They were two academics who had never attempted anything of the sort. But they learned one step at a time. They worked with an architect to lay out the plans in detail. They went to bank after bank to get a loan. When that did not succeed, they found a private investor who backed them but required them to give up majority ownership and to accept personal liability for failure. They signed the deal. Then the state of Oregon threatened to withhold licensing as senior housing because the plans stipulated that people with disabilities would be living there. Wilson spent several days camped out in one government office after another until she had secured an exemption. Unbelievably, she and her husband cleared every obstacle. And in 1983, their new “living center with assistance” for the elderly—named Park Place—opened in Portland.
By the time it opened, Park Place had become far more than an academic pilot project. It was a major real estate development with 112 units, and they filled up almost immediately. The concept was as appealing as it was radical. Although some of the residents had profound disabilities, none were called patients. They were all simply tenants and were treated as such. They had private apartments with a full bath, kitchen, and a front door that locked (a touch many found particularly hard to imagine). They were allowed to have pets and to choose their own carpeting and furniture. They were given control over temperature settings, food, who came into their home and when. They were just people living in an apartment, Wilson insisted over and over again. But, as elders with advancing disabilities, they were also provided with the sorts of help that my grandfather found so readily with his family all around. There was help with the basics—food, personal care, medications. There was a nurse on-site and tenants had a button for summoning urgent assistance at any time of day or night. There was also help with maintaining a decent quality of life—having company, keeping up their connections in the outside world, continuing the activities they valued most.
The services were, in most ways, identical to the services that nursing homes provide. But here the care providers understood they were entering someone else’s home, and that changed the power relations fundamentally. The residents had control over the schedule, the ground rules, the risks they did and didn’t want to take. If they wanted to stay up all night and sleep all day, if they wanted to have a gentleman or lady friend stay over, if they wanted not to take certain medications that made them feel groggy; if they wanted to eat pizza and M&M’s despite swallowing problems and no teeth and a doctor who’d said they should eat only pureed glop—well, they could. And if their mind had faded to the point that they could no longer make rational decisions, then their family—or whomever they’d designated—could help negotiate the terms of the risks and choices that were acceptable. With “assisted living,” as Wilson’s concept become known, the goal was that no one ever had to feel institutionalized.
The concept was attacked immediately. Many longtime advocates for the protection of the elderly saw the design as fundamentally dangerous. How was the staff going to keep people safe behind closed doors? How could people with physical disabilities and memory problems be permitted to have cooktops, cutting knives, alcohol, and the like? Who was going to ensure that the pets they chose were safe? How was the carpeting going to be sanitized and kept free of urine odors and bacteria? How would the staff know if a tenant’s health condition had changed?
These were legitimate questions. Is someone who refuses regular housekeeping, smokes cigarettes, and eats candies that cause a diabetic crisis requiring a trip to the hospital someone who is a victim of neglect or an archetype of freedom? There is no clean dividing line, and Wilson was not offering simple answers. She held herself and her staff responsible for developing ways of ensuring the safety of the tenants. At the same time, her philosophy was to provide a place where residents retained the autonomy and privacy of people living in their own homes—including the right to refuse strictures imposed for reasons of safety or institutional convenience.
The state monitored the experiment closely. When the group expanded to a second location in Portland—this one had 142 units and capacity for impoverished elderly people on government support—the state required Wilson and her husband to track the health, cognitive capabilities, physical function, and life satisfaction of the tenants. In 1988, the findings were made public. They revealed that the residents had not in fact traded their health for freedom. Their satisfaction with their lives increased, and at the same time their health was maintained. Their physical and cognitive functioning actually improved. Incidence of major depression fell. And the cost for those on government support was 20 percent lower than it would have been in a nursing home. The program proved an unmitigated success.