On December 12, 2003, a federal court approved settlement of a class action law suit, Davis, et al. v. CHHSA, et al., (Case No. C00-2532-SBA) which alleged violations of the Americans with Disabilities Act.  The settlement agreement between the Plaintifs (seven Laguna Hona Hospital residents and the Independent Living Resource Center–San Francisco) and the City and County of San Francisco, created a “Targeted Case Management” program to assess whether residents of Laguna Honda Hospital could be served in community-based settings. One of the co-counsels who assisted with filing the Davis lawsuit is Protection & Advocacy, Inc. (PAI), a non-profit agency with responsibility for providing advocacy services.

The Davis settlement stipulated that by March 29, 2004 San Francisco would implement a Targeted Case Management Program within San Francisco’s Department of Public Health to conduct screening, assessments, service/discharge planning, and ongoing case management. Using a tool that it had developed (but which is not validated for using in nursing homes), the Targeted Case Management program estimated that 80% of Laguna Honda’s patients could live in the community. The TCM’s claim found its way into other public documents in San Francisco, although some staff at Laguna Honda have asserted TCM’s 80% estimate is wildly inaccurate.

In a separate lawsuit — the so-called Chambers† case — filed by PAI as one of the co-counsels, PAI has asserted that “According to TCM assessments, the vast majority of the over 1,000 Laguna Honda residents could live at home or in the community if housing and appropriate services were provided to them.”  One of the attachments to the Davis settlement agreement is not posted on PAI’s web site. It is data from the “Minimum Data Set – Home Care (MDS-HC),” which is based on another assessment tool that has also not been validated for use in nursing homes.  PAI surely must be aware of the MDS data that disproves TCM’s flawed data.

The MDS system reports clinical “quality measures” data to the federal Centers for Medicare and Medicaid Services (CMS) during a resident’s stay in a skilled nursing facility. The MDS data is also analyzed by researchers at the University of Wisconsin–Madison at the Center for Health Systems Research and Analysis, in reports known as CHSRA, named after the Center.  CHSRA reports compare data for a given facility against state and national averages for a variety of data points, including such things as the prevalence of falls, high risk residents with pressure ulcers, and residents who are physically restrained, among other quality measures.

In response to a public records request, Laguna Honda Hospital has released a CHSRA data analysis for Fiscal Year July 1, 2006 through June 30, 2007 that shows fully 73% of Laguna Honda’s residents have no potential for discharge to the community.  As well, during a comparable period, CHSRA data for the comparison groups document that 54% of residents in other California nursing homes have no discharge potential, and the national average of those with no discharge potential is 63%, demonstrating that residents of Laguna Honda have a statistically-significant higher prevalence of no discharge potential.  In contrast, while the state and national averages for those with discharge potential within either 30 days or 30–90 days stood at approximately 20% and 18%, respectively, residents of Laguna Honda who had an identified discharge potential of less than 30 days or between 30 and 90 days fluctuated between 4.5% and 5.9% during FY 06–07, roughly three to five times lower than state and national averages.  (Residents with uncertain discharge potential at LHH ranged from 20.6% to 21.8%, while state and national averages for those with uncertain discharge potential were approximatly 25% and 18%, respectively.)

The CHSRA data is an antidote to the misinformation that 80% of Laguna Honda’s resdients could be served in the community.  The MDS and CHSRA data clearly illustrate that the TCM’s assertion that 80% of Laguna Honda’s residents, and PAI’s allegation that “the vast majority” of Laguna Honda’s residents, could live in the community, are wildly incorrect.

Both the federal Courts and San Francisco’s public policy makers should ignore TCM’s and PAI’s exaggerated claims, and the Courts and San Francisco officials should pay closer attention to verifiable MDS and CHSRA data provided to CMS.

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† Mark Chambers, Woodrow Falls, Jr., M.H., Phillip K., Gerald Scott, Mary T. and the Independent Living Resource Center of San Francisco, et al., Plaintiffs, vs. City and County of San Francisco, Defendant, Case No. C06-06346 WHA.

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