Laguna Honda Hospital and Rehabilitation Center is a city-owned acute care hospital providing long term care and rehabilitation services to seniors and adults with disabilities in San Francisco, CA.
Laguna Honda is a safety-net hospital serving 780 seniors and adults with disabilities, 97% of whom are Medi-Cal recipients. The hospital’s services emphasize cultural effectiveness. It received the Hobart Jackson Cultural Diversity Award in 2008 from the American Association of Homes and Services for the Aging (AAHSA) for its commitment to culturally effective health care.[1]
Ethnic Breakdown: African American: 25%, Chinese: 6%, Other Asian: 13%, Hispanic: 13%, Non-Hispanic White: 39%, Filipino: 2%, Other: 2%.
Age: Seventy percent of residents are over 60, and any San Franciscan over 16 is eligible to apply for skilled nursing and rehabilitation services at Laguna Honda.
Gender Balance: 52.4% men; 47.6% women
Laguna Honda provides three distinct types of services, skilled nursing, rehabilitation, and acute care.
The acute care services are for residents only. The hospital provides no general emergency services.
The Laguna Honda Rehabilitation Center provides physical, occupational, speech, and vocational therapies as well as audiology. Every year as many as 200 people complete rehabilitative therapy at Laguna Honda and return to independent living or a lower level of care.
Skilled nursing services include the following:
Laguna Honda is publicly funded. Its operating budget is $162 million annually. Most Laguna Honda residents are Medi-Cal recipients. Just over 75% of operating funds, or $122 million, are provided by Medi-Cal and Medicare reimbursements. The city's General Fund provides just under 25%, or $40 million.[2]
The three new buildings, housing 780 people, are designed to help create community. They were designed by Anshen & Allen architects with input from the Center for Health Design, and built by Turner Construction Co.
The central building is the Pavilion, site of the Rehabilitation Center and the hospital’s acute care services. Sixty people receiving short term care live in the Pavilion. Two new residence buildings to the north and south of the Pavilion house 720 residents in households of 15 people each. Every household has its own living room and dining room. Each floor functions as a neighborhood of four households, or 60 people, participating in one of the specialized skilled nursing programs:
Memory Care, for people with Alzheimer’s and other dementias; Enhanced Support, for people living with the effects of stroke, traumatic brain injury, multiple sclerosis or other degenerative diseases, and other complex or chronic conditions; Integrated Wellness, for people with behavioral support needs; Positive Care, for people with HIV/AIDS; Chinese and Spanish Language Communities, for monolingual speakers.
Neighborhoods are organized around a central Great Room where daily activities take place.
Most residents live in suites of two or three single rooms with a shared bathroom. Some share a room with one or two other people. There are also single rooms with private baths. Every room has operable windows overlooking the 62-acre (250,000 m2) campus.
The buildings open onto a central park offering a variety of opportunities to take advantage of the healing effects of nature: an animal therapy center, a small orchard, raised planting beds for growing vegetables and flowers, walkways for strolling or rolling, and a meadow named for Betty Sutro, a longtime benefactor of the hospital.
Secured therapeutic gardens provide a safe environment for people with Alzheimer’s disease and other dementias to enjoy the outdoors.
The heart of the new buildings is the Esplanade, a broad indoor boulevard modeled after the main street of a small town. Along the Esplanade are a variety of places to meet and greet, a community meeting center and theatre, an art studio, a multi-media library with a fireplace, barber and beauty shops, and a cafeteria with indoor and outdoor seating.
The new Laguna Honda was built to stringent environmental specifications, and is the first LEED certified hospital in California.
The facade of Laguna Honda's 1920's-era Spanish Revival building will be preserved and used as administrative offices. Wings that were added to the original building in subsequent decades, and are no longer seismically safe, will be demolished.
Capital costs for the new Laguna Honda are funded by $299 million in general obligation bonds and $100 million in revenue from the settlement of city consumer protection lawsuits against the tobacco industry filed in the late 1990s. Voters approved the funding package, known as Proposition A, in 1999 by 73%.
Hospital construction costs have doubled since 2001. In the year and a half that the new Laguna Honda went out to bid, costs rose by 30%. The 30-year average had been 3% annually. Hospitals throughout the state that were rebuilding to meet more stringent seismic requirements imposed by California State Senate Bill 1953 were forced to reduce scope and add dollars. Laguna Honda was among them.
The city closed the gap with additional tobacco settlement revenue ($97 million) and city-issued certificates of participation, tax exempt securities used to raise capital funds or purchase equipment ($72 million). Including interest income, final construction funding is approximately $584 million.
The Laguna Honda financing package contains some unique tools to reduce the cost to taxpayers. In addition to the use of revenue from the settlement of the city’s tobacco lawsuits, California State Senate Bill 1128 authorizes the city to receive partial federal reimbursement for construction costs associated with certain seismic upgrades related to health care. As a result, up to 45% of Laguna Honda capital costs could be paid for by federal dollars.
Initial plans for the new Laguna Honda envisioned a capacity of 1200 residents, but steeply rising construction costs required that the project be scaled back. A planned fourth building, with a capacity of 420, has been preserved as open space. In addition, plans to construct 250 units of assisted living were also put on hold. To move into the scaled-down facility, the hospital suspended most admissions during part of 2008 and 2009, accepting new residents only in the Rehabilitation Center, the Positive Care program and the hospice.
Central to the mission of the new Laguna Honda is the integration of the campus into the civic life of the city.
San Francisco enhances the beauty of its public spaces through the Art Enrichment Ordinance. One of the first in the country, the ordinance provides that 2% of the total eligible construction costs of public works projects be allocated for public art.
The Laguna Honda Replacement Program generated $3.9 million in art enrichment funds for a public art program that contributes to the quality of life at the hospital by helping to create an aesthetically pleasing environment and a sense of place and home.
Eighteen artists were commissioned to create works to support the hospital’s clinical needs and therapeutic goals. Sculptures, paintings and multi-media works are installed throughout the campus to assist sensory stimulation, wayfinding, encouragement of activity, interaction with nature and stimulation of memory.
The works are wheelchair accessible and tactile so they can be enjoyed by residents with mobility and sight limitations. They also provide a new destination for San Francisco art lovers.
A central feature of the new Laguna Honda is its attention to the healing effects of the built environment. It is the first LEED certified hospital in California.
The new buildings allow in ample light and contain operable windows in each bedroom. The windows open onto a large central park with opportunities to take advantage of the natural environment of the Laguna Honda campus. Living quarters are organized into households and neighborhoods, each with a virtual town square or Great Room at its center. The indoor heart of the campus is a long boulevard called the Esplanade modeled after the main street of a small town. Lining the Esplanade are shops and meeting places to encourage relationship-building and community interaction.
The U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) program, the leading industry standard for designating sustainable buildings, conferred LEED silver status on the hospital in June 2010.
The hospital’s three new buildings address environmental impacts in their design, construction and operation across six LEED-designated categories: sustainable sites, water efficiency, energy and atmosphere, materials and resources, indoor environmental quality, and innovation and design process.
Over the past decade, Laguna Honda has faced a critical challenge to improve services for people with disabilities. Disability rights organizations filed two federal lawsuits (known as Davis and Chambers) seeking greater community integration for Laguna Honda residents.
The city created two major new programs to serve disabled San Franciscans.
The Davis case, filed in 2000 and dismissed in 2008 following the fulfillment of a settlement agreement, sought to accelerate and streamline the discharge process for people living at Laguna Honda. To meet the goal of increased and improved discharges, the San Francisco Department of Public Health created the Targeted Case Management(TCM) program to assess the ability of residents to live at lower levels of care, and to provide assistance in finding accessible housing.
The Chambers case, filed in 2006 and settled in 2008, sought to create housing and service options for former Laguna Honda residents and potential residents. The city addressed the goal of expanded opportunities by creating the Diversion and Community Integration Program (DCIP), a joint venture of the Department of Public Health and the Department of Aging and Adult Services. The program evaluates applicants to Laguna Honda to determine if they can be served in other community settings, and serves as one-stop shopping for low-income, accessible housing and services.
In addition to improving community integration for current and potential residents, Laguna Honda is itself working to become a more integrated setting. An important part of the mission of the new hospital is provide a venue for public events in its theatre and on its grounds, including major new art installations, bringing all of San Francisco onto the Laguna Honda campus in new ways.
The U.S. Department of Justice completed a 15-year period of oversight at Laguna Honda in June, 2010. In 1997, the Department initiated an investigation into whether Laguna Honda was adequately assisting residents to move to lower levels of care or independent living, and whether it was providing services that supported individual needs and preferences. The department retained health care consultants to review Laguna Honda’s programs and recommend changes.
In its letter notifying city officials of the completion of its investigation, the Department said that San Francisco has "taken creative and somewhat extraordinary steps to expand residential and other service capacity in the community to provide meaningful alternatives in integrated settings for a host of persons who live, had lived, or might live” at Laguna Honda.
Laguna Honda's development of community integration services over the past decade is designed to help achieve the highest level of independence for each resident.
The hospital's transition from an institutional to an individual model of care mirrors a sea change in American nursing care. In recent years, skilled nursing facilities have made what some reform advocates refer to as a "journey from institution to community" by refocusing their priorities on the individual needs and preferences of the individual client.
Laguna Honda has been a civic icon in San Francisco since 1866. It opened as an almshouse to care for one of the first generations of San Franciscans, the Gold Rush pioneers. Over the decades, as the city grew up around it, Laguna Honda embraced generation after generation of people in need.
To meet the changing health care needs of San Francisco, Laguna Honda has served many purposes over the years. It provided important care during a smallpox epidemic in 1868, served as a place of refuge for people displaced by the 1906 earthquake and fire, and now provides the Bay Area’s only dedicated skilled nursing services for people with HIV and AIDS.
Notable moments in the hospital's history include a visit in 1909 by President Theodore Roosevelt, who was in San Francisco observing earthquake recovery efforts; installation in 1934 of five murals by South African artist Glen Wessels, one of the first depression-era federal art projects in San Francisco; and annual holiday performances in Gerald Simon Theater in the 1960s and 70’s by Bing Crosby, Merv Griffin, Frankie Lane, Donald O’Connor, and other hoofers and crooners of the Greatest Generation.
The Friends of Laguna Honda, a philanthropic organization founded in 1957, supports the work of the hospital by providing amenities such as aviaries, aquariums, books, personal necessities, assistive devices and other items. Under the auspices of the Friends, over 400 San Franciscans donate their time as volunteers to Laguna Honda every year.