Black Seniors and Disabled To Be Particularly Hit By City Policies on Laguna Honda Hospital

San Francisco has a severe shortage of nursing home beds that accept Medi-Cal, yet the City is planning to reduce the number of nursing home beds when Laguna Honda Hospital is rebuilt. Read the SF Gray Panther position on Laguna Honda Hospital.

San Francisco BayView, Wednesday May 2, 2007

African American displacement looms at Laguna Honda Hospital

by Patrick Monette-Shaw

Town hall meeting on Laguna Honda Hospital
Thursday, May 10, 7 PM
Forest Hills Church, Laguna Honda Blvd & Clarendon, SF

Laguna Honda Hospital (LHH) has provided nursing care to San Francisco’s African American community for decades. Drastic changes are underway. On May 10, a community-organized town hall meeting is scheduled to discuss which patient populations will be the new residents of the replacement hospital under construction.

Voters passed Prop A in 1999 to authorize re-building 1,200 skilled nursing, and 140 assisted living, beds for the elderly and people with disabilities, not to build housing for the homeless or people with primarily psychiatric diagnoses.

Although San Francisco’s Black population plummeted from 13.4 percent in 1970 to just 6.5 percent in 2005, African Americans account for 25 percent of the patients at LHH. A report provided to Supervisor Sean Elsbernd shows with a “snapshot” on March 31 in each of the last three years that 25 percent of LHH’s residents are Black. However, the April 19 report shows that between Jan. 1 and March 31 of this year, that figure jumped to 32 percent. Nearly 95 percent of LHH’s residents rely on Medi-Cal for payment.

While the Department of Public Health’s director of placement has told a Health Commission subcommittee she’ll study why LHH has a disproportionate mix of Black patients relative to City demographics, answers are painfully clear.

LHH has been a central part of San Francisco’s African American family, in part because many elderly and disabled Black residents have few options, given access-to-healthcare disparities. LHH is one of few nursing facilities accepting Medi-Cal patients and also the only facility accepting patients with diabetes or morbid obesity, known as bariatric patients. Other facilities won’t accept Medi-Cal or bariatric patients needing long-term care.

This is due, in part, to the City’s failure to build alternative facilities and in part to the loss of healthcare beds throughout the City. Between 1992 and 2005, 300 Medi-Cal beds were lost due to nursing home closures. Currently, another 120 nursing beds are closing.

Between 1987 and 2005, the City also lost 951 board-and-care beds, some operated by African American families forced to relocate outside of San Francisco due to the City’s economic policies. It’s unknown how many additional skilled nursing and board-and-care beds were lost since 2005. These closures increase the need for LHH’s full rebuild.

Although over 1,700 “assisted living” beds were built since 1992, average monthly fees are $4,000 for “rent” alone, with additional fees for healthcare services. It’s unreasonable to believe Medi-Cal clients can afford these fees.

Seniors and people with disabilities needing skilled nursing at LHH are being displaced to out-of-county facilities to create transitional beds for the homeless at LHH. Mayor Newsom’s administration has authorized only 780 of LHH’s planned 1,200-beds for construction. A decision to authorize re-building the additional 420 beds has been stalled for two years.
Neither Supervisor Sophie Maxwell, representing Bayview Hunters Point, nor Supervisor Ross Mirkarimi, representing the Fillmore, have held City Hall hearings to ensure LHH’s full rebuild for their Black constituents. Without LHH’s full rebuild, loss of access may drive more Black San Franciscans out of the City.

If one-third of LHH’s beds are eliminated, many of the hospital’s Black residents will be displaced. Of the 780 approved skilled nursing beds, 210 have been allocated for core populations, leaving 570 beds for LHH’s current dementia, chronic care/ high support (“total care”), and complex medical/ co-morbidity patients, among others. Over 900 residents can’t be squeezed into only 570 beds.

Additional “assisted living” beds for elderly and disabled people needing assistance with activities of daily living planned for LHH may be changed to “supportive housing,” a national model providing permanent housing with social services for homeless people over 18 years old.

Edna James, OMI Community Action Organization’s president, recently presented an update on the African American Community Partnership to the Mayor’s Long-Term Care Coordinating Council regarding disparities in access to healthcare and experiences of elderly and disabled African Americans. I asked her to investigate the impact of the loss of LHH’s beds on San Francisco’s Black community.

Our town hall meeting on Thursday, May 10, is scheduled for 7 p.m. at the Forest Hills Christian Church located at 250 Laguna Honda Boulevard, at Clarendon Avenue; parking is available. Speakers from LHH, local politicians and San Francisco neighbors will discuss concerns regarding who will be the new residents served at LHH.

Patrick Monette-Shaw is a patient and healthcare accountability advocate. He can be reached at


1 Response to “Black Seniors and Disabled To Be Particularly Hit By City Policies on Laguna Honda Hospital”

  1. 1 mlyon01 May 6, 2007 at 1:01 am

    The SF Health Department wants to use Laguna Honda Hospital to care for psychiatric patients from SF General Hospital whose state funding has run out, because Laguna Honda care is much less expensive than SF General care. As a Health Commissioner said “It’s time to get out of the nursing home business.” But as the article above shows, there is a shortage of nursing beds accepting Medi-Cal, so working class seniors and disabled people are being shipped out of county, away from family and friends.

    Efforts to keep Laguna Honda as a nursing home have been characterized as discriminating against people with mental illness. The following letter explains why this charge is false, and how the Health Department itself is responsible for the dire situation of people in San Francisco with mental illness.

    = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =

    Alicia Hopper
    San Francisco Mental Health Association

    Dear Alicia Hopper,

    There may be things you can say about Proposition D that are objectionable, but I think it is really missing the boat to say that it discriminates against people with mental illness.

    First, I’m sure you must realize that Prop D sets no more restrictions on admission to Laguna Honda than already exist by its license as a Skilled Nursing Facility. Medical Skilled Nursing Facilities are licensed to only take patients whose primary diagnosis is medical, that is needing 24/7 nursing care and periodic doctors visits. By its license, Laguna Honda can, and does, take patients with mental illness (including Alzheimer’s and other dementia), but their mental illness must be secondary to a medical diagnosis. Prop D does not change the legal requirements for admission, but adds a backup or additional enforcement mechanism, in case existing legal requirements for admission are being violated, as is the case now.

    But more important, your saying that any way of reserving Laguna Honda for elders and disabled is discriminating against the mentally ill is like swallowing an elephant and then choking on a flea. For years, the City has cut mental health and substance abuse treatment. There was the attempt to cut one quarter of the acute psych beds at SF General. There were years of cuts to various modalities of mental health day care and outpatient treatment. Every budget year there were attempted and actual closures of mental health centers. There were cuts to Jail Health services. There was the elimination of all substance abuse treatment except for Methadone. “And most importantly for this discussion, there was the Mental Health Rehab Facility: first the attempt to farm it out to a non-union private company paying staff half of county wages, then its opening with fewer and less trained staff, then the attempt to close it completely, then its conversion to half locked facility and half board and care with limited oversight and no psychiatric rehabilitation. It is the City’s ongoing closure and reduction in services for people with mentally illness and substance abuse that got us into the situation that Prop D is trying to correct: the build-up of large numbers of mentally ill and substance abuse patients with nowhere to go. So who’s discriminating: advocates for nursing home beds for elders and disabled, or the City?

    The City is trying to get two vastly underserved populations, elderly/disabled and mentally ill/substance abusers fighting each other, instead of supporting each other’s demands for the services we both need and deserve, and this “discrimination” rhetoric is the way the City is trying to trick us into doing it. Look at who’s financially supporting the “discrimination” rhetoric: the Committee on Jobs and the Chamber of Commerce. These are the very forces that pushed for these service cuts so they could save on their taxes. This is the group that sued the City to recover $100 million in back business taxes and stop payment of $25 million per year of current business taxes. This is who pushed Care Not Cash to deprive thousands of homeless, many mentally ill, of their General Assistance checks, while offering only one person housing for every three whose GA check was taken away. These are the people who set up special police districts for downtown shopping areas to harass the homeless, who were on the streets because of cuts in service. Business wants to cram elders and disabled and mentally ill and substance abusers into an area that’s only big enough for elders/disabled, and yet we’re arguing over whether there’s discrimination. Business in San Francisco must be laughing up their sleeves at these developments.

    Part of SEIU’s argument against Prop D has been that all but a few hundred Laguna Honda beds would be eliminated if Laguna Honda were only for elderly and disabled patients. Apparently, DPH plans to fill the rest of LHH beds with mentally ill patients. Is the Mental Health Association in agreement with this plan? Is the SF Mental Health Association doing mentally ill people a service for advocating they be treated at Laguna Honda? Even if the staff is given crash retraining to serve mentally ill patients, is the physical setup of the rebuilt Laguna Honda suitable for the new patients? Three hundred of the new beds would be lockable, but where are the observation rooms, the seclusion rooms? And what about DPH’s plan to integrate SF General’s and Laguna Honda’s medical and administrative staffs, a process already under way? Isn’t that going to accelerate SF General’s practice of transferring out mentally ill people not when they’re ready, but when their state money runs out. That’s the immediate cause of how we got where we are.

    Whether Prop D passes or fails, many of these problems are going to continue. Elderly and disabled are going to continue to need badly under-funded home and community-based care so they won’t have to enter Laguna Honda’s skilled nursing facility before they need it. Mentally ill, substance abusers, and others with behavioral problems are going to continue being seen by business and the City as an unsightly problem that needs to be swept from the streets and put away as cheaply as possible. We’re all considered unproductive and disposable members of society. We are going to need each other, but casting an effort to save skilled nursing care for elders and disabled as discrimination isn’t a hopeful sign. Please, let’s talk reality instead of repeating the slogans of our malefactors.

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