Supervisors press health officials for details as Laguna Honda cuts beds and plans Clarendon Hall closure

Supervisors and advocates on the San Francisco Board of Supervisors Rules Committee pressed city health officials on Thursday about plans for residents and staff after Laguna Honda Hospital began reducing its census and preparing to close Clarendon Hall.

At the hearing, John Keneally, executive administrator at Laguna Honda Hospital, said the hospital’s fiscal-year average census was 1,016, the current census had declined to about 940, and that between Jan. 1 and April 11 the hospital recorded 234 discharges including 63 deaths. Clarendon Hall’s occupancy fell from 107 to 30, Keneally said, and the hospital expects to close Clarendon Hall by July 1, which would remove the 108 beds that were occupied on Jan. 1.

The data prompted sustained questioning from Supervisor Tom Ammiano and other supervisors about where residents will go, whether community services and housing subsidies are sufficient, and how many staff positions will be affected. Keneally said the hospital had identified 135 full-time-equivalent positions affected by Clarendon Hall’s closure and that, after matching staff to vacancies across the Department of Public Health and accounting for part-time roles, only three FTEs currently lacked placements. He added that the majority of staffing reductions will be achieved through vacancies, citing an overall DPH vacancy rate and turnover figures he included in his materials.

Advocates and union representatives told supervisors they remain unconvinced the community has adequate alternatives. Herb Levine, executive director of the Independent Living Resource Center and a Long Term Care Coordinating Council member, said advocates have seen elements of a plan but called for a comprehensive, transparent plan that links operational savings to community services and ensures staff are retrained or reassigned. Levine told the committee he was “disturbed about the math” and urged the board not to proceed without clearer evidence that displaced residents will receive appropriate care.

Liz Gray, who oversees placement and community living efforts referenced by hospital staff, said the most common preference among surveyed residents is independent living followed by group living; she told the committee that, for cases placed thus far, about 90% of placements have matched stated preferences. Gray noted the agency could provide aggregate or resident-level data if supervisors requested it.

Supervisors and speakers also discussed Medicaid waiver programs that could fund community placements. Keneally described a so-called “super waiver” worth up to roughly $77,000 per client per year but said only 11 residents were enrolled in that program at the time of the hearing. Keneally and Gray pointed to barriers including provider enrollment and rate competitiveness; both said staff were working to increase provider participation and to use other waiver and subsidy sources in the interim.

Union speakers and staff from Laguna Honda told the committee that rapid discharges, reduced community services and cuts to home-based programs could increase pressure on acute-care hospitals and emergency departments, and that displaced residents may end up in SROs or facilities outside San Francisco if appropriate placements are not available. Several nursing assistants and longtime hospital staff recounted the emotional toll of moving frail residents and warned of higher mortality and increased acute care use if transitions are rushed.

While hospital leadership argued the downsizing derives in part from changes in the capital plan (notably the cancellation of a fourth building that would have preserved operational capacity), supervisors repeatedly asked for a written, transparent timeline and a clearer account of how operational savings would be redirected to community-based services and housing subsidies.

After extended public comment and questioning, Supervisor Ammiano moved to continue the Laguna Honda matter to the call of the chair to allow further work and more detailed information. The committee approved the continuation without objection.

What’s next: the committee left the matter open for additional staff work and follow-up with supervisors, the hospital and stakeholder groups. The continuation means no final action was taken at this meeting on the Clarendon Hall closure or on specific discharge placements.