Get Up & Live

Cupped in a patch of wooded hills in Issaquah, Wash., some 15 miles southeast of Seattle, a one-story building rambles comfortably across a meadow. A clear creek ripples near by, filled at the moment with salmon heading upstream to spawn. There is an air of bustling activity about the place, a liveliness that is surprising because the rustic building is a nursing home. It is one of an increasing number that are teaching their patients to get up and live rather than follow the old nursing-home formula of lie down and die slowly.

At Dr. John L. Whitaker's Issaquah Villa, every patient who is able to get up is routed out of bed at 8 in the morning. They are encouraged to wander the grounds; each afternoon everyone is invited to formal tea. Whitaker and his staff, which includes his energetic wife Mary as administrator, carefully address each of the 86 patients by name, even those who are close to senility. Such continuous and careful respect for the individual is an important part of the Whitaker therapy. "Our aim," says the husky, gentle doctor, who was a crack Marine transport pilot in World War II, "is to rehabilitate each one to his greatest capacity."

Leaving Alive. That attitude sums up a noteworthy change in U.S. nursing homes. "In the past they have been associated with preterminal care," says Dr. Philip Lee, the Health, Education and Welfare Department's assistant secretary for health and scientific affairs, "but increasingly nursing homes serve in a rehabilitative capacity. The emphasis is no longer on care that is merely custodial." And he guesses that 80% of nursing-home patients eventually leave alive.

The trend is sure to continue. This January the Joint Commission on Accreditation of Hospitals will begin a voluntary program for nursing homes. The commission will have 1,750 homes accredited at the start, out of a U.S. total of some 10,000. And it will have a growing power to encourage improved standards in the rest. By January 1967, medicare will begin paying benefits for oldsters who require nursing-home care. Those benefits will cover a so far unspecified "reasonable cost" and will be granted only for patients in homes that meet Government standards.

Nonterminal Case. There would be no problem at all if more of the homes were like Issaquah Villa. For John Whitaker is one of a growing number of doctors who realize that nursing homes have become a necessary and important extension of overcrowded hospitals. In the better homes, a patient can get what care he needs during a simple convalescence or rehabilitation without paying the astronomical costs of an extended stay in a hospital. The average cost of similar care in a hospital is $30 a day; it can be obtained in a nursing home for half, or sometimes a third the price.

Dr. Whitaker, a busy general practitioner, was so concerned for his aging patients who had no place else to go, that he decided to start Issaquah Villa in his "spare time"--that is, when he was not attending to the daily 50-patient load of his regular practice and helping to raise his eleven children and his black Angus cattle. Even with all those demands on his energy, he has been able to operate profitably a home that ranks with the best in the U.S. What's more, the unusual presence of a doctor as medical director, rather than a registered nurse or less well-trained personnel, has helped set a tone that has resulted in some remarkable recoveries.

One boy of 18 who had suffered severe head injuries in an automobile accident, and had undergone three brain operations plus extended treatment in a hospital, was sent to Whitaker on the theory that he would soon die and needed only minimal care until he did. Though the boy had failed to regain consciousness for six weeks, the staff at Issaquah immediately took special interest in him. He got all the standard medication for someone in his condition. But beyond that, staff and family were instructed to talk in his room as if he could hear them. Daily, remarks and greetings were directed at him. Some of the nurses even came in on days off, along with the Whitakers, to say hello to the unconscious teenager. Then one afternoon three months after arriving, he showed a dim but encouraging response. Within another seven months the supposedly terminal case was discharged. He was well enough to begin retraining for a useful life.

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