Laguna Honda Hospital and Rehab Facility is now a fully functioning “five-star facility.” However, the federal government, through the Center for Medicare and Medicaid Services, has refused to allow patients to occupy 120 safe and serviceable bedrooms.
This is happening while in 2024 alone, almost 900 San Francisco residents who need skilled nursing facility care have been sent to hospitals outside the city, where it’s harder for family and friends to maintain connections. The numbers presented to the Health Commission Aug. 18 are a bit funky, since the California Pacific Medical Center reports are limited and inaccurate, but for the past four years, that number is at least 3,614 people sent out of county.
The problem is based on a 2016 regulation for new skilled nursing facilities, which limits rooms to two patients. Laguna Honda, which has 120 three-patient suites with shared bathrooms, has been operating since the late 1800s, and by law should be grandfathered in. It stayed open in 2022 after too many people died when, under CMS pressure to close, evictions were attempted, but Laguna Honda did not and could not close.
Laguna Honda has more than one third of all nursing home beds in San Francisco. Many city SNF beds have been shut; there is a profound shortage of SNF beds in SF
There are 769 SNF beds at Laguna Honda. More than 550 are occupied now, and the remaining empty ones are filling. But with this federal decision, only 649 may be occupied. Others who need to come to Laguna Honda either must take a chance on a facility out of county—many of which are severely understaffed—or wait and hope that they will not get sick and die at a lower-level care facility.
This could lead to an increase in very dangerous scenarios for San Franciscans who are in a low-quality facility or getting inadequate care at home. If you need help to move in bed and keep clean: “Is my infected bedsore sending me into septic shock yet?” If you have severe memory problems and like to walk: “How far south can I walk on freeway 101 at 3am without getting hit?” (These are real life scenarios taken from my experience as a geriatrician).
The California Department of Public Health is willing to license these 120 beds, and the San Francisco Department of Public Health is willing to provide staff to care for people in those beds. But what our city movers and shakers are unwilling to do is to have a public fight with the current administration over this.
There has been no discussion of litigation; the mayor and the city attorney) refuse consider it. The official reason is that this might not result in success with the current administration; privately, DPH staffers say it’s best to lie low and not anger the Trump Administration, which could cause even more serious harm in this city.
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In the meantime, people who are elderly and/or too disabled to live outside a skilled nursing facility are pushed out of the city’s system of care.
Teresa Palmer, MD, is a geriatrician who has worked at Laguna Honda. An earlier version of this story appeared in the newsletter of the Haight Ashbury Neighborhood Council.
