1108.1 Over the last decade, the District focused public health efforts on expanding primary care across Washington, DC. During this time, the District invested over $71 million in the construction of new state-of-the-art primary care facilities and the renovation of existing primary care facilities across Washington, DC. DC Health funded a total of 15 medical home-focused capital expansion projects between 2006 and 2016 in seven of the District's eight wards (1, 2, 4, 5, 6, 7, and 8). Twelve of these 15 projects were completed in collaboration with the District of Columbia Primary Care Association (DCPCA), a nonprofit health care and advocacy organization dedicated to improving the health of Washington, DC's vulnerable residents by ensuring access to high-quality primary health care, regardless of one's ability to pay. DCPCA has worked for more than a decade to enlarge and enhance the network of community health centers and to improve access to non-emergency care regardless of one's ability to pay.

1108.2 These past investments have increased provider capacity throughout Washington, DC. The strategic focus needs to emphasize coordinated, patient-centered care: the right care, at the right time, in the right place. Looking to the future, the District should invest in addressing the underlying factors that pose persistent barriers, including factors that lead to the underuse of preventive services, while retaining emergency care capacity.

1108.3 While health care coverage in the District was already high after the 2006 adoption of the Comprehensive Plan, implementation of the federal Affordable Care Act (ACA) in 2010 provided more residents with increased access to health insurance—leading to Washington, DC achieving the second-highest coverage rate in the nation in 2017. As highlighted in the District's 2017 HSP, the ACA led to early expansion of Medicaid in the District, which in turn raised health insurance coverage to 93 percent of adult residents and 96 percent of children residing in the District. While significant strides have been made, Washington, DC residents, particularly residents of color, continue to face barriers to accessing some types of health care. Promoting health care coverage and appropriate use of services for all its residents therefore continues to be a challenge in the District.

1108.4 Washington, DC is fortunate to have many health care facilities, including full-service hospitals, primary care health centers, long-term care facilities, and assisted living residences (ALRs). Additionally, as shown in Figure 11.8, in 2017 there were 161 pharmacies and a variety of outpatient private medical facilities in Washington, DC that offer an expanding range of services. However, with the changing demographic and health care services landscape, new needs and gaps have emerged.

1108.5 Hospitals are an important part of the health care delivery system. Numerous

hospitals provide services to Washington, DC residents, including large full-service facilities, such as the George Washington University Hospital, the Medstar Georgetown University Hospital, and the Medstar Washington Hospital Center, and more specialized facilities such as the Psychiatric Institute of Washington. The text box to the right includes a list of existing hospitals located within Washington, DC.

1108.5a Text box: Hospitals in the District of Columbia as of 2019

1. BridgePoint Capitol Hill Hospital (Long-Term Acute Care)

2. BridgePoint National Harbor Hospital (Long-Term Acute Care)

3. Children's National Medical Center (Acute Care)

4. Hospital for Sick Children Pediatric Center (Specialty Care)

5. Howard University Hospital (Acute Care)

6. Medstar Georgetown University Medical Center (Acute Care)

7. Medstar National Rehabilitation Hospital (Rehab Services)

8. Medstar Washington Hospital Center (Acute Care)

9. Psychiatric Institute of Washington (Behavioral Health)

10. St. Elizabeths Hospital (Behavioral Health)

11. Sibley Memorial Hospital (Acute Care)

12. The George Washington University Hospital (Acute Care)

13. United Medical Center (Acute Care)

14. Veterans Affairs Medical Center.

1108.6 The distribution of these facilities across Washington, DC is presently uneven, with most hospital beds on the west side of the District and only one planned full-service hospital in Wards 7 and 8.

1108.7 In addition to hospitals, the District counts on a broad array of facilities that provide a wide range of health care and health services. Many of these facilities provide services that enable Washington, DC residents to age in their

communities. As of 2017, the District has 12 ALRs, which provide long-term care in the form of housing, health, and personalized assistance. However, ALRs are not distributed throughout the District and ALR fees may exceed the means of many District residents. Some Washington, DC residents who are not eligible to receive Medicaid benefits find it challenging to pay for ALR care. Many smaller, private-pay ALR providers closed their doors in recent years due to their inability to meet regulatory requirements or attain financial support.

1108.8 Prior to the advent of ALRs in 2009, the District had approximately 20 homes licensed as Community Residence Facilities (CRFs), most located in Wards 7 and 8 and catering to low-income residents. However, there has been a steady decline in the number of CRFs, as most of them converted to ALRs. In 2017, three CRFs remain in business, and while they provide support in a safe, hygienic, and protective living arrangement, today's CRF residents generally require a lower level of care and services than those residing in ALRs. However, that, too, is changing, as CRF residents who also wish to age in place find that their support needs are becoming more intensive and costly. In addition to facilities, it is important to consider the growing need for health care workers, including home health care workers, to provide the services that offer older adults care and housing options, including aging in place at home.

1108.9 In addition to CRFs and ALRs, Washington, DC's four hospices and 18 nursing facilities continue to provide care and services to those who meet admission criteria. Two facilities provide hospice care where the patient resides, including their home or a long-term care facility. The District continues to support development of hospices and other long-term care facilities to serve those with a need for these services.

1108.10 For a more detailed picture of health service facilities in the District, please see Figure 11.8, Health Service Facilities in the District.

1108.11 Figure 11.8. Health Services Facilities in the District

Facility Type	Facility Subtype	Physical Characteristics	Number in the District	Ownership (public/private)	District Role	Eligibility	Services Offered	Stay Type	Notes/Other Issue Areas
Long-Term Care Facilities	ALRs	Institutional, residential	12	Private ownership	District licenses and regulates	Over 60, privately insured, and private pay, and three subsidized by Medicaid	Long-term care that provides housing, health, and personalized assistance in accordance with individually developed service plans.	Live-in, long-term stays	Three subsidized through Medicaid Home- and Community-Based Waiver Program; nine funded through private payments; many of the smaller, private-pay ALR providers closed in recent years because they could not meet regulatory requirements or acquire financial support to allow residents to age in place.
	CRFs	Institutional, residential	3	Private ownership	District licenses and regulates	Over 60, privately insured, and private pay, and Supplemental Security Income	Provides a sheltered living environment for individuals who desire or need such an environment because of their physical, mental, familial, social, or other circumstances.	Live-in, long-term stays	20 prior to 2009; most converted to ALRs; most catered to low-income residents.
	Community Residences for Individuals	Residential	19	Private ownership	District licenses and regulates	Medicare, Medicaid, and EPD waiver	Provides a home-like environment for at least four but not more than eight individuals with	Live-in, long-term stays

Facility Type	Facility Subtype	Physical Characteristics	Number in the District	Ownership (public/private)	District Role	Eligibility	Services Offered	Stay Type	Notes/Other Issue Areas
	with Intellectual Disabilities						intellectual disabilities who require specialized living arrangements, programs, support services, and equipment for their care and habilitation.
	Intermediate Care Facilities for Individuals with Intellectual Disabilities	Residential	66	Private ownership	District licensee, federally certified, and regulates	Medicare and Medicaid	Provides active treatment in the least restrictive setting. Includes all needed services for individuals with intellectual disabilities with related conditions whose mental or physical condition require services on a regular basis that are above the level of a residential or room and board setting and can only be provided in a facility equipped and staffed to provide the appropriate services.	Live-in, long-term stays
	Hospices	Institutional	4 (2 inpatient and 2 home hospice)	Private ownership	District federally certified and regulates	Provide care and services to residents who meet admission criteria without discrimination or disease.	Two facilities provide inpatient hospice care where the patient resides, including the patient's home or a long-term care facility.	Live-in only stays	Need more education on the hospice concepts, including palliative care and pain management.
	Nursing Facilities	Institutional	18	16 private ownership and 2 District ownership	District licensee, federally certified, and regulates	Medicaid, Medicare, privately insured, and private pay	Provides acute and chronic health care and personalized assistance in accordance with individual care plans.	Live-in only stays
Hospitals	N/A	Institutional	14	12 private or 2 District ownership public ownership	District licensee, federally certified, and regulates	All	Provides emergency room services (except for six) and all other services, including some specialties such as skilled care services, intensive care units, and psychiatric units.	Short-term, outpatient stays
Ambulatory Surgical Centers	N/A	Outpatient	6 (1 HMO)	Private ownership	District licensee, federally certified, and	All, except children	Provides surgical services to patients not requiring hospitalization and for whom the expected	Short-term, outpatient stays

Facility Type	Facility Subtype	Physical Characteristics	Number in the District	Ownership (public/private)	District Role	Eligibility	Services Offered	Stay Type	Notes/Other Issue Areas
					regulates		duration of services would not exceed 24 hours following an admission.
End-Stage Renal Disease (Dialysis) Centers	N/A	Outpatient	21 (2 nursing homes, 1 hospital, 1 HMO, 1 home program)	Private ownership	District federally certifies and regulates	All	Provides both hemodialysis and peritoneal dialysis for patient to repair renal functions.	Short-term, outpatient stays
Maternity Centers	N/A	Outpatient	1	Private ownership	District licenses and regulates	All, except children	Provides antepartum and postpartum care to women eligible for labor and delivery through a developed plan of care.	Short-term, outpatient stays
Pharmacies	N/A	Community, institutional	161	Private and public ownership	District licenses and regulates	All three pharmacies owned by DC Government, St. Elizabeths, 35 K Street NE, and United Medical Center	Dispenses medications for patients.	Outpatient stays	147 community pharmacies; 14 institutional pharmacies.
Private Clinics	N/A	Institutional		Private ownership	District licenses and regulates	All	Offers full range of primary care.	Varies
Medical Homes DC	N/A	Varies by location		Private ownership	District licenses and regulates; can provide grant and other funding and disburse Medicaid reimbursement	All uninsured and underinsured residents	Varies by location.	Varies

(Source: DC Health, 2017)

1108.12 The 2017 HSP aims to provide the equitable geographic distribution of community health care facilities throughout Washington, DC. The primary means of achieving this goal is the Certificate of Need (CON) Program, which reviews proposals for the establishment and/or expansion of health care facilities and services in the District. An upcoming Primary Care Needs Assessment will provide greater clarity concerning the relationship between facilities and services and how these can better meet the needs of the District population.

1108.13 In addition, the District's Health Strategic Framework emphasizes the importance of applying evidence-based programs for special populations with chronic and complex conditions and promotes healthy aging. DDS and DACL are well-positioned to support implementation of these key goals through their plans and programming. DC Health also supports policies to better coordinate resident- and

patient-centered services for residents.

1108.14 Policy CSF-2.3.1: Primary and Emergency Care Ensure that high-quality, affordable primary health care, preventive health, and urgent care centers are available and accessible to all District residents. Medical facilities should be geographically distributed so that all residents have safe, convenient access to such services. Priority should be given to improving accessibility and quality of services at existing facilities/centers. New or rehabilitated health care facilities, where warranted, should be developed in medically underserved and/or high-poverty neighborhoods and in areas with high populations of older adults, persons with disabilities, persons experiencing homelessness, and others with unmet health care needs.1108.15 Policy CSF-2.3.2: Public-Private Partnerships Develop public-private partnerships to build and operate a strong, cohesive network of community health centers in areas with few providers or health programs.1108.16 Policy CSF-2.3.3: Coordination to Better Serve Older Adults and Residents With Disabilities Design and coordinate health, housing, and human services to foster the maximum degree of independence for older adults and persons with disabilities.1108.17 Policy CSF-2.3.4: Connecting for New Families Encourage the creation and implementation of initiatives that can improve health care navigation for new families.1108.18 Policy CSF-2.3.5: Development and Coordination of Behavioral Health Issues and Substance Abuse Treatment Facilities Coordinate development of an adequate number of equitably distributed and conveniently located behavioral health issues and substance abuse treatment facilities to provide easily accessible, high-quality services to those District residents in need of such services. DC HP2020 identified behavioral health issues as the District's number one priority.1108.19 Policy CSF-2.3.6: Health Care Planning Continue to use strategic plans to improve community health. These plans integrate demographic forecasts and health data to prepare for Washington, DC's socio-economic changes and growth.1108.20 Policy CSF-2.3.7: Hospices and Long-Term Care Facilities Support the development of hospices and other long-term care facilities for persons with advanced HIV/AIDS, cancer, and other disabling illnesses, such as dementia, including Alzheimer's.

1108.21 Policy CSF-2.3.8: Increasing Supply of Facilities That Support Assisted Living Promote expansion of the supply of facilities that provide assisted living services in Washington, DC. These include ALRs and CRFs, as well as adult daycare facilities. Encourage actions to expand the workforce numbers and appropriate skills of health care workers, including home health care workers, to support aging in place and assisted living.1108.22 Policy CSF-2.3.9: Improving Access to Long-Term Supports and Services for Vulnerable Populations Continue to improve access to long-term supports and services (LTSS) for vulnerable populations, including people with disabilities, older adults and their families, and members of the LGBTQ+ community. Enhance the network of government and nonprofit organizations that provide LTSS to these individuals and seek to improve their experience.1108.23 Policy CSF-2.3.10: Prioritize Investment in High-Quality Health Care Services for Underserved Residents in Wards 7 and 8 Prioritize investment in high-quality health care services for residents, specifically for residents living in Wards 7 and 8, by developing a new acute care community hospital and health services complex at the St. Elizabeths East campus in Ward 8. Support the medical education, research, and technology uses that the new hospital and health services complex aims to provide.1108.24 Action CSF-2.3.A: Review Zoning Issues Continue to review and assess zoning regulations to identify barriers to, and create opportunities for, increased access to primary care facilities and neighborhood clinics, including through the reuse of existing non-residential buildings in residential zones, after a public review and approval process that provides an opportunity to address neighborhood impacts.1108.25 Action CSF-2.3.B: Increase Supply of Assisted Living Residential Facilities (ALRs) and of Community Residential Facilities (CRFs) Explore a variety of approaches for increasing the number of CRFs, as well as small and mid-size ALR facilities, in underrepresented areas and areas of high need in the District. These approaches can include financial strategies and partnerships, as well as regulatory reform. Work to increase community awareness of these needs.1108.26 Action CSF-2.3.C: Connecting District Residents to Resources Continue to maintain a digital resource portal that disseminates resources on a cross-agency basis to better connect people with government and community-based health resources.

1108.27 Action CSF-2.3.D: Improving Coordination and Service Delivery Among District Agencies Explore the potential to create and implement a cross-agency case management system that can enhance coordination among relevant agencies to improve service delivery to persons with disabilities, older adults, members of the LGBTQ+ community, and other vulnerable populations. 1108.28 Action CSF-2.3.E: Health in All Policies To the extent possible, relevant District agencies should evaluate the potential impact of their policies and actions on population health and align these with strategies identified in Sustainable DC 2.0 and in the 2017-2019 Action Plan of DC HP2020. 1108.29 Action CSF-2.3.F: No Wrong Door/DC Support Link Continue to develop a person- and family-centered and linguistically and culturally responsive No Wrong Door system (also known as DC Support Link) across District agencies that can better support the needs of people with disabilities, older adults, and their families by providing them with links to government and community-based resources, such as LTSS, regardless of their point of entry into the District's service system.

SOURCE: District of Columbia Comprehensive Plan Act of 1984, effective April 10, 1984 (D.C. Law 5-76; 31 DCR 1049 (March 9, 1984)); as amended by District of Columbia Comprehensive Plan Act of 1984 Land Use Element Amendment Act of 1984, effective March 16, 1985 (D.C. Law 5-187; 32 DCR 873 (February 15, 1985)); as amended by District of Columbia Comprehensive Plan Amendments Act of 1989, effective May 23, 1990 (D.C. Law 8-129; 37 DCR 55 (January 5, 1990)); as amended by District of Columbia Comprehensive Plan Amendments Act of 1989 NCPC-Recommended Amendments, and Closing of Public Alleys in Square 669, S.O. 88-452, Act of 1990, effective May 23, 1990 (D.C. Law 8-132; 37 DCR 2213 (April 6, 1990)); as amended by District Government Land Use Temporary Amendment Act of 1994, effective October 1, 1994 (D.C. Law 10-190; 41 DCR 5360 (August 12, 1994)); as amended by Comprehensive Plan Amendments Act of 1994, effective October 6, 1994 (D.C. Law 10-193; 41 DCR 5536 (August 19, 1994)); as amended by District of Columbia Comprehensive Plan Act of 1984 Land Use Amendment Act of 1994, effective March 21, 1995 (D.C. Law 10-235; 42 DCR 30 (January 6, 1995)); as amended by Technical Amendments Act of 1996, effective April 18, 1996 (D.C. Law 11-110; 43 DCR 530 (February 9, 1996)); as amended by Second Technical Amendments Act of 1996, effective April 9, 1997 (D.C. Law 11-255; 44 DCR 1271 (March 7, 1997)); as amended by Comprehensive Plan Amendment Act of 1998, effective April 27, 1999 (D.C. Law 12-275; 46 DCR 1441 (February 19, 1999)); as amended by Technical Amendments Act of 1999, effective April 12, 2000 (D.C. Law 13-91; 47 DCR 520 (January 28, 2000)); as amended by Comprehensive Plan Amendment Act of 2006, effective March 8, 2007 (D.C. Law 16-300; 54 DCR 924 (February 2, 2007)); as amended by Technical Amendments Act of 2008, effective March 25, 2009 (D.C. Law 17-353; 56 DCR 1117 (February 6, 2009)); as amended by Comprehensive Plan Amendment Act of 2010, effective April 8, 2011 (D.C. Law 18-361; 58 DCR 908 (February 4, 2011)); as amended by Comprehensive Plan Amendment Act of 2021, effective August 21, 2021 (D.C. Law 24-20; 68 DCR 006918 (July 16, 2021)).