Sharing Expertise on Aging Across the Globe

July-August 2009


Bill Thomas, MD, on stage and dressed in jeans, addresses a conference of long-term care providers. He talks about the public image of long-term care that providers contend with. "We've had to face the strange kind of conversation that comes with announcing to someone you meet for the first time what kind of work you do," he says to titters from the audience.

From humor — "Nursing homes make a Ford Pinto look good" — he segues to tragedy, the tragedy of "being big-hearted people trapped inside a rigid, cold, difficult institutional system." By that, he makes clear, he means both the elderly who live in institutions and those who take care of them.

By turns passionate, thoughtful, provocative and inspirational, Thomas' speech, captured on YouTube, suggests the many aspects of a man who has spent his career revolutionizing care of the elderly and who is an eloquent champion of the wisdom they bring to society. Compassionate care for the elderly — liberation from stifling institutional confines that, in his view, make nursing homes a polite term for prisons — is for Thomas important not only for the aged but also for society at large.

"People of all ages will live better lives when we succeed in bringing elders back to the heart of our society," he declares. "But for a really healthy community you need to have people of all ages … people of different generations interacting with each other."

For nearly 20 years, Thomas has been treating creatively the issues of aging, both as a doctor and as a writer and thinker. In that time, he has re-imagined not only the nursing home but also the nature of aging and the role of older people in society. His view of seniors as people to nurture, engage with and learn from first found expression in Eden Alternative, a not-for-profit organization he founded with his wife Jude in 1991. Its goal was nothing less than to change the culture of long-term care organizations from sterile medical environments to "habitats for human growth," places where plants, animals, children and gardens help seniors lead vibrant, vigorous lives. Empowering seniors, granting them decision-making roles about their lives, is another Eden principle, a way to contend with the modern-day plagues of boredom, loneliness and helplessness that afflict so many residents of nursing homes.

Thomas' thinking also undergirds the Green House Project, an innovative concept for housing the elderly in homes holding eight to 10 persons that is now being underwritten by the Robert Wood Johnson Foundation, one of the country's largest philanthropic enterprises. Currently, 50 Green Houses are operating in 12 states and 39 more are under construction. While the Eden Alternative is meant to help revitalize existing nursing homes, Thomas said the Green House Project takes the Eden philosophy and puts it into a new architectural model. Rather than housing ailing seniors in large institutions, the project builds small homey environments where seniors can sit before a blazing fire, enjoy a communal meal, and have their own private room, while still receiving skilled nursing and care.

Thomas' immersion in the problems of the aging came by chance. In 1991, he was a young doctor planning to go into emergency care when he was offered a part-time job in a nursing home in upstate New York. "It was right near my house and I thought I could do it easily," said Thomas, now 49. "I didn't count on falling in love with it."

What he fell in love with, he said, was both "the elders," his term for older people, and those who care for them, health care workers whom he describes as the unsung heroes of our society and "some of the most beautiful, deeply ethical people in our nation." What he also became enamored of, he acknowledged, was the enormous ability to do good that lay in the field of long-term care.

Today, Thomas still resides in the same area with his wife and five children. Two years ago, he sold the 285-acre farm that he had worked for 20 years. He is a professor at the Erickson School at the University of Maryland, Baltimore County, and lectures across the globe. Recently, he helped design the nation's first elder-friendly emergency room at Holy Cross Hospital in Silver Spring, Md. In addition, he writes daily and considers that work an important part of his medical practice. "Good writing has the power to heal," he noted. "You can impact people's lives and you can impact society in a way that is actually not possible if you're strictly and only in clinical practice."

The author of five books, Thomas most recently published What Are Older People For?: How Elders Will Save the World. In it, Thomas discusses the pitfalls of "declinism," the widespread belief that old age is a time of inevitable loss and surrender.

As in adolescence, Thomas said the growth people experience in old age is difficult yet important. But in a youth-obsessed society, evidence that older people grow, albeit in different ways than younger people do, tends to go ignored. There is something vital to be learned in the necessity of aging, he contends. In his book and in his blog, http://changingaging.org, he argues that everyone in society suffers when elders are kept from reaching their full potential.

In conversation, Thomas exudes the same kind of energy and dynamism that those who interact with him often comment on. In an article in The Wall Street Journal in June 2008, officials at the Robert Wood Johnson Foundation who met him when he first described the Green House Project to them likened him to an evangelist in his persuasive powers. Jane Isaacs Lowe, overseer of the foundation's Vulnerable Population portfolio, recalled seeing him at the foundation in 2001 in jeans and Birkenstocks and thinking he could be mistaken for the electrician. But Lowe said she quickly found herself won over by Thomas' idea that it was time to turn off the lights on nursing homes and replace them with centers where elders could not only subsist but flourish.

Thomas' ideas and his achievements have attracted attention from The New York Times, The Washington Post, CNN, NPR and other media outlets. In 2005 he was named the AARP Visiting Scholar of the Year; a few years earlier he won a three-year fellowship from Ashoka, a global not-for-profit organization honoring social entrepreneurs, for his promotion of person-centered care; that is, health care centered around the person rather than around the building or the technology or staff.

Jaclyn Harris is president and CEO of Trinity Senior Living Communities, a member of Trinity Health. The senior living organization, with 33 communities across four states serving 35,000 seniors, has educated some 1,500 of its employees in the principles of Eden Alternative; many of its communities are Eden-certified. Harris said Trinity employees decided several years ago that if they were going to stay in the business of long-term care, they wanted to do it differently. In investigating innovative approaches, Harris said she was drawn to Thomas because of his emphasis on the employee, and the relationship between employees and elders as key to building better lives for elders.

"What Eden has really done is to allow individuals to come to work and bring their hearts to work," Harris said. "The nourishment they get is through the relationships they develop with the elders every day so when they leave it's not about the tasks they check off every day."

Thomas said he's witnessed an emerging commitment among long-term care providers to make their organizations conform to the needs of the elderly rather than demanding the elderly conform to the needs of the organization.

He said obstacles to further progress are the misunderstanding of old age as a kind of failure ("Oh, she's not what she used to be.") and the fear built into the health care system — fear of regulatory penalties.

"People fear that if they color outside the lines, they're going to be penalized. The people in the field of long-term care need to know that the public is ready for change," he said.


Copyright © 2009 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Sharing Expertise on Aging Across the Globe

Copyright © 2009 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.