AIDS Dilemma

Need for long-term care

Like so many victims of Acquired Immune Deficiency Syndrome (AIDS), Morgan MacDonald, 27, has had his good periods and his bad as the disease runs its course. Last month officials at Shands Hospital in Gainesville, Fla., pronounced him "well enough to walk," and spent three weeks looking for an extended-care facility that could handle his needs. They could find none. Finally, Shands got in touch with the AIDS/KS Foundation, a private group in San Francisco that helps those with the affliction. On Oct. 4, Shands paid for flying MacDonald, accompanied by a doctor and two social workers, to San Francisco aboard a chartered air ambulance. But when he arrived, MacDonald was so weak that he had to be admitted to San Francisco General Hospital. Mayor Dianne Feinstein charged that the transfer was "outrageous and inhumane," and Mervyn Silverman, the city's public health director, declared that the episode was "a dump of the worst kind" and accused Florida of "abandoning" an AIDS patient.

Last week those claims were bitterly denounced by Shands officials, who convincingly argued that they had acted in good faith, but the MacDonald case focuses attention on a growing medical problem: how to handle AIDS patients who do not need hospital care. Most victims who are discharged from hospitals, which have neither the facilities nor the money to handle them indefinitely, are forced to fall back on family and friends, plus the support of homosexual organizations. (About 70% of AIDS patients are gay or bisexual.) In Florida's Dade County, which encompasses Miami, only one of the 37 state-licensed nursing homes has ever taken in AIDS victims. Miami's Jackson Memorial Hospital has had patients who could have been discharged if a place had been found for them; the hospital has not even been able to find a foster home for a patient who is nine months old.

San Francisco, which has 289 AIDS victims, a group surpassed only by New York City's 988, is trying to ease the dilemma by helping finance two home-care plans: a visiting-nurse program and Shanti ("inner peace" in Sanskrit), a volunteer organization that provides peer counseling for the terminally ill and their families and runs two residences for AIDS patients. San Francisco is also planning to open a special, long-term treatment center.

The problem of handling AIDS victims as outpatients seems sure to grow. As of Oct. 122,467 cases had been reported to the Government's Centers for Disease Control in Atlanta, compared with 1,180 at the end of 1982. Moreover, the incidence is increasing. In July (the latest month so tabulated) there were 53 new cases a week. A year before, there were eleven. This file is automatically generated by a robot program, so viewer discretion is required.