The following is from the upcoming issue of the SF Gray
Dangers to Long Term Care in SF
On March 15, the SF Health Commission heard that 1999’s
$299 million Prop A bond issue to rebuild Laguna Honda Hospital at its current
1,200 beds will build only 360 beds. More beds could follow more funding. The
commission ordered a new white paper, not only on SF’s future needs for nursing
home beds, but also on more basic questions like, “Should the City be in the
long term care business at all.”
DPH’s 1999 white paper had predicted 92,000 more over-65 SF
residents by 2020, requiring 1,300 to 2,400 more nursing home beds, assuming LHH
were rebuilt at 1,200 beds and no other beds were lost. Two hundred beds have
been since converted to ambulatory care beds. The lower estimate assumed a
serious campaign to find alternative care, as occurred in Oregon.
Our real nursing home needs are extremely controversial,
and very difficult to assess. Insufficient funding for home and community-based
care (e.g. the IHSS crisis) makes it hard to know what can be done in these
areas. U.S. usage is down, but it is extremely uneven, and difficult to
attribute to more and better alternatives, or high costs of nursing homes
coupled with a decrease in Medicaid-eligible beds.
UCSF’s nursing home expert Charlene Harrington says nobody
has a good answer on how many nursing home beds should exist. She believes that
300 beds at LHH could be sufficient for people needing nursing home care, if
sufficient community resources were available, particularly for mentally ill
aged people. If this is true, let DPH develop the alternatives before cutting
LHH beds. (LHH has done nothing to implement Mayor Newsom’s recent order to
re-prioritize elderly and frail admissions.)
Given the U.S.
push to cut long term care out of Medicaid and Newsom’s corporate agenda of
reducing and privatizing City services, the LHH news must be seen as a very
bad for all City health services. But why can’t we get an honest assessment of
our real long term care needs?
To put these
remarks in more context, here are the comments of San Francisco's long term
care ombudsman, testifying at a Board of Supervisor's hearing on February 28:
Naddell Testimony to SF Supervisors’ Government Audit and Oversight Committee,
Feb. 28, 2005
the long term care ombudsman program in San Francisco since 1986. The
ombudsman takes complaints from all long term care facilities, not just LHH.
That includes assisted living, and board and care homes also.
clarification: all nursing homes are “skilled nursing facilities,” which
provide long term care as well as rehab. So it’s deceptive to talk of “a shift
from long term care to skilled nursing facility care.”
For context in
discussing placements and available beds:
presently 1,214 available beds for MediCal patients at LHH.
Out of 20
private nursing homes in SF, only 11 accept MediCal patients, providing 1,442
MediCal beds. This gives a total of 2,657 total MediCal beds in the City. This
is the telling figure when considering present and future policy, considering
the aging population and the demographic cohort of old-old (over 85).
Since 1992, SF
has lost 300 potential MediCal beds, due to nursing home closures or
conversions (to assisted living facilities).
For board and
care homes, since 1987 San Francisco has lost 119 board and care home beds
(assisted living beds).
There has been
a total loss of 950 beds, all of which were available for low- and
moderate-income residents. They were also called SSI homes.
Since 1992, there’s been a 1,693 bed increase in assisted
living beds. This is the only growth sector in long term care beds in the City,
but the monthly rate averages $4,000, with additional charges for care in a kind
of graduated fee structure.
There are no affordable alternatives to nursing home beds
and we’ve lost MediCal beds in SF.
I’ve been on the Discharge Planning Task Force, where we’re
looking at difficulties with safe discharges from acute care hospitals into the
community and into nursing homes. Placement of patients from hospitals has never
been adequately monitored. I suggest that in addition to the long term care
Planning Council, that some other group monitor discharges, not just the
services offered, but actually overseeing the system.
The recent LHH consolidation and the recent admission
policy (giving San Francisco General patients priority), which is now reversed,
and the administrative integration (of LHH and SFGH) have sought to convert LHH
into a more short term stay facility. There is a pilot program meagerly funded
to turn one ward to a social rehabilitation facility emphasizing self-care skill
training. This pilot, once tested, will turn 40 wards into a similar paradigm.
This is not a good idea.
Instead, they need hybrid thinking that combines long term
care with rehab, and the admissions policy needs to reflect this hybrid
approach, one that is open to all SF, not just SFGH.
There has been talk of eliminating the silo of LHH to lower
the barrier to patients from SFGH in discussion in the Health Commission. LHH is
a regulated silo under state and federal regulations for nursing homes certified
to bill Medicare and Medi-Cal. Since the silo talk has occurred, there’s been a
shift away from these regulations.
Long term care is about caring, in terms of continuous
relationships between caregivers and patients. We need to say that LHH is a
nursing home, it is for long term care, and it is not part of SFGH.
For more on Laguna Honda, listen to
KPFA’s morning show of March 22.