A proposed Ordinance being vetted by Supervisor Michela Alito-Pier is a trojan horse seeking a “financing grab” of the tobacco settlement revenue (TSR) trust account that had been designated to rebuild all 1,200 beds at Laguna Honda Hospital.

Although the proposed ordinance does not explictly state that the TSR account will be depleted, it does state that funds for a new “Aging and Adult Services Community Living Special Fund” may “be appropriated from any lawful source for this purpose pursuant to Article IV of the City Charter.”  

You can bet if her proposed ordinance is passed, Alioto-Pier’s next fiat will be to introduce a companion piece of legisation to “appropriate” funds from the TSR account intended to rebuild Laguna Honda into her new Community Lliving Fund.   From our perspective, that would be misappropriation of funds promised to voters who passed Prop A in 1999.

And if this ordinance is passed, it virtually guarantees that the 420 beds at Laguna Honda that are “on hold” will never be built, ensuring that Alioto-Pier’s distant relative, Mayor Newsom — who opposed the 1999 ballot measure to rebuild Laguna Honda — will get his way to downsize Laguna Honda in ways voters never imagined in 1999.

Although neither the Health Commission, Mayor, or Board of Supervisors, nor any other policy body, have officially approved the “Option 2” recommendation made by City Controller Ed Harrington in his May 9, 2005 paper “Where Do We Go From Here?” on how to finance the LHH replacement project — in which option he proposed diverting $100 million from the TSR trust fund in order to create a “Community Living Trust Fund” — Supervisor Alioto-Pier’s proposed ordinance is prematurely seeking to misappropriate Laguna Honda Hospital replacement funding from the TSR account to other purposes, instead.

But she is being more nefarious than even Controller Harrington. Her proposed ordinance seeks to also circumvent recommendations made by auditors Harrington had hired from Chicago — Health Management Associates (HMA) — who had recommended that the Department of Public Health hire a long-term care administrator to oversee the provision of long-term care services in community-based settings.

Shockingly, according to the Long-Term Care Coordinating Council (LTCCC), an official policy advisory body to Mayor Newsom, Alioto-Pier is proposing to single-handedly introduce an ordinance to move coordination of long-term care programs out of the realm of the Health Department, and over to the Department of Aging and Adult Services. The LTCCC is hell bent on de-medicalizing long-term care (as if elderly and disabled people have no medical needs whatsoever), because it (wrongly) believes that all elderly and disabled people need are “social supports” in the community.

More shockingly, Alioto-Pier’s proposed “Aging and Adult Services Community Living Special Fund” explicitly removes from Harrington’s proposed title the word “Trust.”  If her ordinance is approved by our misguided Board of Supervisors, oversight and accountability provisions that apply to funds held in “trust” will be removed, and there will be no guarantee that the funds will be entrusted, or spent, for the purposes intended.

In the attached PDF file, neither Alioto-Pier’s proposed ordinance, nor the background paper titled “Working Draft — Community Living Trust Fund” provide for actual medical care in the community, at least not beyond “home health care,” which is insufficient for many people needing 24/7 skilled nursing care.  In the “potential services to be supported” by a Community Living Fund, there is no provision for actual medical care, beyond “transportation to medical appointments” and “linkages to primary and acute care” (linkages means transportation and case management, not actual medical care).

It should be noted that at least one Laguna Honda resident in the “Targeted Case Management” program fired his TCM social worker, because she had neglected to include in his discharge plan explicit information on where and how he would receive medical services in the community if he were discharged from LHH.

And there is nothing in either Alioto-Pier’s proposed ordinance or the list of potential services to be supported describing how residents discharged from Laguna Honda to the community who subsequently decline or fail in the community can be readmitted to Laguna Honda for long-term care, nor whether the Community Living Fund will then permit the Community Living “money to follow the patient back into Laguna Honda.”  This is a big deal to the community-based service providers: They want the “money to follow the client,” but there is no provision in the proposed ordinance regarding whether the Community Living funds will permit that money to follow patients who subsequently need to be admitted to an institutional-based long-term care facility when physical decline necessitates 24/7 skilled nursing care in a nursing home.

Finally, the draft document in the PDF file contains a two-page list of “unresolved questions” regarding services to be provided in the community and funded by the Community Living Fund. Chief among the unresolved questions are questions about whether adequate capacity of services in the community currently exist, or how long it will take for services to become available in the community, given long waiting lists, and non-existent services.

Until the litany of unresolved questions are resolved, it is inappropriate to raid (i.e., misappropriate) the TSR account intended to replace all 1,200 beds at Laguna Honda with a nebulous set of services that have significant unresolved, and deeply problematic, issues.

It is unclear whether Alioto-Pier has already introduced this legislation and whether it is sitting in a B*oard of SUpervisor ssubcommittee under the Board’s 30-day “rules.”

But now is the time to write and call your City Supervisor’s, the Health Commission, and the Mayor.  Tell them that until all 1,200 beds are funded and built at Laguna Honda, the TSR account should not be raided to create a Community Living Fund. And tell them that you will support using any remaining TSR funds for community-based alternatives and programs — but only after Laguna Honda is fully rebuilt as promised to voters who passed Prop A in 1999.   

Remind each of them that the November 2006 elections are quickly approaching, and their chances for re-election hinge on what they do to the fate of Laguna Honda Hospital!  Remind them that LHH may well become a campaign issue in November 2006, and also during the election for Mayor in 2008.

After all, there is only one way to define the word “replacement”:  LHH’s current 1,200 beds need to be fully replaced with 1,200 skilled nursing beds, as we were promised.

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