As the first step in its new $1.5-million AIDS hospice program, the County Board of Supervisors this week awarded contracts totaling $500,000 to the Visiting Nurse Service of Long Beach and to a nursing agency in Los Angeles.
County officials, responding to pressure last year from AIDS organizations, say they are attempting to treat acquired immune deficiency patients in ways that are cheaper and more appropriate than hospitalization.
The nursing agencies' home-care costs for AIDS victims should be about $150 a day, compared to hospital expenses of about $750 a day, said Robert C. Gates, county Department of Health Services director.
"It's also the right thing to do from the patient standpoint" because patients are generally more comfortable in their own homes, Gates said after the supervisors' vote on Tuesday.
The hospice program also includes funding for a 16-bed shelter and for a day-care center to temporarily take the burden of extended care at home off the shoulders of families and friends.
Long Beach, where many of the region's AIDS hospices are located, is one of three sites being considered for the 16-bed shelter, Gates said. Operators of the Padua House on Atlantic Avenue, one of six small shelters opened in the city since early 1986, have applied for $250,000 to $500,000 to expand their 12-bed facility, he said.
Health Workers Assigned
Under a fourth element of the program, social or health workers will be assigned to coordinate care for AIDS patients, he said.
The full program should be in place by March 1, said Gates, whose department is developing a five-year plan for hospice care. He said he expects funding of at least $1.5 million for the next fiscal year, and "escalating" budgets thereafter.
Among government agencies in Los Angeles County, only West Hollywood, which is supporting a six-bed AIDS shelter that opened in November, has contributed significantly to hospice care for AIDS victims. The City of Los Angeles has earmarked about $200,000 for an AIDS hospice, but the money has not yet been awarded. In California, only San Francisco has consistently provided long-term hospice care, county officials said.
Although a number of small hospices have been opened recently or are planned--mostly in the Long Beach and West Hollywood areas--services have only begun to meet the need, said John Schunhoff, analyst for the county AIDS Office.
"These are all small facilities," he said. "It's growing six beds, by six beds, by six beds."
Los Angeles County had confirmed 4,069 AIDS cases by Nov. 30, and the number of new cases has recently been about 200 each month, he said. The county ranks third among the nation's metropolitan areas, behind only New York and San Francisco, in number of AIDS cases.
Under the nursing contracts, the county should begin referring patients within days, officials said. By the time the contracts expire June 30, about 150 patients will have been treated by the Long Beach agency and the larger Visiting Nurses Assn. of Los Angeles, which has five offices around the county, they said. At that time, new contracts will be awarded.
The local nursing organization serves Long Beach, Lakewood, Hawaiian Gardens and the unincorporated Dominguez Hill area, a spokeswoman said.
The two nonprofit nursing agencies will provide therapists, nurses and attendants up to 24 hours a day as a patient nears death. They will also assign housekeepers and offer other types of assistance to patients for many months before they die, officials said.
"This is a multidisciplinary team, including bereavement counseling for the family," Schunhoff said.
Patricia Buehnerkemper, executive director of Long Beach's 24-employee visiting nurse service, said she expects many referrals.
"There's no doubt about (the need). Long Beach has quite a high population of AIDS victims," Buehnerkemper said.
Other areas with many AIDS patients are West Hollywood, Los Angeles' Westside and downtown areas, and, increasingly, the San Fernando Valley, said Sharon Grigsby, president of the Los Angeles nursing agency.
A couple of years ago, AIDS cases were often reported in only a few areas, but "I'm sorry to say the disease is now . . . all over the city," said Grigsby, whose agency has offices in Bell Gardens, Santa Monica, Redondo Beach, North Hollywood and central Los Angeles.
As county health officials have begun to implement their hospice program, criticism that health officials have been too slow to spend the $1.5 million allocated last July has died away.
"The wheels are moving very well at this point. It's never fast enough when the need is so great, but it's certainly a lot better than it was," said Michael Weinstein, chairman of the county AIDS Hospice Planning Commission.