you. How are you doing, how is school . I have never been in the city, its overwhelming. You get to know people and through the music and the food, you get to know people. We never know what impact were going to have on folks. If you just practice love and kindness, its a labor of love and thats what the Food Recovery Network is and this is a huge i believe they salvage our mission. To me the most important part is its about food waste and feeding people. The Food Recovery NetworkNational Slogan is finding ways to feed people. Its property to bring the scientific and Human Element into the situation. Chairwoman good morning, everyone. The meeting will come to order. This is the september 25th, 2019, regular meeting of the budget and finance committee. Im sandra lee fewer. And im joined by supervisors