In nursing homes, a doctor is guaranteed payment by Medicare or MediCal only once a month. MediCal payment is minuscule, and either type of payment is usually denied for more visits even if the M.D. can justify it with big-time paperwork. Nursing home patients quickly exhaust any other type of insurance.

Thus, there is no incentive to keep a private nursing home patient if he/she is at all "difficult": The nursing home gets no additional pay, nor does the doctor. Such patients are quickly sent to the nearest acute hospital.

Ask any hospital social worker in town to which nursing home she sends her most difficult patients -- if she can get a bed. Complicated patients may simply have to stay in high-priced acute hospital beds until Laguna Honda has room.

Of course insurance payment is "denied" because the poor soul isn't really "sick enough" to be in the acute hospital. So he or she can be sent to a private nursing home and end up back in the hospital even sicker (sometimes after two or three rounds of this) until he or she gets the comprehensive support offered at Laguna Honda.

Yes, the private hospitals in town would like to use their extra space for nursing home grandmothers and grandfathers -- as long as they behave.

But when the going gets rough, the ambulance gets called, and suddenly there's "no bed" back at the private hospital. Amazingly, this is almost always after the better-paying insurances have been exhausted and MediCal must begin picking up the tab. This is when Laguna Honda gets a call.

Doctors at Laguna Honda are in-house and on salary; they come when needed. It's a big enough place so staff can be found to help the patient needing extra attention, and the nurses know their patients well. Like any large institution, Laguna Honda has its inefficiencies and should deal with them.

But it's still there for you if you really need it; and there is still enough staff to deal with the complicated patients. Come the autumn, significant cuts have been promised. The general public won't feel the loss until they are old or too sick to be heard.

"There but for fortune go you or I." If the people of San Francisco don't support their public nursing home, they are hurting themselves.

Teresa Palmer, M.D.

Wheels of Change
In "Roller Derby" (Bay View, Feb. 28), concerning disabled access in San Francisco, you quoted both Paul Church and Larry Paradis. I find it interesting that no disabled San Francisco resident was quoted.

I am the president of Independent Housing Service, the agency that filed the first suit that created the settlement agreement with the Building Inspection Department (BID) (for some reason Matt Melucci failed to contact us). We have declined to participate in the newest suit against the BID.

While I am not thrilled by the progress in complying with the agreement, it should be made clear that what has held up implementation of the enforcement effort has been the refusal of the Jordan administration's fiscal staff to approve the funding for the new access inspectors.

In this regard, I find it curious that Church, who was closely associated with the Jordan administration as chair of the mayor's Disability Council, and someone who met with the mayor on a regular basis, now brings forth this issue. A new administration that is committed to the rights of all San Franciscans including the disabled is now attempting to undo the harm done to the disabled community by the Jordan administration, which placed political expediency above civil rights.

I also do not understand the comments from Paradis as to exceptions for access being granted by the BID, when a member of Disabled Rights Advocates' own board of directors is the president of the Access Appeals Commission.

We all want access, and most of us want it now. However, our city agencies can only enforce the laws as they are written in a manner that is fair to all parties.

I think that this article was a cheap shot at the BID and the Brown administration.

As president of the FDR Democratic Club, which was formed and chartered to empower the disabled and senior communities through the political process, we find the recent progress under the Brown administration to be a refreshing change.

August J.P. Longo, President
Franklin Delano Roosevelt Democratic Club for Persons With Disabilities & Seniors

South of Market

Bench Press
Matthew Rothschild did a good job of getting his troops to blanket SF Weekly with letters expressing outrage at George Cothran's profile ("Judging Matthew Rothschild," Feb. 28).

Behind all the vitriol, however, was only one disputed fact (and it wasn't about his lack of qualifications): whether or not Rothschild's childhood dream was to be a judge or a politician.

Suffice it to say that the only dream consistent with the way Rothschild has conducted his life is the dream of becoming a politician. Ron Albers, on the other hand, does not have to talk about dreams of serving on the bench; becoming a judge is the natural next step in his 20 years of service to the legal profession and to the community from within that profession.

Regardless of boyhood dreams, I am not convinced by Rothschild's argument that justice and politics should mix.

Grant Martin
Noe Valley

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