In 1964 the Senate Committee on Aging reported that "once admitted to an institution ... the veteran begins ... to show signs of social and physical degeneration," a phenomenon that has not escapted the attention of clinicians, social scientists, veterans, and other chronic-care patients.

Assuming that social withdrawal in the institutional setting was avoidable ad that a strictly medical model of chronic care was inappropriate, Lella and his collaborators established a patient-government project designed to give thirty elderly men in a large veterans' hospital, who suffered from...