Laguna Honda: Almost out of the woods?
Unusual praise from an outspoken critic—with a word of warning
SAVE THE DATE
What San Franciscans Need to Know about Laguna Honda — In case you ever need a nursing home bed.
Zoom Forum • Wed • April 23 • Noon-1:30
Details in the next WSO in April.
Plenty of time for Q&A • Laguna Honda Staff will be present.
• • • • • • • • March 2025 • • • • • • • •
Progress toward resuming full operations at Laguna Honda Hospital and Rehabilitation Center has finally begun. In their presentations to our Health Commission on March 10, Laguna Honda leaders and management gave convincing evidence that LHH is now better than ever and is, once again, a state-of-the-art skilled nursing facility (SNF)!
Admissions Up!
While improving, the ease of applying for admission and the rate of new admissions is still too slow to prevent more San Franciscans from being transferred out of county when they need SNF care. LHH has more than a third of all SNF beds in San Francisco, and there is a city-wide shortage of beds, especially for those in Medi-Cal.
Laguna Honda is a major safety net for any San Franciscan who encounters severe disability and loss of independence. We are all one car accident or one bad diagnosis away from needing more care than our families can give us! And who is not getting older?
Another hurdle: the future use of 120 LHH semi-private single rooms is still in jeopardy. These rooms do not meet 2016 regulations (limiting bathroom sharing to 2 patient beds instead of 3). The newly constructed building opened in 2010, and the rooms are spacious and safe.
The federal government is demanding documentation of “benefit to existing patients” for patients to use those 120 beds—despite a shortage of nursing home beds per capita in San Francisco. If the federal government refuses to pay (Medicare certification) for these beds, the City may need to file an appeal to the state to approve the 120 beds for the lower Medi-Cal rate. It is hard to understand … our state and Federal representatives need to work for us to fix this!
The current building has 769 SNF beds (including those 120 beds in jeopardy) and a small 11-bed acute hospital (suitable for in-house residents who temporarily need an acute hospital level of care but not intensive care).
San Franciscans are blessed with a public Skilled Nursing Facility (SNF), which, according to the City Charter, is legally separate from other City and County Facilities. The SNF's mission is to serve the rehabilitation and long-term care needs of San Franciscans over 16 who are in need.
By early 2022, Laguna Honda management had been replaced by obedient managers. Managers with the competence to run a Skilled Nursing Facility legally and ethically found other jobs.”
Laguna Honda generally offers superior care and staffing compared to many other smaller nursing homes. I am proud to say that I worked there as a ward physician for 15 years and learned best practices.
We San Franciscans need our LHH to be fully functioning! We do not want to, and should not have to, leave our beloved City for nursing home care! Our representatives at all levels of government must insist that all 769 beds be available to those of us who need them!
Write to your local, state and federal representatives and bring it up at every town hall!
Looking Back
Cost to the City and County of San Francisco: Medicare, Medi-Cal, and other insurance pay 80% of Laguna Honda’s bills. This is a cost-effective way to care for San Francisco’s most vulnerable folks whose round-the-clock needs require an SNF level of care.
San Franciscans were convinced and voted to fund a new LHH SNF facility through a 1999 bond issue intended for San Franciscans who needed SNF care! However, by the time the new building opened, LHH's function had been subverted to other priorities. Despite behavioral and diagnostic red flags, there was tremendous pressure to prioritize the admission of “hard-to-discharge” patients from our SF General Hospital. This saved space and money at SFGH.
The problem was aggravated by a massive number of nursing homes and mental health/behavioral treatment beds that were shut down in the ‘90s, both locally and statewide.
Thus, political and budget pressure pitted the needs of frail, aging and disabled LHH folks against the need to find treatment and housing for those who are unstable or undertreated due to mental illness and substance abuse. That led to episodes of patient harm and staff being abused AND being abusive at LHH. Management ALSO ignored safety issues in the oversight and maintenance of the facility.
By early 2022, Laguna Honda management had been replaced by obedient managers. Managers with the competence to run a Skilled Nursing Facility legally and ethically found other jobs! (Sound familiar?)
The federal shutdown of all admissions and the attempted emptying and closure of the facility came down in April of 2022. The bungled attempt to empty Laguna Honda of its remaining patients was halted when many died immediately after eviction.
Prior to the 2022 LHH admission shutdown, Health Department management did not follow safety and human rights regulations at LHH. It was publicly admitted (in retrospect) that top managers were unaware of SNF regulations. Of course, the awful working conditions that evolved for any staff who cared about their patients were also neglected, and a “culture of silence” pervaded.
Public outcry was a key factor in the immense effort going forward from 2022 to prevent closure, regain certification (payment for new admissions) for Medi-Cal and Medicare, hire and retrain both management and staff and turn this agonizing mess around. And-this has almost worked….
However, hundreds of empty beds remain to be occupied. Even though admissions resumed in 2024, the current census indicates less than 460 beds are filled out of 769 SNF beds—when there is a dire need for SNF care in the county. The rate of admissions must pick up!
Medicare and major insurance pay for acute hospital care and most of the bills for short-term rehabilitation in an SNF setting (aka “Post-acute Care”). However, those who require long-term residential care (“custodial care”) in a nursing home setting are not covered by Medicare or major medical insurance. The cash cost of “custodial” long-term nursing home care is 10 to 18 thousand dollars a month. These patients (“residents” because this is their home) must pay with cash, long-term care insurance (if they have it), or they must be or become poor enough to qualify for Medicaid (Medi-Cal in California).
Laguna Honda, with new management and determination, is almost out of the woods. The people of San Francisco need to let their elected officials know that we understand past mistakes and that they should not be repeated!
Let us proceed outspokenly and vigilantly: a fully functioning Laguna Honda is part of making San Francisco the best it can be!
Teresa Palmer MD, Family Medicine/Geriatrics
Board member SF Gray Panthers
March 2025
