Guest Commentary
Catholic San Francisco
Northern California’s Weekly Catholic Newspaper
October 27, 2006

City responsible for broken promises at Laguna Honda Hospital
by Sister Miriam Walsh

Planning to rebuild Laguna Honda Hospital and Rehabilitation Center (LHH) began in 1980. After 19 years of studies, community debates, and development of an Institutional Master Plan and a four-volume Facility Master Plan that received approval of the Department of Public Health and the Planning Department, San Francisco voters in 1999 were asked to authorize a bond measure for LHH to be rebuilt as a healthcare facility. Seventy-three percent of voters approved the $299 million bond measure to rebuild LHH to safely care for poor, elderly, and physically disabled San Franciscans. The bonds were for healthcare, not housing.

Now 26 years into the LHH planning process and seven years after voters were led to believe that LHH would be built with 1,200 skilled nursing beds plus an additional 140 “assisted living” beds, construction is underway on four of the five buildings project architects were paid $30 million to design in the intervening seven years. But the fifth building, designed to contain 420 skilled nursing beds, may be scrapped entirely.

Unexpectedly, just three months after the defeat of Prop. D — a June 2006 ballot measure to preserve the safety of LHH’s skilled nursing care for elderly and disabled San Franciscans — a new plan has suddenly emerged to spend $562,800 to study and develop a “Senior Housing Plan” for the LHH campus, possibly including fully-independent senior housing apartments. The “study” does not fund architectural fees that will be required to design actual housing, only conceptual schematics. Consultants with experience in integrating senior housing projects with commercial and retail projects have suddenly been hired to help design a new plan for housing on the LHH campus. Will commercial and retail uses replace skilled nursing care at LHH?

Although San Francisco desperately needs housing projects of all types, the crisis of an insufficient number of skilled nursing beds, particularly for medically indigent San Franciscans relying on Medi-Cal, is even more desperate. The Health Department eight years ago projected the City would be short 2,380 skilled beds by the year 2020 even if all 1,200 beds at LHH were rebuilt. Between a disputed number of beds that accept Medi-Cal patients and current proposals to eliminate 420 of LHH's skilled nursing beds by not constructing the fifth building, the City may end up more than 3,700 skilled nursing beds short by 2020.

The City’s long-term care ombudsman has said that between 1992 and 2004, a total of 1,693 new assisted living units were built, most out of the reach of Medi-Cal patients. Since 2005, many more assisted living and supportive housing beds have also been built. So why are we cutting skilled nursing beds at LHH to build even more senior housing apartments?

Meanwhile, senior and disabled San Franciscans are being shipped to out-of-county nursing facilities away from their homes and families, and City officials are now authoring documents describing the LHH replacement project as building housing and only secondarily as building a healthcare facility. We may end up with fully independent senior apartments and retail establishments at LHH, sacrificing sorely needed skilled nursing beds. That’s not what voters were promised in 1999.

We must not abandon senior and disabled San Franciscans. Selling us LHH as a safety-net for “Old Friends,” then changing LHH's mission from a medical model to a new so-called “social-residential” model for housing, is another injustice. Until the City builds LHH’s 1,200 skilled nursing beds as promised, and until we are absolutely certain that City officials will use bond financing on what we vote for, voters should reject future bond measures. If the City really wants the school bond measure passed this fall, and the San Francisco General Hospital bond measure passed in 2008, they’ll deliver on their 1999 promises for use of the Laguna Honda bond measure first. After all, a first promise actually kept helps make subsequent promises believable.

Sister Miriam Walsh, Mission Helpers of the Sacred Heart, has been Laguna Honda Pastoral Care Director for 25 years.