America Living With AIDS

Caring for People with HIV Disease

direct health care services available for
treating AIDS patients in the United
States. Implementing findings from
health services research can help
ensure that decisions about where to
deliver care are based on individual
needs and not administrative convenience or the exigencies of particular
reimbursement strategies. Health services research can also help identify
the variables that would contribute to
a community's decision to centralize
care in one unit or hospital. While
centralized AIDS care or AIDS-dedicated units may be appropriate for
some communities, they may not be
practical for others. Evaluating the
different approaches as to where and
how care can be provided would be
very helpful to those communities
beginning to organize HIV-related
care services.
Many people with HIV disease would
in certain stages of their illness fare
better in a less intensive and less
expensive setting, but they languish in
hospitals because of a lack of access to
rental housing, congregate living facilities, nursing homes, and hospices.
Many nursing homes have been
reluctant to admit people with HIV
disease, citing the fears of other
clients, inexperience with managing
infectious diseases, and lack of adequate reimbursement. People with
HIV disease are typically much

younger than most nursing home
clients. Moreover, nursing homes may
not always meet the needs of people
with HIV disease who alternate
between periods of illness and relative

well-being. The Commission believes that nursing
homes must overcome
their reluctance to accept
people with HIV disease.
At the same time, other
options for long-term
skilled care should be
developed and encouraged.
There may also be a
poor fit between HIV care
needs and traditional
hospice services. Hospice
clients have traditionally
been cancer patients
whose prognosis and
decline could be predicted with relative certainty.
HIV disease is much
more unpredictable. People with HIV disease in
hospices sometimes wish
to seek readmission to a
hospital or to undergo
therapies (such as ventilator assistance) that would
otherwise be unavailable
in a traditional hospice
setting, where the focus is
exclusively on palliative care.

We nee
the same range of ho
options for people li
with AIDS as we do f
group of people who
experience deterior6
health: apartments t0
accommodate walker
wheelchairs, congregate
group homes. And it
to be subsidized beca
our limited incom
We need home care
personal care attenm
services to help people
their homes. And we
flexibility so that pe
can move back and;
between those arrange
as their needs chat
REBECCA LOMAX, M
M.P.H.
July 1990

In a

number of cities, hospices have been
created exclusively for people with
AIDS. Both options should be available.
People with HIV disease are at the
forefront of a trend toward minimiz
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