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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 LHHs 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 LHHs future mission.
For a number of years, the Mayors 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 Hondas Executive Administrator. Kanaley was present during the October, November, December, and January meetings of the Council, suggesting Isaksons removal had been long considered.
Kanaleys official January report to two Health Commissioners - and LHHs January newsletter, The Grapevine, distributed externally - indicated Isakson took an extended leave and wasnt expected to return, and Skovrinskis 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 LHHs change in model of care.
The Mayors 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 Citys Sunshine laws, the group pretends it is a passive meeting body, not a formal policy body, while, in fact, it develops policies regarding San Franciscos long-term care continuum of services, and aggressively pushes its policy recommendations on the Mayor, Board of Supervisors, and several City departments.
At the Councils 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 Citys 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 Franciscos 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 LHHs 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 Alzheimers 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 hospitals FY 09-10 Line Item Budget, since City budget decisions are now being made. The Council apparently wants to tweak the hospitals budget and monitor the conversion to social-health programming.
Staff at the Citys Mental Health Rehab Facility (now called the Behavioral Health Center) have already heard unofficially about plans to integrate the hospital and the MHRFs 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 isnt what voters were led to believe in 1999.
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 publics right to know.
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