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SF’s waiting list for skilled nursing beds is already at a critical level

Petition to Help Save Laguna Honda Hospital Beds Needs Support

Laguna Honda Still Risks Losing 120 of Its Beds Following Partial Recertification

LHH Has Received Only Partial Recertification.
Still Faces Four-Month Process for Full Recertification.
San Franciscans and Greater Bay Area Need to Support Petition

Help Save 120 Beds at Laguna Honda Hospital

Laguna Honda Puzzle

Please Sign My Petition

Given our severe shortage of Skilled Nursing beds, DPH claimed it would do “everything it can” to save LHH’s 120 beds. But it hasn’t submitted a written waiver request yet!

Please share this petition widely with your contacts, I’d really appreciate your help.

• • • • • • • • • • August 31, 2023 • • • • • • • • • •

It’s great news that California’s Department of Public Health (CDPH) approved Laguna Honda Hospital and Rehabilitation Center’s (LHH) application for recertification on August 16 as a Medicaid (Medi-Cal) provider.

But the facility remains at risk of losing 120 of its 780-bed capacity, ostensibly because of a federal regulations change, and must clear a few more hurdles. Luckily, there’s a provision to save those beds.

Meanwhile, San Franciscans, our Greater Bay Area neighbors, and Californians concerned about losing these crucially needed beds can sign a petition urging LHH to submit a written waiver request to CDPH to save the 120 beds.

Unfortunately, LHH still faces at least two significant hurdles following its partial victory in obtaining Medicaid (Medi-Cal) certification. It still must submit another application to the Centers for Medicare and Medicaid Services (CMS) seeking recertification as a Medicare provider. Then, it must pass two separate facility survey inspections successfully, separated by a 90-day "reasonable assurance” waiting period to ensure that remedial corrective actions LHH has implemented over the past 18 months remain sustained. 

That’s likely to be a four-month process before LHH is “made whole" and allowed to resume admitting patients again. New patient admissions haven’t been allowed for the 18 months since April 2022.

After Laguna Honda lost certification in April 2022, CMS and CDPH advised LHH orally (not in writing) that LHH would have to reapply to become both Medicare and Medicaid providers to qualify for CMS’ Federal reimbursement programs, LHH could no longer have two patients sharing a common bathroom.

That would require closing one bedroom in each of 120 three-person suites. LHH would lose 120 beds.

But that ignores a provision allowing waivers to be submitted requesting up to four patients per room. Such waivers have reportedly been granted to some skilled nursing facilities in California for up to six patients per room. 

LHH Exceeds Federal Standards

The rule in 42 CFR §483.90(f), Bathroom Facilities, says nothing about — is totally silent on — how many nursing home residents can share a bathroom. The paragraph only says, "each resident room must have its own bathroom equipped with at least a commode and sink.”

It was a creative misinterpretation of CMS’ own rules because a provision allows waivers to be submitted requesting permission to have more than two patients per room.

Admittedly, §483.90(e)(1)(i), Resident Rooms, restricts nursing home facilities to no more than four patients per room, but if they are decertified and have to apply for Federal recertification, they can have no more than two patients per bedroom. 


LHH’s patient bedrooms and suites exceed the minimum square footage restrictions. They have sliding doors between each bedroom and a 79 sq. ft. short hallway inside the three-person suites — essentially making them all private, single-person rooms, not shared bedrooms. The issue of two-person rooms should essentially be moot, given LHH’s actual circumstances.”

Fortunately, 42 CFR §483.90(e)(3)(ii) clearly states CMS, or the State survey agency — in this case, CDPH — may grant a variation to the two-patient per room rule specified in §483.90(e)(1)(i) if the facility demonstrates in writing the variation that having more than two patients per room “will not adversely affect residents’ health and safety" — provided the facility meets specific requirements.

So, managers can solve this problem by simply submitting a written waiver request asking to keep all 120 of its three-person suite bedrooms. When architects designed LHH’s replacement hospital that opened just 13 years ago in 2010, the three-person suites were pre-approved by California’s Office of Statewide Hospital Planning and Development (OSHPD, subsequently renamed “HCAI”). Such rooms complied with California’s building standards codes for hospitals. The room occupancy didn’t become an issue until late Summer 2022, following LHH’s decertification on April 14, 2022.

LHH’s patient bedrooms and suites exceed the minimum square footage restrictions. Each bedroom in the three-person suites averages 125 sq. ft. (45 sq. ft. larger than the 42 CFR §483.90 regulation of 80 sq. ft.-per-resident minimum for shared rooms, or 25 sq. ft. larger than 100 sq. ft. for single-person rooms).

They have sliding doors between each bedroom and a 79 sq. ft. short hallway inside the three-person suites — essentially making them all private, single-person rooms, not shared bedrooms. The issue of two-person rooms should essentially be moot, given LHH’s actual circumstances.

It’s clear LHH’s bedrooms exceed requirements in the 42 CFR §483.90 regulations. CMS’s gripe about LHH’s three-person suites is essentially a bogus quibble.

Had LHH not been decertified in April 2022,  this problem would never become an issue, and CMS and CDPH would not have claimed LHH must give up its three-person suites.

LHH and its governing body — the San Francisco Health Commission — repeatedly stated during open sessions of the Commission’s meetings during the past year that they fully plan to keep all of LHH’s 780 beds and have planned to submit the waiver request once LHH was recertified.

Indeed, Laguna Honda’s previous acting CEO, Roland Pickens, has repeatedly testified to the Health Commissioners: "We are doing everything we can to pursue the process[submitting a waiver].”  Pickens asserted that maintaining the 120 beds at risk of loss is a high priority for the Health Commission, the Department of Public Health, and LHH. So far, the new CEO and licensed Nursing Home Administrator, Sandra Simon, hasn’t spoken publicly about saving LHH’s 120 beds.

When CDPH approved LHH’s Medi-Cal recertification on August 16, Medi-Cal restored funding to 95% of LHH’s patients whose healthcare payor source is Medi-Cal.

All LHH should do now is submit its written waiver request to CDPH, the same regulatory agency that just restored LHH’s Medi-Cal certification!

SNF Bed Supply and Demand

LHH’s census in October 2021 of 710 patients has shrunk to 490 patients as of August 22, 2023. That 220 patient census loss suggests new patients who could have filled those beds faced out-of-county discharges.

Between 1997 and 2022, San Francisco lost 1,381 Skilled Nursing Facility (SNF) beds. Losing LHH’s 120 beds will push that to 1,501 beds lost, leaving only 2,161 remaining. 

An April 2023 San Francisco Department of Public Health report documented that 4,186 patients were discharged to out-of-county SNF’s across all reporting private-and public-sector San Francisco hospitals during calendar year 2022.

If we lose LHH’s 120 beds, more elderly and disabled low-income San Franciscans will be dumped out-of-county. We can’t afford to lose these beds! 

Petition Needs Stronger Bay Area Support

A petition requests LHH submit its written waiver request immediately to CDPH to retain all of LHH’s beds threatened with permanent removal. The petition has gained 1,420 signatures so far. But it needs stronger support by San Franciscans and our allies in the greater San Francisco Bay Area to demonstrate broad community resolve to help permanently save these beds.

Community support is critically needed. Please support this petition by signing it today and encourage others to sign on, too!

Monette-Shaw is a columnist for San Francisco’s Westside Observer newspaper, and a member of the California First Amendment Coalition (FAC) and the ACLU. He operates Contact him at

September 2023


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