LAGUNA HONDA: Vital Alternative for Some Patients

      Writing in Wednesday's San Francisco Chronicle, Dr. Kathryn Borgenicht, an associate clinical professor of medicine at UCSF who worked for six years at Laguna Honda Hospital, argues in favor of Proposition A -- the controversial $299 bond issue to finance a $401 million replacement for the 133-year-old facility. The crux of Borgenicht's argument is that Laguna Honda is a crucial link for the city's elderly, poor and disabled, providing services that nearby community-based care programs "simply cannot provide." She notes that Laguna Hospital maintains several specialized inpatient units, including AIDS, geriatric psychiatry, dementia, rehabilitation and a hospice care unit -- that provide a level of care unequaled by community care programs. Herself a medical director of a community-based care program, Borgenicht is a strong proponent of that delivery model. But while community care "is an excellent choice for many with disabilities," she writes, it "does not work for everyone." Indeed, many Laguna Honda patients require highly specialized care. Borgenicht points to a recent national study showing that "Laguna Honda residents are sicker and have more complicated problems" than most skilled nursing facility patients, requiring a "much greater level of care than average." She closes by noting that as the city's population ages, "San Francisco will face a major shortage of nursing home beds." A new facility is needed, she argues, especially one with "exciting" new plans for "innovative programs" that will lend themselves to the "dignity and choice of its residents" (9/29).