The Greening of Aging
William Thomas | physician, farmer
It's summer in upstate New York, the sun is shining, and it's time to make hay. Bill Thomas, medical doctor, gentleman farmer, and deep thinker, heads out to take the year's first cutting. His is a "mixed power" farm, which means that the tractor shares the load with a pair of massive 1-ton workhorses. Thomas takes the reins, clucks his tongue, and sets out across the field.
"People have forgotten some of the most important things that animals can teach us," he says over the din. "These horses aren't machines. They demand respect, and a good teamster is always thinking about what they are thinking." Near the top of a rise, Thomas stops the team for a rest. They huff audibly. "It happens all the time in organizations," says Thomas. "Managers let themselves be driven by results alone; they just want more, more, more, and they don't listen when the people who work for them start breathing hard and getting tired. They think the world is a machine, and it's not."
Perhaps because of his vantage point, here among the plants and living creatures of Summer Hill, a 258-acre working farm in Sherburne, N.Y., this Harvard-trained doctor doesn't look at organizations and search for the efficiency of a machine but instead imagines the wild and nurturing possibilities of a garden. He's brought this perspective to a most unlikely domain--the world of nursing homes. As a medical director at an upstate New York nursing home in the early '90s,Thomas moved dogs, cats, birds, and plants into a facility and radically shifted the focus from delivering scheduled institutional care to providing for the dignity and emotional well-being of the residents. Called the Eden Alternative, the project was a success and allowed Thomas to create a nonprofit that now lists 300 Eden Home conversions in America and an additional 200 overseas.
Thomas is now on to his next big thing: the Green House Project. The first Green Houses were constructed in Tupelo, Miss., in 2003. Now that an intensive evaluation has documented their success, Thomas has teamed up with the Robert Wood Johnson Foundation to replace more than 100 nursing homes nationwide with clusters of small, cozy houses, each sheltering eight to 10 residents in private rooms, with private bathrooms and an open kitchen. In other words, a place like home.
Revolutionary. With his startling common-sense ideas and his ability to persuade others to take a risk, this creative and wildly exuberant 46-year-old country doctor has become something of a culture changer--reimagining how Americans will approach aging in the 21st century. And with 35 million Americans over 65--a number that will double by 2030--that takes a big imagination indeed.
Standing over 6 feet tall with a bushy brown beard, Thomas is typically dressed in old fleece outerwear, jeans, and Birkenstocks. At a recent conference on aging where he was a keynote speaker, Thomas conceded to convention by exchanging the fleece for a linen sports jacket, but he's been known to deliver a talk in overalls while standing on top of a table.
It's an outsider image he uses to his advantage. "A person who is well trained as an expert can be surprisingly unprepared to act as a leader," says Thomas. But he's an outsider who makes others want to come out and join the party. In almost any group, he's the center of attention with a booming voice, infectious laugh, and gift for storytelling. "He's so dynamic and energetic," says Barry Batzing, professor of biological sciences at the State University of New York Cortland, who taught Thomas as an undergraduate. "He talks with you for five minutes and could probably get you to do anything."
Yet for a long time, all Thomas wanted was to be left alone. After medical school, the young resident bought a farm in upstate New York, and later he and his wife, Jude, built a small house that ran entirely on solar and wind power. "I wanted to be alone on top of the hill," says Thomas. That's perhaps not surprising for someone who was raised along a creek in New York's Appalachia in a house surrounded by those of his relatives. As a youth, Thomas had to overcome low expectations; because he came from a family of tradesmen, he was not expected to go to college. But he won a scholarship to SUNY-Cortland, where his leadership skills emerged. He created a student-run system to evaluate professors, and he challenged the procedure by which the housing department penalized students for dorm room damage.
In 1991, he was pressed into service as medical director of a nursing home, called Chase, and found himself forced to engage with a strange system. "People are trained and required to operate a nursing home like a well-oiled machine. Follow the rules; obey the budget," says Thomas. The residents were woken up at the same time for the convenience of shift change and feeding schedules. It was a total institution imposed upon a group of elders whose only crime was having grown old.
Meanwhile, "I was living up here at the farm, keeping a garden, and chopping firewood," recalls Thomas. "I would get on my bike and ride to the nursing home, and then that whole living world would be gone. It was an immense conflict for me." And so Thomas imagined a world like his made possible for his seniors. "What we want are gardens that grow people," says Thomas. Mary Jane Koren, a senior program officer at the Commonwealth Fund, a foundation that makes health-related grants, recalls meeting Thomas when she worked for the state. "I stopped in this 80-bed nursing home, and suddenly this guy with a great bushy beard and sandals comes running up to me." Back at the office, Koren received Thomas's proposal to give every Chase resident a parakeet, populate the home with cats and dogs, and plow up the manicured front lawn for an organic garden. "Everyone said, 'This is nuts,'" recalls Koren. But it was also something no one there had ever seen before. The result was the first Eden Alternative. According to a study by the New York State Health Department, after Eden, the home experienced a 50 percent decrease in infection, 71 percent dip in daily drug costs for each resident, and a 26 percent drop in nurse's aide turnover.
The success of the Eden Alternative launched Thomas's career in aging. He quickly trained three other New York State homes in his philosophy and then set about creating a nonprofit to disseminate his ideas. The author of five books, Thomas maintains a regular writing schedule. Most mornings, he has breakfast at D&D's Diner in Sherburne, which serves him "the Doc"--a cheese omelet with well-done home fries and toast. He opens his laptop and starts writing. His most recent book, What Are Old People For? draws on sources as diverse as Shakespearean sonnets and Greek philosophy and returns (as Thomas always does) to the firmly rooted idea that old age is no accident. Thomas says, "People of all ages will live better lives when we succeed in bringing elders back to the heart of our society."
A popular public speaker, Thomas travels from his home 35 or 40 times a year. It's a busy schedule for a man who is also helping to raise five kids under the age of 17, serving as an AARP visiting scholar, running a working farm, and overseeing several nonprofits. The glue that keeps Thomas's life together is his wife, Jude. She rules a sprawling farmhouse that blends old and new in surprising ways. A wood-burning stove heats every room, but the electricity is provided by solar panels and a wind generator. Sunlight warms the knotty pine walls, and everyone eats dinner together by candlelight. Also on hand is a nurse. The Thomases' two daughters, Hannah and Haleigh, were born with a medical condition that means they'll never see or move with intention. What they experience is a mystery, but the Thomases say the girls have deepened their understanding of elder care. In fact, his book In the Arms of Elders: A Parable of Wise Leadership and Community Building re-imagines his daughters as wise old women who teach him and Jude about the true plagues of old age--loneliness, helplessness, and boredom.
The next few years will be key in reimagining how nursing homes look in the future. Steve McAlilly, CEO of Mississippi Methodist Senior Services, was about to build a 140-bed, state-of-the-art facility when he had a talk with Thomas about Green House. "Intuitively I knew it was the answer we were searching for," says McAlilly. "I went to the board of directors and told them we were about to make a $12 million mistake."
Together, McAlilly and Thomas managed to persuade the board to instead build 10 separate houses, each with private bedrooms and bathrooms arrayed around a "hearth room" with an open kitchen. Seniors would be free to eat at any time they wanted, participate in all house decisions, and generally make themselves at home. Nurse's aides--the caregivers who work most closely with the elders--would have greater authority and would serve many functions, including cooking family-style meals.
Big picture. It was a typical Bill Thomas idea--simple, intuitive, and emotionally resonant but also perhaps somewhat lacking in detail. Moving 140 seniors, many demented or with Alzheimer's, into 10 separate houses while still following state regulations was not so simple. "Little did we know at the time that the idea wasn't fleshed out very well, and we would become the organization that would help him flesh it out," says McAlilly.
Two more of the projects have now broken ground, and the Green House Project has also received a $10 million grant from the Robert Wood Johnson Foundation that will allow it to rapidly replicate in all 50 states. Both Baltimore and New York City are planning apartment-style, vertical Green Houses that create the same family atmosphere in the city.
Thomas, the ultimate ideas man, has handed off the day-to-day operation of the Green House Project to trusted associates and has begun focusing on what might be the closest project yet to his heart, Eldershire, a multigenerational "intentional community" that he plans to build on his property in Summer Hill. In the past, he has struggled to translate the world of Summer Hill into nursing homes. With Eldershire, the home will become another part of his growing garden.
AGE: 46 CAREER: Founder of the Eden Alternative nursing homes EDUCATION: State University of New York-Cortland; Harvard Medical School FAMILY: Married, five children QUOTE: "People of all ages will live better lives when we...bring elders back to the heart of our society."
This story appears in the June 19, 2006 print edition of U.S. News & World Report.