Hospice Nearing the End : Fledgling AIDS Facility Will Fold Without State License

Ron McKennell thought his business idea was a good one: to provide round-the-clock medical care for AIDS patients in a homelike setting during their final months of life.

He had found a niche too, as the hospice--a single-family home in a residential neighborhood--was to be the first of its kind in Orange County. If successful, McKennell said, he would start other hospices in Orange County--where 4,112 AIDS cases have been reported, 2,354 deaths have occurred as a result of the disease, and as many as 8,600 people are estimated to be infected with HIV, the virus that leads to AIDS.

But just five months after Care International’s Tustin facility opened its doors to patients with a temporary license, it might be forced to close.

The state Department of Health has twice declined to grant the six-bed facility a permanent hospice license after finding numerous violations, including improper monitoring of some patients’ medicines and diets, disorganized record-keeping and lack of official policies to oversee patient care.

Last month, the company was fined $10,000 after an administrator admitted a patient while knowing that necessary medication and special equipment for the man were not available--a move that “presented an imminent danger . . . or substantial probability that death or serious harm would result,” according to state reports.

McKennell and the directors of Care International said they have fired the administrator responsible for the incident, hired a private consultant to help correct problems and have made other staff changes.

“There’s been a definite learning curve involved,” McKennell said. “In fact, it’s been two years of absolute purgatory. But we are taking care of the problems. I’ve put everything I have into this and I don’t want to fail now.”

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The company is quickly running out of money, McKennell said. The facility can afford to stay open for only about two more months--at a cost of about $30,000 to $35,000 a month--if state officials do not approve the application for a hospice license, he said.

The facility now has two patients, and a total of seven have been admitted since September, officials said.

If the license is approved, Care International could begin to collect more than $100,000 owed by Medicare and MediCal for patient care, McKennell said. But state licensing officials said they might not be able to inspect the site within two months.

“With the limited resources we have, they get one chance, maybe two,” said Jaqueline A. Lincer, director of licensing and certification for the health department’s Orange County office. “[Then] they go to the bottom of our priority list.”

McKennell, a native of England and a former engineer, said he began discussing plans to open a hospice about 2 1/2 years ago with a friend who was in the medical business, he said.

“I thought it was a laudable idea,” McKennell said. “It is a business, yes, but it is also a way to help a community that really needs help. However, I was misled as to the time and money it would take.”

McKennell later teamed up with four other partners--including his wife, Janet--who have invested a total of about $500,000 into the project, he said. He is no longer working with the friend who originally suggested the hospice idea, he said.

Soon after the facility opened, McKennell said, Care International officials found themselves in something of a Catch-22. They could not be granted a full hospice license without first demonstrating they could care for patients--and to do that, they needed a full staff, including 24-hour nursing care, on-call doctors, social workers, aides, administrators, cooks and cleaners, McKennell said.

The costs would have been offset by patient fees: about $250 to $700 a day depending on the level of care required, McKennell said. AIDS experts said the fees are significantly lower than hospitals usually charge for the same services.

The facility has taken some patients with private insurance, but most are covered by state insurance programs, McKennell said.

Many of the problems and delays have resulted because of “differences in interpretation of what can be done,” McKennell said.

He added: “We may have lost some credibility because of the past administrative difficulties, but we want to comply with everything the state wants. We realize the mistakes we’ve made and now we want to be open.”

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Sarah Kasman, executive director at Laguna Shanti, an AIDS referral organization, said the tough codes for hospices are needed. Kasman said she recognizes a need for such facilities but that the state is right to demand a high standard of care for AIDS patients.

“The new laws are that tough for a reason,” she said. “That’s why it can take years to get these licenses. If I was sick, I’d want to know that [the hospice] was under the auspices of something bigger.”

Care International has its supporters.

One of them is Barbara Hobson, whose son, Michael, died of complications of AIDS on Christmas Eve at the facility. She said that if the facility shuts down, patients such as her son would have fewer options available.

“We were very fortunate to find this place,” she said. “We just didn’t have any workable solutions for Michael. He was living with my brother for a while, but there were stairs and he kept falling.”

Hobson said her son was pleased with the care he received.

“Its a very comfortable atmosphere, like a home, and he enjoyed having the freedom to sit in the back patio or watch TV,” she said. “And if [a visitor] wants to stay there all day and night they can, which is important when someone’s that sick and you don’t want to leave them.”

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And David Reid, a housing coordinator at the county’s AIDS Assistance Foundation, a referral service, complimented Care International’s efforts.

“We’ve worked with them from the get-go, and we’re very supportive of their venture. Some of our clients have gone there and we’ve had nothing but positive feedback,” Reid said. “Right now, we have to place clients out of the county, and that usually means Long Beach. But when they get licensed, they will be high on our referral list.”