Laguna Honda opened in 1866 to care for one of the first generations of San Franciscans, the Gold Rush pioneers.  

Many people who had come west seeking their fortunes in the gold and silver mines of Northern California went bust instead.  The burgeoning city responded to its growing numbers of people in need by constructing a four story wood frame building to house indigent San Franciscans on the old San Miguel Rancho west of Twin Peaks. 

The rancho had been the property of José de Noe, the last alcalde, or mayor, of San Francisco in the days when the city was still part of Mexico.  It was a good place for people to grow their own food and tend animals.  Nearby, on the sloping land behind Twin Peaks, a natural spring fed a deep lagoon, a laguna honda. 

The building was known as the Almshouse, which until the 20th century was a common term for a place of refuge housing people who were chronically ill or impoverished with nowhere else to go.  

Like many such places, the Almshouse grew its own food and livestock on 87 acres of farmland.  By 1870 the farm not only fed an Almshouse population of over 500 men, women and children, but produced a surplus harvest as well, enough to cart into town, three miles to the northeast, to sell at market.  

There were scant amenities for the people of the Almshouse.  They made their own clothes and their own shoes.  But in 1872 the administrator reported to city officials that “together with the food, clothing and general cleanliness of the place [it] is equal, if not superior, to any of the same nature either in the U.S. or Europe.” 

The first medical services were provided in 1868 when the city opened a 24-bed hospital during a smallpox epidemic.  After the epidemic abated in 1870, the hospital closed and was replaced by a small asylum. Like many such institutions throughout the country, the Almshouse was a refuge for a wide variety of people who lived at the margins of society. 

As the century ended, new buildings went up on the Almshouse grounds to serve an increasingly diverse population.  In 1890, the administrator reported that Almshouse residents represented some forty different nationalities. 

The defining event of the early part of the new century was the great earthquake and fire of 1906.  The Almshouse was pressed into service to house and care for thousands of displaced San Franciscans.  Now known as the Relief Home, it consolidated earthquake victims living in refugee camps scattered across the city.  A new pavilion-style building was constructed, able to accommodate 1,000 people.  The building was dedicated in 1909 by President Theodore Roosevelt. 

By 1910, the city had added another stately new building to the Relief Home.  Known as Clarendon Hall, it housed 250 people, and for the first time was intended specifically for people who needed long term medical care.  Clarendon Hall was demolished in 2008 to make room for today’s Laguna Honda, a facility able to withstand an earthquake many times more powerful than the one that caused Clarendon to be built. 

The leap from Relief Home to skilled nursing facility began in earnest in the 1920’s when Mayor James “Sunny Jim” Rolph turned over the first spade of earth for the Spanish Revival-style buildings that would become Laguna Honda Hospital and Rehabilitation Center 

Those buildings, whose Mediterranean tile work is echoed in the architecture of today’s Laguna Honda, were opened in 1926 and continued to grow in the decades that followed with the addition of new “finger wings,” the long, Florence Nightingale-style open wards that were customary at the time. 

In the 1930s, Laguna Honda became a teaching center for the University of California medical school.  Surgery began to be performed, and cardiograph and x-ray technology was introduced.  The entryway to the main building was graced with now-classic WPA murals, which are still on display. 

After the war, Laguna Honda was the site of a cancer research program funded by the National Cancer Institute and the University of California.  Occupational therapy was introduced with a technical arts program in weaving and basketry.  A large room fitted with looms became known as the “rug room,” named for the acclaimed products of the resident weavers.  The program grew into a fully fledged department of occupational therapy in 1953. 

In 1957, local businessman Gerald Simon founded the Laguna Honda Volunteers, Inc., a philanthropic organization that to this day funds amenities for Laguna Honda residents such as personal items, assistive devices, books, music, outings, and celebrations. In the 1960s and 1970s, the Gerald Simon theatre at Laguna Honda was a venue for performers like Bing Crosby, Merv Griffin, Eddie Fisher, Phil Harris, Donald O’Connor and Frankie Lane. 

Laguna Honda became accredited as a hospital in 1963 as it continued to redefine itself in ways that would allow it to meet the needs of its diverse service population.  The 1920s-era buildings underwent a major renovation in the mid-70s. 

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.  

Central to the design was the intention to create choices for Laguna Honda’s 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.  

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.

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.