Is the City writing off 120 badly needed public nursing home beds?
Emergency: San Francisco’s Frail Elderly and Disabled Need a Champion at City Hall
• • • • • • • • July 2025 • • • • • • • •
Laguna Honda Hospital and Rehab Facility (LHH), our city and county public nursing home, maintains at least 1/3 of the steadily dwindling skilled nursing home beds in San Francisco. The beds include both post-hospital “rehab” and long-term residency. Of course, skilled nursing facility (SNF) care is for individuals who require a higher level of assistance and/or supervision than they can receive in residential care, assisted living, memory care, or at home. Our aging San Francisco population needs more nursing home beds.
On August 18, the Health Commission will hear the (legally required) 2024 tally of how many San Franciscans had to leave the county to receive nursing home care after being discharged from a hospital. People who need a nursing home bed and cannot get one do not usually come to our attention on the street. Instead, these folks move between hospital and home, are behind a door, lie in a bed with a worsening pressure sore, or are dwindling in an understaffed “care” facility out of sight.
The City Attorney and Public Health department, working together, informed the public that they had decided not to pursue reactivating these 120 beds...”
As of early July 2025, the federal government (CMS: Centers for Medicare & Medicaid Services) has definitively refused to allow Laguna Honda to use 120 of its spacious and modern single-bed rooms. The refusal is due to a 2016 regulation that only two patients can share a bathroom in a “new” facility. LHH has 120 of these spacious “triplets” that share a bathroom as the photos included here show.
On July 14, the City Attorney and Public Health department, working together, informed the public that they had decided not to pursue reactivating these 120 beds with CMS. (Discussed at June 14 Health Commission Laguna Honda Joint Conference Committee meeting.) Administrator Diltar Sidhu wrote a letter to LHH staff about this.
Although the commission discussed the possibility of fighting for those beds at some future date, it was not mentioned in any document available to the public as of this writing.
So, these 120 beds will remain empty indefinitely. Once the available 659 (769 minus 120=649) LHH SNF beds are full (current occupancy is in the low 500s), any San Franciscan who needs a bed at LHH will have to wait or go out of county.
CMS shut down new admissions in April 2022 and ordered Laguna Honda to close, but LHH never closed. It has been continuously operating since the 1800s. The City built the new facility in 2010. There is a state-wide, regional and local shortage of decent, safe long-term care options. After evictions from LHH between April and July of 2022, many transferred patients died. The outcry about this meant emptying and closing Laguna Honda had to be STOPPED — and was never resumed.
LHH is not a “new” facility. It has been in continuous operation since the 1800s! Therefore, it is entirely reasonable to “grandfather” these 120 beds (provide a waiver or exception to this 2016 rule.)CMS’s current “reason” for refusing to allow Laguna Honda a “waiver” so patients may occupy these 120 beds is that Laguna Honda has had too many deficiencies. This mindset ignores the fact that LHH is a huge public nursing home and has had a vast decline in the rate of deficiencies that were found to be real (“sustained “as opposed to unsubstantiated reports)! The extensive (and expensive) work to improve care and accountability at Laguna Honda since late 2022 has been successful.
CMS is willing to allow any of these 120 beds to be used temporarily on a single-bed “case-by-case” basis — which is not workable. It will take weeks to get CMS to agree to admit a specific patient to just one of those beds, which won’t work for a sick person who needs to go quickly from hospital to nursing home for ongoing care!
The City is overwhelmed with working on the current Federal Administration's cuts to services, violations of due process, and the rule of law. LHH leaders justified the decision not to fight this 120-bed loss. Many people will be jeopardized by cuts to Medi-Cal (Medicaid nationally) and by Trump administration budget cuts in San Francisco. The City decision-makers have more important things to do.
People who need a Laguna Honda bed are predominantly on Medicare and/or Medi-Cal or will predictably have to “spend down” to Medi-Cal as they become impoverished from the cost of nursing home care. They are not usually part of the visibly homeless or of politically visible coalitions of the vulnerable or of the powerful corporate class. So, this group: frail, disabled, behind a door somewhere, has been triaged by our city government out of the list of folks who are worth fighting for in San Francisco. After all, people who decline quietly due to lack of nursing home care are not BOTHERING our hard-working city government. No corporate, business, or billionaire-funded AstroTurf organization complains about them. Administrators can simply send them out of county — not to be heard from again!
In fact, activists in the nursing home reform movement know that nursing home patients are ALWAYS at the bottom of any list. The triple sin of age, disability, and predictable poverty from the cost of nursing home care makes it unpleasant (and unprofitable) to think too much about these folks — who in addition — are disproportionately older women and people of color.
It may be true that the Trump administration will never do anything good for San Franciscans who are not rich and powerful — and that efforts to appeal the 120 beds again at this time will not work. Does that mean the people of San Francisco will let those 120 beds fall off the radar and be forgotten?
Medi-Care and Medi-Cal pay 80% of the cost for any given patient at Laguna Honda. The space for the 120 beds will remain at Laguna Honda. The public must continue to remind the Mayor/Supervisors/Health Commission and Laguna Honda leaders that we have a right to stay in our own community when we need nursing home care! Those beds are needed!
Private litigation could be effective if the City Attorney is unwilling to pursue this!
Administrators will present the 2024 Out of County Transfer to SNF data to the Health Commission on August 18, 2025, and at some point, to the Board of Supervisors.
I recommend that the public participate in the August 18 Health commission meeting (Monday, 4 pm — agenda and details will be online the Friday before the meeting.
No matter how frail we are, or how invisible we become as time goes on— we have a right to live in the City we love.
Dr. Teresa Palmer M.D., Family Medicine/Geriatrics. Laguna Honda 1989-2004
Email: Teresapalmer2014@gmail.com
Special thanks to Patrick Monette-Shaw for assistance with the linked data!
June 25, 2024
