The Comfort of Home : Health care: Private, nonprofit residential shelters for AIDS patients represent an experiment in cost-effective alternatives to hospitalization. Their role is expected to increase.

After a life in which he suffered from abandonment, abuse and sexual exploitation, Michael Crable has found a home in Los Angeles County’s often cold and impersonal public health care system.

The satisfaction in Crable’s life these days is all the more remarkable because he is intermittently disabled by AIDS and lives in a home with other men acutely ill from the disease. Still, Crable, 31, said he is just where he wants to be.

Without his small furnished room in a neat, two-story home in central Los Angeles--complete with rose gardens and a swimming pool--Crable figures he would be back among the homeless of West Hollywood, struggling to stay alive.

“I am the kind of person who can’t be alone, who doesn’t want to be alone. At least in the park there were other homeless people, people walking their dogs or whatever,” said Crable, a talkative, enthusiastic man who keeps his hair dyed a distinctively loud shade of red.

Crable’s home is part of one of the more successful new public health programs to get off the ground in recent years. It is set up for people who are disabled by AIDS but who do not need the 24-hour medical care provided by AIDS hospices.

Created as a result of legislation passed five years ago, the homes represented an experiment in cost-effective alternatives to hospitalization. The residences are owned by private, nonprofit groups. (Crable’s is owned by the Roman Catholic Archdiocese of Los Angeles.) The residents’ day-to-day expenses are paid by the county, with additional help from state and federal sources.

Government officials say the homes are working so well that they have found a niche in the health care delivery system. In fact, they are expected to play an even greater role because of the expected growth in the numbers of people with acute cases of AIDS.

Today, there are about 7,000 men and women with AIDS in Los Angeles County, health officials say. People in Crable’s position represent a potentially huge bill for taxpayers.

Dr. Martin Finn, medical director for Los Angeles County’s Department of Health Services AIDS programs, says it is the 45,000 to 50,000 people carrying the AIDS virus who will have a huge impact on the county health care system in the next few years. Because the rate of new infections was considered to be at a high point between 1983 and the early part of 1985--and the median length of time between infection and full-blown AIDS is 10 to 11 years--Finn said sometime in the near future “we expect to have very large numbers of patients, who will require far more care. . . . More and more of those will become the responsibility of public medicine.”

Today, there are about 150 people living in these residential care shelters, scattered in 14 homes throughout Los Angeles County. Other AIDS patients are being treated in hospitals, hospices or in their homes.

The residential care homes are for people with nowhere else to go. Depending on the medical services provided, the county pays $100 to $135 a day for their care. One day in a county hospital can cost nine times as much, and a private hospital as much as 30 times more, health officials say.

“We believe they’ve proved themselves,” said Rand Martin, chief consultant to Assemblyman Terry B. Friedman (D-Brentwood). Friedman is carrying legislation that would create tighter controls on the homes and require uniform health and care standards. The residential care homes have been operating under loose licensing and regulation for the last five years because supporters wanted to give them a maximum amount of freedom to grow.

The program was designed with the idea that residents would be moved to hospices or hospitals as their medical needs became more acute, but residents and officials say that more people with AIDS are choosing to die in the homes.

Crable, who has been living at his home for two years, concurs solemnly: “I am going to die here.”

For Crable, the room was his way off the street. His living space is bright and cheery, full of photos and mementos. Sweeping his arms expansively, he said: “Everywhere you look is a part of me.”

Crable said he never knew his father and does not know whether his mother, an alcoholic who he said physically abused him as a child, is dead or alive. He was in a foster home when he ran away at 14, hitchhiking to Los Angeles. Once here, he worked the streets of West Hollywood as a prostitute, he said. He abused alcohol and drugs and one day found himself on the streets without a home and with full-blown AIDS. For two years, he camped out with other homeless people in a park across the street from the West Hollywood sheriff’s station.

Now, on his “good days,” Crable said he is capable of long bike rides and exhausting aerobics routines. He likes to go dancing at a favorite club in West Hollywood until the early morning.

But like other people with AIDS, he does not know from hour to hour, or day to day, what his body is going to do, when he will be struck by pain, nausea or exhaustion. On his “bad days,” Crable said it can take him five hours to get out of bed and get cleaned up.

There are many like Crable in the county. In Long Beach, at St. Francis House, 32 men and women share a residence. They range in age from boyish-looking teen-agers to street-weary men in their 50s. They come from different racial and ethnic backgrounds. They are survivors of crack alleys, makeshift homes under bridges and crowded county hospital wards.

At this home, as at others, eating and putting on weight is a virtue. Recently, a group of about half a dozen residents sat down to a breakfast that included sausage, grits, eggs, toast with homemade apple butter, five gallons of juice, cold cereal and fresh fruit.

Afterward, many had simple chores to do. One older gray-haired man, battling cancer as well as AIDS, said helping others in the house is an important part of the routine.

“You’ve got to get up every day, stay busy,” he said. “Right now, the cancer is bothering me. But I feel if I sit here and say I am dying of cancer, that is what will happen. I am not going to give in to it.”

Juan Delgado, 19, a Mexican national, came to St. Francis House from a county hospital, where he was treated for cancer that was attacking his stomach and other internal organs. Since moving in six months ago, Delgado has gained 19 pounds, although he still carries only 106 pounds on a 5-foot, 2-inch frame.

Delgado said he left his mother and large family in Mexico when he was 14 in order to search for his father in Orange County. Delgado said he found his father but not a home. He turned to the streets and prostitution. A few months later, he was found to be HIV-positive.

These days, he is pushed to eat and care for himself by Peter Alvarez, 30, one of the full-time workers employed at the house.

Alvarez, who does not have AIDS, is a nonstop cheerleader. He knows that Delgado and other residents of the house will probably require hospitalization as the disease progresses. But, he said, even when they leave, “I’ll have their room waiting for them when they get out.”

Alvarez insists that “they are not dying. . . . They are trying to live one more day, and that is very different.”