Care Homes for AIDS Patients Caught in Crunch

A bitter fight has developed over state-licensed residential care homes for people with AIDS that may threaten the survival of some of the facilities.

The relatively low-cost homes, many of which care for AIDS-afflicted prostitutes and drug addicts who have no other place to live, have been forced to undergo expensive upgrades to meet state licensing requirements.

Now, after operating for less than a year under the new rules, they are trapped in the squeeze on AIDS funds by federal, state and county health agencies. Some homes are also caught up in a bitter turf war over patients with a longtime AIDS hospice care provider in Los Angeles.

At the center of the dispute is the question of how much and what type of government assistance will be available to indigent people in the final stages of AIDS. Among the questions being raised is whether they will be allowed to die in homelike settings or be moved to hospices where there is more advanced medical care available to reduce suffering.

The number of AIDS patients given care in these homes is relatively small--there are 22 homes with 228 beds statewide. More than half are in Los Angeles County. But many see them as an essential component of AIDS care.

The homes were developed in the late 1980s as a low-cost alternative to hospitalization, to reduce suffering and help stop the spread of the disease by providing homes to AIDS-afflicted drug addicts and prostitutes who might be likely to spread the human immunodeficiency virus, which causes AIDS.

Proponents cite their low cost: Housing a person in a residential care home costs about $120 a day, compared to $316 for a hospice and well over $1,000 a day at a county hospital.

Los Angeles County fired the first shot in the growing controversy. The source of the current dispute may be traced to a budget prepared by the county’s AIDS Programs Office. The budget reflects an anticipated $4.8-million reduction in federal Ryan White Care Act money and gives a low priority to the residential care homes, calling for a $900,000 cut in the $1.9-million annual allocation.

The first victim of this squeeze appears to be St. Francis House in Long Beach, the county’s oldest and largest residential AIDS home, which announced this week that it may have to close one of its two homes July 1.

Upgrading to meet state licensing requirements drove the cost of operating the homes from about $100 to $116 a day, while county budget problems are limiting allotments per patient to $71 a day, said administrator Steven E. Toth III. “Under the circumstances, we can’t stay open,” Toth said.

John Schunhoff, the county’s director of AIDS programs, said he hopes to avoid the closure of any residential care homes, primarily through county lobbying efforts in Congress.

Others close to the programs believe that even if part of the White Act money is restored, the threat to the residential care homes will remain.

“If the problem is made to go away this year, we are still looking at something pretty serious next year,” said Ferd Eggan, director of AIDS programs for the city of Los Angeles. “I think we have probably passed the peak of AIDS dollars coming from the Congress.”

As a member of the County Commission on HIV Services, Eggan voted against the proposed cuts in residential facilities, but was in the minority.

Further fueling the pressure on the residential care homes is an attack from the biggest local player in AIDS hospice care, the Aids Healthcare Foundation, which runs three hospices in Los Angeles.

The foundation argues that as primarily a medical facility licensed by the state Department of Health Services, it is better qualified to deliver hospice care than residential care homes, which are licensed by the state Department of Social Services.

Michael Weinstein, president of the Aids Healthcare Foundation, complained in a letter to Martha Lopez, director of community care licensing for the Department of Social Services, that residential care homes were encroaching on his turf by keeping AIDS patients until they die, thus caring for patients that rightfully and legally should be treated in a hospice.

He cited homes run in the Los Angeles area by the Serra Project and Homestead Hospice and Shelter and asked for an investigation, contending that the homes “are providing hospice-level services for people with end-stage AIDS.” He argued that people in the final stages of AIDS are much better able to find the kind of pain management and comfort control they need in a hospice.

Officials of the homes say they are operating entirely within the law. They accuse Weinstein of attacking them in an effort to fill beds in his hospices. The Aids Healthcare Foundation recently opened a third home and concedes that the beds in all three facilities are only about half full. Most of the beds in residential care facilities are full, administrators say.

“The charges [raised by Weinstein] are completely without merit,” said John Maceri, director of the Homestead homes. “The dispute is whether people who choose to are allowed to die in a homelike setting or be forced to transfer to another facility. We are home to most of our residents.”