New Help for Hospices

The California Senate has approved a plan to extend Medi-Cal funding to group-living facilities as alternatives to hospitals, a promising step toward providing optimum care for AIDS patients.

As the epidemic progresses, the need for alternative facilities is increasing. Several of the two dozen residential-care facilities in Los Angeles County are already at capacity with waiting lists, and the demand for home-care services is running ahead of projections.

Los Angeles County is committed to funding 40 beds in alternative facilities and currently has 32 in operation, including eight at Chris Brownlie Hospice at Barlow Hospital. The Brownlie unit at Barlow is the first of five facilities planned by the AIDS Hospice Foundation, using $5 million in state-backed revenue bonds. It sets an important example of cooperative efforts among governments as well as the private sector. Without support from Medi-Cal, however, it will be difficult to expand this level of service. That is why particular importance is attached to the Senate action approving SB 276, sponsored by Sen. William Campbell (R-Hacienda Heights).

The new Brownlie Hospice in Los Angeles is a remarkable achievement. The two-story building, formerly the nurses quarters at Barlow Hospital, was converted to a 24-bed facility. With substantial donations supplementing state and county funds, the building and its hillside site have been developed to offer a tranquil, cheerful setting for the patients. Staffing includes full-time registered nurses and, of particular importance, a full-time bereavement counselor to assist the dying and their loved ones. The average stay for these terminally ill patients has been 25 days. The hospice operates at a daily per-patient cost of $200, a fraction of the cost of hospitalization.

Brownlie already has a waiting list. The size of the facility is regarded as optimal by Michael Weinstein, head of the AIDS Hospice Foundation, and will be the model for others planned by the foundation. Two more are tentatively scheduled for operation next year, both with 25-beds. One will be in a remodeled administration building at Metropolitan State Hospital in Norwalk, another in a new building in South-Central Los Angeles adjacent to Martin Luther King Jr. Hospital. But Gov. George Deukmejian’s veto of $450,000 in state funds for the two projects has now placed them in jeopardy.

The establishment of care standards in the residential facilities poses problems. Brownlie is the first in the county to be licensed under the 1988 state law establishing standards for group-living health facilities. Several other existing residential units are applying for that license. In addition, the state has granted residential AIDS shelter exemptions to a few of the residential facilities that offer less medical care. Among them are Our House, operated by AIDS Project Los Angeles primarily for AIDS patients with dementia; Dignity House, operated by the AIDS Minority Project, and Serra Ancillary Care Corp., sponsored by the Roman Catholic Archdiocese of Los Angeles. Traditional skilled nursing facilities have resisted taking AIDS patients. The majority of the residential facilities serving those with AIDS in the county have no licenses. That is not prudent. The state needs a new license category for the residential facilities offering custodial care with a minimal medical staff, a service that will be in increasing demand.

As license standards are sorted out, Medi-Cal can play an effective part in supporting the alternative care that is both cost-effective and humane.