The crisis unfolding at Laguna Honda in part represents the culmination of a years-long decline in public health resources for low-income elders and people with disabilities including those with substance use challenges.
A review of federal inspection reports from Laguna Honda Hospital and Rehabilitation Center reveals a tipping point for many aspects of San Francisco’s public health system.
The most recent safety survey in April found staff members failing to follow protocols around personal protective equipment. Previous findings were more serious. In October 2021, 13 out of 37 sampled residents tested positive for nonprescribed substances. The reports say two of these residents experienced life-threatening emergencies and hospitalization, and two others were reported to have fallen.
The Centers for Medicare & Medicaid Services, which oversees government health care programs, will return to Laguna Honda for follow-up inspections in September and December. At the same time, the hospital must implement a closure plan that involves moving people out in order to sustain federal funding during the recertification process.
“San Francisco is being punished for addressing a need while everyone else has abandoned the field,” Supervisor Rafael Mandelman said at a Board of Supervisors meeting on June 14. “This is some Kafkaesque nonsense.” “The City and county have minimized the infractions to the public, but in fact they are quite serious,” said Teresa Palmer, a geriatrician who worked at Laguna Honda from 1989 to 2005. “By not admitting the real problem, by minimizing it, that doesn’t make for a good prognosis.”
Hospital officials said they are exploring changes to where residents with substance use disorders, mental disabilities and other health needs are located within the facility. At the same time, patient flow into Laguna Honda has evolved greatly in the last 20 years so a growing number of residents now come directly from San Francisco General Hospital. Laguna Honda has become a key destination for the population that has most suffered from the decline in assisted living facilities that take Medi-Cal or Medicaid patients.
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