“‘You need to retire,’ I wanted to tell him,” Carson recounted. Instead, she said to the patient, “Let’s just change your doctor, because he’s too old to learn.” She told the woman’s family, “If I’m going to waste my energy, it’s not going to be on him.”
I asked Carson to explain her philosophy for enabling her residents to continue to live their own lives, whatever their condition. She said her philosophy was, “We’ll figure this out.”
“We will maneuver around all the obstacles there are to be maneuvered around.” She spoke like a general plotting a siege. “I push probably every envelope and beyond.”
The obstacles are large and small, and she was still sorting out how best to negotiate many of them. She hadn’t anticipated, for example, that residents themselves might object to her efforts to help other residents stay in their homes, but some do. She said they would tell her, “So-and-so doesn’t belong here anymore. She could play bingo last year. Now she doesn’t even know where she is going.”
Arguing with them didn’t work. So Carson was now trying a new tack. “I say, ‘Okay. Let’s go find a place for her to live. But you’re going with me, because you could be this way next year.’” So far, that has seemed enough to settle the matter.
Another example: A lot of the residents had pets, and despite the increasing difficulties they had with managing them, they wanted to keep them. So she organized her staff to empty cats’ litter boxes. But the staff balked at dogs, as they required more attention than cats. Recently, though, Carson had worked out ways that her team could help with little dogs, and they’d begun allowing residents to keep them. Big dogs were still an unsolved problem. “You have to be able to take care of your dog,” she said. “If your dog is running the roost, it may not be such a good idea.”
Making lives meaningful in old age is new. It therefore requires more imagination and invention than making them merely safe does. The routine solutions haven’t yet become well defined. So Carson and others like her are figuring them out, one person at a time. Outside the first-floor library, Ruth Beckett was chatting with a group of friends. She was a tiny ninety-year-old woman—more twig than trunk—who had been widowed years ago. She had stayed on in her house alone until a bad fall put her into a hospital and then a nursing home.
“My problem is I’m tippy,” she said, “and there’s no such thing as a tippy doctor.”
I asked her how she’d ended up in Sanborn Place. That was when she told me about her son Wayne. Wayne was a twin born without enough oxygen. He developed cerebral palsy—he had trouble with spasticity when he walked—and was mentally delayed, as well. In adulthood, he could handle basic aspects of his life, but he needed some degree of structure and supervision. When he was in his thirties, Sanborn Place opened as a place offering just that and he was its first resident. Over the three decades since, she visited him almost every day for most of the day. But when her fall put her in a nursing home, she was no longer permitted to visit him, and he wasn’t cognitively developed enough to seek to visit her. They were all but completely separated. There seemed no way around the situation. Despairing, she thought their time together was over. Carson, however, had a flash of brilliance and worked out how to take them both in. They now had apartments almost next to each other.
Just a few yards away from where I was talking with Ruth, Wayne sat in a wing chair sipping a soda and watching people come and go, his walker set to his side. They were together, as a family, again—because someone had finally understood that little mattered more to Ruth than that, not even her life.
It didn’t surprise me to learn that Peter Sanborn Place had two hundred applicants on its wait list. Jacquie Carson hoped to build more capacity to accommodate them. She was, once again, trying to maneuver around all the obstacles—the lack of funding, the government bureaucracies. It will take a while, she told me. So in the meantime she’s created mobile teams that can go out to help people where they live. She still wants to make it possible for everyone to live out their days wherever they can call home.