Cooperative Care: Hospital Patients Bring a Friend and Get New Freedom

Shahla Gavaghan, 36, wears 3-inch spike heels, a brightly colored dress and a stylish turban, hiding surgical scars from the removal of a benign tumor and hair loss from radiation.

She takes her coffee from the dining room into a glassed-in sun room to gaze at the Manhattan skyline punctuated by the Chrysler Building, or, in the other direction, the tugboats and yachts on the East River.

Surrounded by her family, she sometimes finds it hard to believe she is in a hospital.

It is New York University Medical Center’s cooperative-care unit, a 104-patient hospital that last year celebrated its 10th anniversary, but one that experts call a hospital of the future.

Its most unusual feature is that the patients must bring along a “care partner,” a friend or relative who will have a bed, receive three meals a day and provide one-on-one care.

Patient ‘More Independent’

“It is a hospital turned inside out,” said Dr. Anthony J. Grieco, medical director. “Instead of having everything focused on the patient in bed, the patient comes to centralized educational, nursing and dining services. Instead of the patient being in a dependent position, having everything done to him or her by the professional staff, the patient, with the assistance of the care partner, becomes more independent.”

Grieco said the criteria to be admitted to a traditional hospital and the cooperative-care center are the same with a few exceptions. The cooperative patient must be able to move about, even if by wheelchair, and must not need constant professional monitoring. But he stresses that the cooperative-care center is an acute-care facility, not just an after-care center, a rehabilitation unit or a hospice.

It provides quality care, he said, and at a much cheaper price.

For instance, a private room here is $311 a night. Across the quadrangle at the Tisch University Hospital, private rooms cost $691 a night and semiprivate rooms $540.

Overall, it is one-third cheaper to run this building than a traditional hospital. The staff of a traditional hospital would be twice the size.

Hospital Not Replicated

It is a hospital that has been constantly studied since it opened in 1979. But it has not been replicated, exactly.

“For reasons I can’t understand or explain, other facilities that have tried cooperative-care centers have never met with the kind of success the NYU facility has,” Barbara Giloth of the American Hospital Assn. in Chicago said. Giloth specializes in new ways to care for ambulatory patients. “There are no others anywhere near its size nor with its scope.”

On a typical day, many of the patients were busy. One met with a pharmacist for an explanation of possible side-effects of a medicine. Some attended a class on insulin injections; others participated in a relaxation seminar.

In the dining room, patients, with the help of care partners, choose the correct foods even if they are on a restricted diet. This is not a hospital that provides salt-free trays; it is one committed to teaching the patient how to care for himself or herself after discharge.

Only under special circumstances would a doctor or a nurse invade the privacy of the patients’ spacious 16-by-18-foot rooms. (There are also 15 slightly larger suites.)

Three out of four patients administer their own medicines, and Grieco said fewer medication errors have resulted than in traditional hospitals.

Serious Illnesses Involved

These are not patients with minor problems. Some will be dead within the year. They are afflicted with cancer, heart disease, AIDS--the big three--and other serious ailments.

The five floors where the patients sleep look more like a hotel than a hospital. Only the wheelchairs parked outside indicate otherwise.

There are no nursing stations on those floors, thus no staff noisily dealing with emergencies throughout the night, no telltale hospital odors, no one awakening patients for that annoying 6 a.m. check.

The patient awakens to find a daily schedule taped to the door: the time of the physical, blood pressure, temperature and pulse checks, plus any specific needs such as diagnostic tests or individual meetings with a nutritionist, social worker or pharmacist.

It is more like a business day than a hospital day. It is, well, grown-up.

More important, according to studies, it results in shorter hospital stays and fewer future admissions. The average stay here is 4 1/2 days, and 6,500 patients were admitted last year.

‘Like Going Into a Hotel’

“Going into a traditional hospital is a lot like going into a jail,” said Dr. Howard Winer, a cardiologist. “Here, it is more like going into a hotel. In a traditional hospital, you’ve potentially got someone in the next bed who is very ill. There is moaning; there are procedures that are overdone.

“In a traditional hospital, it’s sometimes difficult to control the house staff. They will perform a procedure three or four times to feel safe. They tend to run the patient through the medical gantlet when there is no need for it.”

Here, there is a relinquishing of control by the professional staff.

“We worried about some physicians and nurses whose view was total control, but it’s worked out to be not much of a problem,” Grieco said.

Giloth said there are some pragmatic reasons why NYU, which now has a waiting list, worked. For one thing, it started out with an enormous commitment, $11.1 million in 1979 to put up the building.

Also, New York’s occupancy rate for hospitals is usually about 95%, contrasted with about 65% in other parts of the country. So New York doctors who may have been reluctant at first to try the cooperative-care center had little choice. The alternative often was a two-week wait for a bed at a traditional hospital.

Woman Admitted Repeatedly

Dr. Donald Brandon, an internist, is frequently the care partner for his wife, Janet, who suffers from a rare nerve disease, myasthenia gravis. He admits her several times a year for massive amounts of intravenous gamma globulin, an experimental treatment for the disease.

Brandon, like Winer, recalls some early reluctance. Some doctors complained that they could never find their patients, despite the public address system to summon patients who might be in a class, enjoying the view from the 15th floor lounge, playing gin rummy or attending a macrame class.

Patients, who wear pink tags as well as the traditional hospital plastic bracelet, are supposed to tell the nursing staff if they leave the building to stroll outside, but some do not.

In fact, said Kim Glassman, assistant director of nursing, the staff spotted one man in a tuxedo returning from the opera, tickets apparently too good to give up. Patients also sneak off to a nearby diner.

Some patients never want to see the inside of a traditional hospital again. This is particularly true of the AIDS patients, many of whom know that they will eventually need the respiratory machines and constant monitoring of a traditional hospital.

Praise From AIDS Patient

“I feel that I am a chosen person in getting to be here,” said Eric Klarer, 32, an AIDS patient. “This is the hospital of the future.”

Another AIDS patient, who was making trouble for his care partner and the staff, was told he would be transferred to a regular hospital.

He shaped up.

The nurses are all senior clinicians and there is a waiting list to get on the staff. Nurses say they appreciate being treated as professionals here, and they are relieved of the custodial duties, such as making beds, that many nurses must perform in other facilities.

“They are also free of the tyranny of first-year residents,” Brandon quipped. They are instead dealing with more experienced physicians who put more trust in them.

The mood is upbeat for a hospital. There is a “happy half-hour” every afternoon and as often as not there is a talented piano player among the patients. Patients and care partners enjoy fruit drinks and snacks. Tuesday night is movie night. With popcorn.

But serving as a care partner for a long period can be wearing.

Clare Trimble, who looks far younger than her 75 years, said she had to call her daughter to relieve her as her husband’s care partner.

Too Much for Wife

“He’s a difficult patient,” she said of Joe Trimble, 75, a retired newspaper sportswriter. “This time we have been here for 10 days, and that’s too much for one person to be on call for 24 hours a day.”

Some of the care partners, usually the spouse of the patient, tend to be elderly and it is common for them to trade off the use of the wheelchair for a while.

One nurse, asked how many patients were in her unit, replied: “Including the care partners?”

“In fact,” Grieco said, “our first cardiac arrest when we opened was a care partner, not a patient.”

The care partners also serve as ombudsmen for the patients.

“They’re not isolated and alone,” Grieco said. “We can mess up just like anyone else. Here, you’ve got a care partner to argue for you. There’s something healthier about that interaction. Here, it’s not as though there is a boss looking down at the lowly patient; there is a sharing of responsibility.”

The care partner can call for immediate help on a 911 system in the room if something goes wrong.

Grieco notes that fewer elderly people fall and break hips here than in traditional hospitals.

“Part of it is that there are rugs on the floor, but the other part is that, if you get up and feel a little unsteady, you’ve got the care partner right with you,” he said. “You can’t buy that kind of care. This is very expensive care.”

One care partner said she felt like she was at a spa.

Trimble bemoans the loss of the Perrier-filled champagne glasses that used to accompany dinner.

“That was such a nice touch,” she said.