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 number of people in need by constructing a four story wood frame building to house 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 food and care for 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 people, but produced a surplus harvest as well, enough to cart into town, three miles to the northeast, to sell at market.  

The first medical services were provided in 1868 when the city opened a 24-bed hospital during a smallpox epidemic. 

As the century ended, new buildings went up on the Almshouse grounds to serve an increasingly diverse population. 

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 added another stately new building to the Relief Home. Known as Clarendon Hall, it housed 250 people and was intended specifically for people who needed long-term medical care for the first time. 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 a 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 funds amenities for Laguna Honda residents. 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.