Do-It-Yourself Hospital

Richard Cwiklinski got out of his hospital bed in Milwaukee at 6:30 a.m., threw on a sports shirt and slacks, strolled down to the cafeteria for breakfast. After breakfast, he had a back rub, went for a walk in the hospital park, leisurely enjoyed the Lake Michigan landscape in the brisk spring air.

Cwiklinski, a 45-year-old fireman with an ulcer, was not flouting hospital rules. As one of 24 patients in St. Mary's 25-bed self-care unit, he was well within them. For over six months the new unit had been taking in patients whose needs are not urgent: observation, a routine physical exam, daily physical therapy, post-operative recuperation. Normally, the patients would have been confined to a bed, wakened regularly each morning, prodded unnecessarily with a thermometer, served lukewarm meals. In the self-care unit, they take their own medicine and their own baths, eat in a cafeteria that has all the liveliness of a summer cookout.

Within liberal limits, the self-care patients are encouraged to indulge their whims. They get haircuts and permanents when they please, sunbathe on the hospital roof, play cards, browse in the gift shop, receive visitors from noon until 8 p.m. One man got permission to go home for some summer shirts when the weather turned warm. A housewife used to get a midafternoon snack of scrambled-egg sandwich and caramel sundae. Exclaimed she: "I had no idea being in a hospital could be so much fun. I did have one problem today. I just could not find a fourth for bridge."

The self-care unit relieves St. Mary's of one of its biggest problems: finding enough nurses. Self-care requires a staff of only five for a 24-hour period, one-fourth the usual staff. The saving is passed along to the patient. A double room costs $14.50 as compared to $22.50 in the rest of the hospital; a single costs $16.50 compared to $28. St. Mary's carries no extra liability insurance on its mobile, self-care patients. Its position has been justified: only one person has had a slight accident.

St. Mary's staff often has to convince hospital patients that they are fit enough to go to self-care. Some have made friends on their floor and do not want to leave; others simply like the service. "Why should I move?" asked one. "Blue Cross is paying for it." But the staff is determined to help patients help themselves. Their best argument is the cheerful people in self-care. Says Patient Cwiklinski: "The less attention they give me the better. And that's the way it is here."

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