THE TIMES POLL : Health Care of Growing Concern to O.C. Seniors : Nearly all have insurance, but 20% say they can’t afford ‘good medical care’ for a critical illness.

Like nervous schoolchildren, these special passengers disembark from the county’s dial-a-ride buses each morning in the parking lot of the Adult Day Health Care Center in San Clemente.

They are mainly elderly people--retired teachers, truck drivers and doctors--who now have one thing in common: They cannot care for themselves. Some suffer from Parkinson’s or Alzheimer’s, but the majority are debilitated by strokes. They hunker down in the center’s recreation room, some staring into nothingness.

A short time later, their children and spouses arrive, gathering in a separate room to talk about their daily anguish.

One woman volunteers that caring for her Alzheimer’s-stricken husband is like “waking up to find out that you’ve been living with a complete stranger that you don’t much like.”

“But you’re stuck and you have no choice,” she said, fighting back tears.

With seniors (ages 60 and older) making up the fastest-growing segment of the local population, the support group depicts what is becoming a more common part of life in Orange County for relatives of the elderly.

The Times Poll found that one of every five county residents provides some kind of assistance to an aging parent. And looking to the future, 63% of adults with parents believe that they will eventually have to care for or support them in some way.

Seniors, too, are wary about the future, especially about the ravages of aging.

Fully 40% of the county’s 304,000 seniors identify declining health as their biggest fear concerning old age, followed by lack of mobility (13%) and burdening their families (10%).

Although the poll found overwhelmingly that seniors are in good health and describe themselves as “financially secure,” some 20% say they lack the money and medical insurance to get “good medical care” for a critical illness. An additional 7% are uncertain about their ability to handle such an illness.

And when seniors need help, the poll found, they turn primarily to family members, with about half saying they look first to a spouse, while 25% say they seek assistance first from their children.

The Times Poll, directed by John Brennan, surveyed 1,128 people in Orange County during five days in December. It has a sampling error of plus or minus 3 percentage points.

Those 60 years of age and older were oversampled to provide a larger group for analysis. The sampling error for this group is plus or minus 5 percentage points. The survey does not include institutionalized elderly, who represent about 3.5% of the county’s senior population.

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Despite Orange County seniors’ concerns about health care, this poll and another Times survey three years ago found that county seniors seem more secure in their health care coverage than other groups, including young adults locally and elderly citizens nationwide.

In the latest poll, 97% of county seniors say they have Medicare or other health coverage. And while 20% of these seniors say they cannot afford “good medical care” in a critical illness, that’s a far better percentage than among their counterparts nationwide, half of whom said in a 1990 poll that they couldn’t shoulder such a medical crisis.

Lee S. McCamon, publisher of Senior Highlights, a monthly Laguna Hills newspaper, said stiff local competition among four major health maintenance organizations for the senior business is probably responsible for the comparatively excellent health coverage for people 60 and older.

“Seniors here are in a very unique situation,” said McCamon, whose newspaper boasts a 350,000 circulation in the Southland. “They can sign up with an HMO at no cost because it is covered by Medicare, and the industry has to be responsive to their needs because the (HMOs) are in fierce competition for their business.”

But officials with the county’s Area Agency on Aging said such confidence does not mesh with the increasing demand placed on their agency. The notion that “life is a bunch of roses for all seniors” and that there are few needy seniors in Orange County is “simply not true,” said Jerry Bellsmith, the agency’s contracts manager.

The agency will spend almost $6 million in federal and state funds this year to provide a range of services, including meals, day care, health and legal assistance for 50,000 Orange County seniors.

There are about 15,000 local seniors below the poverty level, according to the 1990 census, and an additional 3,000 to 5,000 are considered low-income.

Ruben Aguilar, 62, a retired construction worker of Santa Ana, doesn’t live below the poverty level. Barely.

Aguilar, a respondent in The Times Poll, has been a cardiac patient since he had a heart attack 10 years ago. He and his wife, 61-year-old Aurora, have since lived on a $1,100 monthly income. Half of that amount pays their mortgage, while the remainder is used to pay the bills and buy prescription drugs for Aurora, who has a blood disease but no medical insurance.

Aguilar qualifies for Medicare because of disability, but his wife must wait until she is 65 before she is covered.

“I do well to break even every month,” said Aguilar, who is also diabetic. “If I could work I would, but the doctors say that’s out of the question for me. I just have to make do.”

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And while some discuss timeless issues of poverty and plenty, gerontologists point to a new phenomenon involving the oldest old--those 85 and older. They are the fastest-growing population segment in Orange County, quadrupling to more than 23,000 since 1960, according to the latest census.

And the poll found that 15%, or about 45,000, of those 60 or older have a living parent.

Experts say the longevity of the aging population will raise profound questions concerning health and security as retirees in their 60s struggle to provide emotional and financial support for their aged parents.

It is a struggle that caught 62-year-old Nancy Box of Laguna Hills by surprise.

Box moved to Leisure World five years ago after teaching high school in Santa Rosa for 20 years. She dreamed of spending her retirement playing tennis and “hanging out with the girls.” But her plans almost crashed two years ago when her 90-year-old mother, another Leisure World resident, fell in her bathroom in the middle of the night and was seriously injured.

Box made constant trips to the doctor and ran numerous errands while trying to provide round-the-clock care for her mother. She even gave the older woman a bell so that she could summon Box if she needed her medication--or simply some attention.

“It was a definite strain,” Box said. “I was hearing bells in the middle of the night even when she did not ring it.”

Fortunately, Box’s mother could afford to hire round-the-clock companions and did so, an arrangement that restored the old relationship between mother and daughter.

Gemma Heffernan, manager of the social services department at Leisure World, said she is increasingly seeing cases in which graying seniors care for their elderly parents.

“Some people retire with expectations that they are now free to do the things they always wanted to do,” Heffernan said, “and they find out instead that they have to use most of the time caring and running around for their parents, who are living longer. A great deal of resentment builds up because they don’t see any end in sight.”

Heffernan, who is now planning a seminar for seniors who take care of their elderly parents, said she often lectures seniors to be realistic about their duties.

“We have to assuage their guilt and let them know that it’s OK to get a paid care-giver involved,” Heffernan said. “We let them know that they don’t have to do it all, that they could still enjoy their retirement.”

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At the heart of such issues is the reversal of the parent-child relationship. And contained within that turnabout is a sea of conflicting emotions.

The poll found that seniors want to be independent and are likely to resist relying on their grown children. On the other hand, adults under age 60 feel the strong tug of responsibility for an older generation.

Almost two-thirds of the younger generations, those 18 to 59, say grown children should be expected to support their parents.

That is in marked contrast to the views of the elderly--58% of them feel grown children have no such obligation.

Dorothy Duthie, 72, said she relishes her independence and would prefer not to share a home or be dependent on any of her three grown children.

Duthie, a respondent in The Times Poll, is a retired high school teacher who lives with her husband, Walter, in Huntington Beach.

If she suffered a serious illness, Duthie said, she would not want her children to take charge of her life.

“I would prefer to leave it to the professionals--doctors and nurses,” she said. “I don’t want to be a nuisance.”

She also would not want to share a home with her offspring. “When you get old you slow down and people become impatient with you,” said Duthie. “Plus I don’t want to live with younger people who bustle in and out, I don’t want to fit in with that fast pace anymore.”

Carol Quintana, the director of the adult day care center in San Clemente, said many seniors may not have a choice. She predicted that many people--especially those who cannot afford expensive health care such as a nursing home--will have to turn to the day-care option and be dependent on their children for other support.

“People are beginning to see that the care their parents and grandparents need is a problem that is at their doorstep,” Quintana said. “A lot of them are starting to get worried.”

Times librarian Sheila A. Kern, Times statistical analyst Maureen Lyons and Times assistant poll director Susan Pinkus contributed to the research for this article.

Tuesday: Retirement, now and in the future.

Caring for the Elderly

Nearly all of Orange County’s senior citizens say they are healthy. One-fifth say that, if they became critically ill today, they couldn’t afford good medical care. One-fourth of residents who have at least one parent living say they are providing some kind of assistance. A look at how Orange County is confronting the issue of care for the elderly:

Most of those 60 and older say they are in good health. Good health: 91% Poor health: 8% Don’t know: 1% *

Kinds of medical insurance coverage that people 60 and over say they have: No coverage: 3% Medicare only: 18% Medicare plus coverage provided by a private company or union: 20% Medicare plus buy their own insurance: 19% Medicare plus Medi-Cal: 2% Medicare plus some other kind of insurance: 1% Provided by private company or military: 22% Buy own coverage only: 11% Medi-Cal only: 1% Other: 3% *

More elderly than young people say they think they could afford good medical care if they became critically ill.

18-29 30-44 45-59 60 and older Could afford 62% 69% 74% 73% Couldn’t afford 36 26 24 20 Don’t know 2 5 2 7

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The biggest fears about old age:

18-29 30-44 45-59 60 and older Declining health 34% 38% 45% 40% Financial insecurity 18 25 13 9 Lack of mobility 12 9 9 13 Loneliness 18 9 4 4 Burden to family 4 7 10 10 Dying 5 1 6 2 Nothing to do 3 2 1 0 No fears 15 22 22 30

Numbers do not add up to 100% because respondents could offer more than one response

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All respondents were asked whether they agree with the following: “Grown children should NOT be expected to support their parents.”

18-29 30-44 45-59 60 and older Agree 26% 33% 45% 58% Disagree 72 60 49 36 Don’t know 2 7 6 6

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The young and the elderly differ widely on who has the most important obligation to provide long-term nursing care for the elderly.

18-29 30-44 45-59 60 and older Families of the elderly 42% 24% 20% 17% The elderly themselves 12 21 27 26 The government 19 18 17 23 Retirement plans 10 14 10 7 Community services 5 4 3 2 Religious groups 1 1 - - All of the above 9 15 17 10 Other, none - 1 - 2 Don’t know 2 2 6 13

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A substantial group is providing assistance to an elderly parent (Asked of the 75% of Orange County residents who have a parent still living) Not providing assistance: 76% Providing assistance: 24% *

What people are doing to help care for or support an elderly parent (Asked of those providing assistance to elderly parents): Financial assistance or shelter only: 20% Providing service only: 20% Doing both: 42% Providing other types of assistance: 17% Don’t know: 1% Source: Los Angeles Times Poll

HOW THE POLL WAS CONDUCTED

The Times Poll interviewed 1,128 adult residents of Orange County, by telephone, Dec. 4 through 8. Telephone numbers were chosen from a list of all exchanges in the county and random-digit dialing techniques were used to ensure that both listed and non-listed numbers had an opportunity to be contacted. Results were weighted slightly to conform with census figures for sex, race, age, education and household size. Interviewing was conducted in English and Spanish. Those aged 60 and over were oversampled in order to provide a larger group for analysis; their answers are weighted to their proper proportions in the population when the responses of all adults are cited. The margin of sampling error for the total sample is plus or minus 3 percentage points. For certain subgroups, the error margin is somewhat higher. For example, the sampling error for those 60 and over is plus or minus 5 points. Poll results can also be affected by other factors such as question wording and the order in which questions are presented.