Nursing: Get Up & Live

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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.