The Way Out

U.S. city and county hospitals generally have been hard enough put to it to provide enough beds for the chronically ill; they have spent little effort fitting those patients for useful, self-sufficient life. Last week, reporting on a year's trial program of rehabilitation, New York City's Commissioner of Hospitals, Dr. Marcus D. Kogel, showed how much difference a change of emphasis could make.

Beginning a year ago, doctors attending the 1,500 patients at Goldwater Memorial Hospital on Welfare Island in New York's East River nominated 100 candidates to start rehabilitation training. Patients chosen ranged in age from 16 to 85; some were disabled by polio, heart disease or cerebral palsy, some were arthritics, some were amputees, many were paraplegics (paralyzed from the waist down) or hemiplegics (paralyzed on one side).

The 100 Skills. As a first step, the patients were moved to big, airy, first-floor wards with a view of the river's tug and barge traffic. Instead of cluttering the place with terrifyingly complicated equipment, everything was made as casual and simple as possible. Each patient was put to work for an average of five hours a day, learning or relearning the "100 average daily living skills." Each was assigned a card listing the skills to be acquired (e.g., walking, turning on lights, opening doors, turning over in bed, combing one's hair). When one skill was mastered it was checked off on the card. When the card was full, the patient was ready for discharge.

Patients who had lingered in the hospital, apparently doomed to end their days there, soon lost their helplessness and hopelessness. Some patients filled their 100-skill charts in only six weeks; others were still cheerfully working on them after a year.

A truck driver who had lost both legs had learned to stand and was starting to walk. A mother of two who had been scarcely able to lift a finger because of arthritis mastered the controls of a wheelchair, flexed her hands, learned to walk a few steps.

Back to Work. Of the 150 admitted for rehabilitation during the year, 50 patients have been discharged, and more will soon follow. Nine, including a laboratory technician and an elevator operator (both had been disabled by strokes), have gone back to work; many are at home, taking care of themselves. Even patients who could not be discharged from the hospital have improved their living skills so markedly that they take more care of themselves, make fewer demands on the time and energies of nurses and attendants.

Some of the rehabilitated patients had been in the hospital as long as ten years. If other cities followed the same program, Goldwater doctors estimated, it should be possible to clear the nation's hospitals of half the patients now imprisoned there.

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