— Anonymous LHH Nurse

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Over 73% of voters approved Prop A in 1999 based on assurances by City officials that Laguna Honda Hospital would be rebuilt — not converted to other purposes — to provide elderly and disabled San Franciscans with “long-term care, including skilled nursing, AIDS and dementia services, hospice, rehabilitation, and acute care,” as noted in the voter guide. (Assurances by City officials in the 1999 voter guide are located on the 1999 Prop A Promise page on this web site.)

San Franciscans “put their money where their mouth is,” voting to increase property taxes to preserve Laguna Honda because they believed so strongly in its mission, and to ensure that Laguna Honda is dedicated to San Francisco seniors and disabled people who could not otherwise afford a safe and caring environment.  Many had friends, neighbors or family members who received care at Laguna Honda.  Many had volunteered there, or worked there, or knew someone who did. But even more important than personal connections, San Franciscans voted their hearts, not their pocketbooks.

But just a year after Prop A was passed, the Department of Public Health (DPH) began quietly converting Laguna Honda to other purposes. In 2000, DPH proposed sending psychiatric patients from San Francisco General Hospital (SFGH) to Laguna Honda to ease financial pressures on SFGH’s psychiatry service.  In 2001, DPH converted several wards at Laguna Honda into psychosocial units, displacing elderly and disabled long-term residents.

In 2004, Laguna Honda’s admission policy was changed, eliminating the San Francisco residency requirement for admission, and prioritizing admissions from SFGH above all other hospitals and above admissions from home. This change resulted in the displacement of elderly, frail and disabled San Franciscans needing long-term skilled nursing care, in favor of younger, more alert and able-bodied patients with behavioral problems and reversible medical ailments in need of short-term care.  The two patient populations have been mixed together in Laguna Honda’s open wards.  Also, Laguna Honda’s mission statement was changed so that long-term care is no longer its primary mission.

The changes have led to large increases in:

• Violence against residents and staff. (See State Citations on this website for details of incidents found by state and federal inspectors.)
• Serious citations and financial penalties by Licensing and Certification, the state agency that monitors the care and safety of nursing home residents.  Citations in the February 2006 report related to violence are the worst in Laguna Honda’s history.
• Drug abuse and drug dealing.
• Psychiatric emergencies.
• Residents who went AWOL (absent without official leave).
• Serious citations and fines by Cal-OSHA, the State agency which monitors employee safety
• Younger, mostly male patients with behavioral problems and short-term medical needs displacing elderly and disabled people, mostly females, who have long-term care needs.
• Elderly San Franciscans being sent to nursing homes in other counties.
• Increased turnover of experienced, dedicated staff members.
• Greatly increased security costs and diversion and waste of time, energy and money.

In addition, an arson fire gutted a 30-bed ward in March 2004 that wasn’t reopened until May 2006, reducing the number of beds available for elderly and disabled San Franciscans.  The loss in revenue over the 26-month period this ward was closed was significant.

A loud public outcry from a diverse spectrum of San Franciscans and pro bono litigation forced the Mayor to announce a reversal of the new admissions policy. But the reversal in policy has been incomplete. The latest admission policy took nine months of internal struggle between LHH's Medical Staff and LHH Administration to restore first priority to:

“Persons not in a medical facility, as well as persons who are wards of the Public Guardian or clients of Adult Protective Services, who cannot receive adequate care in the present circumstances.”

After complaints to State Licensing Dr. Katz was removed as having “final authority over admissions decisions to LHH,” and the LHH Executive Administrator was granted that authority in accordance with State law. However, recent experience has shown that the Health Code and the LHH Admission Policy can be subverted by the Health Director at the drop of a hat. The admission policy reversal was half-hearted, not fully implemented, and without Prop D, is likely to be short-lived.

For example, a previous admissions policy reinstatement was later reversed after the litigation was withdrawn. The February 2006 state/federal citations for failing to protect residents against violent incidents and underreporting of incidents, shows that the policy hasn't really changed. Any short-term improvement there may have been was due largely to the pressure from Prop D and its proponents. Prop-D prevents this from happening again.

San Franciscans passed Prop A in 1999 to ensure Laguna Honda would always be available for San Francisco’s seniors and disabled people who need long-term skilled nursing care and who choose to live at Laguna Honda.  But multiple bait-and-switches are occurring that will convert Laguna Honda to uses other than intended and promised.  The bait-and-switch worsened in 2005 when a long-term care ward was converted to short-term “social rehabilitation.”  Details are described in “Seniors Sold Out by Supes,” an editorial posted on the Media Coverage page of this web site.

A similar broken promise occurred when voters approved $26 million in bond financing in 1987 to build the Mental Health Rehabilitation Facility (MHRF), a 147-bed psychiatric sub-acute facility on the grounds of SFGH. Today, the MHRF (now called the San Francisco Behavioral Health Center) contains only 47 psychiatric beds; the remaining beds have been converted to other uses and the facility now operates under three separate licenses. This state-of-the-art psychiatric facility is now largely used for housing, rather than a psychosocial rehabilitation facility, as intended and promised. Were the MHRF restored as designed and intended, the unstable, violent patients - now being inappropriately dumped from SFGH into wards at Laguna Honda with elderly and younger physically disabled residents - would finally have a safe and effective place to be treated and effectively rehabilitated, and a far better chance of resuming productive and satisfying lives outside of institutions.

The promise to voters that the LHH bond financing would be used to rebuild Laguna Honda for frail elderly and disabled San Franciscans is being broken. Health Management Associates (HMA) — outside auditors from Chicago hired by the City Controller — issued a report to the City in July 2005 recommending that LHH be used for “hard-to-place“ patients (read: hard-to-discharge from SFGH).  Had voters been told that the bond financing would be used to create a different type of facility, with a different purpose and a different resident population than presented in 1999, it is unlikely Prop A would have passed.

The HMA consultants also recommended merging Laguna Honda with San Francisco General Hospital under a single license.  This would reverse Laguna Honda’s decades-long distinct status, jeopardize its long-term care mission, and put admissions decisions in the hands of bureaucrats outside of Laguna Honda who lack a commitment to long-term nursing care for frail elderly and physically disabled persons.  Health Commissioners and City officials have voiced support for implementing the take-over of Laguna Honda by SFGH.  Now, plans for the new LHH include 180 to 300 “securable beds“ (read: locked wards) for “hard to place patients” (read: behaviorally disruptive), which were never mentioned to voters in 1999.

San Franciscans for Laguna Honda was formed to advocate for San Franciscans who rely today — and will increasingly rely in coming decades — on Laguna Honda.  Prop D will repair broken promises by creating a Special Use District to protect Laguna Honda’s long-term skilled nursing care, medical specialty programs, and future assisted living units for elderly, frail, and physically disabled San Franciscans.

Most importantly, Prop D will protect Laguna Honda residents, staff, volunteers, and neighbors from violence!