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What's Happening at Laguna Honda

By Michael Lyon

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 crisis!

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 budget?

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 LHH?

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.