Op Ed                                       Return to “News Stories about LHH and SFGH“ Index
Westside Observer
March 2009, at www.westsideobserver.com

War on Laguna Honda Seniors Heats Up
by Patrick Monette-Shaw

Although voters approved a 1999 bond measure to rebuild Laguna Honda Hospital (LHH) to care for elderly and disabled San Franciscans needing long-term skilled nursing care, a sudden plan to convert it from a “medical model of care” to a “social-health model of care” is advancing rapidly - less than a year before the replacement facility is scheduled to open. The design and construction has been underway for over six years. A May 23, 2008 side letter to the Department of Justices ettlement agreement stated that the “City shall introduce as much flexibility as possible into existing and ongoing construction efforts at Laguna Honda Hospital so as to maximize adaptability of use from skilled nursing facility services to other integrated services going forward.”

The sudden removal in January 2009 of LHH’s Medical Director, Paul Isakson, MD, and Assistant Medical Director, Tim Skovrinski, MD, may be related to upcoming changes to that model of care. Staff at the hospitial have asserted privately that Skovrinski was removed because he expressed concerns about the “vision” of implementing a “social-health” model of care and was viewed as not being “aligned” with LHH’s future “mission.”

For a number of years, the Mayor’s Long-Term Care Coordinating Council (LTCCC) has been aggressively involved in micromanaging the facility. Their “Living With Dignity Strategic Plan” was distributed in November 2008, including a membership roster that showed Isakson was replaced as a member by John Kanaley, Laguna Honda’s Executive Administrator. Kanaley was present during the October, November, December, and January meetings of the Council, suggesting Isakson’s removal had been long considered.

Kanaley’s official January report to two Health Commissioners - and LHH’s January newsletter, The Grapevine, distributed externally - indicated Isakson took an extended leave and wasn’t expected to return, and Skovrinski’s position had been eliminated. These two documents report a nationwide search is underway to hire a new Medical Director, presumably someone who will support the “social-health” care model change.

Many staff believe unofficial, not official, reports of what transpired. A recent “communications audit” revealed that even senior administrators believe “official channels” of communication are the least reliable and the least believable, and that some administrators apparently disagree with LHH’s change in model of care.

The Mayor’s Council has significant political clout at City Hall, since its members are appointed by the Mayor (except eight, who are employees in various City departments). To skirt the City’s Sunshine laws, the group pretends it is a “passive meeting body,” not a formal “policy body,” while, in fact, it develops policies regarding San Francisco’s long-term care continuum of services, and aggressively pushes its policy recommendations on the Mayor, Board of Supervisors, and several City departments.

At the Council’s December 2008 meeting, a draft of priority objectives was discussed for its “Living With Dignity Strategic Plan,” a policy document developed by the Human Services Agency and staff members in the Department of Aging and Adult Services and the Department of Public Health. This document guides programming by those agencies, and is used to develop the City’s budget.

Priority objective 1E asserts that the Council will “Participate in advocacy efforts to move Laguna Honda Hospital from a medical model to an inter-disciplinary social-health model of care, based on a philosophy of community re-integration, choice, providing rehabilitation services, chronic care, dementia care, and end of life care.” This may sound very worthwhile to untrained consumers of bureaucratic gobbledygook, but to advocates for senior care at Laguna Honda, it indicates an extreme shift in scarce resources away from the promises made during the campaign for the $299 million bond financing to rebuild LHH “for our seniors and disabled.” Critics of the program fear that the plan will move San Francisco’s most vulnerable population to out-of-county “senior mills” to make room for less-expensive drug treatment and mental maintenance programs. [One irony is that LHH has utilized Interdisciplinary Teams for over a decade.]

The City capitulated in its “friendly” (read uncontested) Chambers settlement agreement, and the separate U.S. Department of Justice settlement agreement, to increase mental health and substance abuse services to prepare and enable residents to be discharged to the community. Both settlement agreements indicated the City will provide a “continuum of care” model at LHH to focus on options that will enable individuals to age in place outside of hospital, even if they need long-term, skilled nursing care, and even though there is no plan to raise funds to move the patients into their own apartments outside the facility. A May 23, 2008 side letter to the Department of Justices ettlement agreement stated that the “City shall introduce as much flexibility as possible into existing and ongoing construction efforts at Laguna Honda Hospital so as to maximize adaptability of use from skilled nursing facility services to other integrated services going forward.” I guess that means it will be converted to a “social-health” model of care, just before its replacement facility opens.

A consultant recently hired to interview senior hospital staff reportedly expressed shock that LHH’s staff have not been openly informed about plans to convert to a “social-health” model of care.

The LTCCC will be aggressively pursuing the conversion from a medical model of care to this new “social-health” model of care. How do you tell a patient with advanced Alzheimer’s that they only need “social-health” care, not a medical model of care?

The Council is stepping up its micromanagement at the hospital. On February 2, Margaret Baran, Executive Director of the In-Home Supportive Services Consortium and a member of the Council, submitted a public records request to DPH seeking the hospital’s FY 09-10 Line Item Budget, since City budget decisions are now being made. The Council apparently wants to tweak the hospital’s budget and monitor the conversion to “social-health” programming.

Staff at the City’s Mental Health Rehab Facility (now called the Behavioral Health Center) have already heard unofficially about plans to “integrate” the hospital and the MHRF’s patients. Changes to the patient population to be served in early 2010 in the newly rebuilt replacement facility are still being developed at this late date, but are slowly leaking out to the public.

This isn’t what voters were led to believe in 1999.

Patrick Monette-Shaw

Monette-Shaw, an accountability watchdog, operates www.stopLHHdownsize.com and is a member of the California First Amendment Coalition, an organization protecting and defending the public’s right to know.

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