At one of many nation’s largest nursing properties, an uncommon regulatory maneuver is jeopardizing a whole lot of weak sufferers, resident advocates say.
In about two weeks, federal regulators might require Laguna Honda Hospital and Rehabilitation Heart in San Francisco to restart the method of transferring all residents out of the roughly 770-bed facility–a process that was paused final 12 months after it turned lethal. State enforcement actions late final month towards the general public facility, which is owned and operated by the San Francisco Division of Public Well being, revealed new particulars concerning the dangers to sufferers who have been moved out of Laguna Honda final 12 months as the power rushed to adjust to regulators ‘ necessities.
Final 12 months, for instance, a 68-year-old girl was transferred to a facility with a identified COVID outbreak, the place she was identified with the virus and died inside two weeks. In one other incident, a 79-year-old man with superior dementia, who had lived at Laguna Honda for 19 years, began consuming much less after his switch to a different facility and died inside 10 days, the regulatory reviews present. The person was beforehand identified to be in danger for relocation-related trauma.
Twelve of the 57 Laguna Honda residents who have been transferred or discharged final 12 months–or 21%–died inside weeks or months of leaving the power, in accordance with a press release from Laguna Honda.
The regulatory predicament on the 157-year-old facility is out of proportion to the violations that sparked the shutdown plan, many resident advocates and nursing-home consultants say–and a resumption of the resident-transfer course of, they are saying, will doubtless result in extra deaths.
Laguna Honda reported two non-fatal overdoses to regulators in 2021, triggering a sequence of inspections that discovered regulatory violations together with cigarette lighters and drug paraphernalia on campus and an infection prevention issues, in accordance with the San Francisco metropolis legal professional’s workplace. Though the power labored to right the problems, the Facilities for Medicare and Medicaid Providers (CMS)—the federal regulator that oversees nursing properties–terminated Laguna Honda’s participation in Medicare and Medicaid in April 2022. Such a step is “a radical intervention” hardly ever utilized by CMS, mentioned Tony Chicotel, senior employees legal professional at nonprofit advocacy group California Advocates for Nursing House Reform. But the variety of regulatory violations at Laguna Honda, he mentioned, have been pretty typical for a facility of its dimension.
The ability’s federal funding was set to be minimize off in mid-September 2022, giving Laguna Honda just some months to switch a whole lot of residents. After some transferred residents died, regulators agreed to pause the transfers. And after the town sued regulators in an effort to keep away from the compelled shutdown, it reached a settlement permitting Laguna Honda to proceed receiving Medicare and Medicaid funds via mid-November 2023 and persevering with the pause on resident transfers till Feb. 2 of this 12 months, with an possibility to increase the pause past that date.
“Laguna Honda strongly advocated towards these transfers,” the power mentioned in a press release. “We warned CMS that the four-month deadline to switch practically 700 residents to different amenities was solely inadequate given the advanced nature of our resident inhabitants and the shortage of obtainable beds” at nursing properties within the area and state, the power mentioned. The citations issued late final 12 months by the California Division of Public Well being associated to the resident transfers, the power mentioned, have been the bottom degree issued beneath state regulation, and the power has filed a discover of attraction whereas it evaluates the allegations. “CMS and CDPH positioned Laguna Honda beneath an impossibly quick deadline to switch or discharge residents, and that deadline has a direct relationship to the occasions described within the citations,” the power mentioned within the assertion.
CMS mentioned in a press release to MarketWatch that it’s “dedicated to working with state and native officers to be sure that the residents of Laguna Honda have a secure atmosphere the place they’ll obtain high quality care.” The company has reviewed the findings of the resident-transfer investigations and “continues to work with the state to observe the circumstances on the facility and assess its compliance” with the settlement settlement, CMS mentioned.
By regulation, any nursing house that doesn’t obtain substantial compliance with federal necessities inside six months should be terminated from Medicare and Medicaid participation, CMS mentioned. Laguna Honda’s participation was terminated after “a protracted historical past of non-compliance with our well being and security requirements,” together with compliance issues that hit the six-month mark, CMS mentioned. The company mentioned it “additionally relied on its discretionary authority” to terminate the participation of non-compliant amenities.
CDPH didn’t reply to requests for remark.
Though Laguna Honda was based within the 1860s to look after Gold Rush pioneers, it is not a crumbling relic, nursing-home consultants say. The nursing house now spans a number of LEED-certified buildings, inbuilt 2010. It has “enormous, fashionable, well-ventilated rooms,” mentioned Dr. Teresa Palmer, a former attending doctor on the facility.
With the pause on resident transfers set to finish on Feb. 2, Palmer, together with members of the family of present and former residents, advocates, and metropolis and facility officers are calling on CMS to make sure that extra residents aren’t compelled out of Laguna Honda after that date. Laguna Honda has requested CMS to increase the pause on transfers, CEO Roland Pickens mentioned at a San Francisco Well being Fee assembly Tuesday.
In a letter to US Division of Well being and Human Providers attorneys dated Jan. 13, San Francisco metropolis legal professional David Chiu wrote that Laguna Honda is asking CMS to proceed the pause on transfers and discharges till at the very least Might 30, 2023, with a potential extension past that date primarily based on the power’s progress towards Medicare and Medicaid recertification. “Transfers mustn’t resume now given the potential hurt” to residents–an pointless hurt, given the power’s “progress towards recertification,” Chiu wrote. The letter requested a response by Jan. 27. Town legal professional’s workplace has not but acquired an official response, a spokesperson mentioned.
Restarting resident transfers “sounds egregiously irresponsible,” given the dangers highlighted in regulators’ December citations relating to final 12 months’s resident transfers, mentioned Joseph City, whose mother-in-law lived at Laguna Honda for about 4 years earlier than passing away final fall. Regulators are actually “totally conscious of the results of turning this system again on,” he mentioned.
Former San Francisco metropolis legal professional Louise Renne mentioned she plans within the coming weeks to amend a class-action grievance she filed final 12 months on behalf of Laguna Honda residents, looking for to cease the shutdown plan and affected person transfers. Federal regulators responded in a courtroom submitting that “Laguna Honda has an intensive historical past of noncompliance with program necessities” and that the courtroom lacked jurisdiction over the Medicare-related claims. A federal choose within the Northern District of California agreed that the courtroom lacked jurisdiction and denied the class-action certification in November.
Usually, amenities with a monitor document of great regulatory violations are positioned in CMS’s “particular focus facility” program, which includes common inspections of all well being and security necessities. However Laguna Honda shouldn’t be a present participant or candidate for this system, in accordance with the newest special-focus checklist launched by CMS. Regulators “may have performed every kind of sanctions earlier than they decertified” the power, mentioned Charlene Harrington, professor emerita on the College of California San Francisco.
CMS mentioned within the assertion to MarketWatch that the particular focus program is separate from the authority to terminate amenities’ participation in Medicare and Medicaid, and the requirement to terminate any nursing house that is not compliant inside six months exists no matter whether or not a facility is within the particular focus program.
If the resident-transfer course of resumes in February, Chicotel, the California Advocates for Nursing House Reform legal professional, mentioned he’ll do all he can to advise any residents who want to stay on the facility to easily keep put. “We all know now that among the residents will die once they get moved. They will die before they in any other case would have,” he mentioned. “And I am unable to sit by and let that occur.”