A Wish List. (Not-For-Profit Report).

As songwriter Harry Nilsson wrote, "Dreams are nothing more than wishes and a wish is just a dream you wish would come true." At Penacook Place, a 160-bed nursing facility in Haverhill, Massachusetts, the "Tree of Dreams" program has been making residents' dreams come true since the autumn of 2000.

This program has added another dimension to the quality of care the facility provides. Its goal is to resurrect and fulfill forgotten dreams. The staff at Penacook Place has found that dream fulfillment instills in the resident a tremendous sense of self-worth and emotional well-being, which extends beyond clinical needs. As a residual effect, family and caregivers are uplifted to see a loved one renewed and rejuvenated.

The "Tree of Dreams" program was born from a chance encounter in late summer of 2000. During a physical therapy session, a retired sea captain resident told PT Assistant Marilyn Cox that he longed to see the ocean again. Since Penacook Place is not far from the water, this seemed a simple request to grant. Because it took so little to make a resident feel good, she suggested to Penacook Place President/CEO Julian Rich that a program could be created to grant special wishes.

In response, a committee was formed to formalize the concept. Barbara Sarkissian, COTA/L, co-chair of the Tree of Dreams committee, explains, "Dream fulfillment is available to every resident. If a resident is unable to complete the short questionnaire, a staff member will speak to the family to help determine the resident's interests or what his past dreams were.

A special committee composed of rehabilitation and recreational therapy staff, as well as members of the nursing department and management team, reviews dreams and then categorizes, consolidates and establishes an action plan. Because some dreams are more complicated than others, explains Tricia Horgan, director of community relations, the committee assesses each dream's feasibility and how best to fulfill it. Then staff are assigned to strategize in the planning and implementation of the dream.

"We have encountered dreams, such as traveling to Ireland," says Shannon Najjar, director of special projects, "that pose challenges. Although we couldn't fulfill the literal dream in this case, we plan to bring Ireland to the resident via film, music and food. We also are asked to consider some tongue-in-cheek dreams like marrying a millionaire. Of course, requests such as this are impossible to accomplish. I believe some residents are just having a little fun with us."

At a national meeting of the American College of Health Care Administrators, Rich attended a seminar on wish fulfillment by P.K. Beville, founder of Second Wind Dreams, a nonprofit dream-fulfillment organization (www.secondwind.org). Penacook Place became a member of Second Wind Dreams and shares ideas with them. Although other facilities might grant a formal "Make-a-Wish"-type request, Rich has not heard of another area nursing home having a dream-specific program in place. "This program is our own invention," he points out. "We were responsible for its practical and creative implementation. It is serviced by an enthusiastic staff backed by the support of the board of directors."

Dreams take many shapes and forms. For example, last November a resident expressed a desire to go home for Thanksgiving. However, according to Beth Torla, co-chair of the Tree of Dreams Committee, her sitting tolerance was only a two-hour span--much shorter than the trip's duration. After careful evaluation, it was arranged for an ambulance to take her to the event, where she happily reunited with 30 family members.

"With these successes," says Najjar, "we were encouraged to discover and fulfill other wishes of our residents." Recently three residents were taken deep-sea fishing on the Captain's Lady III, a fishing boat out of Plum Island, Mass. To assist the residents, a nurse, a certified nurse aide and two members of the management team accompanied them on the trip. One resident, a double amputee, posed some strategic hurdles for boarding the boat. His family never thought he'd do this, but he did and thoroughly enjoyed his day on the water.

"We're very lucky to have a van that was donated by the family of a resident who passed away," says Torla. "This enables us to consider wishes that need to happen off-site." For example, a 59-year-old man suffered a stroke that left him paralyzed. His greatest passion in life was playing guitar in a country and western band. A stroke had left him unable to play his guitar or lead his band, which left him depressed. After discovering his dream, staff took him to The Museum of Fine Arts in Boston to see its guitar exhibit.

His son wrote, "To everyone's surprise, there was a western guitar just like the one my father played. His enthusiasm and joy was beyond expression. Our family was deeply moved to see him come back to life at that moment. This is a dream come true. My father has a different perspective on life. His attitude changed; he's more receptive to simple activities that bring joy. Today he enjoys listening to country and western music and he's not despondent that he cannot play."

Because each dream has its own subtleties, possibly requiring a specific location, travel time, special equipment, etc., costs will vary. Although dreams have been quite reasonable to fulfill and the facility has its own van for transport, Rich is still surprised at how little the program has actually cost in comparison with the rewards realized. Not only have the lives of residents been brightened, but the staff has reaped positive benefits; they have a fresh outlook on and appreciation for the work they do.

The Penacook Place "dream team" always has something on the drawing board. For example, a woman who wanted to go to college will be attending a slide presentation at a local community college, while a man who loves the theater will be treated to a performance of an Agatha Christie murder mystery.

Does the program achieve lasting results? When someone asked a resident about his deep-sea fishing trip, he replied, "I'm still fishing."

For further information on the "Tree of Dreams" program,

RELATED ARTICLE: Tree of Dreams Committee:

Barbara Sarkissian, COTA/L, Co-Chair; Beth Torla, Rehab Aide, Co-Chair; Tricia Horgan, Director of Community Relations; Shannon Najjar, Director of Special Projects; Julian Rich, President/CEO.