Laguna Honda Faces COVID Outbreak, Amid Looming Patient Transfer Deadline

Amid other challenges, Laguna Honda Hospital and Rehabilitation Center in San Francisco has been grappling with a COVID-19 outbreak that has outpaced those in some previous years of the pandemic.

The latest uptick in cases arrived at a particularly tough time. The hospital is facing a major regulatory crisis that threatens to close the 153-year-old public skilled nursing facility, home to more than 500 residents, many of whom require high levels of nursing care.

COVID “cases were generally mild, and many were asymptomatic and identified due to Laguna Honda’s proactive testing of entire units until no new cases are identified for 14 days,” a spokesperson for Laguna Honda said in an email on May 12. “Laguna Honda Hospital was a model for pandemic response, and we continue to respond effectively to COVID by slowing the spread of the virus on campus and caring for residents if they test positive.”

The largest resident outbreak in 2023 peaked in April at 79 cases, and as of May 15 there were 10 residents with active cases, signaling a significant downward trend.

The outbreak in 2023 surpassed the total number of COVID cases that occurred at Laguna Honda in 2020 (46) and 2021 (32), when nursing homes across the country saw devastating impacts of the virus, which disproportionately affects older adults. The highest number of overall cases at Laguna Honda occurred in 2022, which had a total of 246 cases.

“Throughout the pandemic, Laguna Honda has responded to many surges, and we will continue to respond as needed due to the contagious nature of the virus and continually emerging variants and the importance of residents hosting visitors and leaving campus for outings and appointments,” the spokesperson said.

Path to recertification

In 2022, the hospital was found out of compliance on a number of safety issues across multiple regulatory surveys that were triggered after Laguna Honda self-reported two nonfatal overdoses that occurred on-site.

As a result, federal regulators stripped Laguna Honda from Medicare and Medi-Cal, subsidized health care plans that cover the vast majority of residents at the facility, most of whom have extremely low incomes.

In order to sustain health care funding while Laguna Honda worked to address its deficiencies, the Centers for Medicare and Medicaid Services required that the hospital craft and implement a plan to prepare for closure. That plan involved assessing and relocating as many patients as possible in 2022.

Of 57 residents who were transferred or discharged during that process, 12 died shortly after their relocations. The city sued the federal government in response, and the transfer process was paused temporarily as part of a settlement agreement.

In February 2023, regulators agreed to extend the pause on transfers to May 19.

Simultaneously, Laguna Honda had until May 13 to implement an “Action Plan” that aims to address some of the areas where the hospital was found out of compliance, ranging from basic hygiene to medication storage and illicit substances on-site.

As part of its agreement, Laguna Honda must complete hundreds of items in the action plan to address deficiencies. So far, the hospital has cleared all of those: 126 in January, 133 in February, 77 in March and 122 in April. Officials said they are on track to complete all May milestones, also.

“We are confident that Laguna Honda has delivered on our end of the settlement to date,” the hospital spokesperson said.

Once the action plan is completed, the hospital can apply for recertification, according to San Francisco Health Commission documents.

‘Unacceptable’ options

Meanwhile, the hospital has resumed voluntary discharges of residents who are found to no longer require the level of skilled nursing care that Laguna Honda provides.

But the entire Bay Area is facing a drastic scarcity of affordable care and living accommodations for older adults, making it difficult to find new homes for discharged residents.

A total of 41 people have so far been identified as appropriate for discharge. However, only eight alternative placements have been identified for those residents, CEO Roland Pickens said during a recent Board of Supervisors hearing.

“In terms of clients who are allegedly no longer eligible for skilled nursing care, I am deeply concerned about transfers for them,” Laura Chiera, executive director of Legal Assistance to the Elderly, said at the supervisors hearing. “In the past some have been transferred to homeless shelters. That is completely unacceptable.”

Three people were sent from Laguna Honda to homeless shelters during the 2022 transfers (PDF).

Older care and disability advocates warn that many residents who are being discharged may still need some degree of assistance, and with a dearth of affordable assisted-living options in the Bay Area, some residents, they warn, are being discharged to inappropriate facilities.

“I’m concerned that residents will be dumped inappropriately and this will green-light discharges of residents that Laguna Honda has wanted to rid themselves of and their discharge plans will not be adequate,” said Tony Chicotel, staff attorney with California Advocates for Nursing Home Reform.

Across the state, older adults are the fastest-growing segment of the unhoused population. While California’s overall older adult population grew by 7% from 2017 to 2021, the number of people 55 and over seeking homelessness services increased 84%, according to the state’s Homeless Data Integration System.

“You want residents who don’t need to be (at Laguna Honda) to find appropriate housing,” said Chicotel. “But you don’t want to dump them to the first place that takes them or shows up available.”