What makes life worth living?

A tough question, often asked too late, only after positive reasons have been subtracted and what remains is meaningless and empty.

I meditated on this question recently because my grandmother, Sumiko Higa, has lost her garden.

My grandmother (I call her Bachan) lives in the Makua Alii Senior Center near downtown, a project of the Hawaii Public Housing Authority.

For more than a decade, Bachan has cared for a tiny plot of land, 5 feet across and 5 feet deep. Dozens of these plots ring the parking lot behind her apartment complex. Resident gardeners grow all sorts of plants – some for consumption, others just for display.

Often, when I visit Bachan, I see elderly people tending to their plants, moving buckets of soil or watering their plot. It’s simple work performed slowly, with the unhurried calm of those who have few other responsibilities and nowhere else to be.

The building manager recently announced the gardens must go. Apparently, they have long been in violation of Hawaii Public Housing Authority rules against planting in common areas. Residents have a few weeks to clear their plots before authorities remove all plants and throw them away.

This, to my mind, is a great loss.

The Tyranny Of Bureaucracy

To learn more, I spoke to Marisa Castagna, a social service assistant with the Hawaii Public Housing Authority. Castagna said that the housing project rules prohibit the use of open yard spaces for storage and planting. The rules additionally specify that any planting must be pre-approved by management.

Castagna suspects that a previous building manager allowed tending of the gardens, despite concerns about safety.

To be fair, there are good reasons for rules such as these. You don’t want residents to plant just anywhere, but this doesn’t appear to have been the problem at Makua Alii.

Indeed, the plots have been tended for more than a decade without major incident. A few stray pots here, a bit of  a mess there, but otherwise an orderly array of gardens.

Given past leniency, the sudden crackdown by the Hawaii Public Housing Authority feels heavy handed.

The rules in question were drafted many years ago. It might instead be worthwhile to reevaluate them and see whether they are written in the interest of the people served by the housing authority.

We use rules to purchase order, but at what cost? Perhaps the meaning in life, if we aren’t careful.

Unfortunately, this type of periodic review is rare in the halls of bureaucratic government.

Bureaucracy sustains itself and cares little for life. The authors of the rules are disconnected from their effects. Sometimes, they’re long dead. The enforcers ignore the suffering caused by the rules, otherwise they risk their jobs.

Sometimes, rules once deemed necessary end up inhibiting future innovation.

The medical model of a nursing home was established in the 1950s, as government regulators sought to end abuse of the elderly. The medical model focused on treating ailments, not necessarily improving the quality of life of residents. Backed by force of law, the medical model prevailed for decades, with nursing homes resembling hospitals.

Curing Loneliness

In the early 1990s, a rural physician, Bill Thomas, proposed the Eden Alternative as an alternative paradigm for long-term care.

Thomas’s idea was simple. The elderly don’t just have illnesses. They’re also afflicted with loneliness, helplessness and boredom. These aren’t medical disorders, so medicine isn’t an appropriate treatment.

Instead, the elderly are suffering from a lack of companionship, responsibility and spontaneity that only life can provide. To help, Thomas suggested bringing plants, animals and kids into the facility. At the time, this was a radical idea, and Thomas had to fight officials to make it happen.

As an experiment, Thomas brought two dogs, four cats and 100 parakeets to the Chase Memorial Nursing Home, a facility serving 80 severely disabled elderly residents. He also filled the facility with plants and encouraged staff to bring their children to work. The only thing more impressive than the amount of paperwork necessary to allow the experiment were its results.

Over the course of a two-year study, the number of issued prescriptions fell. The total drug costs dropped dramatically. And the number of deaths decreased.

Now, many medical professionals support Thomas’s model, but old rules and regulations still make it difficult to implement common sense reforms. Despite empirical evidence and common sense, the medical model prevails.

Rules In The Twilight Of Life

In his book, “Being Mortal,” the surgeon Atul Gawande notes that many people find an individualistic life to be meaningless. Quality of life increases as we assume responsibility for others. There seems to be an intrinsic human need to seek a cause beyond ourselves.

Many of the residents of Makua Alii have no nearby family members or dependents. They live on their own, and they suffer all the ailments that attend old age.

They may seem insignificant, but the gardens provide a sense of purpose and community. Residents grow food and share with their neighbors. Rather than being reduced to pure dependency, they retain dignity and independence in their twilight years.

There are good reasons to regulate the gardens, to ensure basic standards of cleanliness and order. But to destroy the gardens in service of a “rule” feels insensitive and clumsy. Better to act in the spirit rather than the letter of the law. Even better to change the law.

Our rules and regulations are wondrous things. They allow us to order and structure life.

We use rules to purchase order, but at what cost? Perhaps the meaning in life, if we aren’t careful.