Aging at Home : Health: Caring for infirm elderly relatives within a family setting is becoming a more popular--though expensive--option, some experts say.

Sick and frail, John Stewart, 77, can hardly get around anymore. Five strokes have left him partially paralyzed, and radiation therapy on a cancerous tumor has made him thin and pale.

Stewart’s daughter, Judy, considered placing him in a convalescent hospital. But after visiting one of the facilities, Stewart decided it was best to keep her father at home, even though it meant changing her life drastically.

And she is not alone.

Ventura County experts on the elderly say it is becoming increasingly popular for family members to care for the infirm elderly at home because of concerns over the quality of treatment at convalescent homes and reluctance to move the aged away from familiar surroundings.

Recently, the Ventura County Area Agency on Aging listed in-home care as one of its top priorities for the 1990s.

“Dad hated the thought of leaving the house,” Stewart said. “As long as we’re able to, I want to keep him at home.”

When John Stewart’s health started to deteriorate five years ago, Judy Stewart moved out of her apartment in Santa Monica and into her father’s home in Oxnard. She hired a full-time nurse’s assistant and spent thousands of dollars remodeling the house to include handrails and ramps.

“It’s like we’re turning back to the 1800s, when people took care of their loved ones at home,” Stewart said.

Ardith Winters, nurse consultant with the state Department of Aging, agreed: “The population of elderly is growing and we’re keeping people alive longer who have chronic illnesses.”

Over the past five years, the number of agencies that provide in-home care in the county has nearly doubled to about 14. Two years ago, the Legislature passed a bill regulating home-care agencies.

But despite the growing popularity of caring for the frail elderly at home, many obstacles remain.

Although several insurance companies recently announced that they would cover in-home care, insurance coverage is still difficult to get. Also, most in-home care is not covered by Medi-Cal.

As a result, families are finding that they still have to reach deep into their pockets to pay for the care.

Marion Schillinger of Thousand Oaks said she spent about $80,000 last year for in-home care for her husband, George, a retired AT&T; executive, who is partially paralyzed from a stroke.

Although her husband’s treatment is taking a huge chunk out of their savings, Schillinger, 72, said she wants to keep him at home.

Schillinger has hired a nurse and a physical therapist to help care for George, 67. She has also installed bars and ramps in the house to help him maneuver.

“This is the rainy day we saved for,” Schillinger said. “I’m trying to give him the best I can, but the best is very costly. You have to give up a lot.”

In most cases, however, home care can be less expensive than care in nursing homes under a case-management system, officials with the state Department of Aging say.

According to state figures, home care for an elderly person costs an average of $1,038 a month, compared to nearly $2,000 for a nursing home.

Stewart estimates that she pays about $1,450 a month for live-in aide Maggie Del Castillo to care for her father. Del Castillo also helps clean the house and cook the meals.

Even though Stewart has given up her social life and commutes to her job in Los Angeles, she said she wants to care for her father for as long as she can. Simply mentioning the words nursing home makes her father cry.

“The reality is my father is going to die, and there is nothing I can do about it,” Stewart said. “I want to make him as comfortable as possible while I still have him.”

She said she plans to hire a physical therapist to come to the house two days a week.

Although Stewart has found good care for her father, experts say it is not always easy to hire reliable medical assistants.

Ann Laycock, whose 90-year-old mother lives alone in Camarillo, said she advertised in a local paper for someone to help take care of her mother.

Although a myriad of people applied, most were unqualified or unwilling to spend the time necessary to assist the frail, elderly woman.

“Nine out of 10 of the people just wanted a place to live,” Laycock said. “The first gal we hired didn’t last two weeks.”

Laycock said one woman stole $50 and then disappeared, and another took the painkillers that had been prescribed for Laycock’s mother. Yet another left without notice, she said.

She said she finally called an in-home assistance referral service based in Ojai to find a dependable worker.

The nurse’s assistant the service sent over has worked out well, Laycock said.

“She has become a real companion for my mother,” she said. “It gives me a feeling of confidence.”

But Linda Conner said her family was not as lucky.

“We vowed that we would keep my stepfather at home,” said Conner, a lawyer who analyzes insurance policies for the elderly in the county. “But we absolutely could not do it.”

She said the family was unable to afford the intensive in-home medical assistance.

“We just needed 24-hour care and could not get it,” Conner said. “It is very difficult to find people who want to come and do the work. It’s hard work.”

Her stepfather, who had a brain tumor, was placed in a nursing home in Santa Monica. He died in January at age 65.

Colleen L. House, the executive director of Ventura County’s Area Agency on Aging, said the agency wants to make home care more feasible for families by offering transportation, day care and medical assistance to the homebound elderly.

“Because people are living longer, it’s not uncommon to find four generations in one house,” she said. “As things change with society, a whole new vista of problems open up. We need to address those problems.”

May Stage, a family consultant for Coast Caregivers Resource Center, said her organization also is trying to make life easier for family members of elderly people with brain impairments, such as Alzheimer’s disease.

She said the resource center in Ventura offers support groups and day-care services for the elderly and their families.

Over the last couple of years, the number of people participating in the center’s programs has more than doubled, Stage said.

Winters, with the state Department of Aging, is seeking funding to expand a state-sponsored program that offers help to people caring for elderly family members.

“Nursing homes will never go out of business because there will always be the need for them,” Winters said. “But it comes down to the quality of someone’s life.

“People want to stay at home,” she said. “That’s not taking anything away from nursing homes, that’s just a fact of life.”