Over the past decade, there has been an important national shift of perspective in skilled nursing care. Practitioners have moved away from an institutional model in which the priorities of the service provider determined such vital matters as when patients ate, slept, bathed and dressed. The emerging national best practice is a person-centered model in which the needs and preferences of the consumer, the patient, drive the kind of care provided.

The Laguna Honda organizational development project puts the hospital in the mainstream of the movement to foster resident choice and person-centered care. Working with two national leaders in nursing home reform, Lumetra Health Care Solutions and B & F Consulting, Laguna Honda is advancing its efforts to help residents achieve the highest level of independence possible and to increase staff engagement and satisfaction.

The project is managed by the Controller’s Office of the City and County of San Francisco, and is made possible by voter-approved funds designated for the improvement of city services.

To read the Lumetra team’s assessment report, issued in August 2010, click here.

Working in partnership with The San Francisco In-Home Supportive Services Public Authority is one way we are helping residents move out of Laguna Honda and live independently.  The Public Authority’s Consumer Peer Mentor Program provides training for people with disabilities who serve as mentors to help Laguna Honda residents prepare for independent living.

Along with the training, peer mentors use their personal experience to smooth the way for their mentees as they re-enter their communities. Mentors become trusted counselors and teachers – they’ve been there, so they know how to confront the challenges of independent living and reap the rewards of an independent life.

Mentors help other people with disabilities learn to use Muni or Bart, shop for groceries, or access resources that will help them live independently and successfully. Just as importantly, mentors help with the emotional and attitudinal barriers that can lead to dependency.

Sergio Alunan, who directs the peer mentor program, says it best. “It’s just about living like everybody else.”

Over the last year, more than 41 residents have been discharged from Laguna Honda to live independently. Their peer mentors continue to provide support, working in conjunction with other social service agencies, to build a healthy, integrated community.

For more information about the Consumer Peer Mentor Program, contact Sergio Alunan at 415-593-8112 or salunan@sfihsspa.org.

Here at Laguna Honda, it is always our goal to create community partnerships that provide residents with the latest and best options available. For developmentally disabled residents, our partnership with Golden Gate Regional Center enables us to successfully move residents from long term hospital living to more intimate, specialized residential homes in and around San Francisco.

Former Laguna Honda nurses now manage two fully-licensed remodeled residential homes under the GGRC umbrella. Both house seniors who are developmentally disabled. A third will open later this year to house residents aged 18-59, and plans for a fourth are already underway.

These GGRC homes offer residents 24-hour care and enable them to participate in day programs and outings and have access to their surrounding communities. Because they are under the care of former Laguna Honda staff, residents and their loved ones are afforded a continuity of care and the personalized attention they have been accustomed to. In addition, GGRC staff have long been a part of residents’ care teams, providing additional familiarity.

“It is exciting to be able to offer Laguna Honda residents new options, and very rewarding to see the progress even our elderly residents make in their new environments” says Alan Wilens, Supervisor of Resource Development for GGRC.

We at Laguna Honda are pleased to assist residents and their families in choosing the living situation that makes the most sense for them and will lead to accessibility and integration. Our partnership with GGRC is just one more way we’re building community and helping people fulfill their potential.

We are pleased to welcome our guest blogger, Dr. G. Allen Power. A board certified internist and geriatrician, Dr. Power is Eden Mentor at St. John’s Home in Rochester N.Y. A widely published and highly sought-after lecturer, Dr. Power presented a Grand Rounds talk August 4 at Laguna Honda for memory care specialists from hospitals throughout the Bay Area.  Part of his talk is excerpted here.

Dr. G. Allen Power .

The care of people who live with dementia is impeded by the high use of psychotropic medications in response to the behavioral distress commonly seen in such people. Recent evidence shows these medications to be responsible for a number of serious side effects—even increased mortality—yet their use continues to rise.

Studies have shown that, among people with dementia living in nursing homes in most industrialized countries, about 40% are given antipsychotic medications.

This problem is not confined to residential care settings. A review of people admitted to St. John’s Home in Rochester, New York in 2007 showed that, among those with a cognitive score indicating advanced dementia, 50% had been taking antipsychotic medications in their own homes as well.

Non-pharmacological approaches to care are widely touted, but often fall short in practice. This is because we are still working within a badly flawed model of care that has dominated our approach to dementia over the past half-century. This biomedical approach sees dementia purely as disease and decline, and therefore attributes people’s distress to neuropathology and responds in kind with a medication approach.

The problem with this approach is that most behavioral distress can be tied to unmet needs in the care environment. Instead of understanding those needs, we simply medicate the symptoms, often with disastrous results.

What is needed is a radical shift in the way in which we view dementia. I have taken the basic tenets of the nursing home “culture change” movement (and the work of dementia pioneers like the late Tom Kitwood) to construct a new “experiential” view of dementia. This model reaches beyond the narrow biomedical view and views people as continuing to have opportunities for growth and meaningful engagement throughout their lives with dementia.

The key to this approach is to truly connect with each person, in order to understand the world as he or she sees it. Instead of trying to force each person to adapt to our institutional care environment, our challenge is to change the environment to meet the needs of the person with dementia. In this way, we create a world in which he can continue to succeed. (This concept is similar to building access ramps for people in wheelchairs, rather than asking them to climb stairs.)

The experiential model provides a framework for understanding the causes for distress in people with dementia, creating a response that is humanistic, attentive to individual needs, and succeeds without the need for medication. The reason that non-pharmacological approaches fail in the traditional care setting is because such discrete interventions are not sustainable without changing the larger care environment as well.

The primary goal of the experiential approach is not to eliminate behavioral symptoms—it is to maintain well-being. A more holistic definition of dementia holds that it is a shift in the way a person experiences the world around her, creating a situation where one’s ability to maintain her own well-being is challenged. By restoring well-being, we can eliminate most distress without resorting to medication. Several studies have shown that, with targeted interventions, the vast majority of antipsychotic drugs can be stopped without significant worsening of distress.

In summary, by embracing the philosophies and practices of person-directed care, and “taking them deeper” into the world of dementia, we can create a pathway to reconnect people with meaningful life and growth. This process creates a better experience for their care partners as well. It is time to move away from the “quantum” biomedical model of dementia, toward a “theory of relativity”—an experiential model of care.

One of Laguna Honda’s core values is to be a part of our community. In addition to enabling residents to connect to the community as much as possible, we also invite the community to be a part of Laguna Honda. One of the key ways we do this is through our psychology internship program.

For nearly two decades, we have drawn advanced graduate students and pre- and post-doctoral candidates from professional psychology programs throughout the Bay Area to our highly coveted internship positions. Interns follow either a neuropsychology track or a substance abuse treatment track and become an integral part of resident care teams. With staff supervision, the interns provide individual and group psychotherapy and conduct evaluations and assessments.

Nearly half of our current staff psychologists began as interns in our program, including Brenda Austin, Ph.D, who did one year of her two year post-doc training with us, and has been Co-Director of our Psychology Training Program for the last several years.   Many have gone on to impressive positions in the field around the country. Among the illustrious graduates of the Laguna Honda training program is Laura Howe, PhD., J.D., currently chair of the Legislative Action Committee for the National Academy of Neuropsychology.

“The internship program provides value and benefit for all sides,” says Dr. Lorraine Killpack, Co-Director of the Psychology Training Program. “Residents benefit from direct service, interns benefit from field training at one of the only skilled nursing programs in the country to offer it, staff is invigorated by energetic students who bring the most current field knowledge, and Laguna Honda’s reputation grows as our interns go on to esteemed positions nationwide, having received top notch training at our hospital.”

Our mission at Laguna Honda is to provide a compassionate, individualized approach to rehabilitation and long term care. A team of nurses, doctors, social workers and therapists consults with each resident and their loved ones to create a comprehensive plan to ensure the most positive outcome possible. One of the many options available to assist in rehabilitation is our award-winning restorative nursing program.

The daily lives of nearly 90% of residents are improved through our interdisciplinary approach to restorative care. Our goal is to enable people to achieve their highest level of independence whether they are learning to negotiate city streets with a wheelchair or relearning after a traumatic injury how to lift a glass of water and drink.

With a tailor-made program that takes into account specific needs and preferences, personal goals and likes and dislikes, each resident in the restorative program works with a specially trained staff member in any number of 11 target areas. Some may work on medication management while others concentrate on range of motion or walking. We also supply techniques for residents who have completed their therapy at Laguna Honda to continue to become more self-sufficient.

In 2007 the restorative care program was honored with a prestigious Best Practices Award by the California Hospital Association . We earned this distinguished tribute for achieving astounding success by steadily increasing the number of residents we serve, expanding the variety of programs we offer and by demonstrating greater measurable success.

The designer of our restorative therapy program, Jill Le Count, RN, says, “Our certified nursing assistants must be specialists in restorative care. It is very important to us that residents here receive hands-on therapy that helps them to thrive.”

Everyone on the restorative nursing team is excited about enhancements the new Laguna Honda will bring to their program. In addition to being a specially designed therapeutic environment, the new Laguna Honda features state-of-the-art equipment to give residents more options for restorative exercise.  Also, new dining options will provide more opportunities for relearning relevant skills and the many new therapeutic gardens on campus will afford greater accessibility to the healing effects of nature and enhanced opportunities for outdoor exercise and activities.

Our restorative nursing program is just one more way that Laguna Honda values the whole person in our approach to long term care and rehabilitation.

At Laguna Honda, we have rebuilt from the ground up to enhance our therapeutic environment. Thanks to the Laguna Honda Foundation, we are renovating much of our landscaping as well.

Wanting to keep our business local, we approached the Department of Environmental Horticulture and Floristry at City College of San Francisco. Through this exciting community partnership, we worked with award-winning student landscape designer John Alexander, who planned and supervised the renovation of twelve garden areas on our 62 acres. Among them is the redesign of our front lawn and its iconic “LHH” topiary. The surrounding community can enjoy this huge expanse which has been beautified with native plants and drought resistant succulents.

John was integral in developing our therapeutic gardens and outdoor planters (pictured) as well as designing and planting the garden in our soaring atrium. Our therapeutic gardens contain raised beds for gardeners who use wheelchairs. Residents will help tend the gardens and assist in various green programs such as propagating new plants.

The atrium plantings feature two 4’x4’ panels with 24 pockets on each side containing a variety of plants that allow for sensory stimulation (pictured). Eventually, residents will be able to enjoy plant and flower clippings in their own rooms, bringing home the sights and smells of the outdoors.

Our community partnership with San Francisco City College has resulted in the flourishing redesign of our campus – just one more way the new LEED-certified Laguna Honda is environmentally aware and therapeutically grounded.

The Garden in Our Atrium

Outdoor Planter

Andy Schoenwetter has worked in Food Services at Laguna Honda for 21 years and is excited for the improvements his department will bring to residents when they move in to the new hospital later this year. He and fellow workers have participated in the creation of new service delivery systems and are eager to put their re-training to work.

After nearly 30 years of bedside tray service, the new Laguna Honda will feature dining with a social touch thanks to galley kitchens and household dining rooms in each 60-person Laguna Honda neighborhood. Residents will still have many meal options, including ethnic and vegetarian food, and they’ll be able to eat in an atmosphere that has the sights, sounds and inviting aromas of a restaurant. In addition, food can now be served in courses, helping to ensure that nutrient rich soups, salads and entrees won’t be overlooked by dessert-lovers.

In the new Laguna Honda, food service staff and dietitians will be part of each neighborhood’s care team, along with nurses, physicians, social workers, activity therapists and housekeepers, helping to build rapport and create the personal touches that make a house a home. Paying attention to who likes their salad dressing on the side or prefers the white meat of the chicken is one way that food service staff members help to meet individual needs and preferences at the new Laguna Honda. Multi-lingual workers for non-English speaking residents will also add to personalized care and comfort.

Andy is most excited about the ecological impact of the new facility. With solar panels on his home and a high mpg car, Andy clearly cares about the environment. Every neighborhood galley will have juice dispensers, eliminating the use of non-recyclable plastic and aluminum serving packs which have contributed to the hospital’s 2-tons of weekly garbage. That, along with new composting and recycling systems, will greatly diminish Laguna Honda’s environmental impact. Its commitment to composting is one reason why the new Laguna Honda is the first LEED-certified hospital in California.

In his more than two decades at Laguna Honda, Andy has seen many beloved colleagues and residents come and go. He wishes they’d all had the opportunity to benefit from the new Laguna Honda, and he knows it would make them all proud.

When then former San Francisco City Attorney Louise Renne filed pioneering consumer protection lawsuits against the tobacco industry in the 1990s and went on to win millions of dollars for California, San Francisco and other cities and counties, she had no idea it would lead to rebuilding Laguna Honda into a world class center for skilled nursing and rehabilitation.

In 1998, Renne approached then Mayor Willie Brown with the idea to use the tobacco money to save Laguna Honda, which was in disrepair and threatened with closure. Working with Brown, the Board of Supervisors and San Francisco Director of Health Dr. Mitch Katz, Renne got a bond measure on the 1999 ballot to use the settlement funds to defray the cost of rebuilding.

A resounding 73% of voters approved the measure and now, just over ten years later, the hospital’s 780 residents are poised to move to a spectacular new hospital modeled on the latest research into how the built environment of health care facilities can improve patient outcomes.

Renne has been a driving force all along. She is president of the Laguna Honda Foundation, which supports the hospital’s organizational development initiatives and underwrites research. The Foundation is also working on refurbishing the legendary Laguna Honda Theater, which once saw the likes of Bing Crosby, Merv Griffin, Frankie Lane, Donald O’Connor, and other hoofers and crooners of the Greatest Generation on its stage. The theater is on track to reopen by 2012.

When asked how she feels about her decade of work coming to fruition this week with the Gala Celebration and Ribbon Cutting, Renne said, “It’s the people of San Francisco who said the tobacco money should be spent on healthcare. The new Laguna Honda is a credit to them. I think this is a city that believes a strong commitment to public health is a measure of the worth of any community. And, of course, I think with Laguna Honda we’ve all hit a homerun!”

Imagine that your mother developed Alzheimer’s.

What if caring for her at home became too difficult? Would you know where to turn? We have the answer, right here in San Francisco. The new Laguna Honda is now a state of the art skilled nursing facility designed to create community, promote self-sufficiency and let you rest assured that your mother is being cared for with compassion and dignity.

Laguna Honda has long been at the forefront of memory care. In fact our nursing staff and comprehensive approaches are featured in an upcoming educational series for care providers. Our new facility will enable us to give our residents an even greater quality of life.

Your mother would move into our new memory care neighborhood, which is divided into four 15-person households organized around a central Great Room, or town square, that will allow her to get to know and recognize her neighbors and participate in a variety of therapeutic and social activities. The neighborhood is one of 13 specialized nursing programs on our campus.

Your mother can participate in daily therapeutic activities in the Great Room, and have meals with her neighbors, further encouraging choice and social interaction. Wouldn’t you feel better knowing your mom wasn’t eating alone off a bedside tray, with no opportunity to express her own needs and preferences?

At Laguna Honda, we know that being part of a community and interacting with others slows the progress of the effects of Alzheimer’s and other dementias, like isolation and the chances of falling.

Hallways and room numbers in the memory care neighborhood are marked with designated colors to help her find her own way, so she doesn’t have to rely on others. Colorful, original works of art designed specifically for Laguna Honda serve as “way-finders” as well, while also adding beauty to the surroundings, making for a warm and livable environment. Our sunny facility is the anti-institution.

The memory care neighborhood leads onto a secured garden, helping to keep residents safe while enabling them to reap the healing effects of the natural environment on our campus.

And we’re not just taking care of residents – we’re actively fighting disease. Our Laguna Honda team is participating in the Alzheimer’s Association Memory Walk, the country’s largest event to raise awareness and funds to defeat Alzheimer’s. We are well on our way to meet our fundraising goal of $5000. We hope you’ll join the fight.

Moving a family member into a residential facility is always difficult, but often it can be the safest and wisest choice. Laguna Honda’s compassionate care is delivered round the clock, keeping your loved ones healthy and protected.