Services Available for Orange County Families in Need of Help : Private counselors and county agencies can help guide people through a difficult time.

At 87, Charlie Hinton was the state shuffleboard champion; at 98, he was still a contender. Now 102, his vitality mainly shines through his eyes, which twinkle up at strangers he can barely hear.

His main caretaker is his wife Dorothy, who is 83. She cooks his meals, helps him into his walker and writes important reminders on a chalkboard. She also works three days a week to keep active and to bring in a few needed dollars. On those days, Charlie happily takes the bus by himself to adult day care.

With a little luck and a lot of gumption, the Garden Grove couple have managed to attain the goal of most older Americans: independence. Dorothy will tell you candidly that it isn’t easy. For others, it can be much rougher.

In Orange County, as elsewhere, the older elder population (sometimes called the “old old”) is mushrooming. In the 1980s, it is estimated the number of people over 60 grew from 221,584, or 11.5% of the county population, to 325,125, or 14.3%. The largest increase, 31%, was found among those 75 and older--the ones most likely to need outside assistance, according to the County of Orange Area Agency on Aging.

Only an estimated 5% are in nursing homes or board-and-care homes, while 15% are living alone but need social services, such as meals, housekeeping or transportation, or help with eating, dressing and bathing. About 65% live independently and 15% are living--almost always reluctantly--with one of their adult children, according to Le Ann Donaldson, director of community outreach at St. Joseph Hospital, which sponsors Project PACE, a psychological counseling agency for Orange County’s elders and their families.

The county draws affluent retirees to the Leisure Worlds in Laguna Hills and Seal Beach, and to a proliferating new breed of full-service retirement hotels. But about half the senior population struggles to make ends meet with monthly Social Security checks of $550, social workers said. There are waiting lists up to six years for federally subsidized housing projects, although some non-subsidized apartments accept federally subsidized housing vouchers. Nearly every county program that assists the elderly, including nutrition services, is strained, often hindering people from doing what they want most: to grow older with dignity, in their own homes.

“People do best in their own environment,” Donaldson said. But typically, she counsels adults with a parent--usually a mother--who can no longer live alone at home. Typically, the parent lives far away, has suffered a stroke or other health crisis, and is unable return home from the hospital.

“They sell her apartment and move her out here. She’s mad. She wants to go back home, but there’s no home to go back to.”

Project PACE trains adult children to help their parents remain as independent as possible and offers support groups for them to deal with their own anger that may be lingering from childhood.

For the elderly who live alone--whose children are elsewhere, or the few who have been abandoned--a conservator such as geriatric social worker Maria Estrada may be appointed by the court. Founder of a Tustin firm, Senior Support Services, Estrada is sometimes called on to make decisions for people being kept alive on respirators and feeding tubes.

“Now people go on living and living,” Estrada said. “They have all these antibiotics, cures, open-heart surgery. We don’t let them go naturally with dignity.”

People should specify in advance details such as whether they want doctors to take heroic measures or whether they prefer no care at home to a nursing home, she said.

“Every family has to face it. It’s a rough question. But people need to think and talk about it,” Estrada said.

Confronted with sudden debilitating illness, families are often bewildered by the maze of legal, financial and emotional problems of old age.

For fees ranging from $22 to $65 an hour, Estrada’s counselors assess an elder’s situation, including health, bills, transportation, social involvement and property; counsel families on role reversals and legal options; design a custom plan of care, and monitor the new situation--whether the elders remain at home with a nurse’s aide, in a board-and-care facility, a specialized home for Alzheimer’s patients or a nursing home.

Registries and agencies providing in-home care can be found in the Yellow Pages at fees ranging from $6 to $13 an hour, but non-medical custodial care is not covered by insurance. Low-income seniors may qualify for in-home support services from the county.

Resource, referral and monitoring are also available free from the Orange County Council on Aging’s ombudsman, Pamala cq McGovern. She will provide background information--including citations and deficiencies found by state licensing officials--on board-and-care homes or nursing homes.

Although few of them probably chose it, 16,000 people are being cared for in 68 nursing homes and 375 board-and-care homes in the county.

A few nursing homes are run by Lutherans, Presbyterians or Quakers, and five accept private paying patients only. But most are run by for-profit chains that are certified to accept Medi-Cal.

The supply of nursing homes appears to be adequate countywide, but sparse in the South County, social workers said. What’s more, the quality can vary, they said.

Scores on a rating system based on deficiencies and violations range from 4 to 134, with the vast majority “right in the middle,” said Jacqueline Lincer, district administrator for the state Department of Health Services, which licenses the homes.

Finding people to provide quality care in institutions and private homes is particularly difficult because the jobs do not pay well enough in Orange County, with its high housing prices.

Payment for nursing home care is the biggest misconception among institutionalized people and their families, Lincer said. Medicare covers only an average of 20 days in a nursing home for most people following acute care at a hospital. They can qualify for Medi-Cal only if they “spend down” their resources to $2,000. The waiting time for Medi-Cal to kick in can be drawn out while the person’s savings are located and spent and while eligibility requirements are verified.

Most board-and-care homes--which provide assistance to the residents, but no nursing care--accept private pay only, but may offer reduced charges for the low-income elderly, accepting their Supplemental Security Income checks.

There are unresolved issues concerning the elderly who are incapable of taking care of themselves but who have no family and cannot contract for their own care or release access to their accounts. Some homes have those residents’ assistance checks sent to the facility. “It’s kind of a conflict for them, but what can you do?” McGovern said.

More information on Medicare, supplemental insurance and HMOs may be obtained by calling the Health Insurance Counseling and Advocacy Program at (714) 639-4962.

To give caretakers a break, about a dozen public and private centers offer adult day care. The Garden Grove Community Adult Day Care Center, for example, caters to less-active adults 60 years and older. It offers daily hot meals, transportation, exercise classes, entertainment and field trips. Fees are on a donation basis. For information, call (714) 530-1566.

Others, known as adult day health care centers, also provide nurses on staff, as well as physical, speech and occupational therapy. They include: St. Joseph’s Adult Day Health Care in Laguna Hills, and VIP Adult Day Health Care Centers in Santa Ana and Anaheim, run by the Feedback Foundation. The foundation also operates the financially troubled Meals on Wheels program, which serves 3,000 seniors at 28 sites countywide and hundreds more at home. For information on Meals on Wheels, call (714) 973-1656.

A popular, short-term alternative for still-active elders in high-priced Orange County is shared housing. The Area Agency on Aging’s Shared Housing Program offers a free roommate referral service, primarily for healthy seniors on fixed incomes who need company and security, but not living assistance. The county matched 774 people from July to March. Some successful matches have paired older people with younger companions who seek a quiet home life, said Roberto Melendez, program coordinator. The length of a match is usually four to five months. For information, call (714) 560-7500.

A growing, yet still-expensive, alternative to nursing homes is the full-service retirement hotel, some offering nursing-care wings so that elderly can “age in place.”

Most often geared to wealthier people who need assistance in daily living, the continuing-care projects draw many older people “imported” from other areas of the country by adult children living in Orange County, said Annie Gerard of Market Profiles, a Costa Mesa development research firm. The hotels provide transportation, housekeeping, meals and emergency services at an average $1,100 a month. Costs can reach more than $3,000 a month at the Wellington in Laguna Hills, a luxury project with a board-and-care wing.

Similarly, Freedom Village, a senior apartment complex in El Toro, offers units for sale from $65,000 and fees from $892 a month for a “guarantee of lifetime care.”

When shopping for a continuing-care project, Consumer Reports suggests buyers ask what happens if residents cannot afford fee increases, who decides when residents are transferred from their home to the nursing center, and what fees apply thereafter.

Some of the more innovative projects, such as Park Plaza in Orange, have employed designs geared to the elderly: short hallways, waist-high refrigerators and electrical plugs, and kitchens in every room--to lend at least the psychological feeling of home and independence, even for those who no longer cook.

So sure were developers of their market that they have overbuilt congregate projects by 900 units in south Orange County.

“This is an emotionally charged issue--moving from private homes to any kind of congregate setting,” said Steve Steele, executive vice president for Birtcher Community Management, which operates the Wellington. “We’re in competition with their home, and their home comes first.”