“I have a confession to make,” Bill Thomas announced at a conference on aging in Oregon. “I am an old man”.
“No, you’re not!” an audience member called out. It was meant no doubt, as a compliment: Despite his gray-streaked beard and crow’s feet, the 56 year old geriatrician crackles with high-octane energy. And isn’t that what we all want to hear as we age? That we don’t look old? That we seem younger than we are?
It’s not what Thomas wants to hear. After more than 20 years of trying to make life better for old people. He believes the correct message is the opposite: That we are lucky if we get to grow old. That there is a “third” phase of life beyond adulthood that can be as rich as either of the phases that came before.
In the day of Botox and celebrity teenagers and the 18 to 34 year old target consumer, the idea that old age can be as rewarding as youth is not an easy sell. In fact, consumers have bought so willingly into the idea of aging as something to be feared that it has become a self-fulfilling prophecy leading to isolation, loneliness and lack of autonomy. Bill Thomas wants to change that, and he is well qualified for the job.
Thomas is a Harvard Medical School trained physician and professor at the University Of Maryland Baltimore County’s Erickson School of Aging is known for sparking explosive new ideas in elder care. He is responsible for creating a radical system of humanizing nursing homes by introducing live animals and plants; known as “The Eden Alternative”.
Dr. Thomas has given up his practice in favor of proselytizing. For the past few years, he has travelled the United States on a mission to raise public consciousness – he strums a guitar and presents a stage show that illustrates a post-adulthood period when age and experience are associated with enrichment rather than decrepitude.
He believes that his generation, which reinvented what it means to be young, should now be reinventing what it means to grow old. “We need people to get out of hospitals, we need to create a rich set of community-based alternatives.”
We have often heard the expression – ‘you’re as young as you feel, and I feel like I am 22 years old.’ This isn’t good, it isn’t right….and the reason it is wrong is it doesn’t allow us to be who we are.
Increasingly, research has shown that regimentation and institutionalization work against well-being and good health in old age and that people with negative conceptions of aging are more likely to experience dementia later in life.
Thomas was an exhausted emergency room physician in 1991 when he received a call asking him to be medical director of a nursing home in Upstate New York. He accepted, but when he got there, he found the place depressing, a repository for old people whose minds and bodies seemed dull and dispirited. So he decided to transform the nursing home. He persuaded his staff to stock the facility with two dogs, four cats, several hens and rabbits, and 100 parakeets, along with a hundred plants, a vegetable garden and a day-care for the staff’s children.
It turns out that all those animals in a nursing home broke state law, but for Thomas and his staff, it was a revelation. Caring for the plants and animals restored residents’ spirits and autonomy; many started dressing themselves again, leaving their rooms and eating again. The number of prescriptions fell to half of what was previously prescribed, especially for the drugs that were used to treat agitation. Medication costs plummeted, and so did the death rate.
He named the approach the Eden Alternative – which was based on the idea that a nursing home should be less like a hospital and more like a garden; and has since been replicated in hundreds of institutions in Canada, Europe, Japan and Australia as well as in all 50 U.S. States (the animal restriction in New York was voted down).
Despite glowing results where the Eden Alternative had been applied, most nursing homes still languished in the institutional-warehouse model. Thomas refers to himself as a “cultural-jammer” – someone who upturns orthodoxies and tries unproved methods, someone who basically throws spaghetti against the wall to see what will stick. So he tried something new.
He moved beyond nursing homes to set up small, intimate residences called Green Houses. With private bedrooms and bathrooms, they offered dignity and privacy. Their size had an unexpected effect.
Within 6 weeks, they had to send a truck around to pick up all the wheelchairs! Do you know why most people in nursing homes use wheelchairs? Because the buildings are so damn big…the buildings disable elders.
The Green House homes were an instant success. His idea won multiple awards and was widely replicated. Green Houses and the Eden Alternative were clearly good ideas. But they failed to do what Thomas had hoped they would: change how society thinks about old people.
Changing attitudes required a more seismic shift than just improving nursing homes. And, so, Thomas switched direction again. Maybe it was time to challenge the status quo not as a doctor in a white coat, but as a man in a sweatshirt and Birkenstocks, standing on a stage.
Thomas is currently on a tour, called “Age of Disruption,” which is a combination of sociological analysis, memoir, myth and singalong. There are charts and slides, but also guitar-strumming and video clips. His message is simple: Old and young are two distinct times of life, neither one better or worse than the other. He talks about the different ways brains process information and foster creativity at different times of life – the young are more literal and mathematical; the old are better at improvisation and making associations.
The show includes a fable about a woman passing into old age who serenely gives up the physical attributes of youth in exchange for wisdom and a revered place in her community. “The crone finds new beauty in age,” Thomas proclaims to his audience. “It’s a loveliness the maiden cannot know. Honor this beauty, and it will honor you.”
He says the tour is as carefully designed as the Eden Alternative and Green Houses. The show does not tell people what to do, but is intended instead to raise consciousness. The show is creating a dialogue and creating joy in the world of aging.