Should I Stay or Should I Go Now?


Below Twin Peaks’ epic views of San Francisco rests a city health icon dating back to the Gold Rush era that today offers high-tech health services for underserved San Franciscans in a glittering facility brimming with art, light and individualized care.

The dazzling Laguna Honda Hospital and Rehabilitation Center has proved so inviting after its three-building expansion in 2010 – with spacious hallways, sun-drenched rooms, and sophisticated technology – it has visitors gaping in jaw-dropping admiration.

“It blows any other facility I’ve seen out of the water,” says visitor Jake Weissich, who has worked in healthcare facilities across the country. “I’ve never gone into a geriatric facility ever before that’s just (so) gorgeous.”

At the same time, the expanded facility is so breathtaking it has also solidified Laguna Honda’s greatest problem: patients have a hard time leaving.

“It’s a beautiful place, but it’s not meant to be a long-term independent home,” says Bill Fricker, who helps residents transition back into their homes as head of the center’s Peer Mentor Program.

The challenge can be a difficult one.

Laguna Honda serves as the city’s primary “hospital-based nursing facility” for San Francisco’s old, poor and sick, offering an astounding array of rehabilitation services amidst a welcoming atmosphere that’s a far cry from typically sterile healthcare interiors.

Nearly three-quarters of its 768 patients are 60 and over.

On one day in May, a jazz combo serenades the second floor, filtering music throughout the center.

Along with concerts like these are resident-created art and poetry via the city’s expansive Art with Elders program, which houses one of its many satellite studios at Laguna Honda. The sunny room with open air construction blends with the surrounding hallway to embody holistic architecture.

“I was meeting with architects three years before our program and they were saying ‘What do you need?’” says Mark Campbell, program director for the center’s art program.

Campbell says the artistry infusing Laguna Honda benefits both patients and staff.

“Art’s kind of infectious,” he smiles.

“This program gave me a chance to get back to something that was always inside me,” says David Ratliff, a tattoo artist who once spent six months in state prison for armed robbery. “It’s an expression of love.”

Laguna Honda’s architectural collaborations and artistic flourishes are a far cry from the outdated facility next door known for its noise and chilly drafts.

Underlying all of its services is a central philosophy of respect for the patient that revolves around this goal: individualized care. The center’s goal is to give patients an active role in deciding their daily treatment and personal schedule: healthcare, eating, sleeping, and recreating.

The range of health services offered by multi-lingual staff is impressive by any standard. Patients receive round-the-clock attention for acute disorders and chronic conditions. There’s a physical therapy room. A gym for low-impact rehabilitation. An exterior courtyard features different ground surfaces where patients can practice treading on various surfaces once discharged. A Wellness Center helps with joint strength and range of motion concerns.

Laguna Honda also provides hospice and palliative care for patients facing terminal illnesses. (It does not provide emergency room services.)

Patient wings, called “neighborhoods,” also serve those with dementia or HIV / AIDS – who receive “Positive Care.”

Jacky Spencer-Davis, a nurse and social worker who heads Positive Care, says that the complexities of chronic disease at Laguna Honda are multiplied by substance abuse and poverty – frequent cohabitants for its patients. Some younger patients even suffer from AIDS-related dementia – a disorder that traditionally strikes older adults.

At the same time, says Spencer-Davis, the center’s focus on humane care has provided most patients private rooms (with shared bathrooms) since the expansion – along with other benefits.

“The patients love having more privacy,” says Spencer-Davis. “And they love having their own TV.”

Laguna Honda also offers dental health services, a rare treat for patients insured by public programs. (Medicare excludes dental health treatment except in special cases; Medi-Cal cut dental benefits in 2009 and they were only partially restored in June.)

The center features a petting zoo as part of its “animal therapy” along with a small orchard and raised planting beds accessible to wheelchair users within a larger horticultural program.

Laguna Honda has long been the safe haven for San Francisco’s poor and sick. Its history dates back to 1867 when California miners desperate for riches went bust and had nowhere to live.

All of this, of course, comes at great expense. The cost per patient runs $680 per day. Funding comes from local property taxes, a general city bond, and money from a city lawsuit against the tobacco companies.

Because of the hospital and rehabilitation center’s popularity, only the most acute or complex cases are taken.

Laguna Honda is the first green-certified hospital in the state and gained a coveted LEED silver designation from the U.S. Green Building Council for energy use and environmental design.

To many, Laguna Honda is a shining example of high-quality healthcare for the underserved.

“I’ve never seen all of those things under the same roof,” says Weissich. “They’re not just committed to their patients in a medical capacity, but making sure they have a nice life while they’re there. It’s just really special.”

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