The moment I met Mr. Lambert that fall day in 1991 I knew my medical training wouldn't be much help to him.
Tall and frail Mr. Lambert held onto his son's arm as he shuffled through the front door of Chase Memorial Nursing Home in New Berlin, N.Y., where I was medical director. Mr. Lambert had just been in an accident the police suspected was an attempted suicide. As I learned the old man's story I could understand his depression. In three months he had lost his wife of 60 years, then, as his health failed, his independence. Mr. Lambert got into bed, turned his face to the wall and refused to look at his dinner tray.
"He doesn't have much to live for," I said to Roger Halbert, Chase's administrator. If Mr. Lambert remained in such despair he was likely to die. Could the program I had just been given permission to try make a difference to him?
I had come to Chase six months earlier, and still had trouble believing I was spending my time in a nursing home. I had graduated from Harvard Medical School without once setting foot in such a place. Later, during my residency, I did have to take my turn at various nursing homes. What an education those visits were! I would march into an old person's room with clipboard and stethoscope: "And how are you today, Mrs..."--a quick glance at the chart--"Mrs. Walker?" Mrs. Walker would be asleep, medicated, or both. "Better today? Good, good."
When I finished my residency I went into family practice in upstate New York, loving everything about my work except the occasional unavoidable stop-off at a nursing home. My wife, Judy, and I lived in the country, where we surrounded ourselves with vigorous young growing things--plants and animals and soon two lively little boys. For Judy and me our hilltop homestead was our personal Eden.
Then one warm spring afternoon in 1991 came a phone call from Roger Halbert at Chase. "Would you consider becoming our medical director?" he asked.
I almost laughed aloud. But after I hung up I found myself thinking about a phrase Roger had used. "We pride ourselves," he had said, "on the kind of care we provide here." What did it mean, I wondered, to care for patients? In medical school we had been taught treatment, not care. At our hilltop Eden, on the other hand, Judy and I were caring for our family, not treating them. The two things were quite different.
Days later Roger called again. "Why not come down just for a look?" he asked.
I saw at once Chase was well run. Still...it was not Chase, it seemed, but the nursing-home system that was wrong. The 80 residents lived in a setting that was a hospital in all but name. The rooms were spotless, the windows fitted with efficient venetian blinds, the pale-blue walls so antiseptically bare that there were echoes. Were America's nursing home a setting for treatment instead of care?
As I walked through the halls I found myself thinking of a Gospel commandment often quoted at our church: Love your neighbor as yourself. "Who is my neighbor?" Jesus was asked. In his answer the neighbor was a Samaritan, an unacceptable member of society. Like the aged and infirm in our society? I wondered. Shut out of sight, invisible though they might be to someone like me, weren't they still my neighbors? What would it mean to love those neighbors as myself, to want for them what others routinely enjoyed?
Right then I knew I was going to try to bring a bit of our Eden to Chase Memorial Nursing Home.
It wasn't easy to change the way things had always been done. I'll never forget the day five months after I took the job when I asked for a meeting with Chase's board of directors. As my listeners sat with arms folded, I outlined my dream: "We'll have growing things everywhere! Plants in every room. Plants in the hallways. And birds!"
Scores of birds, I told them, singing away in their cages. Cats and dogs wandering the halls. Rabbits in hutches. Daily visits from children--there was a day care center right next door. Curtains and pictures would help too, but mainly it would be the continuing close contact with living things that would make the difference.
There was a barrage of questions. What about allergies? Wouldn't we need different insurance? What if a resident didn't like animals, or the children made too much noise? And how about the staff--it would mean a lot more work for them. In the end, though, the board agreed our top priority was to do our best for the residents. If Roger and I could solve the various problems, we could go ahead.
Persuading the staff was more difficult. Nearly 130 men and women worked at Chase, and all were justifiably proud of the fact that year after year the state inspectors had given the home highest marks. Now here I came--a young doctor who rode to work on a bicycle, telling them they had to do things differently. One nurse in particular voiced the fears of many: Bring a bunch of children and animals into a nursing home? Play gardener when they had been hired only to look after the residents? Wouldn't it all create a mess--and more work for them?
Roger and I worked hard to gain the trust and support of staff and community members, and in the end the resident council voted yes. The outspoken nurse quit, but she was the only one to do so. The rest of the staff agreed to give the "Eden Alternative" a try. We received grant money and New York State waived a regulation about animals for the experiment. Eight months after I came to Chase we were ready to begin.
Mr. Lambert's depression became for me a test case for the new approach. Day by day he remained isolated in his room; most of his meals, even when concerned family members sat with him, were returned uneaten to the kitchen.
The maintenance staff had come up with what they called a life pole, a floor-to-ceiling steel rod fitted with arms for holding potted plants. As his was installed, Mr. Lambert glanced up with the first flicker of interest: Perhaps something in his farmer's heart had stirred at the sight of growing things. Next we hung from his pole a cage containing two bright-blue-parakeets. The following day Mr. Lambert asked to have the pole moved closer to his bed.
Mr. Lambert had been at Chase for several weeks when one of our mutts, named Ginger, appeared in his room. A nurse reported that Mr. Lambert had raised himself in bed and reached out to scratch the dog's ears.
And then came the day when the nurse found Mr. Lambert sitting on the edge of his bed. "You know those dogs have to be walked, young lady," he said. "Maybe that's something I could help out with."
From that day forward, at four o'clock each afternoon Mr. Lambert was at the front door dressed and ready to take Ginger and a greyhound named Target for a stroll around the grounds. Week by week his strength and good spirits returned. Six months later Mr. Lambert said an affectionate good-bye to Ginger and Target and went back home to his family.
Such stories, less dramatic, were repeated many times at Chase over the next few years. The great enemies of the elderly, I came to believe, are loneliness, boredom and, above all, feeling unneeded. To that, compare Mr. Lambert walking the dogs; a blind woman carefully measuring out feed and water for her birds; another patient absorbed in pruning and watering plants while her neighbor reads to a smiling little boy. All those people, despite infirmities and disabilities, found they had something to give.
Quality of life cannot be measured, but other results of the Eden Alternative can be. We cut our pharmacy bills in half, slashed the infection rate by 50 percent, reduced mortality by 25 percent. And to everyone's surprise, staff turnover, always high in nursing homes, dropped by more than a quarter despite the extra work.
State surveyors on their regular inspection tours became enthusiastic about what was happening at Chase. A state law limiting nursing homes to the housing of only one animal was repealed. The inspectors too had enjoyed and seen the benefits of the more than 100 birds and animals in our Eden. They noted the flourishing jungle of plants, and the kids showing off their day's drawings to the elderly art connoisseurs who lived there. They saw the parakeets in the residents' rooms, the rabbits, the flock of laying hens, the dogs and cats. One day I saw the chief surveyor trying to fill out his report while a cat walked across his paperwork, her tail trailing slowly across his nose.
I stayed at Chase four years, then set out to introduce the Eden Alternative in neighboring areas. Our son Zachary--age five at the time--went along on one such trip, enthusiastic as we set out. "When we get to the home," he said, "I'll play with the other kids."
"I'm afraid there won't be any other children, Zach."
"I'll play with the dogs, then."
"There won't be any dogs there either, Zach."
"Gosh, Dad," Zach said. "I thought we were going to a nursing home."