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LHH is being oriented “toward being able to care for people with mental health issues ...”  and “... although it is not feasible today to move all people who need long-term care from the MHRF to LHH, the future larger LHH will offer ... the same kind of services as offered at the MHRF [Mental Health Rehabilitation Facility, now renamed the San Francisco Behavioral Health Center].”	The DPH Strategic Plan, which is in the process of being updated, will [change] the role of Laguna Honda. “While there are process problems, the structure of service [delievered at the new and current LHH] is going to change.”	“LHH’s mission is not going to change [reassuring neighborhood association members, homeowners, and neighbors of LHH].”	[During two LHH Executive Committee ‘retreats’ held Nov. 23 and Dec. 9 2004] “... one Committee member introduced wording for a new mission statement; it was accepted unanimously by the Committee.  The mission statement will remove the term ‘long-term care’ from LHH’s mission.” †
— Mitch Katz, MD Director of Public Health Statement to Mental Health Rehabilitation Facility Blue Ribbon Committee October 22, 2003 Minutes	— Jim Illig SF Health Commissioner Statement during LHH Joint Conference Committee Meeting May 27, 2005 Minutes	— John Kanaley, MPH LHH Exec. Administrator Statement during St. Brendan’s Parish Town Hall Meeting December 16, 2004 [Knowing mission statement had already been changed by LHH Executive Committee]	— John Kanaley, MPH LHH Exec. Administrator Paraphrased Statement LHH Joint Conference Committee Meeting December 23, 2004 Censored Minutes [One week after the Dec. 16 Town Hall Meeting†]
† The minutes of the LHH-JCC meeting contain on Page 9 written testimony submitted by Patrick Monette-Shaw, in which he notes that during Agenda Item 3, Executive Administrator’s Report, John Kanaley had made a statement that a single member of the Executive Committee had introduced proposed language for the new LHH the mission statement that would remove the term “long-term care” from LHH’s mission.  The minutes were “creatively edited” (a common DPH practice) — or censored, depending on your point of view — to remove that statement from the minutes of Kanaley’s December 23 report to the JCC; Monette-Shaw’s testimony accurately notes Kanaley’s un-censored remarks.

As the documents below show, LHH is intending to implement both a Social Rehabilitation program, and a separate Behavioral Health program at Laguna Honda Hospital; both programs will likely further differentially displace San Francisco’s frail elderly and disabled, in order to provide social rehabilitation and so-called behavioral health programs in its wake.  As Health Commissioner Jim Illig and others keep asserting, LHH’s mission is going to change, and services formerly offered at the Mental Health Rehabilitation Facility, a.k.a. the MHRF, [pronounced “merf”] will be offered at LHH.  

Although Dr. Katz may may have mislead the MHRF Blue Ribbon Committee (BRC) into believing that it would be the “future LHH” that would provide “the same kind of services as offered at the MHRF,” in reality, the Social Rehabilitation grant being implemented in 2005 at LHH (two to three years before the “future” LHH will begin coming on-line) was developed as a program for the MHRF, but is now a model of care being implemented at LHH even before the new facility is scheduled to open in late 2007.  And despite the fact that the Social Rehabilitation grant is being passed off as a “short-term care” program, readers should note that Katz had assured the MHRF BRC that it would be long-term care MHRF patients being re-routed to LHH for SNF care, despite the fact that both the MHRF and SFGH had [formerly] had their own SNF beds.  The community should demand an answer why SNF beds at the MHRF were converted to board and care beds, and why over half of the SNF beds in SFGH’s Ward 4A have recently been closed.

Changing Mission of LHH

Document	Description
New DPH “Strategic Plan” Reveals Details About LHH's Changing Mission	The Department of Public Health revised its strategic plan in late 2004, including changes to the mission of LHH.
LHH’s New CEO, John Kanaley, Releases 18-Month LHH Strategic Plan January 26, 2005	During the Executive Administrator’s Report at the January 27 LHH-JCC meeting, LHH’s CEO released an 18-month Strategic Plan for LHH that had not been discussed with the LHH Medical Staff, nor with LHH’ middle-management and line staff prior to its release.
LHH CEO John Kanaley, Presents LHH’s New “Mission and Vision Statement” to Health Commissioners January 27, 2005	During the Executive Administrator’s Report at the January 27 LHH-JCC meeting, LHH’s CEO released the new mission and vision statements for LHH.  Once again, the mission of LHH has been changed without soliciting beforehand input from San Francisco’s electorate, in contravention of the will of the voters who in 1999 said they wanted LHH to provide long-term care to our elderly; the new mission statement removes “long term care,” or even “care” from the wording contained in the new mission statement.
Meeting Notes:   December 23 LHH-JCC Meeting Reveals Rapid Major Change to LHH Mission Statement and Social Rehab/ Behavioral Health Focus December 23, 2004	Notes from the LHH Joint Conference Committee meeting of December 23, 2004 reveal how rapidly LHH’s mission is being changed.
Public Testimony:  December 23 LHH-JCC Meeting December 23, 2004	Written public testimony presented during the December 23 LHH Joint Conference Committee discusses a number of issues facing Laguna Honda Hospital, including its changing mission.

Social Rehabilitation Programming at LHH

Health Commissioner Jim Illig, who was appointed to the Health Commission by Mayor Newson, was formerly President of the HIV/AIDS Provider Network (HAPN), an association of non-profit organizations holding contracts with the City to provide HIV/AIDS services.  Illig was a member of Newsom’s Transition Team, so it is no surprise that one of the recommendations from the Transition Team was to increase the role of non-profit service providers on city boards and commissions, and to privatize the delivery of City services through the use of personal services contracting with the City.

Illig helped found the California Association of Social Rehabilitation Agencies (CASRA). He has been saying every since Newsom was elected that the role and mission of Laguna Honda Hospital was going to change, so is no coincidence that social rehabilitation programming is being fast tracked for implementation and operationalization at LHH.  It is no mere “political’ coincidence that the social reahab grant application submitted to the California HealthCare Foundation (CHCF), lists Illig’s colleague, Health Commissioner Roma Guy, as an advisory board member for the LHH social rehab pilot project.

Between his roles with non-profit service provider networks and CASRA, Commissioner Illig may potentially have real or perceived conflicts of interest that should be monitored over time.

The State of California’s Community Care Licensing Division in the Department of Social Services defines “Social Rehabilitation Facilities (http://ccld.ca.gov/SocialReha_1754.htm) as:

“... any facility that provides 24-hour-a-day non-medical care and supervision in a group setting to adults recovering from mental illnesses, who temporarily need assistance, guidance, or counseling [emphasis added].”

Readers should note that LHH does not have a license from the California Department of Social Services to provide social rehabilitation.

CASRA indicates the social rehabilitation www.casra.org/SocRehab/sr-frame.html) model implicitly involves:

“... a shift in the notion of care for those considered to have a psychiatric disability. In contrast to institutional treatment of custodial care, for example, in board and care homes, social rehabilitation may not involve taking care of the client.  Rather [the goal] is to help clients care for themselves by developing social, vocational, or other ‘living’ sills.  Such skills include finding ways to help oneself and others independent of professional care.”

CASRA also indicates that “social rehabilitation” is defined as:

“... an earlier term describing the emphasis and perspective of the initial pioneers in the field.  Its origins are in California, where the focus was in integrating people back into the community.  [An] Individual[’s] problems were placed in a context of social issues, such as discrimination and poverty.”

CASRA members offer a variety of services, including “crisis and transitional residential treatment programs.”  One such CASRA member is San Francisco’s Baker Places, which holds significant contracts through the Department of Public Health to provide detox and residential drug treatment services.  Among other problems, LHH is not licensed as a residential drug treatment facility, nor as a residential mental health facility, nor as a residential social rehabilitation facility.

This is precisely what the LHH social rehab grant — as it was written and submitted to CHCF — claims it is designed to do:  To teach people “self-care” activities.  And it will not be surprising that at the end of the first year of the demonstration pilot project, LHH may re-apply to CHCF for a much larger grant for continuing years in order to expand the pilot project significantly throughout LHH’s facilities, therein further changing its mission from long-term care to short-term care, or self-care.

Part of the problem is that proposed services for the social rehab grant were initially developed, as stated in the response to the CHCF reviewers concerns, as a BioPsychoSocialSpiritual model of care for the Mental Health Rehabilitation Facility (MHRF) located on San Francisco General Hospital’s campus.  The model of care was never implemented nor tested in the MHRF; as such it is an untested, unproven approach. As well, LHH is not licensed as a mental health rehabilitation facility, and as such, this programming is an inappropriate model of care for San Franciscans needing long-term care at LHH.  

Indeed, the “social wellness” model of care being rapidly implemented is designed for LHH’s changing patient population to replace the long-term care medical model of skilled nursing for long-term care patients who face enormous hurdles to admission to LHH, since the frail elderly are being differential displaced.

All of this was done without a single public hearing before the Health Commission, and without hearings before the Board of Supervisors.  Instead of approaching the voters who had passed Proposition A in 1999 to provide long-term care for the frail elderly and disabled, knowing that the electorate would not likely pass a new “Proposition B” ballot initiative to implement social rehabilitation, the Health Commission, the Board of Supervisors, and the Mayor have quietly and quickly changed LHH’s mission without a single public hearing, and will be using Prop A funds to do, essentially, Prop B work.

In the end, it is no accident that:

• The Director of Public Health unilaterally changed LHH’s admission policy
• Mayor Newsom has failed for well over two months to follow up with Sister Miriam Walsh with his “mayoral vision for Laguna Honda Hospital,” since he has never issued a position paper on LHH’s mission, nor has he “gotten back” to Sister Miriam, as he had promised during a meeting on November 17
• LHH’s Executive Committee changed the LHH misssion statement without holding any public hearings or Town Hall meetings on LHH’s mission
• The Board of Supervisors have failed to schedule and hold a follow-up hearing before the City Services Committee regarding the June 24 LHH admission policy hearing
• The Health Commission held no hearings on either the changing mission of Laguna Honda or acceptance of the social services grant.
• The advisory committee to the Social Rehabilitation grant includes, among others:  (1) Health Commissioner Roma Guy, a social worker, and (2) Mozettia Helney, RN, now an LHH Program Supervisor of some sort who was formerly an employee at the MHRF.  In 1993 Henley developed and authored a BioPsychoSocialSpirtual (BPSS) model of care for the MHRF that was never tested or implemented at the MHRF.  The Social Rehab grant funded by CHCF is adapted from Henley's BPSS model, which document may have accompanied her move from the MHRF to LHH.
• Others who participated in “discussion and buy-in” of the Social Rehabilitation grant application, ostensibly prior to its submission to CHCF, included (as the LHH response to the CHCF reviewers concerns asserts):  (1) Dr. Katz, and (2) Both SEIU Locals 250 and 790, most likely RN’s in 790-Nursing [but most likely not social workers and activity therapists, among others, in LHH’s Chapter of 790-Miscellaneous] according to the LHH response to the CHCF reviewers concerns.

Instead, Proposition A bond money intended to build a long-term care nursing home will eventually be used to open the replacement facilities for LHH featuring social rehabilitation and behavioral health programming.

Social Rehabilitation Grant Application to the California HealthCare Foundation
CHCF’s Reviewers Concerns
LHH’ Response to the CHCF Reviewers

Public Testimony to the Board of Supervisors’ City Services Committee, January 27, 2005

Letter to:	Description
Board of Supervisors City Services Committee Considers “Resolution” to Accept Laguna Honda “Social Rehab” Grant January 25, 2005	In order to accept a California HealthCare Foundation (CHCF) grant to perform social rehabilitation at Laguna Honda Hospital, the Board of Supervisors City Services Committee must first approve accepting the grant award.  This link provides a printout of the City Services Committee agenda for January 27, 2005.  Agenda item 4 states only that the grant is to reintegrate clients into independent living; it does not describe accurately the purpose of the grant, and therefore, is too vague a description for public notice under the Sunshine Ordinance of the true nature of the proposed Board Resolution.
City Services Committee Background Material on LHH Social Rehab Grant January 25, 2005	In the background material posted to the City Services Committee hearing noted above, this 16-page “background” file contains only a portion of the full materials related to the grant.  This file does not contain the full grant application made to the California HealthCare Foundation, nor does it contain the funding agencies “reviewer’s remarks,” and as such, does not reveal properly the full purposes of the Social Rehab grant.  While this material shows that Social Rehabilitation will be implemented on a full Unit (ward) at LHH, it does not accurately report that the current long-term care residents of the proposed Unit will be displaced in order to provide 30 beds in which to perform Social Rehabilitation. Further, the proposed Resolution implies on line 20 of page 1, that the “Consent” process is reserved for matters “usually considered to be routine items.”  Since implementing this new Social Rehabilitation programming by way of changing LHH’s mission cannot be considered a “rountine” matter, using the Consent agenda may be an improper procedure by the Board of Supervisors to ram this grant through the Board without fully informing the public of what is being planned for aggressive, rapid implementation at LHH.
LHH’s New Executive Administrator’s Social Rehab Spin Control January 25, 2005	In response to concerns raised by the West of Twin Peaks Central Council, the new Executive Administrator of LHH, John Kanaley, attempts to pass off to the community that the new focus of social rehabilitation at LHH is merely to better “coordinate the provision of social services in a more efficient manner.”  Kanaley indicates that the intent of the social rehabilitation focus is to supplement social services LHH residents are receiving at LHH in addition to the medical care that they are already receiving.  What Kanaley fails to tell the West of Twin Peaks Central Council is twofold:  First, that there is no mention in the social rehab grant to CHCF that the new programming is to supplement existing social services programs, and second, that current residents needing long-term care are being displaced in order to provide new admissions with more social services.  Indeed, the social rehab grant materials obtained under a public records request indicate that social services are not being provided to supplement existing programs; they may indicate that social rehabilitation is being used to supplant existing programs for LHH’s traditional long-term care residents.  There is little in the grant materials to support Kanaley’s claim the grant is merely to more tightly integrate and coordinate the provision of social services.

Behavioral Health [Mental Health] Programming at LHH

A proposal to hire 22 additional staff members for LHH — including neuropsychologists, psychologists, psychiatric technicians, social workers and others — to develop and implement expanded $1.7 million “behavioral health” [read: “mental health”] programming at LHH is being developed.  [Forthcoming, as public records become available.]

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