Halfway Wards

Earl Perry, an elderly bachelor, has primary cardiopathy, a common disease of the heart muscle. He lives alone and has a difficult time sticking to the diet necessary to control his salt intake, which is essential if he is to prevent heart failure. As a result, Perry, who also has diabetes, periodically lands in a medical ward of the Boston Veterans Administration Hospital. A year ago he would have stayed for perhaps two months in a section nominally reserved for the acutely ill, wearing hospital pajamas and attended by orderlies or nurses, until the day doctors judged him ready for release.

Yet today, the worst part of his latest seizure past, Perry can wear street clothes if he likes. He makes his own bed and keeps his room tidy. For meals he can go to a cafeteria, and for company he has not the seriously ill but people like himself who are convalescing. Perry is in the hospital's new intermediate ward, which it calls its "selfhelp unit."

The ward is a place for people who no longer need all the nursing and housekeeping services normally given to hospital patients but who are not quite ready to leave either. The arrangement frees a bed in the hospital's acute section and gets the patient accustomed once more to caring for himself. In a VA hospital, with its relatively aged clientele, the program also reduces the number of patients who grow so used to the invalid's routine that they prefer it. Fourteen VA hospitals now use the system; private hospitals are beginning to follow suit, and not only for the elderly. Besides those nearly ready to go home, other types of patients are considered eligible, including those admitted for presurgical testing, businessmen undergoing executive physicals, certain psychiatric patients and those undergoing treatment for alcoholism.

Nursery Duty. Most hospital administrators who have tried self-help programs are pleased with the results. Officials at the Hospital of the Albert Einstein College of Medicine say that the system allows them to assign more registered nurses to the seriously ill. The reduced number of nurses in self-help spend much of their time teaching patients how to take care of themselves at home.

There are economic advantages as well. William Grove, administrator of Chicago's Grant Hospital, estimates that a bed in a self-help unit costs the hospital only $70 a day, compared with more than $ 100 for a bed in a general-care ward. Patients, however, do not save any money; hospitals, reimbursed by insurance companies on a per diem basis, charge uniform rates.

Few patients seem to mind. "They regain their independence on this floor," says Jeanne Salerno, Einstein's ambulatory care coordinator. She tells of one woman who had been particularly depressed and unwilling to do things for herself. The patient was recently moved to Einstein's self-help unit and encouraged to help out during feeding time in the maternity-ward nursery. Performing a useful task convinced her that she was better and could manage for herself, and a few days later she went home.

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