O.C. Puts Hard Numbers on Its Need for a Safety Net

For months, an overwhelmed Maria Nieves could do little more than pray when her two epileptic children suffered convulsions at the same time.

Nieves, a nighttime office janitor, was one of the thousands of Orange County residents who lack transportation, affordable housing and health insurance for themselves or their children, each factor compounding the challenge of dealing with her children’s epilepsy and other disabilities.

For nearly a year, she and her children lived in a dank toolshed behind her brother’s Anaheim home. When the 6-year-old boy, Marco Antonio, had repeated convulsions, Nieves would pick up his stiff body and take him by bus -- with two or three transfers -- to a hospital or clinic. Because the boy was born in Mexico and had no health insurance, Nieves would pay cash for his treatment. But she couldn’t afford to buy medicine as well, so she gave him medicine from prescriptions intended for his sister, who had the same problem but, because she was born in California, had state-funded insurance.

Nieves’ story illustrates the problems outlined in a report, issued today, called the Orange County Health Needs Assessment. Using raw data and extrapolations, it provides a statistical snapshot of the healthcare and other needs of county residents.

Based on a survey of 3,380 households, researchers figured that 9% of Orange County residents are uninsured for health care, compared with more than a quarter of those who live in more urban areas, such as Los Angeles County. The situation for Orange County’s poor is exacerbated, the study found, by the high cost of housing, which limits financially struggling residents’ ability to pay for healthcare as well.

“I tried to do whatever I can to help my children,” said Nieves, a 35-year-old single mother. “But after calls and calls to doctors almost every day, I felt totally desperate. I just hope my children will get well.”

Nieves has found some relief. A local nonprofit organization that provides health insurance for children who can’t otherwise obtain it is paying for her son’s insurance. And her housing situation improved two months ago, when Nieves joined another brother in renting an apartment after he separated from his wife.

But her life remains a struggle, and the county needs assessment sheds light on why:

On average, a family of four with an annual income of $47,125 -- 250% of the federal poverty line -- needs to earn $644 a month more than that to pay for typical health insurance premiums along with other necessities: housing, food, taxes, transportation and child care.

Financially strapped families frequently must skimp on their housing to make ends meet, creating another set of problems, officials note. Cramped housing and lack of space to play can lead to obesity and asthma, a growing problem attributed to bugs and mold, said Pamela Austin, chief executive officer of the Orange County Health Needs Assessment.

The assessment, first conducted in 1997, was developed by an organization sponsored by several area hospitals and the county Health Care Agency. The state requires nonprofit hospitals to conduct assessments of community health and housing needs and develop programs to address them.

After the first report, for instance, a partnership of foundations committed $3 million to combat diabetes. The report is intended to provide raw data for healthcare providers and policymakers but not draw its own conclusions or make policy recommendations.

Despite the perception that Orange County is generally affluent, “there are more and more people with needs for housing and health and less ability to access them,” Austin said.

About 35,000 Orange County residents were homeless at some point in 2004, the assessment found, an 88% increase since 2000. Among them, 75% have children, 65% have jobs and only about one-third have health insurance.

Most of Orange County’s homeless are not the commonly stereotyped street people with substance abuse or mental problems, officials note. Rather, most are working families living marginally who, faced with the loss of a job, a health problem or some other financial stress, are unable to pay rent. Typically, they are not seen on the streets but find temporary or emergency housing, including with family, friends or as long-term residents of low-end motels.

Each situation, including Nieves’, differs.

Nieves left Anaheim for Mexico with her husband eight years ago and returned last year after he left her. Her parents and siblings, who live in Anaheim, promised to help her, she said.

The family assistance ended up being use of the toolshed in the back of the brother’s house. A bed filled most of the floor space. When it rained, the clothes and bed became damp. At night, she couldn’t access her brother’s bathroom because the house was locked.

“I felt like a duck, I was so wet, and it got to be unsafe for the children,” Nieves said. “The doctors say my children are especially sensitive so that was not a good place for them.”

Last month, she rented an apartment with the other brother. The two pay $915 for a one-bedroom apartment.

Nieves’ daughter, Wendy, 12, cannot speak but only gestures and mumbles. Her convulsions have stopped because of insurance-funded medicines and medical attention.

And with his new health insurance, Marco Antonio -- who had been losing weight and can’t walk -- is undergoing physical therapy.

But getting to the therapy sessions is a challenge in itself, and it speaks to another finding in the needs assessment: that health insurance is not enough to ensure access to needed care. Survey respondents cited limited clinic hours, work responsibilities and transportation as barriers to getting care.

To take Marco Antonio to therapy, Nieves hoists the 37-pound boy on her hip and carries him down the apartment complex stairs, then gently puts him in a stroller she has left at the bottom. To avoid a longer walk to an intersection, she darts across six lanes of Knott Avenue with the two children.

She carries Marco Antonio onto the bus, then retrieves the stroller at the curb.

The $3 bus fare dents the family’s fragile budget.

On Monday, after taking two buses, she arrived to the appointment late, and only after reconsideration was the boy given therapy.

“This is a family that has done everything possible to get healthcare,” said Nora Mendez, assistant executive director of the Orange County Community Housing Corp., which helped the boy get insurance. “They were lucky because they got insurance for the kids. And even with that, it’s still really hard” because of transportation and other challenges. “It shows you what the barriers are here in Orange County.”