Are Plans for Assisted Living Housing Units at
Laguna Honda Hospital in Complete Shambles?

Key Players: The Assisted Living Project Planning Workgroup
Flaws in the Glass: An Analysis of the Assisted Living Draft Feasibility Report

Considering that plans to develop senior housing for the Laguna Honda campus appear to be in complete shambles, a reasonable question is whether nearly $700,000 in federal grant funds has been simply thrown down the toilet? How can an advisory workgroup have provided input into the planning process, only to have had a design team develop recommendations the planning workgroup then disavows?


On February 9, 2000, San Francisco’s Director of Public Health, Mitch Katz, submitted a grant application to the U.S. Department of Housing and Urban Development, seeking $750,000 to conduct an assisted living study for the Laguna Honda Hospital campus to ensure “a continuum of services for frail elderly and disabled adults.” Katz’s rationale was that placing “assisted living units on the campus of Laguna Honda will enable the City and County [of San Francisco] to provide additional … housing for the elderly and disabled who require on-site services, but who do not need 24-hour skilled nursing care.”

HUD awarded Dr. Katz a grant a month later on March 28, 2000, but scaled back the award to $693,750, citing the Consolidated Appropriations Act of Fiscal Year 2000, which directed recissions. Reductions of 11.23% were made to various line items Dr. Katz had proposed.

Of the $693,750 grant awarded, the City and County of San Francisco nearly seven years later finally awarded a $562,800 subcontract to Anshen+Allen Architects/Gordon H. Chong & Partners in January 2007 to conduct a “feasibility study” to assess four options for assisted living housing for the Laguna Honda Hospital campus. A timeline presented in September 2006 indicated a draft feasibility report would be released for public comment on March 1, 2007. When the Anshen+Allen Architects/Gordon H. Chong & Partners draft feasibility study was released to the public on August 2, 2007 — five months later than first planned — suddenly five options were presented in the draft feasibility study released to the public.

As an aside, no mention has been made to date about how the $131,000 difference between the HUD grant amount received and the subcontract later awarded to Anshen+Allen Architects/Gordon H. Chong & Partners has been spent.

Of the five options presented in the draft report, one proposes to construct 246 housing units (albeit, to house 251 residents), at a total project cost of $246.7 million, or just shy of $1 million per housing unit.  The so-called “sticker shock” that resulted is, oddly, being attributed in part to the fact that all five options presented involve Residential Care Facilities for the Elderly (RCFE), a venerable and licensed category of housing. Many RCFE projects have been built for far less per unit.  The Assisted Living Project planning workgroup now disavows that it had instructed the design team to develop any, or only, RCFE options.

Despite having budgeted $13,000 for an architectural peer review, noticeably absent from the Draft Feasibility Study are comments from the peer review specialist hired under a subcontract to the project. The firm of Patri-Merker Associates had been hired to provide peer review of the draft recommendations, reportedly, in part, due to Patri-Merker’s experience incorporating retail and commercial projects into senior housing projects. A public records request has revealed that as of August 29, 2007, Patri-Merker had still not submitted its assessment of the assisted living draft feasibility study. The Department of Public Health claims that it expects the peer reviewer’s report will be incorporated into the final assisted living report scheduled to be completed by the end of September.

At two community meetings held on August 15 and August 27 following release of the draft feasibility study, interested community members expressed shock at the proposed costs and a possible recommendation to privatize development of the planned senior housing that started out as a public works project.  Leading up to the June 2006 Proposition D ballot measure regarding Laguna Honda, allies of Mayor Newsom’s administration and the Service Employees International Union shrieked continually that if Prop. D were passed, it would lead to private development on Laguna Honda’s campus. Isn’t it more than a just a little ironic that allies of the Mayor are now proposing to privatize development and construction of the proposed assisted living housing at Laguna Honda?

City officials have now gone back to the drawing board to revise the draft recommendations prior to release of the final report, expected to be completed by the end of September 2007.  Now back to square one, and starting over, has this project flushed $693,750 down the toilet?


Key Players: The Assisted Living Project Planning Workgroup

A steering committee called the Assisted Living Project workgroup was formed to guide the development of the senior housing plan for Laguna Honda's campus. The workgroup met repeatedly between February 2006 and June 11, 2007, when the workgroup appears to have been suddenly disbanded. During its deliberations, the workgroup met with representatives from Anshen+Allen Architects/Gordon H. Chong & Partners to develop parameters to study feasibility of the four planned housing options. It is not known why the workgroup suddenly stopped meeting after June 11, nor is it known why the workgroup was not presented with the draft feasibility report prior to its release on August 2. The Assisted Living Project workgroup included, among other members, these key players (sorted by last name):

Nancy Brundy, Just on Aging
Jaya Chattersee, Service Employees International Union – United Healthcare Worker's-West
Meg Cooch, Planning for Elders
Sue Eisenberg, NBC Development Corporation
Larry Funk, Laguna Honda Hospital Replacement Project
Mary Ruth Gross, Service Employees International Union – United Healthcare Worker's-West
Bill Haskell, San Francisco Department of Aging and Adult Services
Mauro Hernandez, University of California
Marie Jobling, Mayor's Long-Term Care Coordinating Council
John Kanaley, Laguna Honda Hospital and Rehabilitation Center
Joel Lipski, Mayor's Office of Housing
Bensen Nadell, San Francisco Long-Term Care Ombudsman
Liz Orlin, Corporation for Supportive Housing
Anne Romero, Mayor's Office of Housing
Norma Satten, Mayor's Long-Term Care Coordinating Council and Planning for Elders in the Central City Board
Ken Stein, Mayor's Office of Disability
Jean Takauk, Sutter VNA & Hospice, Planning for Elders in the Central City Board
John Thomas, Laguna Honda Hospital Replacement Project
Marc Trotz, Department of Public Health's Office of Housing
Aaron Wagner, Planning for Elders in the Central City

During several of the deliberations of the workgroup, flip charts were used during brainstorming sessions to gather and provide guidance to the design team from the august workgroup members noted above. Were those brainstorming sessions for naught?

During the August 27, 2007 community forum held at the Department of Public Health regarding the draft feasibility study, a member of the public questioned why guidance from the assisted living workgroup resulted in the design team developing five options for an RCFE facility, if that had not been the intent of the workgroup.

Surprisingly, the answer provided was that the workgroup had not explicitly asked that options for an RCFE be developed. So how did the design team decide to provide these recommendations, independent from guidance from the assisted living workgroup?  On August 27, the City acknowledged that some times feasibility studies result in a recommendation that a planned project simply isn’t feasible.

If there was a “communication gap” between the assisted living workgroup members and the design team regarding what options might be feasible to study, does that justify whether 693,750 may have been flushed down the toilet for a study that now is starting all over from scratch, hoping to rapidly develop in a signle month an acceptable and feasible option for assisted living housing at Laguna Honda before the end of September 2007?


Flaws in the Glass: An Analysis of the Assisted Living Draft Feability Report

Lamely, the Draft Feasibility Study notes in its “Final Projections” section on page 102, that:

“The Laguna Honda Assisted Living Facility is still in the preliminary planning stages, and many decisions have not been made regarding the project. The pending decisions include the size of the project, the services that are going to be ordered [to residents], and whether certain services are going to be provided by the facility, or purchased from either Laguna Honda Hospital or an outside vendor.”

The report then states: “Choices made on any of these and other issues can have a significant effect on the costs of the project.” How are members of the public, or key policy makers in San Francisco, supposed to evaluate the costs proposed for this senior housing project without decisions having already been made regarding which services will be offered, to which patient populations, or in what size of a facility?

Three of the five options presented in the Draft Feasibility Study recommend use of land on the Laguna Honda campus that has previously been designated for skilled nursing beds. Notably, neither the Health Commission nor the Board of Supervisors have approved use of the site where the West Residence is planned for anything other than skilled nursing beds, which the City will continue to need when the City will have 10,000 people with Alzheimer's over the age of 85 by the year 2020 just 13 short years from now, many of whom will eventually need skilled nursing care.

The Draft Feasibility Study released on August 2 contains many errors of omission of relevant information and too many flawed assmptions for the public to understand this report. Public comments submitted analyzing the Draft Feasibility Study help clarify the many flaws in the draft report.

Seven-and-a-half years after receiving the HUD grant, can San Francisco officials really not know whether it is feasible to build assisted living housing on the campus of Laguna Honda Hospital to provide a continuum of services for frail elderly and disabled adults? Given that composition of the initial Assisted Living Workgroup included so many of the City’s most prominent senior housing key players, perhaps thought should be given to changing the composition of the planning workgroup. After all, perhaps there are too many competing interests on the workgroup to expect them to be effective.

Additionally, perhaps it might be time to replace the partnership of Anshen+Allen Architects/Gordon H. Chong & Partners by hiring a different design firm. Might another firm be more successful in proposing a feasible senior housing plan for the Laguna Honda campus?



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