The Laguna Honda Campus — Choice and Community in a Therapeutic Setting
San Francisco confirms it reputation for health care innovation with Laguna Honda Hospital and Rehabilitation Center, a technologically sophisticated and holistically planned facility serving seniors and adults with disabilities.
California’s first green certified hospital, Laguna Honda presents a new public health model for providing long term care and rehabilitation services to a safety net population.
Choice, Community, and a Healing Environment
Relying on new research into the effects of the built environment on patient outcomes, the planning team from the San Francisco Departments of Public Health and Public Works, the joint venture of Anshen+Allen Architects and Stantec Architecture, and the Center for Health Design created three new buildings on Laguna Honda’s 62-acre campus which are uniquely suited to support the healing work of the city’s skilled nursing and rehabilitation programs.
Central to the design was the intention to create choices for Laguna Honda’s 765 residents, helping people who receive services to take an active role in directing their own care, including making decisions about basic activities of daily living, such as eating, sleeping or choosing when and where to enjoy recreation and privacy.
In addition to creating choices, the buildings are also designed to foster a community atmosphere and to take advantage of the healing effects of Laguna Honda’s natural environment.
The patient rooms have views of the hospital’s verdant campus. Upper stories look onto the Pacific Ocean several miles to the west. Rooms are filled with natural light and have operable windows. Each building opens onto a large central park, site of the hospital’s animal therapy and horticulture programs. The park features a petting zoo, a small orchard and raised planting beds accessible to people using wheelchairs.
Secured therapeutic gardens will provide a safe environment for people with Alzheimer’s disease and other dementias to enjoy the outdoors.
The heart of the new buildings is the Esplanade, a broad indoor boulevard modeled after the main street of a small town. Among the places to meet and greet that line the Esplanade are a café, a community theatre, two art studios, a multi-media library with a fireplace, barber and beauty shops, a tropical bird aviary, and a cafeteria with indoor and outdoor seating.
Residents of Laguna Honda live in 15-person households, each with its own living room, to provide a setting that encourages community and allows for privacy. Seven types of rooms are available, including suites of two or three individual rooms, shared rooms for two or three people, and single rooms. Each of the hospital’s 13 floors is made up of four households organized into a distinctive neighborhood with a Great Room at the center where daily activities take place.
The household and neighborhood concept is an innovation in long term care that enables skilled nursing to be provided in a community-oriented and person-centered environment where patients, or residents, are understood and embraced as complex and unique individuals and not viewed in a limiting way as people with a diagnosis. The households and neighborhoods allow Laguna Honda to operate 13 specialized skilled nursing programs and still take advantage of the economy of scale offered by a single, integrated organization.
Laguna Honda provides three distinct types of health care services, acute care, skilled nursing care and rehabilitative care. Acute care services are for Laguna Honda residents only. The hospital has no emergency room. Rehabilitative services include physical therapy, occupational therapy, speech therapy, and audiology. Skilled nursing services include the following programs.
- The only skilled nursing facility for HIV/AIDS in the San Francisco Bay Area
- A nationally-recognized Memory Care program for people with Alzheimer’s and other dementias
- Group living focusing on community integration for people with developmental disabilities
- An Enhanced Support Program providing therapeutic services for multiple sclerosis, Parkinson’s and other degenerative diseases, traumatic brain injuries and the effects of stroke
- An Integrated Wellness Program providing guidance and support for people with psychosocial difficulties
- Complex care for people with multiple diagnoses
- An award-winning restorative care program that assists residents to retain and reclaim physical competency
- Pain management and end-of-life care emphasizing comfort and dignity, including an in-house palliative care operated in conjunction with the Zen Hospice Project of San Francisco
- Monolingual care for speakers of Spanish and Chinese
Laguna Honda is California’s first green-certified hospital. The U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED) program awarded the hospital silver certification in June, 2010.
The hospital’s three buildings address environmental impacts in their design, construction and operation across six LEED-designated categories: sustainable sites, water efficiency, energy and atmosphere, materials and resources, indoor environmental quality, and innovation and design process.
Financing For the New Hospital
Laguna Honda’s financing package is unique for its use of $141 million in revenue from the city’s settlement of consumer protection lawsuits filed against the tobacco industry by former city attorney Louise Renne in the late 1990’s.
In the 1999 municipal election, city voters directed that tobacco settlement revenue be used to build a new center for skilled nursing and rehabilitation. The ballot measure, known as Proposition A, passed with 73% of the vote.
General obligation bonds provided $323 million for the project, and the city’s sale of certificates of participation, a form of security, provided the remaining $120 million for a total cost of $584 million.
Up to 45% of Laguna Honda’s capital costs are eligible to be paid for by federal dollars under California State Senate Bill 1128, authored by then-state Senator and now Congresswoman Jackie Speier. The bill authorizes the city to receive partial federal reimbursement for construction costs associated with certain seismic upgrades related to health care.
Central to the mission of Laguna Honda is the integration of the hospital campus into the civic life of the city.
San Francisco enhances the beauty of its public spaces through the Art Enrichment Ordinance. One of the first in the country, the ordinance provides that 2% of the total eligible construction costs of public works projects be allocated for public art.
The Laguna Honda Replacement Program generated $3.9 million in art enrichment funds for a public art program that contributes to the quality of life at the hospital by helping to create an aesthetically pleasing environment and a sense of place and home.
Eighteen artists were commissioned to create works to support the hospital’s clinical needs and therapeutic goals. Sculptures, paintings and mixed-media works are installed throughout the campus to assist sensory stimulation, way-finding, encouragement of activity, interaction with nature and activation of memory.
The works are wheelchair accessible and tactile so they can be enjoyed by residents with mobility and sight limitations. They also provide a new destination for San Francisco art lovers.
Laguna Honda has been an integral part of the San Francisco community since 1866. It opened as an almshouse to care for one of the first generations of San Franciscans, the Gold Rush pioneers. Over the decades, as the city grew up around it, Laguna Honda embraced generation after generation of people in need.
To meet the changing healthcare needs of San Francisco, Laguna Honda has served many purposes over the years. It provided important care during a smallpox epidemic in 1868, served as a place of refuge for people displaced by the 1906 earthquake and fire, and now provides the Bay Area’s only dedicated skilled nursing services for people with HIV and AIDS.
In 1926, the hospital opened large Florence Nightingale-style dormitories, then the accepted practice in nursing care. In the new Laguna Honda, which opened in 2010, residents can choose to spend time in private and semi-private rooms or to enjoy the company of others in the Great Room at the center of every neighborhood, on the Esplanade with its many community gathering places, or outdoors in the central park.
Notable moments in the history of Laguna Honda include a visit in 1909 by President Theodore Roosevelt, who was in San Francisco observing earthquake recovery efforts; installation in 1934 of five murals by South African artist Glen Wessels, one of the first depression-era federal art projects in San Francisco; and annual holiday performances in the hospital’s Gerald Simon Theatre in the 1960’s and 70’s by Bing Crosby, Merv Griffin, Frankie Lane, Donald O’Connor, and other hoofers and crooners of the Greatest Generation. The holiday shows were sponsored by the Friends of Laguna Honda, a philanthropic organization that continues to support the hospital’s mission today.
Laguna Honda is at the beginning of a new era of service. It has moved from a stately, 1920’s-era Spanish Revival building into a modern facility designed to foster integration, independence and community.
The mission of Laguna Honda – to provide culturally competent long term care and rehabilitation services for a safety net population – is focused on achieving the highest quality of care and quality of life for each resident, and encouraging the highest level of independence for each resident whether it be at Laguna Honda or in other community settings.
The new Laguna Honda represents a transitional moment for long term care provided by an urban, public health service, and it is also a rededication to each San Franciscan in need.