When a Doctor Illegally Put the “HOME” Back Into Nursing Homes, Death Rates Plummeted
“If a plant cannot live according to its nature, it dies; and so a man.”
Henry David Thoreau, Civil Disobedience and Other Essays
Thinking about aging conjures unpleasant imagery of becoming weak and frail, losing our autonomy, and being placed in a nursing home to live out the remainder of our days alone.
Dr. Thomas is an international authority on geriatric medicine and eldercare and is the founder of The Eden Alternative, a non-profit organization dedicated to improving the quality of life for elders and their care partners.
After graduating from Harvard Medical School in 1986, Dr. Thomas worked in emergency care until a late night call and an encounter with an elder patient inspired him to change course.
NPR shared Dr. Thomas’ story in Building A Better Nursing Home.
He was a “real” doctor, working long hours in an exciting ER packed with the promise of blood, guts and glory. One night the phone woke him up from a deep sleep. He said, “hello,” and the man on the other end asked him if he’d ever thought about being a doctor in a nursing home. Thomas scoffed and hung up, but when the man called back, after another punishing ER shift, Thomas agreed to check out the retirement facility. He took the job to offset a night in the ER, and bustled about, speaking loudly to his elderly charges. One day, when he visited a resident with a rash on her arm, the woman pulled him close to her. As he tells it, he looked into her beautiful light blue eyes, and she said one thing to him.
“I’m so lonely.”
Thomas bustled out of the room, wrote her a prescription, and tried to move on, but her words haunted him.
He went on to become the medical director of that nursing home in upstate New York. The institutionalized and depressing atmosphere of the facility prompted him to take action.
Even though animals in nursing homes were illegal at the time, Dr. Thomas brought in two dogs, four cats, hens, rabbits, 100 parakeets, a multitude of plants, a flower garden, and vegetable patch.
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, leaving their rooms and eating again. The number of prescriptions fell to half of that of a control nursing home, particularly for drugs that treat agitation. Medication costs plummeted, and so did the death rate.
He named the approach the Eden Alternative — based on the idea that a nursing home should be less like a hospital and more like a garden — and it was 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).
The change was dramatic, reports Good News Network: There was a 50% drop in medical prescriptions along with a dramatic decrease in death rates – but most importantly, the residents were simply happier.
It inspired Dr. Thomas to create The Green House Project, a national non-profit organization that creates alternative living environments to traditional nursing home care facilities. Traditional nursing homes are torn down and replaced with small, home-like environments where people can live a full and interactive life with their peers and caregivers.
In 2005, the Robert Wood Johnson Foundation awarded The Green House Project a five-year $10 million grant to help the organization create Green House projects in all fifty states (they are currently in 33 states).
“Within six weeks, they had to send a truck around to pick up all the wheelchairs,” Thomas told the Washington Post. “You know why most people [in nursing homes] use wheelchairs? Because the buildings are so damn big.”
Dr. Thomas recognized that nursing “homes” are anything but, as he explains in his book What Are Old People For? How Elders Will Save the World:
These buildings give those within their walls little reason to suspect that elderhood can be a rich, rewarding phase of human development. Long corridors disable frail people, forcing them into wheelchairs. Massive dining rooms are impersonal and intimidating and promote anxiety. There is limited access to outdoor space. Double rooms (laughably called “semiprivate” rooms) and shared bathrooms invade privacy. Furniture, floor coverings, and drapery are matched consistently throughout, as if the place were a chain hotel rather than the home it is meant to simulate. The grim institutional appearance damages the well-being of staff and residents alike. (source)
He goes on to explain how aging became “medicalized” by government, with Medicare and Medicaid being given dominion over the care of elders:
Along the way, a powerful industry has grown up around these programs. Being fed by health care dollars, this industry has little reason to imagine that the most important aspects of elderhood might have little to do with medical and surgical therapies. So complete is the medical-industrial domination of aging that people who need long-term assistance can be compelled, for purely economic and political reasons, to live out their lives within the sick role, tended to in medical facilities.
Treating aging as a medical condition that must be managed with the professional distance prescribed by the medical model is wrong and leads to terrible suffering.
Back in 2005, Dr. Thomas told NPR:
“I believe that in [nursing homes] in America, really every year, thousands and thousands of people die of a broken heart. They die not so much because their organs fail, but because their grip on life has failed.”
At the center of the Green House is quality of life — meaning worth and dignity. At the Green House, we put those things at the center of life.”
As Dr. Martin Luther King said, “One has a moral responsibility to disobey unjust laws.” We can all refuse to be governed by laws that support corporations instead of human beings. Dr. Thomas’s example proves yet again that we don’t need “the system” and its onerous regulations. We just need to treat humans like humans.