Laguna Honda Hospital Call to Action: January 19, 2024

Update from January 9 Laguna Honda Joint Conference Committee
The December CMS (federal) survey results show fewer deficiencies than in previous surveys. There are no "actual harm" or "immediate jeopardy" level violations. There are ongoing indications of problems with staffing, oversight, training and environmental management. Nevertheless, the survey attests to improvements in the quality of care. It attests to a quality of care that is higher than in for-profit private nursing homes.
461 residents (out of 780 original beds) remained in LHH on December 1. As of January 9, 48 of these residents do not need to be in a nursing home and are awaiting safe discharge to the community. Apparently, lack of comprehensive services in San Francisco is making this a slow process.

LHH has until January 17 2024 to submit a Plan of Correction(POC) and THEN CMS(fed) will either approve this POC or ask for changes. Once a final POC is approved, CMS surveyors will come on-site for an unscheduled visit to ascertain that these corrections are actually in place. Historically, despite a "30-day window," this process can take up to 3 months.

This delays certification for Medicare and resumption of admissions between until mid-February and mid-April 2024 at the earliest.

After "Certification" by CMS, SFDPH leaders are adamant that they will ask for a "Waiver" (of 2016 rules) to resume use of the 120 beds (that consist of the 3rd bed in 120 airy and spacious 3-bed suites).

IN ADDITION to this delay, it was announced that LHH leadership, headed by Dr. Lam, the Medical Director, and the Director of Nursing, Sandra Simon, need to be satisfied that improvement is "sustainable." A plan to assure this will be called a "Sustainability Transition Plan" (now being written), and the plan may involve a delay in the resumption of all admissions. There are LHH leadership concerns about the "adequacy of care staffing" for safe resumption of admissions. Admissions will start slowly (when they do restart) -with a limited number of admissions per week or month ("tiered").

In addition, the Mayor has asked for every department to cut their budget. The impact of this was minimized January 9.

On January 9, it was again stated that Laguna Honda will prioritize readmission of evicted nursing home residents "who want to come back." However, no plan to proactively notify (surviving) evictees or their decision-makers of this option has been elucidated.

There is no date yet in view for the resumption of admissions, which has been on hold since April 2022. San Franciscans need this 780-bed safety net long-term care facility to resume full operation.

At this rate, resumption of admissions could still be delayed for months!
LHH, due to years of mismanagement, has had an ongoing struggle with "culture change" and "best practices" and it is now trying to transform to a "state of the art" nursing home.

LHH is unable to safely discharge residents who no longer need nursing home care. Laguna Honda's issues with both admission and discharge of residents (even if longstanding problems with management are cleared up) are closely related to a lack of services everywhere in San Francisco for persons who are disabled and medically or behaviorally complex-or both.

Since April 2023, as of January 9, 2024, only 19 discharge-ready residents have successfully found placements. Discharge workers are trying to place SF residents in San Francisco. There is a laudable concern about safe discharge. There is a shortage of services/housing in San Francisco that provide enough support — such as supportive housing, wrap-around mental health care, home care for the disabled, and "board and care."

Ongoing questions and concerns

When will admissions resume, and when will a waiver for the 120-bed loss be submitted?

"Behavioral" services outside of LHH are badly needed. All 780 LHH beds are needed for SF residents needing nursing home care. Inappropriate use of LHH due to shortages in "Behavioral Care," "Board and Care," and Home Care violates the rights and safety of current LHH residents AND the lives of San Franciscans who need a bed at LHH.

In an ideal world, since there is more "behavioral" (non-LHH) funding coming to the counties, we would hope for the rapid creation of safe and appropriate local placements that are an alternative to LHH for people who really are a danger to themselves or others in a nursing home setting.
However, immense pressure will continue to be applied to discharge to Laguna Honda. Of course, this will risk incidents at LHH that will lead to another loss of certification.

Will LHH admitting leaders be given the needed support in saying "no" to inappropriate transfers from SFGH?
Information from previous meetings:

• October 10 LHH Behavioral Health Improvement Project Presentation: Report at the Health Commission was light on specifics. It completely obfuscated the issue of how to manage residents by combining very different groups. The presentation mixed together folks with dementia-related behavioral problems ("neurocognitive disorder") who lack the capacity to direct their own care with folks who do not have dementia and have substance use disorder (SUD) and/or mental illness. Discussion of "cohorting" different groups was all provisional and is still a subject of "research." The purchase of a few robotic pets for residents with dementia was lauded.
• It was disturbing to hear the implication in this October 10 meeting that staff apparently is largely untrained in handling ANY of these categories of "behavioral" residents.
• Standing by exclusionary admission rules and not admitting residents that LHH cannot safely care for was mentioned.

It looks like LHH is on a determined but slow path to full recertification.

This is a relief. However, new admissions must await further work to fix LHH.

It is a worry that no new system of oversight is being proposed (over and above SFDPH and the Health Commission) to prevent profound mismanagement of our public nursing home from recurring. Due to the expense and complexity of properly running a large skilled nursing facility, the political and budgetary pressure to repeat old mistakes will be great.

This needs to be emphasized to the Mayor, the Board of Supervisors, the Health Commission and leaders of our health department (SFDPH).

September 26 Board of Supervisors meeting: The Board of Supervisors/Supervisor Melgar unfortunately did not schedule future meetings about Laguna Honda. This is disappointing. Given profound budgetary and political incentives to mismanage our public nursing home, close involvement by the Board of Supervisors needs to continue.

OUR PUBLIC NURSING HOME MUST NOT BE JEOPARDIZED AGAIN

In general, we heard an attitude of determination by SFDPH to do everything necessary to get safely and fully re-certified and not to take any risks in doing so. This is a higher priority than resuming admissions.
SFDPH was given leeway by the city to speed hiring up in 2023; we do hope that SFDPH avoids penny-wise and pound-foolish hiring decisions in the name of saving city budget money.

Per SFDPH, CMS has strongly indicated that it does not look favorably on submission of a request for a 120-bed waiver until LHH is in "full regulatory compliance." LHH remains fully licensed for the 120 beds by the state of California, and the infrastructure to support those beds remains. Ms. Simon, Dr. Colfax, and the Health Commission have reiterated their commitment to re-obtaining the right to place residents in those 120 beds, which are now empty.

It was re-stated that when admissions do resume, those evicted in 2022 are first priority to return-restated: involuntarily discharged patients (who survived) who still qualify for skilled nursing care have first priority to return. However, no proactive plan to reach out to these frail survivors has been elucidated.

For the revised /final draft of admission guidelines see:
LHH Admission & Relocation Policy Revised September 5 2023

ONGOING worry:
Laguna Honda has permission to discharge people who do not qualify or are inappropriate for skilled nursing home services--but there are insufficient services and housing for timely and safe discharges. This points to an ongoing grave lack of services in San Francisco. This not only violates CMS's request to discharge residents who no longer need nursing home care promptly but violates the health and safety of residents who need a different environment and also (when admissions resume) the health and safety of people who are waiting for a Laguna Honda bed.

All new admissions are forbidden; 120-bed cuts are still on the table. CMS (the Federal Center for Medicare and Medicaid Services) has strict rules; LHH, CDPH(the state) & consultants continue to struggle to make up for years of lax oversight.

Local officials, State officials and Federal Government officials all need to hear from San Franciscans that Laguna Honda must be saved with all beds intact, and we need admissions to restart.

Efforts to educate LHH residents, families and advocates as to their right to refuse inappropriate or unsafe discharge must continue.
We must continue the public outcry to demand that Laguna Honda be saved while simultaneously funding services and stable housing for those in need who cannot be served at Laguna Honda.

We demand no bed cuts, no closure and no evictions, reopen admissions, and provide, in safe and appropriate locations, mental health, substance use treatment and support and home care services to all San Franciscans who need it.

We must continue the community outcry to EVERY AGENCY INVOLVED. San Franciscans, present and future, MUST NOT SUFFER AND DIE due to lack of services at Laguna Honda.

Encourage Laguna Honda residents, and their advocates to KNOW THEIR RIGHTS: Links to resources are here

Local officials, State Officials and Federal Government Officials all need to hear from San Franciscans that Laguna Honda must be saved with all beds intact, and we need admissions to restart.
What to do:
Write in your testimony and get published in the minutes!
Agenda and supporting documents here: https://www.sf.gov/meeting/january-16-2024/january-16-2024-health-commission-meeting-0
Instructions for letters to the Health Commission for January 16 are here.

How to talk to the SF Health Commission remotely (phone) or in person: Instructions are here. NOTE NEW PHONE ACCESS CODE.
NOTE NEW RULE FOR REMOTE PARTICIPATION:
Effective January 16, 2024, members of the public attending the meeting may address the Commission through public comments made in person or in writing. Remote public comment will be available only to those requiring accommodation due to a disability who cannot attend in-person. (You do not have to say what your disability is.)To request accommodation, contact the Commission Secretary by 12 PM (Noon) the day before the Commission Meeting by calling (415)554-2666 or via email at HealthCommission.DPH@sfdph.org

Teresa Palmer MD family medicine/geriatrics

Board member Sf Gray Panthers

FOR MORE DETAILS AND BACKGROUND SEE

Gray Panthers Call to Action

January 19, 2024