After over a year of live-in treatment for drug addiction, liver problems and throat cancer at Laguna Honda Hospital and Rehabilitation Center, Edward Sanchez received a notice stating his health had improved to the point he no longer needed the hospital’s services.
His family disagreed with the decision, but he was released anway. A few weeks later, he died. “If we had a choice, he would be alive,” said Sanchez’s brother Robert.
Sanchez was not the only patient to meet such a grim fate after funding cuts forced the hospital to transfer patients to other facilities. At least nine people have died in connection with a panicked effort by the hospital to comply with federal requirements, said Tony Chicotel, staff attorney at the SF-based nonprofit California Advocates for Nursing Home Reform.
On Oct. 12, the hospital and regulators announced a deal to extend the deadline for bringing the facility up to government standards until November 2023, preserving its eligibility for federal funds and bringing relief to the center’s staff, patients and their families.
But that relief may be short-lived. A report issued Oct. 11 showed unusually slow progress in retraining staff to comply with regulations—even ones as simple as requiring thorough hand-washing, or preventing infection through proper use of protective gear. The situation was so serious, a planned facility-wide inspection preparedness drill was canceled.
Chicotel said Laguna Honda is not out of danger—the recent report shows that there is still the very real possibility that it could lose federal funding and be forced to shut down.
“Here we are, two-and-a-half years after Covid, when hand-washing was a mantra repeated over and over again,” he said. “This is basic and vital, yet until recently we hadn’t had basic compliance. That was alarming. It indicates there are some systemic, long-standing problems with providing quality care at Laguna Honda.”
In a statement, the city’s health department said that Laguna Honda Hospital is on the path toward recertification, and that “focused efforts” have resulted in nearly all staff learning medical hand-washing. Regarding other key health protocols flagged by regulators, the statement said: “Laguna Honda’s recertification remains on track. We are pleased with the progress we are making to date.
“We are holding ourselves to a higher standard and want to be a leader in following hand hygiene protocols as we head toward recertification,” it added.
The stakes of relocating residents have been extraordinarily high; families of elderly patients have been kept waiting and wondering who will be moved first. Patients risk being moved to a facility that may be far away, or in worse shape than Laguna Honda or unprepared for the medical needs of the sudden diaspora of the San Francisco facility’s patients.
The Standard spoke with relatives grieving a resident who died upon being moved; relatives of a patient who is living far from family because of a transfer that was part of the forced spring-summer exodus; and another resident who fears he could be moved.
Together, the experiences show that despite encouraging words coming from city officials, the city is still at risk of letting down the poor, frail and elderly patients that inhabit Laguna Honda.
‘They Didn’t Give Us Any Option’
Laguna Honda, a 156-year-old compound on the western slope of Twin Peaks, once was a safe haven for Edward Sanchez, a disabled former hairdresser whom his family described as well-traveled, an avid cyclist and hilarious to talk to.
But the public hospital—with 782 beds, the nation’s largest skilled-nursing facility—faced an existential threat when state health officials determined that the hospital fell out of compliance with federal health standards, failing to adequately train employees.
Losing its certification from the Centers for Medicare and Medicaid Services imperiled the $200 million a year the facility received in federal funding and meant discharging or relocating hundreds of patients like Sanchez in the span of a few short months amid a regionwide dearth of skilled-nursing beds.
Due to the lack of such nursing beds in San Francisco, 43 people had to leave the city during the 10-week relocation push during May and June, far away from friends and family. Three people even had to move into homeless shelters.
Sanchez’s family said he couldn’t take care of himself, despite assurances from staff. He died on July 17, weeks after the transfer. He was 63.
“They didn’t give us any option,” Robert Sanchez said.
Backlash over a spike in patient deaths caused the city to mount a legal challenge against the federal push to halt funding to Laguna Honda. Meanwhile, former City Attorney Louise Renne filed a suit claiming the hurried relocation put patients in grave danger.
Both lawsuits argued that requiring quick transfers in the absence of alternative nursing facilities caused among patients “confusion, disruption and [the] ordeal of being transferred away from their long-term caregivers for reasons they might not understand.”
With the compromise announced Oct. 12, the city can try to regain certification and federal funding without scrambling to relocate hundreds of medically fragile patients.
‘Eventually, This Will Affect Everybody’
Though relocations have been put on hold, Donna Deufemia is still afraid that her 76-year-old brother, Anthony Deufemia, might be moved from Laguna Honda in the not-too-distant future if the hospital doesn’t meet federal recertification standards.
He gave up his room of 17 years at an SRO to live in Laguna Honda because of his increased difficulty with walking and standing. Upon first hearing of the facility’s decertification, his sister couldn’t believe the news.
“I haven’t been able to sleep at night,” Donna Deufemia said. “I’ve written all the politicians. I’ve done research. I work 40 hours a week, and I come home and I just do as much activism as I can.”
Fearing the hospital’s closure, Deufemia has visions of her older brother lying on the street, without a home. While she has found reprieve in the transfer pause and through working with hospital advocates such as the Gray Panthers, she knows her comfort is only temporary.
Personalized Care
Imelda Sullivan’s loved ones call her a true scholar.
The 96-year-old graduated from San Francisco College for Women—now known as the University of San Francisco—in 1947 and became a teacher. Outside of the classroom, her love of fine art, literature and academics led her to volunteer as a docent at the San Francisco Museum of Modern Art.
When she moved into Laguna Honda eight years ago, the fourth-generation San Franciscan became her family’s second-generation patient at the public nursing home. Her mother lived in the facility in the 1970s.
The hospital provided more than just generational continuity; it offered personalized care tailored to Sullivan’s creativity, expansive intellect and increasing medical needs. Laguna Honda found volunteers that would read to her and discuss art.
She felt comfortable and made friends.
But Sullivan’s family only found out that federal regulators had taken away funding and ordered the hospital closed by reading about it in the news. Concerned, yet unaware of the rapidly unfolding crisis, her family felt sure that the hospital wouldn’t transfer their mother, a longtime resident with acute dementia.
Within a matter of weeks, Sullivan’s family was told—with no written notice—that their mother would be transferred to a Moss Beach nursing facility in 24 hours.
“It was far away,” Sullivan’s daughter Alanna Greenham said. “It was not up to current standards. It had been a property that had gone bankrupt.”
They were told they would have to pay the full amount for her care at Laguna Honda, if they did not accept the option. The payment was $13,000 a month.
From her new bed at a nursing facility in Livermore, Sullivan continues to ask to go home to Laguna Honda and her primary caregiver, her family said. “Her behaviors are so outlandish,” Greenham said. “This is not behavior she displayed while she was at Laguna Honda.”
San Francisco health officials maintain that there is reason for hope.
“Keep in mind that Laguna Honda was one of the nation’s leaders during the pandemic in preventing COVID-19,” the health department’s statement said. “Our aim is continual improvement and we believe the program we have in place, the new settlement agreement, and the surveys by CMS, CDPH, and the external expert, will continue to keep us on the path to recertification.”
Additional reporting by Lisa Moreno.