Nursing home’s patient-transfer delay OKd
San Francisco's Laguna Honda nursing home feared it would have to resume transferring hundreds of frail residents from the facility beginning Thursday — but federal regulators gave a last-minute reprieve that earned applause from city officials and patient advocates.
The Centers for Medicare & Medicaid Services told Laguna Honda on Wednesday that it had granted the hospital's request for a delay, until May 19. The notice came one day before the deadline patient advocates had dreaded, believing it would be a live-or-die moment in time — literally.
Last summer, 12 of the 57 people who were moved out of the decertified nursing home under the first round of forced transfers died soon afterward in cases of suspected “transfer trauma.” A public outcry led the Centers for Medicare & Medicaid Services, known as CMS, to pause the relocations in July. But federal regulators said they might require Laguna Honda to resume moving its hundreds of residents by Feb. 2, in preparation for the facility to shut down next fall — a fate that Laguna Honda is working to avoid.
“Laguna Honda is a critical part of San Francisco's ability to care for our most vulnerable residents and is essential the future of our city,” Mayor London Breed said in a statement. She expressed appreciation that “patients and families do not have to undergo any unnecessary disruptions or trauma.”
Laguna Honda officials also welcomed news of the reprieve, saying the extra time will allow them to focus on becoming recertified.
“Laguna Honda continues to work towards recertification in Medicare and Medicaid,” the hospital said in a statement. “We are working diligently to make the changes needed to ensure Laguna Honda can continue to serve the city's most vulnerable people for decades to come.”
But not all patient advocates were entirely happy.
“This is a step in the right direction — but why not end any transfers?” asked Louise Renne, a former city attorney and Laguna Honda advocate. “Why toy with the emotions of the residents and their loved ones? The fact is, they are receiving good care at Laguna Honda.”
Joe Urban, whose petition to stop the transfers has gathered nearly 1,700 signatures, agreed with Renne.
“Our regulators did the right thing,” said Urban, whose late mother-in-law lived at Laguna Honda until last year and was not one of those relocated. “But discharges shouldn't be a threat while Laguna Honda is making progress towards recertification.”
Urban wrote to CMS this week, saying that if the nursing home were again forced to relocate its medically fragile, lowincome patients, “we are anticipating that 100 or more residents of the 400 remaining skilled nursing facility residents at Laguna Honda Hospital will die” — roughly the same fatality rate as before.
Perhaps more persuasive to the federal regulators was a 98page letter sent by San Francisco City Attorney David Chiu on Jan. 13. In it, he made the case for extending the moratorium until at least May 30, “with the possibility of continuing the pause after that date,” based on progress toward recertification.
The Feb. 2 zero hour came about after Chiu had sued CMS in August, arguing that the facility never should have lost its certification. CMS yanked it last April 14, six months after state inspectors declared the facility to be offering “substandard care.” The loss meant that Laguna Honda, which had more than 700 patients last year, could no longer admit new people. Most important, it could no longer receive Medicare and Medicaid reimbursements of nearly $18 million a month — more than two-thirds of its $26 million monthly budget — and without that money would have to close by fall.
An October legal settlement bought an extra year for the nursing home to try to come into compliance. But the deal also allowed patient transfers to resume on Feb. 2 unless CMS decided otherwise.
“The California Legislature has declared that “the transfer trauma which accompanies the abrupt and involuntary transfer of patients from one nursing home to another should be avoided when reasonable alternatives exist,” Chiu said in his letter to CMS. He said Laguna Honda was a very reasonable alternative.
“Given that Laguna Honda has made considerable progress and expects to obtain recertification in the coming months, it is unreasonable to require (it) to transfer residents now,” he wrote.
Chiu also reminded CMS of a problem that has dogged the transfer plan since May, when the regulators first ordered Laguna Honda to start moving people out: There's nowhere to send them. Because there are so few skilled nursing beds available in the Bay Area that can not only treat people with complex medical conditions, but also accept MediCal, Chiu said Laguna Honda would be forced to send people far away.
“Transferring patients hundreds of miles from their home would uproot them from their family and friends, as well as removing them from the only caregivers they know,” Chiu wrote.
CMS officials caused a bit of anxiety among city officials and Laguna Honda advocates by waiting until the last minute to give their verdict.
Meanwhile, Roland Pickens, Laguna Honda's acting chief executive, has been keeping the Board of Supervisors and the city's health commission updated on the work it's doing to rehabilitate itself.
Pickens has periodically described the work being done with a “quality improvement expert” and other consultants to overhaul Laguna Honda's training practices and operations in hopes of regaining certification.
Recently, Pickens told The Chronicle that many of its problems come from operating more like a hospital than a nursing home. While it's licensed as a hospital, “90% (of patients) are actually here for the skilled nursing care,” he said.
“We're seeing improvements in care. In patient safety. In compliance, as we do our daily rounds,” he added.
Yet Laguna Honda was required to submit an updated closure plan on Dec. 21 that would require the discharge or transfer of every resident.
On Tuesday, Pickens told the Board of Supervisors: “We are hopeful that we will never have to implement a closure plan.”