ItwasthelookoftheplacethatattractedLou—therewas
nothingdispiritinglyinstitutionalaboutit.ButwhenLou
movedin,thewayoflifebecamewhathevaluedmost.
Hecouldgotobedwhenhewantedandwakewhenhe
wanted.Justthatwasarevelationtohim.Therewasno
parade of staff marching down thehalls at7:00 a.m.,
rustling everyone through showers and getting them
dressedandwheeledintoplaceforthepilllineandgroup
mealtime. In most nursing homes (including Chase
Memorial, where Thomashad gotten his start),it had
been thought that there was no other way. Efficiency
demandedthatthenursingaidestaffhavetheresidents
readyforthecookstaff,whohadtohavetheresidents
readyfortheactivitycoordinationstaff,whokeptthem
outoftheroomsforthecleaningstaff,etcetera.Sothat
wastheway themanagersdesigned theschedulesand
responsibilities.Thomasflippedthemodel.Hetookthe
control away from the managers and gave it to the
frontlinecaregivers.Theywereeachencouragedtofocus
on just a few residents and to become more like
generalists.Theydidthecooking,thecleaning,andthe
helping with whatever need arose, whenever it arose
(exceptformedicaltasks,likegivingmedication,which
requiredgrabbinga nurse).As aresult,theyhadmore
time and contactwith eachresident—time to talk,eat,
playcards,whatever.Eachcaregiverbecameforpeople
like Lou what Gerasim wasfor Ivan Ilyich—someone
closer to a companion than a clinician.
Itdidn’ttakemuchtobeacompanionforLou.Onestaff
membergavehimabighugeverytimeshesawhim,and
he confidedto Shelleyhowmuchhe lovedthehuman
contact.Hehadgotsolittleofit,otherwise.OnTuesday