BILL THOMAS, Geriatrician: Straight up. Keep him going. Step up.
SUSAN DENTZER: Watching Bill Thomas at work with his sons on his upstate New York spread conjures up images of a bygone era. Thomas isn't a farmer by training, he's a Harvard-educated physician. Still, he says driving his draft horses across his fields is one way he stays in touch with the rhythms of life. Thomas also strives for that feeling in his day job, caring for elderly and disabled patients in nursing homes.
BILL THOMAS: You sleeping okay?
PATIENT: I am.
BILL THOMAS: Well, that's a blessing right there.
SUSAN DENTZER: Thomas, who's 42 and a geriatrician by training, has been caring for patients like this one for more than a decade. His experiences have turned him into one of the nation's most outspoken nursing home reformers.
BILL THOMAS: What you're seeing right now is the end of the American nursing home. It is finished. And the big question that really ought to be on the lips of the politicians and the leaders and the academics is, what comes next?
SUSAN DENTZER: Across the country, the nursing home industry is in a state of near-crisis. It's been pressured by everything from a shortage of workers to low government payments for patient care. In many states, a number of homes have gone bankrupt or have closed. Bill Thomas says the biggest problem is that nursing homes are anathema to most people.
BILL THOMAS: A hospital and a poor house got together and they had a baby, and the baby was a nursing home. And you know, it's a little bit like it's mama and a little bit like it's papa. And at its deepest heart, it's an institution, and that is just not any way to live a life.
SUSAN DENTZER: Images of life in many of America's roughly 17,000 nursing homes are hauntingly familiar. There's the grim ambiance of bare floors, and of nearly incapacitated patients doubled up in crowded rooms. There's also the centralized food service, and meals delivered at irregular hours on plastic trays. And in the worst cases-- often captured by hidden TV cameras-- there's neglect and abuse of residents by nursing home staff. A Congressional report released last July said state inspectors had cited nearly one in ten nursing homes in the country for instances of serious abuse.
REP. HENRY WAXMAN, (D) California: We found examples of residents being punched, choked, or kicked by staff members or other residents. These attacks frequently caused serious injuries such as fractured bones and lacerations.
SUSAN DENTZER: A new poll by the NewsHour, the Kaiser Family Foundation, and the Harvard School of Public Health, shows the public is concerned.
Almost half of all Americans think people are worse off after going into nursing homes than before they went in. And more than four in ten would find it "totally unacceptable" to move into a nursing home themselves. A smaller group of Americans who've had a friend or family member in a nursing home whom they visited regularly reported experiences that were just slightly better. Six in ten said they were satisfied with the care that person received; almost four in ten were dissatisfied. What's more, one in four reported that the nursing home resident they knew had been badly treated or abused by the staff.
These realities and perceptions have inspired Bill Thomas to make nursing homes more congenial for the 1.6 million Americans who live in them. He's devised one approach that he calls the Eden Alternative.
BILL THOMAS: Eden was the world we were supposed to inhabit. And here we are taking care of our elders, and we have an opportunity to make an environment for them the way it ought to be.
SUSAN DENTZER: A model is St. Luke's home in Utica, New York, part of the Faxton-St. Luke's healthcare system. It's one of roughly 240 nursing homes across the country that have adopted the Eden approach and display its official seal. Standard features of "Edenized" homes include ubiquitous plants, on-site day care centers for the children of nursing home workers, and various animals scurrying or roosting about.
ELDERLY WOMAN: You know, I've never held a baby like you in my hands before.
WOMAN: Gina, that's Kiwi.
ELDERLY WOMAN: Phoebe?
ELDERLY: Oh, Pee Wee.
BILL THOMAS: We poured in plants and animals and children with giant salt shakers, you know, spiced it up with hundreds of birds and dogs and cats and children and plants and gardens, so that the environment itself felt more alive, looked more alive, sounded more alive.
MUSIC: I don't care who's right or wrong...
SUSAN DENTZER: St. Luke's was also made more appetizing in other respects, says Bruce Gendron, a senior officer of Faxton-St. Luke's who oversees the home. He says one of the first things to go was centralized food service.
BRUCE GENDRON: What we've tried to do here is create a pantry adjacent to the dining room. We bring the food down in bulk, and then the food is served on plates, family style, directly into the dining room. We bake bread every day before mealtime in a bread machine, which allows the scent of the baking bread to kind of get out through the dining room and into the halls, which stimulates the appetites of our residents. And then we also have our soup in a crock pot, which is also right out in the dining room they can serve directly from.
SUSAN DENTZER: Does it cost more to do it this way?
BRUCE GENDRON: It is more expensive, it's a little bit more labor intensive to do this this way. But we see the value that we get back from the appetites of the residents and then the ambiance; it's certainly worth the effort.
SUSAN DENTZER: Thomas says one other strategy lies at the heart of the Eden Alternative: Empowering both the people cared for and their caregivers.
VALERIE TURNER, Nursing Home Manager: I oversee 24/7 on the unit, 365 days a year.
SUSAN DENTZER: Valerie Turner is a manager and so-called team leader in a St. Luke's unit for 40 residents. She explains that St. Luke's employees are organized into teams, and cross-trained so they can focus as a group on a particular resident and perform a variety of functions if needed.
VALERIE TURNER: What we try to do here is we do consistency, where our aides have the people on a consistent basis so that they get used to that person.
SINGING: I took Jesus as my savior...
SUSAN DENTZER: Residents are also encouraged to take an active role in the nursing home's operations. That's designed to stave off what Thomas says can be a devastating slide into passivity and helplessness. Take Laurie Hyle, a 28-year-old with end-stage kidney disease, who's spent the past five years in nursing homes. She's been appointed a member of St. Luke's in-house animal care committee.
LAURIE HYLE: I keep track of the food.
BILL THOMAS: What if nobody checked that?
LAURIE HYLE: They'd go hungry. And they'd go dry, too, without any water.
SUSAN DENTZER: Many of Thomas's peers in the nursing home industry are impressed. Dr. Charles Roadman is president and CEO of the American Health Care Association. That's a trade group representing roughly 12,000 of the nation's nursing homes and other long-term care facilities.
DR. CHARLES ROADMAN, CEO, American Health Care Association: Bill's a dreamer. He dreams about, I think, the right answer about how we take care of our elderly and our young. I agree with his dream. He sees the evolution of the Eden alternative, testing the things that work, testing the things that don't work, and modifying it. I think it's a very reasonable approach.
SUSAN DENTZER: Roadman says Thomas' biggest contribution may be opening the door to more variety in long-term care.
DR. CHARLES ROADMAN: Quite frankly, everybody doesn't want necessarily to have birds or dogs or responsibility for plants, and so the real issue is choice. And so I see everybody trying to innovate.
SUSAN DENTZER: In fact, Thomas is now contemplating even more radical approaches to long-term care, based on a transforming experience in his own life. Seven years ago, Thomas and his wife, Judy, discovered that their then-newborn daughter, Haileigh, had a rare neurologic condition, diagnosed as Otahara's Syndrome. Later, a second daughter, Hannah, was also born with the condition.
BILL THOMAS: The kids who have it have terrible, terrible seizures that are really hard to control, and their brains don't grow as quickly or as fully as other children. And they tend to have trouble with their vision and, in fact, Haileigh and Hannah are both blind as a result of this. Things like speaking or talking or walking or sitting or holding your head up, these are things they're not going to be able to do.
SUSAN DENTZER: The two girls, now ages seven and five, require 24- hour a day care in the Thomas's home.
JUDY THOMAS: We live long-term care here with ten nurses and rotating staff, and trying to deal with all the meds and the insurance issues. I'm basically the administrator of a small, long-term care facility.
BILL THOMAS: I think that being a parent of a child with a disability is joining a club nobody wants to join, you know? But, and there's a lot of pain and suffering that comes with that. But if you open yourself up to it, you can learn a lot of things, too. Haileigh and Hannah are in some ways our elders. They've already gone where Jude and I are going to go. If we live long enough, we will be just like Haileigh and Hannah.
JUDY THOMAS: And just because they might be frail like many, as many of our elders become, does not mean they have to have a life that's any less or any different than the rest of us.
BILL THOMAS: We don't care for our girls with a housekeeping department and a nursing department and... everybody participates to get the girls what they need. That's the way we ought to organize care.
SUSAN DENTZER: And that conclusion has led Thomas to his newest idea. He calls them "Green Houses." Architectural renderings show freestanding facilities for just six elderly or disabled persons, who'd live together in as home- like a setting as possible. Residents would be cared for by a sharply higher ratio of nurses and aides than is generally the case in the nursing home industry. Thomas and Bruce Gendron now want to close down an aging nursing home nearby and transfer its roughly 125 patients into 20 planned Green Houses.
BILL THOMAS: As we've said to New York state, "We'll build them for less than it would take to build a new facility. We'll take the reimbursement that you're giving us now to care for the elders, and we're going to reorganize the services."
SUSAN DENTZER: That includes equipping the green houses with up-to-date technology.
BILL THOMAS: We're going to be connecting elders to their family members through e-mail and video conferencing. We're going to create a smart house that... that lets elders turn lights on and off through voice command, rather than having to ask someone to come and do it for them.
SUSAN DENTZER: These are all ideas, says Thomas, that flow from the lessons taught by Haileigh, Hannah, and the elders he's cared for.
BILL THOMAS: In long-term care, love matters. And the heart of the problem is, institutions can't love. When we rethink our mass institutionalization of elders, when we do these things, we're not just making a better life for the elderly, we're making life better for everybody in every part of society.
SUSAN DENTZER: And, says Thomas, shaping a future more like Eden than what we face now.