A stone-built building stands backlit against the sun. Words across the top read, Laguna Honda Hospital
Laguna Honda Hospital seen in 1926. Photo courtesy of OpenSFHistory.org

As Laguna Honda Hospital transfers vulnerable patients as far away as San Mateo County — with multiple patients dying soon after the moves — advocates, health care officials and families again urged the city Tuesday to keep the hospital open beyond September. 

That’s the federal government’s deadline for potentially transferring some 700 vulnerable patients out of the 156-year-old institution. As of this week, city data reports that Laguna Honda has relocated 58 patients; 48 of them have been discharged or transferred to other facilities in the past month and and a bit.

Out of the 35 residents transferred to skilled nursing facilities, all but four have been transferred more than 30 miles south, to San Mateo County. The distance puts them further away from their families, and can exacerbate health problems and lead to an earlier death. 

The pair of patients who died just days after being relocated were two of 120 residents who have been greenlit for transfer, said Pat McGinnis, founder of California Advocates for Nursing Home Reform.

Laguna Honda, a geriatric hospital and rehabilitation center, lost federal funding from the Centers of Medicare and Medicaid Services earlier this year as a result of being decertified for not following Covid-19 protocols. Those violations included not properly washing hands and wearing masks, and storing crash carts, which hold life-saving medicine, behind locked doors. There have also been longstanding problems regarding residents smuggling in and using drugs in the facility. 

Even if the city manages to save the flagging hospital, it’ll become smaller. The Centers of Medicare and Medicaid announced it will cut 120 beds from the facility.

“San Franciscans must make an outcry that Laguna Honda stays open for all of us who may need a bed someday and demand that the feds, state and city accomplish this,” said Dr. Teresa Palmer, a geriatrician who worked at Laguna Honda from 1989 to 2004.

The Centers of Medicare and Medicaid Services “should extend the funding beyond September. They can easily do that,” said McGinnis, during a zoom meeting Tuesday night that was put together by the Gray Panthers.

Laguna Honda “should stay open, and residents’ rights need to be honored,” said Palmer. 

Advocates say shutting down the facility on the federal timeline is impossible.

Moreover, they would like to see the city government more focused on getting residents the housing and care they need.

McGinnis, along with other advocates at the meeting, said regulators were extremely strict in their evaluations of smaller, nonprofit care facilities. McGinnis said some patients are being sent to inferior facilities over infractions that can be “easily corrected.” 

“People would be better off at Laguna Hospital than at the other facilities,” she said.

Problems began at Laguna Honda in 2004, when the city moved patients from San Francisco General Hospital into the hospital for the elderly, as part of the Department of Public Health’s Flow project. Those new patients were younger, and many had substance abuse or mental health issues. In short, a nursing facility set aside for older and frail patients became a crisis center. 

That change happened despite voters approving a $299 million bond to “save” Laguna Honda in 1999, which was sold as a means of building a 1,200-bed geriatric facility. Instead, the city funneled in younger patients, who were often mentally ill and drug-addicted, into a facility that is slated to soon have only 649 beds.

Laguna Honda Hospital “is not a mental health or behavioral facility,” notes Palmer. “If Laguna continues using the Flow project no matter what happens, we will be in the same position soon.”

In the meantime, Laketha Pierce, an organizer for the Coalition on Homelessness, wants to make sure the move is comfortable for people who aren’t being transferred to facilities, but to homeless shelters. So far, 13 residents have been discharged to medical respites or navigation centers, which don’t have much medical assistance for patients.

This leaves younger patients at crossroads: Be discharged to a shelter where you won’t get your needs taken care of, or be on the streets.

“I just want housing for all,” Pierce said, “Nursing homes being closed just put more people on the street.”

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Intern Reporter. William moved to the Bay Area from Nashville to pursue a Masters in Journalism from UC Berkeley. He's covered police reform in Oakland and also investigates correctional officer misconduct at the Investigative Reporting Program. You'll mostly see him behind a camera. Follow him on Twitter @WilliamJenk_

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  1. Well, this predicament is the result of Reagan’s closing state mental health facilities and foisting that onto individual areas.

  2. Dr. Palmer is completely correct. Former state surveyor and LHH employee here. Residents or thier RPs should refuse discharge imo, citing inappropriate discharge. Put the facility into receivership, anything to keep them open. I still don’t know why SFSD are IP there if they are unwilling to assist in contraband searches etc. to keep the community safe. The milieu of the facility’s population must change, contrary to a local supervisor’s opinion. Behavioral health patients should be cohorted more appropriately from the vulnerable, or transferred to Psychiatric LTCs-not that they abound. To put it simply, you don’t introduce Siamese fighting fish into the same tank with Angel Fish, Zebra Fish, etc.

  3. This is just another sad version of the reality that society doesn’t know what should be done about people whose behavior isn’t criminal but is outside the range of what’s acceptable. In the recent past, inclusivity and tolerance were considered fundamental values. So as long as a person is part of a social group that accepts their behavior, there’s no problem. So to minimize conflicts between incompatible social groups, they were kept separated, But demographics have changed, the separations have vanished, and conflicts have resulted. I don’t know what social group LHH should serve. But that question has to be settled for it to continue as a institution.

  4. Why wasn’t conservatorship for the Laguna Honda facility considered? Conservatorship management is an option that CMS (the federal regulatory agency for Medicare and Medicaid) can use, if the state pushes for this option. The state is awash in surplus budget monies and California could afford to pay a management team to take over LHH, bring it into compliance, and pressure San Francisco for the funding the facility needs to hire and train more staff to care for an incredibly challenging population. Instead, SF appears to have capitulated to the feds, instead of advocating for a solution that will keep Laguna Honda fully open.

    Many of the residents of this facility have been homeless for years, some for decades, some have substance abuse problems, and a sizable number have behavioral disorders or behaviors that are challenging to manage, along with physical illnesses and conditions that are also care intensive. The facility has never had enough security to manage this population nor has it been staffed with enough workers trained in behavioral management. As well, Medicare’s regulations simply do not allow for caring for people with such complex needs. These failures will result in more deaths and in more failures at Laguna Honda, unless San Franciscans fund it and defend it.

  5. Thanks for reporting on this, what a horrible situation for everyone

    I’d very much like Mission Local to take this on as a well, mission, and pin everyone in the City, State and Fed on this, from Mayor Breed, to Newsom, Pelosi, Padilla and Feinstein, Becerra and Harris.