Health Service Board sought disclosure amid growing concerns that retirees are being placed far from family advocates and local support networks.
From westsideobserver.net
San Francisco City retirees on Kaiser Medicare are being transferred out of San Francisco for skilled nursing care at a notable rate, according to newly released information provided to the San Francisco Health Service System, prompting concerns from retiree advocates who say distance can weaken critical family oversight and support.
During the San Francisco Health Service Board meeting on May 14, SFHSS Executive Director Rey Guillen announced that Kaiser Permanente had agreed — at the Board’s request — to provide twice-yearly reports tracking where City retirees receiving skilled nursing facility care are placed.
Beginning in June, Blue Shield of California is expected to provide similar data identifying how many San Francisco Medicare retirees enter skilled nursing facilities and how many are placed within San Francisco versus outside county lines.
The request arose from concerns that City retirees may be sent far from their homes and families at a vulnerable point in their lives.
Two-Thirds Transferred Outside San Francisco
Kaiser data covering January through December 2025 shows that among Medicare claimants residing in San Francisco, 54% were referred to facilities in San Mateo County, 33% remained in San Francisco facilities — 13% were placed elsewhere outside the county.
The data involve City retirees enrolled in Kaiser through the SFHSS system.
Retiree advocates say the issue extends beyond simple geography.
For many patients in nursing facilities — particularly older adults requiring rehabilitation or longer-term care — family members often play an active role monitoring conditions, assisting with decisions, and advocating when problems arise.
Advocates say proximity to family matters because nursing homes and skilled nursing facilities have chronic staffing shortages which results in lower quality of care, particularly among for-profit facilities.
Questions Raised Over Major San Francisco Facilities Outside Kaiser Network
The newly disclosed material also highlights another issue that has drawn attention from retiree groups: some large San Francisco facilities are not listed within Kaiser’s contracted network.
The report shows that both Laguna Honda Hospital and the San Francisco Campus for Jewish Living — historically known as the Jewish Home — were identified as non-contracted facilities within the network information provided to the Health Service Board, despite representing substantial bed capacity.
Advocates point to those non profit facilities because nonprofit nursing homes are associated, in general, with better staffing levels and higher quality care than most for-profit institutions.
Retiree Organizations Say Complaints Extend Beyond San Francisco
Retiree organizations, including Protect Our Benefits, say they have received reports suggesting the issue may extend beyond San Francisco residents.
If San Francisco retirees are being placed farther from home, advocates argue, retirees living in surrounding counties could face similar challenges if available placements pull them away from their own communities and support systems.
The forthcoming Blue Shield data may provide a broader picture.
Blue Shield serves City retirees who are not enrolled in Kaiser. Advocates say the next round of reporting is likely to demonstrate the same issues.
Recent research has indicated that elderly Medicare Advantage patients in plans similar to these City retiree plans have a higher death rate after stroke or hip fracture than those in traditional Medicare due to insurance refusal to pay for adequate inpatient rehabilitation.
City retiree advocates are also concerned about a tendency toward premature discharge from acute hospitals. They say that, when coupled with admission to an understaffed for-profit nursing home far from family, such discharge decisions have led to decline, near death or death.
The Board of Supervisors Budget and Finance Committee met with Blue Shield, the Health Service Board and City retirees in a hearing led by Supervisor Connie Chan on April 8. The hearing was mainly driven by Blue Shield’s denial of care to firefighters with cancer, but also touched on issues involving premature discharge from acute hospitals under Blue Shield.
For now, the Health Service Board’s push for regular disclosure appears to have opened a new window into processes that previously received little public attention, including where City retirees ultimately land after leaving the hospital and what can be done to improve patient outcomes.
Teresa Palmer M.D. | Family Medicine/Geriatrics San Francisco.