Laguna Honda update: DPH reports milestones met, CMS orders discharge of ~40–45 residents; advocates press for transparency and bed protections

Laguna Honda Hospital and Rehabilitation Center provided a detailed update to the San Francisco Health Commission on April 18 about its ongoing recertification work and closure‑plan negotiations with state and federal regulators. Roland Pickens, interim CEO and director of the San Francisco Health Network, said the hospital has met the corrective‑action milestones due to date under the November 10, 2022 settlement with the Centers for Medicare & Medicaid Services (CMS), but reported that regulators recently instructed the facility to resume discharges for a smaller group of residents who no longer meet skilled‑nursing level‑of‑care criteria.

Pickens told the commission the facility’s census is about 530 residents and that approximately 40–45 residents currently do not meet federal skilled‑nursing criteria and therefore qualify for discharge to community destinations or lower levels of care. He described the settlement’s monitoring process (90‑day surveys and monthly QIE [quality improvement expert] reports) and said the hospital has submitted revised closure‑plan edits to regulators and was awaiting response as of April 18. Pickens emphasized that most residents remain covered by the pause on discharges and transfers that CMS previously granted through at least May 19, 2023, but that the subset identified by regulators must be processed in accordance with federal rules.

Safety, placements and appeals: Pickens described the institution’s discharge process as multidisciplinary (physician, nurse, social worker, dietitian) and said resident or surrogate input and appeal rights are part of the state and federal discharge procedures (Title 22 and the State Operations Manual). He said the city’s housing, aging and human services departments are now collaborating with DPH and Laguna Honda to locate appropriate board‑and‑care or behavioral‑health placements, and that the state’s ombudsman program serves residents without family advocates.

Public concern and requests for waivers: A large group of advocates and residents — including Melanie Grossman (Older Women’s League), Ken Trey (retired educator), Norman Danglman and members of Gray Panthers — pressed the Commission about transparency, prior discharge‑related deaths, and whether DPH has applied for waivers or other mechanisms to preserve 120 Laguna Honda beds that commenters said are at risk. Several callers asked whether CMS or the state department had signaled a willingness to extend the pause beyond May 19; Pickens said that the closure‑plan negotiation was ongoing and that Laguna Honda had submitted edits to regulators on April 17 and could expect a response as soon as close of business that day but that approval depends on CDPH and CMS.

Operations note: Pickens reported a surge in COVID‑19 cases at the facility (52 residents COVID‑positive as of that morning), which required opening an overflow COVID unit and temporary suspension of communal dining for affected households; he described infection‑control steps including twice‑weekly staff testing and masking in affected units.

What remains unresolved: The closure plan and any waivers to preserve beds remained under negotiation with CDPH and CMS as of April 18. Several public speakers urged DPH to submit a formal waiver request to preserve at‑risk beds and to share the terms of negotiations with the public; DPH staff said they would continue to engage regulators and return to the Commission with material updates.