What's Happening at Laguna Honda
Laguna Honda Hospital is in danger of being both
downsized, and changed from a nursing home for the elderly and frail into
a "social rehabilitation facility for the urban poor," in the words of
Director of Public Health Mitch Katz.
In 1999, voters approved Prop A, a $299 million bond
measure to rebuild LHH at its present capacity of 1,200 beds; the
remainder of funding comes from the tobacco settlement fund. The current
estimated cost for the full replacement facility is $50 million over the
initial estimate, but the Mayor's Office is determined not to exceed the
initial budget, even if it means cutting 300-400 beds. For Director Katz,
reducing the size is apparently preferable to funding all 1,200 beds.
In addition, the Health Department has begun the
process of changing LHH's mission so that a large proportion of patients
will become people who are mentally ill or homeless. These populations
desperately need help, largely because of service cuts the city has
already made (and will continue to make), but this help should not be at
the expense of nursing home services for our senior citizens and others
needing skilled nursing care.
By 2020, the city is expected to have 92,000 more
residents over age 65. According to DPH's own data, even if all 1,200 of
LHH's beds were in the replacement facility, as voters were promised in
1999, and even if a huge effort were undertaken to find and fund
alternative modes of care, such as community-based or home-based care,
there will still be a shortage of 1,288 Skilled Nursing Facility beds.
Without an effort to find alternative care, by 2020 there will be a
shortage of 2,380 beds.
In the last decade, 200 private sector SNF beds were
lost to conversion to more profitable Ambulatory Care beds. And the city
has not even begun planning for the 3,400 developmentally disabled
patients who will come to the city when Agnews and Sonoma State hospitals
close in 2007 and 2008. Now the city is threatening to cut hundreds of SNF
beds for San Francisco's frail elderly, exacerbating the long-term care
The Health Department claims it is expanding the
mission of Laguna Honda to care for new vulnerable populations, but this
is a poor excuse. If the city were truly concerned about seniors, the
mentally ill, and homeless people:
Why did the Mayor try to cut neighborhood Mental
Health Centers and reduce psychiatric beds at SF General Hospital in the
Why has the city cut shelter beds for homeless
who are not on the city 's General Assistance program?
Why is the city already forcing Laguna Honda to
accept behaviorally disturbed patients from San Francisco General simply
to reduce costs, in spite of assaults on LHH patients and staff?
Why did the Health Department try to close the
Mental Health Rehabilitation Facility (MHRF), leading to a
reconfiguration, and the eventual loss, of 100 skilled nursing beds for
disturbed psychiatric patients, the very patients now being forced into
Everyone agrees we need more community-based and
home-based care, and care for the frail elderly, the mentally ill, and
homeless people. But the need for SNF beds is projected to reach an acute
crisis by 2020.
All vulnerable populations in San Francisco deserve
services. The goal should be to fully fund, by increasing the total size
of the funding "pie," and build both the 1,200 Skilled Nursing Facility
beds at Laguna Honda and a complete continuum of assisted living,
supportive housing, and other alternate care in community-based settings.
Pitting healthcare services for one segment of the community against
another is suicidal. Let us work together to make the city find the
resources to increase the spectrum of options available — including SNF
beds — for all San Franciscans.
Michael Lyon edits the newsletter of the
Coalition to Save Public Health-San Francisco.