Op Ed  
Westside Observer
April 2009, at www.westsideobserver.com

Mourning Laguna Honda Hospital’s Changes
by Patrick Monette-Shaw

When my article, “War on Laguna Honda Seniors Heats Up,” appeared in the Observer’s March issue describing changes occurring at Laguna Honda Hospital (LHH), little did anyone suspect the hospital’s Executive Administrator, John Kanaley, would die unexpectedly on March 19 from a heart attack. His sudden demise deeply affected hospital staff. I’m as shocked and saddened as everyone.

LHH hosted a touching, standing-room-only memorial service to honor his four years of service at LHH. Its newsletter, The Grapevine, and speakers at his memorial service, trumpeted Kanaley’s “agent of change” role, touting his “leadership.”

While it’s true Laguna Honda passed its state licensing surveys the past two years in a row on the first visit avoiding a re-inspection, and while it’s true the number of deficiencies found by state inspectors has dropped dramatically, in mid-February Kanaley notified LHH’s medical staff that based on its May 2008 state inspection LHH just received the lowest possible rating on the Five-Star Quality Report issued by the federal Center for Medicare and Medicaid Services (CMS), receiving an overall rating of just one star.

Although by increasing resources Kanaley was able to reduce LHH’s 56 deficiencies received between November 2005 and October 2006 to just 18 deficiencies received between November 2006 and October 2007, the state issued LHH 20 deficiencies between November 2007 and January 2009, a slight increase over the previous inspection. There are nine deficiency categories, including “mistreatment,” “quality of care,” “resident rights,” and “environmental,” among others.

CMS’s rating system focuses on three measures: State health inspections, staffing levels, and quality measures. One star, the lowest-possible rating, represents “much below average”; five stars, the highest, represents “much above average.”

A search of CMS’s Nursing Home Compare web site returns a comparison of 125 nursing homes within a 50-mile radius of LHH (the system returns only 125, even if there are more facilities). Of the 125, there were only 21 including LHH, to its credit, which received the five-star rating for staffing levels, even though LHH’s nurse-to-patient staffing ratio remains below California’s average. Common sense indicates higher staffing levels leads to improved quality measures and favorable health inspections; indeed, low staffing levels typically involve providing substandard care. But 22 of the 125, including LHH, received the lowest one-star rating for the Health Inspections category, and 39 of the 125, including LHH, received one-star ratings for Quality Measures.

Of the 21 facilities that received the five-star rating for staffing, surprisingly 13 received a one-star rating for Quality. Only four of the 21 received a one-star rating for Health Inspections, illustrating a correlation between staffing and inspection performance. Of the 21 that received five stars for Staffing, Laguna Honda was the only facility that received a one-star rating in both Quality and Health Inspections, sinking LHH’s overall rating to just one star. This couldn’t have pleased Kanaley.

Three days before his untimely death, Kanaley answered questions posed by a community member who had inquired about issues raised in my March article. Kanaley attempted to minimize LHH’s change to a “social health” model of care as dealing more with quality-of-life issues - like “providing a more home-like environment, involving patients in activities involving pets, gardens, and children for a more meaningful social life” - rather than the medical model of care focusing on illness and disease treatment.

Kanaley didn’t acknowledge the social health model of care is a nationwide effort to move people out of nursing homes into lower levels of care in “assisted living” and “supportive housing,” driven in part to reduce expenses from the exploding Baby Boomer population expected to overwhelm Medicare and Medicaid. Instead, Kanaley informed the community member he “wished I knew what motives Patrick [me] to be a conspiracy theorist.”

I assure you I don’t believe there’s any conspiracy to implement changes at LHH, other than perhaps a conspiracy of silence designed to keep the community uninformed about changes actually taking place. A concerted effort is being made by City employees, with or without conspiratorial motives, to keep news about these changes out of the local media.

Another person wrongfully accuses me of presenting “assumptions” as fact, and not making clear to readers the difference between facts and assumptions. I completely disagree: My March article reported facts gleaned from ten public-record documents; I included minimal observations or commentary, not assumptions.

Laguna Honda’s Communications Director, Marc Slavin, was so irritated by my March article, he reportedly took a copy to the Mayor’s Long-Term Care Coordinating Council’s March 12 meeting, where according to a reliable, impartial source, Slavin engaged in an ad hominem personal attack against me. This is the second time Slavin has attacked me personally when I wasn’t present to defend myself, and he’s done so elsewhere. The first time, during a West of Twin Peaks Central Council meeting, another community leader was so offended by his personal attacks she wrote Kanaley indicating how inappropriate Slavin’s behavior had been. This hasn’t stopped him; Slavin is viewed by several members of LHH’s staff as another sly “change agent,” and Mayor Newsom’s minister of misinformation and propaganda.

Of the many changes at LHH, Kanaley didn’t address the loss of 420 skilled nursing beds eliminated from LHH’s replacement facility under construction. San Francisco has seen the closure of 312 skilled nursing beds since 1992, and another 618 are planned for closure, bringing to 930 the number of skilled nursing beds that will be lost just before the “silver tsunami” of San Franciscans expected to develop Alzheimer’s will arrive, many of whom will need nursing home level of medical care. Hospital CEO’s in the Hospital Council of Northern and Central California are so concerned about the loss of post-acute hospital discharge locations, they are currently conducting a study to measure the unmet availability of lower levels of care in nursing homes and other facilities.

The minutes of the Health Commission’s March 3 meeting reports the City is being sued by Bay Area Legal Aid over whether San Francisco is failing its Health and Safety Code Section 17000 obligations to provide care to the [medically] indigent. Director of Public Health Mitch Katz reported City officials have agreed to limit publicity about the lawsuit, because opposing counsel hope to reach yet another “settlement agreement.” Details of the case haven’t been made public, so it’s unknown whether failing to provide care to Medi-Cal recipients at LHH is part of the lawsuit.

In addition to mourning Mr. Kanaley’s premature passing, San Franciscans should be mourning the loss of nearly 1,000 skilled nursing beds so desperately needed, the loss of medical care to the City’s medically-indigent frail elderly and disabled citizens, and the loss of publicity concerning the public’s right-to-know about lawsuits against the City.

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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