By Teresa Palmer, MD - Geriatrics / Family Practice
(Attending Physician at Laguna Honda 1989 - 2004)
A large bond issue was passed in 1999 to rebuild the Laguna Honda Hospital and Rehabilitation Facility (LHH). San Franciscans supported this, having been reminded that LHH is an important safety net.
After, City leaders wanted less general fund money to go to LHH. The Mayor and the Health Department decided it would be most economic to use LHH beds (costing a couple hundred dollars a day) for patients who could not otherwise be safely discharged from San Francisco General Hospital (where beds cost over a thousand dollars a day). This would save money for the system as a whole.
Other San Franciscans who needed a nursing home bed found it almost impossible to get in.
LHH management and staff learned that they could not say “no” to San Francisco General transfers-or they were replaced.
LHH has always been a nursing home facility, has no locked beds, and no licensing to take care of those whose primary problems are behavioral, substance use or mental illness. But other, more appropriate treatment programs d0/did not exist or are/were full (another failure to plan by the City Family).
In early 2022, after overdose incidents, Federal government inspectors from CMS—the Center for Medicare and Medicaid Services-- warned Laguna Honda that serial inspections would ensue. No one then in the line of command at LHH was capable of preparing the institution for the predictable attention to detail that this would bring.
CMS noticed the lack of preparedness. CMS threatened to stop funding, “de-certified” the facility and insisted on a complex recertification process. This has never happened before.
CMS’s main power is to stop Medicare and Medi-Cal from paying the bills, which is 80% of LHH revenue. San Francisco Department of Public Health then hired consultants to thoroughly train staff, at the cost of between 5 and 10 million dollars. This training is going on now. It is of note that much of the training is about federal nursing home standards that have been in place since at least 2017.
Medicare (insurance for disabled and those over 65) only pays for short term rehab at a nursing home. Most people who need long term nursing home care end up on Medi-Cal as the payer, unless they are fabulously rich: a nursing home costs about 12-18,000 dollars a month.
CMS’s original date to stop payment was Sept 13 2022; as of mid August, after city lawsuit, deaths of discharged patients, and a public outcry, that date has been extended to November 13.
The California Department of Public Health, which works under CMS, and Laguna Honda managers together worked out a plan in April 2022 to discharge all residents and close. None of the government agencies involved has taken clear responsibility for this. Closure of a facility that is in the process of being fixed implies that it will never be fixed.
Serial discharges up to the end of July resulted in at least 9 deaths after 57 discharges. A class action suit by Laguna Honda patient representatives has been filed by Louise Renne’s law firm to stop further discharges. This occurred around the same time CMS stopped discharges in late July due to the high death rate.
The City family is supporting an additional lawsuit against CMS (Chiu, City attorney) to keep LHH open. The point of the city lawsuit is that the loss of recertification is arbitrary. However, at this time, forced relocations could resume at any time after November 13.
Furthermore, out of about 760 licensed beds, CMS demands a 120 bed cut (to maintain a 2 patient to one bathroom ratio, which is a new requirement as of 2016). The reasoning by CMS is that LHH should be treated like a new facility since it has lost its certification, although the building is less than 15 years old.
What happened at LHH involves incompetence at all levels of government. Shutting or downsizing this safety-net facility given an extreme shortage of Medi-Cal nursing home beds deprives San Franciscans who may needs a bed and just punishes (and may kill many of) the most vulnerable current residents.
San Franciscans are an aging demographic. LHH must remain open with all of its beds and be the best it can be: a high quality public, unionized nursing home with life in its halls from residents, devoted staff and volunteers.
The next hearings that the public can testify at are: Health Commission hearing on Sept 6 at 4 pm, and Full S.F. Board of Supervisors Heating on September 13 at 2 pm.