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Action on AIDS

December 10, 1987

The Los Angeles County Board of Supervisors and the county Department of Health Services moved quickly Tuesday to implement recommendations from the new county AIDS Commission designed to speed hospice and home care for those with acquired immune deficiency syndrome. The cheers from the audience, which included dozens of persons with the fatal disease, measured the importance of this response.

Rabbi Allen Freehling, chairman of the commission, cautioned the supervisors that it was "altogether foolish" to continue a hospital-based care program when other services, including home care and hospice programs, offer an alternative that is both more humanitarian and less costly.

The commission had recommended that March 1 be set as the deadline for implementing a $1.5-million alternative care program included in this year's county budget. The supervisors, on the motion of Ed Edelman, agreed. In addition, at Edelman's request, they ordered an investigation to be completed by Jan. 11 of alternative sites for the new programs, including Barlow Hospital. And Deane Dana, newly installed as chairman of the supervisors, sponsored a further order for an immediate inventory of existing facilities.

Robert C. Gates, director of health services, met later in the day with commission leaders and the chief deputies of each of the five supervisors to review a revised $33-million county AIDS budget, to outline expedited expenditures and to set up briefings before each commission meeting.

Full implementation of home-care programs throughout the state faces a delay until next July 1, when Medi-Cal funds may become available. The state agreed last spring to seek a federal waiver to permit the use of Medi-Cal money, half of which is federal, for home care for AIDS patients. The state expects to complete preparation of the application by the end of this month, but doubts whether federal approval and full implementation will be possible before July 1. Four other states already have received waivers. The Health Care Finance Administration, the responsible federal agency, has promised expedited action. But, according to state officials, approval hinges on the state's ability to prove that this program will be cheaper than the present hospital-based care.

In the meantime, Medi-Cal funding will be made available effective Jan. 1 for hospice care, including AIDS patients. This will cover care both at home and in hospices.

San Francisco already has demonstrated the crucial importance of home- and hospice-care programs for handling the AIDS pandemic. Patients agree that it is more humane--a fact driven home to the supervisors in testimony both by persons with AIDS and by two mothers who had cared for sons who died of AIDS.

One of the most promising proposals pending before the county is the use of Barlow Hospital as a fully integrated AIDS-care facility. Trustees of the hospital have agreed to provide AIDS services. It was created at the turn of the century to treat tuberculosis, and currently specializes in pulmonary disease. Its sprawling but centrally located facility near Dodger Stadium offers the possibility of providing acute hospital, skilled nursing, residential, hospice and out-patient care in a single integrated AIDS facility, according to Edelman.

There is a new sense of urgency in the county. In October, 192 new cases of AIDS were reported--the highest number recorded here. Most of the care is now hospital-based, and most of the deaths are away from home and away from hospices because of the lack of alternative facilities. That is cruel to those burdened with the disease, and it is wasteful of resources.

Michael Weinstein, chairman of the AIDS Hospice Planning Commission whose work inspired the county AIDS Commission recommendations, was elated after the meeting of the supervisors. He had met earlier with scores of people with AIDS, and with the mothers of some who already have died. "They needed a victory," he said. "They face so many defeats."

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