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Laguna Honda Campus
Now is the time if San Francisco wants to save its revered sanctuary for vulnerable Seniors and disabled people

Saving Laguna Honda Hospital Intact

Feds Impose Sept 19, 2023 Deadline

• • • • • • • • May 26, 2023 • • • • • • • •

On May 18 — one day before evictions of all residents at Laguna Honda were scheduled to begin — Laguna Honda got a second and final last-minute reprieve from the Centers for Medicare & Medicaid Services (CMS), its federal funding source.

Reluctantly, CMS granted the reprieve. “CMS agrees to provide Laguna Honda extended federal funding while the facility continues to pause resident transfers and discharges, until September 19, 2023.” CMS delayed the reprieve due to a severe and new deficiency regarding oversight of a Laguna Honda resident who was a suicide risk.

“Specifically, the survey findings documented that Laguna Honda failed to ensure that one resident with a history of two suicide attempts had an adequate care plan that had been communicated to staff to ensure that staff monitored the resident and provided adequate interventions to address the resident’s previous methods of attempting self-harm. Laguna Honda ... has represented that it is attempting to enact an Action Plan to correct the regulatory violation and implement system improvements to prevent future violations and ensure resident health and safety.”


Please remember that major medical insurance does not cover long-term care in a nursing home; only MediCal ... the insurance for poor people, covers this. Nursing homes cost 12,000 to 18,000 dollars a month. Any of us may need a MediCal-funded nursing home bed tomorrow. We are only one car accident or one diagnosis away as we grow old together.”

Lets Re-Open Laguna Honda to Admit Patients

Laguna Honda plans to apply for recertification (re-opening to admissions) by July of 2023: but LHH will only be recertified if its house is in order. Given the problems we continue to see, this is by no means guaranteed. To save Laguna Honda intact and to avoid a repeat of all the chaos, agony, death, as well as the public expense that has occurred in the past year, four things must happen:

1. INVESTMENT The State of California and its health agency, California Department of Public Health, must fully invest in funding and supporting Laguna Honda.

2. STAFFING Laguna Honda must hire competent managers, plus qualified staff in sufficient numbers.

3. ADVOCACY All San Franciscans must pull together to advocate that Laguna Honda be saved intact. But this cannot be done at the expense of those in need of placement in housing or treatment. Divided, we fall.

4. OVERSIGHT The system for local oversight of Laguna Honda must be changed and improved. Oversight must be ongoing and intensive. San Franciscans must insist, and the Board of Supervisors must create an oversight body that can support the independent mission of our public nursing home.

Prevent Bed Cuts

Upon recertification, our City Attorney must request, and CDPH/CMS must approve a waiver of the 2:1 bed to bathroom ratio to prevent the loss of 120 beds. LHH was designed — just 13 years ago — using the one bathroom for three patients plan, and it has served patients well. We already have a severe shortage of skilled nursing beds. San Franciscans must insist on this.

Now is the time to look at what we can do. Given the shortage of skilled nursing beds in San Francisco, every nursing bed (769 out of 780) counts! Laguna Honda will not be "recertified" and open to the admission of new residents again unless all hands are on board to make this happen.

CMS, in its recent letter to Laguna Honda, is very aware of the need for intense collaboration and support. One of the new requirements stated is:

“Laguna Honda will cooperate in convening a summer 2023 meeting where all principals
 of the Parties to the Agreement and Laguna Honda’s union leadership will participate in a
 conversation with the Secretary of the U.S. Department of Health & Human Services,
• The City and County of San Francisco, Laguna Honda, CDPH, Laguna Honda’s
 union leadership, and CMS"

Suppose Laguna Honda must close in September of 2023. In that case, CMS has made the State of California responsible for the planning  and welfare of its hundreds of residents evicted and dispersed:

“California will submit a plan for resident transfers and placements by July 31, 2023, and
 this plan will include:

• A State-led crisis response team
• State-hired temporary management installed at the facility
• Partnerships with other facilities to temporarily expand capacity
• Principles drawing on best practices from COVID-19 response”

Responsible Agencies and Officials

The San Francisco Health Commission, and the Director of Public Health are appointed, not elected. The Health Commission has no actual power, and the Director of Public Health serves at the will of the Mayor. Other than the Board of Supervisors, there is no independent body responsible to the people of San Francisco. Only the Mayor can prevent this mess from happening again.

CMS is the federal agency that oversees nursing homes. (Medicaid is MediCal in California.) CMS works closely with State Health agencies (California Department of Public Health/CDPH) to ensure nursing homes (SNFs/skilled nursing facilities) deliver good care under a myriad of regulations designed to guarantee SNF residents the rights to respect, freedom from abuse and optimal care.

State health agencies, in this case, CDPH, act as the enforcement arm of CMS. When there is a violation of rights /regulations at a nursing home, the nursing home either self-reports or gets reported to the state (CDPH) “licensing and certification. "The report is assigned to a state case worker who investigates. Among state health agencies everywhere, CDPH, unfortunately, is one of the least effective and poorest managed. CDPH has stated that it is underfunded. This is an ongoing issue. 

The City and County of SF, and its public health department (SFDPH),  neglected the management, training & hiring of LHH staff over many years. Direct care of residents and the legally required writing and implementation of care planning for resident care suffered. To make matters worse, to free up precious beds at San Francisco General Hospital, Laguna Honda admitted residents with complex (and sometimes unsafe) unstable behavioral and substance use issues. This is in addition to the usual medical issues that nursing homes encounter. 

CDPH, which was supposed to act as a backstop by monitoring and advising Laguna Honda, persistently delayed a response or provided none at all to reported problems. Of course, the Covid pandemic did not help!

A Credit to the Staff — Management, not so much

To free up precious beds at San Francisco General Hospital, Laguna Honda’s priorities were changed in the early 2000’s. LHH Managers were retained and hired for obedience — not for competence. This abuse of our public nursing home reflects ageism and ableism in the face of chronic underfunding of public health. 

Serial Mayors and chiefs at the Dept. of Public Health — since about 2004 — presided over this. The necessary mission of our public nursing home, to serve elderly and disabled San Franciscans was neglected.  Important safety rules for admission were violated. It is egregious that, beginning in April 2022, CMS had to force LHH managers (bought in from other parts of the public health system) to learn the most basic nursing home regulations. Most of these regulations had been in place for many years.

With all this chaos, it is incredible that Laguna Honda was not forced to contend with more trauma and damage to the patients in its care. That is a credit to the hardworking front-line staff at Laguna Honda. Their diligence prevented — until April of 2022, CMS' shut down of admissions.

Given how many years this 780-bed facility was neglected and misused by the City and County (starting before the 2010 rebuild), it is unsurprising that turning the ship around has been so challenging.

It’s Everyone’s Problem

Please remember that major medical insurance does not cover long-term care in a nursing home; only MediCal (Medi-caid nationally), the insurance for poor people, covers this. Nursing homes cost 12,000 to 18,000 dollars a month. Any of us may need a MediCal-funded nursing home bed tomorrow. We are only one car accident or one diagnosis away as we grow old together.

For more information visit the Grey Panthers Laguna Honda site.

Dr. Teresa Palmer is a geriatrician/family physician who has worked in San Francisco for over 30 years, including at St. Luke’s Hospital, Laguna Honda Hospital, UCSF, and at On Lok, a program of all inclusive care for the elderly.

May 26, 2023

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Dr. Teresa Palmer
Dr. Teresa Palmer

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