Taking the first step in its $1.5-million AIDS hospice program, the County Board of Supervisors this week awarded contracts totaling $500,000 to two visiting-nurse agencies with offices in Santa Monica, North Hollywood and Long Beach.
County officials, responding to pressure last year from AIDS organizations, say they are attempting to treat AIDS patients using cheaper and more appropriate ways than hospitalization.
The nursing agencies' home-care costs for victims of acquired immune deficiency syndrome should be about $150 a day, compared to hospital expenses of about $750 a day, said Robert C. Gates, director of the county Department of Health Services.
"It's also the right thing to do from the patient standpoint" because patients generally are more comfortable at home, 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.
The West Hollywood area, which along with Long Beach leads the county in providing AIDS hospice care, is one of three locations being considered for the 16-bed shelter, Gates said. AIDS Project Los Angeles, operator of the newly opened six-bed West Hollywood House, has applied for $250,000 to $500,000 to open a new facility, he said.
A second applicant, Hospice Los Angeles/Long Beach, also runs a small shelter in West Hollywood, but would use the county grant to expand its larger, 12-bed facility in Long Beach, a spokesman said.
The third applicant, the AIDS Hospice Foundation, also has a West Hollywood connection, since the City of West Hollywood is considering underwriting a share of the cost of setting up a hospice at Barlow Hospital in Elysian Park near Dodger Stadium, city officials said.
The day care center, which would accommodate 20 to 30 patients a day, will likely be set up on Sunset Boulevard in Hollywood, Gates said. AIDS Project Los Angeles will be the operator.
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 governments in Los Angeles County, only West Hollywood--which is supporting West Hollywood House--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 the number of AIDS cases.
With 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 Visiting Nurse Service of Long Beach 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 two nonprofit nursing agencies will provide therapists, nurses and attendants up to 24 hours a day as a patient nears death, and also assign housekeepers and offer other types of assistance to patients throughout their illnesses, officials said.
"This is a multidisciplinary team, including bereavement counseling for the family," Schunhoff said.
Patricia Buehnerkemper, executive director of Long Beach's visiting nurse service, said she expects many referrals.
"Long Beach has quite a high population of AIDS victims," she said.
Other areas with many AIDS patients are West Hollywood, the Westside and downtown, 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 Santa Monica, North Hollywood, Redondo Beach, Bell Gardens 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.