WESTSIDE COVER STORY : Supplying Compassion : Health: At Country Villa South, the elderly and AIDS patients receive care under one roof. Experts say that kind of integration will grow as the number of nursing home beds shrinks.
Chris Reece, a 52-year-old woman who contracted the AIDS virus after receiving a blood transfusion in 1981, is fighting for her life.
So is her roommate--Margaret, a 94-year-old preparing for colon surgery.
The two women live at Country Villa South, a pastel-shaded, 87-bed nursing home in Palms. There, in a 30-bed special-care unit, the elderly and patients with AIDS coexist, side by side.
An unusual mix? Perhaps. But in many ways, Country Villa South might be considered the nursing home of the future.
Nationwide, experts say, there is a fast-escalating demand for the type of long-term care nursing homes provide--sub-acute services such as skilled nursing, intravenous therapies and specialized drug treatments.
Not only are more and more elderly people seeking such care--the result of demographics and growing life expectancy--but so are the nation’s burgeoning number of AIDS patients who, thanks to new drug therapies, are able to live longer with the disease. To complicate matters, the number of nursing home beds has remained static since the 1980s, and home caretakers are in short supply.
The result, experts say, is that AIDS patients and the elderly will increasingly find themselves under the same nursing home roof.
“It’s time to look at the mutualities of the chronically ill, rather than to continue to categorize people according to disease,” said A.E. Benjamin, a UCLA associate professor of social welfare policy who is doing research on the subject for the Robert Wood Johnson Foundation. “There’s no question that Country Villa South is part of the future.”
The trend is sure to cause tension. In fact, it already has: Activists and hospital-discharge planners in several states have claimed that nursing homes have denied admission to AIDS patients. More than 600 such complaints were filed with government agencies from 1986 to 1991, according to a report last year by the U.S. Inspector General’s Office. Small surprise, then, that Country Villa South is attracting attention from health experts as far away as China. Country Villa not only accepts AIDS patients--one of three known to do so in Los Angeles County--but it also integrates them with the elderly, creating a unique atmosphere in which the two groups share rooms and recreation.
“As far as I know, it is the only facility of its kind where the two populations are integrated,” said Sharon Werbel, regional director of the 1,200-member California Assn. of Health Facilities, a nursing home association. Said Barbara Joseph, Country Villa’s director of nursing: “Country Villa is cutting edge.”
Country Villa South, on Overland Avenue just south of the Santa Monica Freeway, is operated by the Country Villa Health Service Corp. The for-profit company owns 1,200 nursing-home beds in the Los Angeles area. It was company president Stephen Reisman who decided four years ago to open the sub-acute care unit for people with AIDS.
But Reisman never intended for AIDS patients and the elderly to room together. The original concept was that there would be a separate wing. But there were not enough referrals of AIDS patients to sustain the unit, Reisman said, and there were numerous elderly patients who needed the skilled nursing care.
The decision was made to consolidate: Those who needed sub-acute care, AIDS sufferers and the elderly, would share the same staff and the same space.
Currently, 23 of Country Villa South’s 30 sub-acute unit beds are filled--16 with AIDS patients and seven with the elderly. Room and board is $250 a day, which might seem steep--especially since it doesn’t include medication and other ancillary services. (For an AIDS patient, medicine costs an additional $1,500 to $8,000 per month.) Still, it is only a fraction of the cost of a hospital stay. And Medicare and health insurance coverage can be used for much of the cost.
The unit is largely the responsibility of Michael Torgan, Reisman’s cousin. Reisman made Torgan administrator of Country Villa in December, 1993. Torgan, 30, has a graduate degree in business administration and health-care management. He supervised another nursing home before coming to Country Villa, but admits: “Nothing prepared me for this.”
Torgan had three challenges: turn a profit at Country Villa, maintain quality patient care and confront--every day--the fear of AIDS.
The profits, Reisman says, have been slow to materialize. But the quality of care has been high, according to health officials and relatives of patients. And visits to the nursing home suggest that patients have forged strong bonds, unfazed by the issue of AIDS.
Consider Reece, who has been living with AIDS for 13 years. She clearly feels a connection to her roommate Margaret.
“If she makes a wrong move during the night, I call out to her, ‘Margaret, are you all right?’ ” said Reece, who is 52. “I want to know what’s happening to her. We have our ups and downs, but I’m just glad I’ve got her.”
As for Margaret, she’s nonplussed by the questions about rooming with an AIDS patient. Like many of the other elderly at Country Villa, she is so frail and faces so many physical complications that the issue of AIDS is not important to her.
Said Bob Stelzer, a stroke survivor who has physical therapy sessions with AIDS patients: “Well, I don’t really know who has AIDS. I’m not sharing the same shaving utensils or anything like that . . . I feel safe.”
Indeed, for patients of all ages the chief concern is survival. At Country Villa’s sub-acute care unit, the average stay is 18 days. Some patients go home; many die. Often, patients are so ill they can only lay in their beds, unable to communicate. Ask the receptionist to speak to a patient and the answer frequently is that so-and-so is sleeping. Or not lucid.
Though AIDS patients and the elderly don’t appear to mind being integrated at Country Villa, there have been signs of concern from relatives of the elderly patients.
“I remember one elderly man who was rooming with an AIDS patient who had absolutely no problem with the situation but was concerned that perhaps his grandchildren wouldn’t visit him, and we moved him to another room,” Torgan said.
Gradually, the nursing home has helped allay such fears.
Barbara Joseph, who joined the staff as director of nursing a few months after the unit opened early last year, drew from her experience as an AIDS unit nurse in Century City Hospital. She formed a team of four staff professionals to educate the elderly patients and their families about AIDS and combat the misconception that AIDS can be transmitted through casual contact.
“I say to these families I’ve hugged people with AIDS, kissed them. They’ve cried on me, sweated on me, died on me while I’ve held them and I’m still HIV negative,” Joseph said. “If I worried about getting AIDS from casual contact I couldn’t work here.”
The message squares with that of health experts. “There’s no reason to isolate AIDS patients,” said Richard Wolfe, regional supervisor of the health facilities division of the Los Angeles County Department of Health Services.
According to Joseph, no one has removed a family member from Country Villa out of concern about its AIDS patients. But often, she says, fear of AIDS prompts families to decide against placing an elderly relative there.
Crystal Morrow, a case coordinator at the nursing home, remembers seeing the relative of a prospective patient pick up one of the brochures that outlines Country Villa’s services. After reading about long-term care for AIDS patients, the relative hurried out of the building.
Torgan says that, initially, some nursing home staff members feared taking on AIDS patients. Once, he says, additional nursing assistance was needed immediately in the sub-acute care unit but none of the regular geriatric staffers wanted to help out. He said he looked into the problem and discovered that the employee in charge of staff development has a phobia about AIDS.
“I fired her,” he said. “When you have your staff educator saying to staff, ‘You don’t want to work up there, do you?’ it doesn’t help create a team.”
Torgan and his staff also had to adjust to the amount of care required by AIDS patients--frequently far more, they say, than that of traditional geriatric patients.
“I tried to staff things traditionally at first. I would go to Barbara Joseph and say we need to cut back to this level and she would say we can’t. And I would reconsider my decisions--a lot,” he said.
Despite all the challenges, Torgan and his team appear to have created a nurturing environment under the most extreme circumstances.
In the nursing home’s television and recreation room one recent morning, the 8-year-old daughter of a staff member daughter was bringing an AIDS patient a drink. A dog walked among the wheelchair-bound and licked a few hands. Family members wiped the brows of their loved ones.
In addition to interacting with the elderly in the sub-acute care unit, AIDS patients at Country Villa also mingle with the nursing home’s regular geriatric residents in common areas such as the television room and outdoor patio.
On bad days, Torgan has plenty of letters to turn to from appreciative family members. One, to members of the Country Villa staff, is from the family of Joey Fisher, who recently died of AIDS:
“You gave him medicines. You helped him to the bathroom, and, when his calls were too late, you helped clean him from top to bottom. You fed him. You changed his bedding. You showered him. (Sometimes he showered you!) You rubbed cream into his dry skin and powered him, so he wouldn’t get skin irritations. You put drops in his eyes which he always tried to wipe out again. You changed his IVs more times than any of us can remember. You dressed him for so many wonderful outings. You managed to deal with that damned bed that was always too soft to crawl out of or too hard to sleep on, and always too high for any of us to work around.
“You came with compassion, understanding, concern and the genuine feeling of caring. You gave Joey dignity when there was little to be had. You gave him hope and confidence in his own abilities, even when those became limited. You let him wisecrack and be funny, and you were his best audience. You let him do what gave him the most pleasure--act. And when his acting covered his real feelings, you pretended not to notice.
“If you wonder if you have made a difference, the answer is yes. You make the difference for patients between just surviving, and being able to live. For families the difference between hope and despair.”
How strong, ultimately, will the demand be for combined facilities like Country Villa? That, experts say, depends in part on how much home-care service will be available in the future for the chronically ill.
Home health care is clearly the direction representatives of the leading AIDS and elderly support organizations favor. But experts agree that other options are needed, given the trends expected in long-term health care.
By the year 2030, close to 25% of the U.S. population will be 65 and older, compared to 12.5% today. And the share of AIDS cases involving people over 50--currently 10%--is also expected to increase.
“We have a generation in their 40s, who were very sexually experimental, who took the least precautions, who are moving into their 50s presenting problems our health care system is not prepared for,” says Rita Strombeck, author of “AIDS and Aging: What People Over 50 Need to Know.”
For his part, Torgan says Country Villa South has proven that nursing homes can help handle the long-term care demands of diverse populations.
“I believe, without a doubt, we made it work,” he said. “We provide an alternative which is cost-effective, serving all races, all genders, all ages and all ailments.”