Christopher House Anew

Will Hospice Austin Continue Serving People With AIDS?

Carol Cody, founder and executive director of Christopher House

photograph by Jana Birchum

When it came time last week to choose a new owner for the beloved Christopher House, its board of directors faced an agonizing decision. Should the non-profit facility go to the city -- the buyer that would focus, as Christopher House had, on AIDS patients exclusively, but without the restful, residential touch? Or, instead, should the center go to Hospice Austin -- the bidder that promised to keep the home-like ambiance, but would serve patients regardless of diagnosis, thus destroying the tradition of Christopher House's single focus on HIV/AIDS issues? It seemed an impossible choice; both components were integral to the mission of Christopher House.

As it turned out, another issue emerged that ultimately became the deciding factor for the board: money. Plain and simple, Hospice Austin tendered the highest offer -- $950,000, which was sufficient to repay Christopher House's bank note of $675,000 and various other debts.

The low bidder in the deal was the city of Austin, which had sought to acquire the property to expand and relocate the David Powell Clinic from its cramped quarters in Clarksville. The city-owned outpatient clinic serves people living with HIV/AIDS, and Christopher House's location in East Austin, at 2820 E. MLK, seemed the most logical site from which to serve the clinic's indigent client base.

In the weeks leading up to the board's May 27 decision, supporters of the city's proposed acquisition of the facility intensified their lobbying efforts, with impassioned letters from health care providers, AIDS activists, and the entire Travis County delegation to the Texas House of Representatives (Glen Maxey, Dawnna Dukes, Sherri Greenberg, Elliott Naishtat, and Terry Keel).

But when the bids came in, the city, for whatever reason, didn't put its money where its mouth was. Assistant City Manager and Acting Health Director Marcia Conner says the city "was prepared to offer around $675,000, with the power to negotiate up to $900,000." Asked why the city chose to low-ball its offer, Conner responded, "The city is a public entity. We must consider the benefit to the public before entering any plan. We could only offer the amount of money supported by the building's appraisal. We could not include money in our bid to pay off Christopher House's other debts."

Considering, however, that the city earmarked $1.3 million last year to relocate or expand the David Powell Clinic, it's unclear why the city could not have offered a more competitive bid. "We were so clear about what we needed," says Carol Cody, founder and executive director of Christopher House. The city's proposal "did not cover the bank note. The bank had the final decision."

Even so, the city's inability to secure the Christopher House site has many in the HIV/AIDS community worried. Charlotte Hale, executive director of Project Transitions and vice chair of the Austin Area AIDS Service Providers Network (the regional planning group that allocates federal funds designated for HIV/AIDS care) is concerned about the fate of AIDS patients who cannot afford to pay for hospice care. "While I'm happy for Hospice Austin, I am disappointed," she says. She fears that without the expansion of the David Powell Clinic at the Christopher House site, there will be an increasingly long waiting list at the clinic.

While strides have been made with new drug therapies, not everyone responds to these treatments, Hale says, adding, "Only a small percentage of Hospice Austin's caseload will be people with AIDS. I suspect that the job of serving AIDS patients will continue to fall primarily to Project Transitions." (Project Transitions is a local nonprofit that provides hospice care and housing for people with AIDS.) Before closing in February, Christopher House served as an acute-care residential facility which provided a comfortable, restful setting for AIDS patients. But with a decreasing number of people needing Christopher House's services -- the result of improved drug therapies such as protease inhibitors -- the facility's leaders decided it was time to shut down the site.

Now, Christopher House will have a rebirth of sorts when the new owners, along with about 24 staff members, open the doors for hospice care in November. While Hospice Austin is a nonprofit program that provides care to patients with a variety of terminal illnesses, cancer patients make up the majority of the program's clientele. And although the program also serves AIDS patients -- Hospice Austin reports that in the last 10 years it has provided care for 560 people with AIDS -- many in the HIV/AIDS community are upset, even outraged, that Christopher House will be used to care for patients who do not have HIV or AIDS. "I am extremely disappointed and discouraged," says Toni Inglis, a member of the Austin Area Comprehensive HIV Planning Council (another strong supporter of the city's proposal). "This could have been a chance to expand the outpatient medical care for the AIDS population of Austin. Now it is a missed opportunity."

And José Orta, AIDS activist and spokesperson for Alive and Surviving with HIV/AIDS (ASHA), says that he and others in the community are perplexed by the decision. "Regardless of what Hospice Austin says, this decision officially puts the facility [Christopher House] outside the AIDS community. What about people with AIDS? What happened to us?" Orta predicted that poor people living with AIDS, more than anyone else, will get lost in the shuffle. "What is Hospice Austin doing for the indigent?" he asked.

For its part, Hospice Austin is trying to answer these questions. "We'll do as much as we can in terms of charity care," says Marjorie Mulanax, Hospice Austin's executive director. "We don't know exactly what will happen until we open. But we do have a great track record on charity care in our homecare program."

Since 1980, Hospice Austin has cared for terminally ill patients and their families, traditionally at the patients' homes or in a nursing facility. Hospice Austin realized the need for a live-in hospice facility in Austin, though, and jumped on the opportunity to acquire Christopher House for that purpose. "People who move here from other areas are shocked to find that there is no hospice facility in Austin. Now we will be able to meet their needs," Mulanax says.

As for Hospice Austin's track record with indigent patients, in 1996 the organization devoted more than $500,000 of its home hospice budget to charity care. That equals about 10% of the organization's total revenue from 1996, according to Mulanax. And as part of its charity care program, Hospice Austin plans to continue the fundraising projects started by Christopher House. One of these, the Walk of Friends Brick Project, allows supporters of the facility to purchase bricks in a memorial garden walkway as a remembrance of loved ones who live in the facility or who have died from terminal illnesses. Hospice Austin faces quite a fundraising challenge, though. Mulanax estimates that one year of care in the facility will cost $127,000 per patient. That's a lot of bricks.

Despite opposition, Hospice Austin did have many advocates who rallied behind the organization's proposal because of its promise to preserve Christopher House for inpatient use and to keep intact the furnishings -- from the hand-made bedside tables, to the fused glass art, to the antique piano -- all the details that helped create warmth and serenity at Christopher House.

Throughout the controversy over who should take over Christopher House, one irony has risen to the fore: The losers may be winners after all. The ruckus that accompanied the bidding process has moved the David Powell Clinic into a favorable strategic position -- the spotlight.

What had been a small AIDS clinic, quietly ministering to the needs of its patients, suddenly became the center of a media and lobbying blitz. For now, the ball is in the city's court. Will city leaders work diligently to find a new home for the clinic? To be sure, there will be more people demanding an answer to that question.

Dwayne Haught, the administrator of the David Powell Clinic, believes that it's time to look beyond the Christopher House controversy to the future. "This can be a win-win situation," he says. "Now that the decision has been made, we can begin to look ahead. We can focus on finding a new place for the David Powell Clinic."

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