
Laguna Honda May Not Close—But Is It Open?
An Open Letter to the Mayor and Board of Supervisors
• • • • • • • • June 25, 2024 • • • • • • • •

Laguna Honda (LHH) has been closed to new admissions since April of 2022; the last hearing of the full Board of Supervisors was on September 26, 2023.
Admissions have not resumed despite recent certification for Medicare payment on June 20, 2024.
Is the failure to resume admissions for so long due to the leaders in place in the “San Francisco Health Network?” The Mayor and the Board of Supervisors need to ask some hard questions. Does Laguna Honda’s governance need to be taken out of its current hands and restructured?
We fear that the resumption of LHH admissions will be limited or delayed so that far too many San Franciscans in need of nursing home care will end up out of the county—exiled to points unknown—in addition to the many San Francisco residents who have already left the county during LHH shutdown to obtain nursing home care.

There is a dire shortage of nursing home beds in San Francisco—especially for those on Medi-Cal (Medicaid)—which pays for chronic long-term care when a resident cannot afford $15,000 a month. Major medical insurance and Medicare do not pay for this.”
There is a dire shortage of nursing home beds in San Francisco—especially for those on Medi-Cal (Medicaid)—which pays for chronic long-term care when a resident cannot afford $15,000 a month. Major medical insurance and Medicare do not pay for this.
The residents of our City must be certain that all 769 Nursing Home beds at Laguna Honda will be available for their use. Those of us who need a bed are burdened by the more than two-year moratorium on admissions, with no end in sight.
Given the sickness, death, and horrible stress and expense that the situation at LHH has engendered since 2019, we ask the Mayor and Board of Supervisors these questions:
1. How can the City create a system of oversight for LHH to ensure that admissions resume and the repeated and profound mismanagement does not persist or recur? Many San Franciscans need a skilled nursing home (SNF) bed, especially those who are on or must use Medi-Cal (Medicaid).
Once admissions resume, due to political and economic pressure, will San Franciscans in need be displaced by the “flow” of inappropriate patients from our county hospital to LHH due to the lack of services elsewhere in the system?
A skilled nursing facility (SNF) is for those who need intensive supervision and care by skilled staff for medical disability and cannot make it in a residential setting.
A skilled nursing facility (SNF) is a congregate setting with medically frail residents.
It is not an appropriate destination for those who have a primary diagnosis of active substance use disorder, which includes predictable drug-using and/or drug-seeking behavior.
Not only is “contraband” illegal in a federally funded facility, but the presence of substances and/or those who actively seek them in the facility puts other fragile residents at risk.
Neither is Laguna Honda an appropriate (or legal) destination for those with a primary diagnosis of mental illness that has not been first treated and stabilized in a psychiatric setting. That especially includes primary psychiatric illness with behaviors that are predictably unsafe to self or others.
There is an ongoing need for skilled oversight of Laguna Honda’s practices, which will protect its mission. Where will it come from? It is better to admit there is a problem than to continue to cover it up.
2. California Department of Public Health/the State of California still needs to keep up with LHH problems; how will this be rectified?
The State of California/CDPH’s inability to offer timely feedback about problems at LHH contributed to the decertification.
3. Can the Board of Supervisors closely monitor the submission of a waiver to prevent the 120-bed loss?
San Franciscans cannot afford to lose these beds!
4. The now-required yearly report from the SF Department of Public Health of Out-of-County Discharges to Skilled Nursing Homes From SF Hospitals for 2023 was due in early 2024; it has been reported that it will be delayed until July 2024.
Why? Is this to avoid publicizing the mess that LHH’s failure to resume admissions has created?
It is extremely frightening for any San Franciscan who may need a bed in long-term care in the future that no one is transparently addressing these concerns. Please address them. San Franciscans need the beds and cannot afford to wait now or wait again if the current “fix” fails and the old ways are resumed.
Dr. Teresa Palmer M.D., Family Medicine/Geriatrics. Laguna Honda 1989-2004
June 25, 2024