COVID-19 in Skilled Nursing Facilities (SNFs)

What is a Skilled Nursing Facility (SNF)?
A Skilled Nursing Facility (SNF) is a type of long-term care facility (LTCF) that provides care to individuals, generally in their 60s and older, who need functional assistance in their daily lives. Residents of these facilities are at greater risk of severe disease and death from COVID-19 due to older age, pre-existing medical conditions, as well as increased exposure resulting from contact with caregivers. As of October 2020, the California Department of Public Health (CDPH) reported that 27% of all COVID-19 deaths in California were among SNF residents.
Twenty SNFs operate in the City & County of San Francisco, with an estimated total of about 2,500 residents in January 2020. Some of the facilities are publicly owned, some are privately owned for-profit facilities, and others are privately owned non-profits. For example, the largest SNF in the nation is Laguna Honda Hospital and Rehabilitation Center, which is part of the San Francisco Health Network, while another is run by the US Department of Veterans Affairs (VA). All private and public SNFs must follow regulations from both the CDPH and the San Francisco Department of Public Health (SFDPH), except for the federally-regulated VA SNF.
This page contains three sections for you to:
  1. Explore data on COVID-19 in San Francisco SNFs;
  2. Learn how the City is working with SNFs to prevent and respond to outbreaks; and
  3. Discover additional resources for those with loved ones in SNFs.
COVID-19 Cases and Deaths in SNFs in San Francisco
Please click the Data Notes button on the dashboard to learn about where the data comes from and how often it is updated.
How is the City working to prevent the spread of COVID-19 in SNFs?
In the early days of the pandemic, the SFDPH identified SNFs as a high priority and established a specialized team to prevent the spread of COVID-19 in these facilities. This SFDPH team works closely with the SNF and provides consultation and assistance for many important aspects of prevention and response, including the areas discussed below.
Guidance and Training
The CDPH and the SFPDH issue evidence-based public health orders and guidance to ensure all SNFs operate safely during the pandemic. Such guidance includes instructions on isolation, quarantine, infection prevention tactics, testing, and contact tracing. The SFDPH team conducts site visits to answer questions and train SNFs on implementing the orders and guidance and on properly using personal protective equipment (PPE).   
Personal Protective Equipment (PPE)
Without proper personal protective equipment, COVID-19 can spread rapidly between people. Given that staff cannot maintain physical distance from residents when caring for them, SNFs must provide staff with appropriate types and amounts of PPE. All SNFs have a process for requesting PPE from the SFPDH for rapid access if their inventory is low and cannot be supplemented via usual vendors. The SFDPH also provides guidance and training on the proper use of PPE.
Visitor Restrictions
In early March, the SFDPH limited SNF visitors to prevent introducing COVID-19 to staff and residents. In early September, a new public healthorder allowed outdoor, window, and vehicle visitation.
Testing and Contact Tracing
In September 2020, CDPH mandated that all SNFs conduct baseline testing of all staff and residents and continue to test all staff for COVID-19 once a week. The testing prevention strategies include:
  • testing of any newly admitted resident and any resident or staff member exhibiting symptoms;
  • regular “screening” testing of staff regardless of symptoms; and
  • testing of potentially exposed residents and staff after a contact tracing investigation at a facility with a new case of COVID-19.
How does the City respond to positive cases or outbreaks in SNFs?
When a staff member or resident of a SNF tests positive, SFDPH advises the facility on testing and other infection control measures. The facility is required to communicate daily with SFDPH throughout the duration of an outbreak (one resident or a cluster of three or more staff) to report new symptomatic staff or residents, staffing levels and shortages, PPE supply, staff or resident hospitalizations, deaths, and other updates to ensure that SFDPH can provide timely and targeted assistance. The SFDPH works closely with the CDPH to support the SNFs when a resident or staff tests positive.
Additional Resources
There are many resources for those with loved ones in a Skilled Nursing Facility.
Some useful links below may help you learn more: