People, not buildings, should be focus of health care planning

By Michael DeNunzio

The following was printed in the Catholic San Francisco newspaper on October 29, 1999, in opposition to Proposition A.

Last year my father, Tony, was diagnosed with Alzheimer's Disease. He was always an active and articulate man. Today he is very quiet. I remember when I was four years old he took me to see President Roosevelt in a motorcade. As the president's limousine passed, my father lifted me up to see his hero. "Did you see him?" I asked as he set me down. "No, but you did," he replied. Like any dad would do, he sacrificed his view so his son could see. That was my first experience of intergenerational responsibility. Today, when I telephone my father he does not recognize me. It is from this perspective that I write about Laguna Honda.

On Nov. 2 voters determine how San Francisco will spend millions of dollars to serve disabled seniors in the next century. Studies show we may need 4,000 to 8,000 skilled nursing beds by 2020 when 23 percent of our City population will be over 65.

Just as the four-year-old had a special need to be held up to see the president, every senior person has special needs. No single type of elder care can fit all. Our God given uniqueness does not end when we become elderly and disabled. For this reason, we have a fundamental moral responsibility to always focus our priorities on the needs of persons as individuals, not the needs of one institution or organization or group.

Every other county in California has ended the outdated Laguna Honda model of institutionalizing indigent, disabled seniors. San Francisco must also adopt a 21st century comprehensive plan that will enable the disabled elderly to live out their lives with dignity and independence in neighborhoods close to friends, family, church and the volunteer and cultural organizations of our diverse City.

"The process of truly understanding the long-term health needs of San Francisco's elderly, disabled population--and providing them with the best and most humane community based care possible--must begin with a No vote on Proposition A," wrote local commentator Arthur Bruzzone in a recent op-ed letter. There is a good reason why. Today America is addressing long-term care with a compassionate continuum of modern, supportive options at half the cost of nursing home care. Disabled seniors receive personal in-home support services and care from visiting nurses and attention from caring staff in adult cay centers as well as community-based assisted living facilities and small nursing homes similar to Laguna Honda.

It is especially noteworthy that the respected FDR Democratic Club, which is chartered by the Democratic Party of San Francisco to advocate for needs of seniors with disabilities, urges NO on Proposition A. Supervisor Barbara Kaufman opposes committing an astronomical $401 million, plus $230 million in interest, to finance Laguna Honda. She also warns that the facility will face a deficit of $31 million on the day it opens. The Independent Living Resource Center opposes expending over $600 million on a 1,200-bed, outmoded facility to the exclusion of modern, lower cost community care options.

Our great City has the ability to provide a multi-service plan for dignified care of our aging population and ensure than no indigent senior will be made homeless by defeat of this flawed proposition. We need only the will to work with qualified providers to convert surplus hospital beds throughout the City. Our long-term care providers include 19 nursing homes and eight acute care hospitals. We are also blessed with On Lok Senior Health Services, Jewish Family Services, North of Market Senior Services and Family Caregiver Alliance. We will increase this supply of providers as we direct resources to community-based services. San Francisco presently spends over 70 percent of its long-term care budget on institutionalizing its elderly at over twice the cost of community care. In his thoughtful article, Bruzzone recommended that before new multi-million dollar construction is authorized, we must know what services will be needed and what can be purchased from community-based groups. Only then should a bond measure be brought before voters.

We have a greater obligation to serve the individual needs of people--not the cost of buildings. Thoughtful rejection of Proposition A will be a positive step to bring 21st century community-based personal assistance to all disabled people, including the paralyzed mothers like Teresa who sit silently in wheelchairs and the confused fathers like Tony who can no longer remember their sons.