About Us

Contact Us


The following is from the upcoming issue of the SF Gray Panthers Newsletter:

Dangers to Long Term Care in SF

By Michael Lyon

On March 15, the SF Health Commission heard that 1999’s $299 million Prop A bond issue to rebuild Laguna Honda Hospital at its current 1,200 beds will build only 360 beds. More beds could follow more funding. The commission ordered a new white paper, not only on SF’s future needs for nursing home beds, but also on more basic questions like, “Should the City be in the long term care business at all.”

DPH’s 1999 white paper had predicted 92,000 more over-65 SF residents by 2020, requiring 1,300 to 2,400 more nursing home beds, assuming LHH were rebuilt at 1,200 beds and no other beds were lost. Two hundred beds have been since converted to ambulatory care beds. The lower estimate assumed a serious campaign to find alternative care, as occurred in Oregon.

Our real nursing home needs are extremely controversial, and very difficult to assess. Insufficient funding for home and community-based care (e.g. the IHSS crisis) makes it hard to know what can be done in these areas. U.S. usage is down, but it is extremely uneven, and difficult to attribute to more and better alternatives, or high costs of nursing homes coupled with a decrease in Medicaid-eligible beds.

UCSF’s nursing home expert Charlene Harrington says nobody has a good answer on how many nursing home beds should exist. She believes that 300 beds at LHH could be sufficient for people needing nursing home care, if sufficient community resources were available, particularly for mentally ill aged people. If this is true, let DPH develop the alternatives before cutting LHH beds. (LHH has done nothing to implement Mayor Newsom’s recent order to re-prioritize elderly and frail admissions.)

Given the U.S. push to cut long term care out of Medicaid and Newsom’s corporate agenda of reducing and privatizing City services, the LHH news must be seen as a very bad for all City health services. But why can’t we get an honest assessment of our real long term care needs?


To put these remarks in more context, here are the comments of San Francisco's long term care ombudsman, testifying at a Board of Supervisor's hearing on February 28:

Benson Naddell Testimony to SF Supervisors’ Government Audit and Oversight Committee, Feb. 28, 2005

I’ve directed the long term care ombudsman program in San Francisco since 1986. The ombudsman takes complaints from all long term care facilities, not just LHH. That includes assisted living, and board and care homes also.

Semantics clarification: all nursing homes are “skilled nursing facilities,” which provide long term care as well as rehab. So it’s deceptive to talk of “a shift from long term care to skilled nursing facility care.”

For context in discussing placements and available beds:

There are presently 1,214 available beds for MediCal patients at LHH.

Out of 20 private nursing homes in SF, only 11 accept MediCal patients, providing 1,442 MediCal beds. This gives a total of 2,657 total MediCal beds in the City. This is the telling figure when considering present and future policy, considering the aging population and the demographic cohort of old-old (over 85).

Since 1992, SF has lost 300 potential MediCal beds, due to nursing home closures or conversions (to assisted living facilities).

For board and care homes, since 1987 San Francisco has lost 119 board and care home beds (assisted living beds).

There has been a total loss of 950 beds, all of which were available for low- and moderate-income residents. They were also called SSI homes.

Since 1992, there’s been a 1,693 bed increase in assisted living beds. This is the only growth sector in long term care beds in the City, but the monthly rate averages $4,000, with additional charges for care in a kind of graduated fee structure.

There are no affordable alternatives to nursing home beds and we’ve lost MediCal beds in SF.

I’ve been on the Discharge Planning Task Force, where we’re looking at difficulties with safe discharges from acute care hospitals into the community and into nursing homes. Placement of patients from hospitals has never been adequately monitored. I suggest that in addition to the long term care Planning Council, that some other group monitor discharges, not just the services offered, but actually overseeing the system.

The recent LHH consolidation and the recent admission policy (giving San Francisco General patients priority), which is now reversed, and the administrative integration (of LHH and SFGH) have sought to convert LHH into a more short term stay facility. There is a pilot program meagerly funded to turn one ward to a social rehabilitation facility emphasizing self-care skill training. This pilot, once tested, will turn 40 wards into a similar paradigm. This is not a good idea.

Instead, they need hybrid thinking that combines long term care with rehab, and the admissions policy needs to reflect this hybrid approach, one that is open to all SF, not just SFGH.

There has been talk of eliminating the silo of LHH to lower the barrier to patients from SFGH in discussion in the Health Commission. LHH is a regulated silo under state and federal regulations for nursing homes certified to bill Medicare and Medi-Cal. Since the silo talk has occurred, there’s been a shift away from these regulations.

Long term care is about caring, in terms of continuous relationships between caregivers and patients. We need to say that LHH is a nursing home, it is for long term care, and it is not part of SFGH.


For more on Laguna Honda, listen to KPFA’s morning show of March 22.