Will It Take a Decade-and-a-Half to Get Back to Previous Capacity?
Snail-Paced Admissions to Laguna Honda Hospital
LHH’s Net Gain of 1.5 Residents Per Month
Since Admissions Resumed Suggests 15.9 Years to Repopulate LHH
Will “Granny Dumping” Continue Another 16 Years?
Monette-Shaw
• • • • • • • • • • November 2024 • • • • • • • • • •
Since Laguna Honda Hospital (LHH) was recertified last June 20 and gained permission to resume admissions that had been forbidden and halted for 26 months following its April 2022 decertification, the snail’s pace of admissions during the past four months has been excruciatingly slow.
It’s important to note that during its two-plus years of decertification, LHH’s patient census plunged by 293 patients (a 41.3% change net decrease) from its customary 710 resident headcount in October 2021 before decertification — to just 417 residents on June 22, 2024. Roughly half of the decline was due to LHH patients dying in-house, without new admissions to replace them.
LHH’s loss of almost 300 patients has not precipitated a direct patient care Nursing staff reduction, which has remained at approximately 800 Nurses in various job classification codes during the entire decertification period despite the reduced patient census.
On November 12, an LHH Executive Team report to the Health Commission’s LHH-JCC declares on page 3 that LHH has admitted 28 residents since admissions resumed in July. That’s somewhat deceptive for several reasons.
First, an accompanying monthly standard chart titled the “State of the Hospital” on slide #9 presented to the LHH-JCC shows that although there have been 28 admissions in the four months beginning in July 2024, across those same four months there have been 11 planned discharges and 11 patient deaths at LHH — representing a net loss of 22 residents during the same period. That translates to a net addition of just six residents to LHH’s total patient census. That’s a snail’s pace!
Slide #3 reveals that of 73 referrals for admission to LHH, just 28 were admitted, and another 11 are in progress. Assuming the 11 pending applications are eventually admitted (and don’t die while awaiting admission), that would total 39 (53.4%) of the 73 referral applications LHH has received.
Does that mean San Franciscans needing SNF-level of care admissions will continue being dumped out-of-county for at least another decade-and-a-half, absent any concern by the Health Commission and Board of Supervisors? Will Mayor-Elect Lurie even notice?”
The report also shows that LHH denied 19 referrals for admissions outright, and 15 other referrals were administratively closed because the patient died while waiting for admission, had refused admission to LHH, was medically unstable and needed ICU level of care, or was discharged home with services instead of being admitted to a skilled nursing facility.
Of the 19 outright denials, six were because the patient no longer needed a skilled nursing level of care, 9 had behavioral health needs LHH was unable to care for, and 4 had medical needs LHH could not meet.
The combined 34 referrals denied or closed represented 46.6% of the 73 referrals.
Repopulating LHH
The November 12 report to the LHH-JCC mirrors other public records that revealed LHH reported a patient census of just 417 residents on June 22. SFDPH reported that as of October 22, LHH’s patient census was 423, confirming the same net increase of just six residents across the four months since admissions resumed in July — for a net increase averaging just 1.5 admissions per month.
That net increase in the census of just 1.5 residents per month suggests that for LHH to increase its census by 287 residents to return to its census of 710 patients three years ago on October 14, 2021, it could conceivably take 191 months (at a net increase of 1.5 admissions per month) to get back to full capacity. That 191 months means it could take fully 15.9 years, a ridiculously slow snail’s pace, for LHH to return to its former capacity.
Sadly, the JCC Commissioners completely overlooked and neglected to ask anything about this glaring problem on November 12.
Unfortunately, the entire Board of Supervisors—including D-7 Supervisor Myrna Melgar—appears unconcerned. It could take almost 16 years to get LHH back up to full speed!
Does that mean San Franciscans needing SNF-level of care admissions will continue being dumped out-of-county for at least another decade-and-a-half, absent any concern by the Health Commission and Board of Supervisors? Will Mayor-Elect Lurie even notice?
LHH’s Unsettled 120 Beds
The November 12 report to the LHH-JCC also indicated LHH has made no progress on submitting a waiver to the Director of the California Department of Public Health (CDPH) — Dr. Tomás Aragón — requesting that LHH be allowed to keep 120 of the beds it had been ordered to close by the Centers for Medicare and Medicaid Services (CMS) during the disastrous decertification of the facility.
LHH claims it must demonstrate sustained compliance with CMS regulations governing nursing homes, but CDPH has yet to indicate or define the length of this period. Alternatively, perhaps LHH has been told how long it typically lasts but will not tell the public.
As previously reported, LHH provides about one-third of all skilled nursing facility (SNF) beds in San Francisco, so if LHH loses 120 of its beds permanently, more people needing SNF level of care will continue being displaced into out-of-county facilities.
The five months following its recertification on June 20 haven’t been a long enough “sustained compliance” period. For all we know, the sustained compliance period might be one or two years from now.
Out-of-County Discharges Will Continue
Readers may recall that the Westside Observer reported on July 10 that a new report with data for calendar year 2023 presented to the Health Commission on July 2, 2024 revealed that somewhere between 2,518 and 9,153 San Franciscans were discharged to out-of-county facilities for routine Skilled Nursing Facility (SNF) level of care across calendar years 2021, 2022, and 2023. The new report followed a report in early 2023 to the Health Commission of out-of-county discharge data that occurred in calendar years 2021 and 2022.
San Francisco’s Department of Public Health is required to report the out-of-county discharge data to San Francisco’s Health Commission by Ordinance #77-22. Former District 4 Supervisor Gordon Mar introduced and successfully passed the law in 2022 requiring all San Francisco private and public-sector hospitals to report to SFDPH their out-of-county discharges to sub-acute SNFs and regular SNFs.
A coalition of patient advocates had asked the supervisors for over four years to introduce and pass such an ordinance. It had taken Mar until 2022 to get the legislation passed.
Without any SNF-bed champions remaining on the Board of Supervisors, it may be that the sheer volume of out-of-county discharges to skilled nursing facilities will increase in coming years — particularly given the slow pace of resuming admissions to Laguna Honda Hospital over the past four months.
Suppose LHH takes 15.9 years to ramp back up its full patient census of 710 residents (assuming the 120-bed waiver is submitted and eventually approved to save those beds at LHH). In that case, the total number of San Franciscans “Granny Dumped” into out-of-county facilities will continue to skyrocket.
That won’t be at a snail’s pace.
The question now is, how can the admissions process be sped up?
Monette-Shaw is a columnist for San Francisco’s Westside Observer newspaper and a member of the California First Amendment Coalition (FAC) and the ACLU. He is a Childless and catless) Cat Daddy and voter for 50 years. He operates stopLHHdownsize.com. Contact him at monette-shaw@westsideobserver.com.
November 2024
