Dr. Bill ThomasI am 55 years old and, if fortune favors me, I hope to remain active in the work of “changing aging” for another 25 years. This means that I am, approximately, at the midpoint of my career. The time has come for a re-consideration of the work I have done and a reimagination of the work I will do.
When I started out as a brand new and completely in-experienced “nursing home doctor” my chief virtue was, of course, my inexperience and my bristling rejection of the status quo. I quickly learned, however, that my rejection of the status quo in long-term care needed to be tempered (in public at least) if I was ever going to make a lasting impact. This understanding led me to embrace “It Can Be Different” as a tagline for the work I was doing and helped me link the core message of The Eden Alternative to a message of hope. I now call this the “lambtail” approach. We shook our adorable lambtail and hoped that long-term care providers would find it so irresistibly cute and so wonderfully optimistic that they would pick us up and take us home with them. Over the years thousands of facilities and tens of thousands of professionals did exactly that.
But it didn’t change long-term care.
The problem is that for every organization that was willing to do the hard work of person-directed transformation there were thousands who were perfectly happy with the status quo. It is true that some of those got “caught up in the moment” and tweaked some of their facility’s most superficial features. But beyond that, they would not go. As my frustration and disappointment mounted something did begin to change– in me.
Slowly, but perhaps inevitably, I became a nursing home abolitionist. It is a position that puts me at odds even with some of my closest allies. You can read a detailed description of why I think we need to abolish the old age asylum in this series of video blog posts.
To my critics I make this point. The word “abolition” is deeply rooted in another flawed and immoral American institution, chattel slavery. During the 19th Century there was a prolonged and fevered debate over the nation’s “peculiar institution.” The Abolitionists argued that slavery debased both and slave and master, and just as importantly tore at the moral fabric of a “free” society that had long proven its willingness to tolerate this persistent and most egregious wrong. History has rendered its judgment– the Abolitionists were right. Those who condoned or were willing to tolerate slavery were wrong. Those who took “reasonable” positions on slavery, those who argued in favor of a “kinder, gentler form of slavery,” were wrong. Slavery could not be reformed or mitigated, it had to be abolished.
I am done with shaking my cute lambtail. I am done waiting for the long-term care industry to decide that it is ready to tiptoe into reform. The time for polite requests and half measures is past. The second half of my working life stretches out in front of me and I no longer feel the need to censor my words and my deeds. I am a nursing home abolitionist and, going forward, I intend to act like one. The lambtail era is over and so is the “culture change movement.”
During the next 25 years I will be embracing the cunning, aggression, and relentless power of the Tiger. In Part Two of this series I will explore just what an embrace of the Tiger strategy means in practice.
I am a student at the Erickson School of Aging, and I completely agree with the abolitionist theory. Change is good but it is ongoing and can last forever. The culture change movement is not bringing about the expected results fast enough for me. As an advocate I have notice over the years that the intentions are always to change and make things better, but somehow things still remain the same. The old ways of doing things seem to creek back in. Its time that we wake up and “smell the coffee” and stop being silent. Its time for a nursing home asylum.abolition. The mortality and morbidity of the older generation is at stake. Also as a boomer myself I refuse tolerate the conditions of “changing” I want abolition to take place starting today.
Dr Thomas , I am a huge fan of yours and the work that you have done to enhance the quality of life of our residents… However , I am a little confuse at to what you are saying about culture change being over… I worked in a long term care home and we have adopted this new culture and it is just amazing the way our principles and priorities have changed when to comes to the well being of our residents…
I’m in. Point me.
I agree that wagging the lamb’s tail is not working. We have come too far to wait any longer. I believe in culture change and believe in fighting for this movement. Dr. Thomas, your vision is clear. Onward!
Cheryl Kruschke
It is a sad time when some nursing home corporations blame regulations for not embracing “culture change”. Excuses…..excuses. Regulations are bare minimum………….provide oral care; provide personal care; change the bed linens; respect privacy; notify the resident/family of medical changes. Some nursing homes act like the regulations are requiring them to do rocket science. Until there are better option for LTC, unfortunately where in some areas one or two corporations own all of the homes, it is a monopoly. They know they own the market, and for those corporations that do not want to effectuate change…..they don’t have a financial incentive to do so because they own the LTC market. Nursing homes are a business, and there is the problem.
Bill, we’re with you. I’m with you. Thank you for being a fearless leader.
It just has to be better. May God bless our efforts and move many to be comfortable with being uncomfortable.
If the Long Term Care system is going to change then we must effect some change in the value and respect we have for aging individuals. The fact that “baby boomers” are themselves part of the aging population is the driving force that will be the catalyst for significant change in the our society’s approach to Long Term Care. Baby boomers do not see themselves as residents of LTC facilities and are motivated to find alternatives for themselves.
Change is needed. I was introduced to Eden Alternative at a fantastic nursing home in Spartanburg, SC. I am convinced that we can do better with the elders. I lost a couple of jobs because of my determination, as a DON, that the facilities WERE going to do better. Unfortunately, at 61 yrs old, I’m just too tired to fight anymore! Keep up the good work!
I wrote a Manifesto- inspired by your work and my 27 years of increasing distress and frustration at the lack of effect of “tweaking” the services and accommodation. My Manifesto was called “A Bold Call to Action” qith the support of the board and overwhelming response of those we served, we withdrew from the publicly funded long-term care system (Ontario Canada) and began a new model of community. What a journey! We need you to keep up your advocacy and aggressive challenges to the status quo. Helps keep us strong as we work to transform Elder Care.Thank you.
I too have been holding back and being, for the most part, polite. I’m 62, a 32 year veteran of long term care and have had it. I won’t give up for the sake of our older counterparts but the gloves have come off. I don’t plan to win Miss Congeniality at this point and zealot doesn’t sound half bad. There are worse things.
Gutsy article! I applaud you and look forward to seeing what cultural alternatives are really possible.
Bravo!
I am in the AIT program currently. This is a career change that society would view as mid-life as I am 42. I, too, am of the belief that change is past due. You are an incredible inspiration and I firmly believe, with your drive and talent, I will absolutely witness you change this industry.
I have worked in nursing homes for what seems a long time. Starting out as a transportation driver and moving right along and now have a BSN. I feel like I have worked a lot of different areas in LTC. As much as I hate to say the main problem in LTC is money. The lower echelon of most of the workers would love to spend individual time with the residents being friendly and making them more comfortable but economics forbids that. Most nursing homes of any kind are understaffed in workers and overstaffed in administration. By the same token if they paid enough to have the workers most people would not be able to afford to live in LTC. It seems like a catch 22 situation! I too have seen LTC fight to keep people alive when they should be allowed to pass in peace. I have given my children specific instructions as to when to “pull the plug” should I end up living in LTC (I am 66) and I know they are strong enough to fight for what I want (this blesses me tremendously). Some people are not this fortunate. Most families do not know who to talk to so that they can better keep an eye on loved ones in LTC and have no idea how to accomplish what needs to be accomplished to help their loved one when things go wrong. Maybe I should right a booklet on how to work within the LTC facility to help the resident live a full a life as possible. Would love to hear ideas from others what should be included.
I’m a newbie on site. My mom – and now an uncle – are in the same nursing home. It’s not wonderful; it’s not horrible. I am not going to take her home for a number of reasons, good/bad/mine ( her physical care has been great, I’m alone, we’ve had put differences, she knows a lot of people there). So I am still interested in how places which care for the oldest and sickest of us operate. I will probably end up in one. So Iwould join with a major crusade to end nursing homes “as they are” but in the mean time . . .
I have to deal with real life, right now. Which means being able to communicate with nurses and aides and administrators, who mostly try to be professional and caring, but have an overwhelming amount of work. Several things have occurred to me: I could have used – ( perhaps should set about writing) a practical guide to your relationship with the nursing home and all of it’s different faces.
A friend – who also has a mother in the same place – and I did confront the administrator about wholly dysfunctional dining room procedures, with a tiny bit of success.
It is very difficult to know how to approach the completely overused RN’s who are the hub of health care. It is almost impossible – if you have a relative for whom you take responsibility – to have contact with the “nursing home doctor,” because of time and perhaps inclination? Perhaps you, as a physician could suggest how to question some decisions without alienating the important folk.
I have found my relation with the ‘home’ is a dance of advocating and adapting, and it can be difficult to find the balance.
Where do I sign up? And please don’t read John Brown or Frederick Douglass this week! It could be very dangerous….We have some amazing abolitionist history to review. What’s a radical revolutionary outspoken nurse to do? Do I take the cultural transformation job? Can you rock the boat while you are in it? Write on!
You captured our hearts and our passion so many years ago. We are with you Bill and Jude. Love Tom and Debbie.
Can hardly wait to see what’s next and not as an observer, but as a participant!
I have to say that I am glad I am not alone in my frustration, Bill. I am with you. You have always inspired me and continue to inspire me to think differently, which is what fuels me to work through the frustration. Maybe we do need to abolish nursing homes as we know them. However, I don’t think I can let go of the need for a culture change movement, to change our culture of aging and to think differently about how we grow older and grow with dementia, regardless of where people live. Thoughts?
We are the non profits..we are the for profits…we can make change..some of you are talking as if we have no power..as if the monster can not be slain…it can be…we are the non profits.. we are the for profits…
Bill, I’m going to enter you in our new #fearless elder campaign! You go! Donna & your fans at Generations United
When there’s money to be made by big corporations (even if they call themselves not-for-profit), lambtail approaches won’t work. You go, Doc!
good for you. I just spent 6 months moving my mother, who had congestive heart failure, back and forth from a nursing home to her apartment in an ‘independent living facility’. This nursing home was a ‘nice’ one – re more expensive than some, very clean, cheerful, well lit. It was fine when she was still in need of P.T. But when she was actively dying, and an outside hospice team became involved things became very murky and strange. Finally I realized that instead of keeping her comfortable and accepting the fact she was dying, which is what she and her family wanted, they were pushing food and liquid on her and actively trying to keep her alive as much as possible. She suffered a lot, and because of complete lack of transparency I felt my hands were tied and that there was nothing I could do to help her. Soon I realized they were lying to me (as well as being uncommunicative) Finally I moved her to a hospice residence, where two weeks later she died. I learned from the hospice nurses that the nursing home had been seriously under-medicating her. Many people in this nursing home should not be alive. They are not living any kind of quality life, and the nursing home is taking enormous amounts of money from basically ignorant families. As well as the society. At the very least, there should be more communication, transparency ie clear choices given to patients and families. Pro Choice for the elderly.
Couldn’t agree with you more. I loved the Eden Alternative concepts. As a consulting psychologist to LTC facilities, I thought I had some credibility. Can’t fight profit motive and even not for profits are very resistant. They agree it’s great, but….
jaded? angry? radicalized? tired? impatient? frustrated? fed up? resigned? rejected? having a bad day? These are just some of the questions that come to mind.
Social change happens slowly. Your analogy to abolitionists is interesting. Yet, I’d argue race relations/rights remain a a slowly evolving process.
You’ve instigated and prodded movement with your efforts. As frustrating as not receiving whole-scale adoption of your beliefs can be, the course of change remains ongoing and correct. While anger can prompt speedier resolutions, it can also close communication lines. Don’t abandon the ship as you take a different tack. I await Part 2 to see how you will be channeling your disruptive energy to positive good.
Your work has been successful and will continue to reward those you serve and those who follow your leadership.
Well now! It’s time to get down to business! This is going to be exciting, AND productive. With you Doc!
Thank you. You have offered support, encouragement, and also a challenge to many who are of like mind and heart. MK
I agree and I’m in to help.
Yes, this article is Age Changing…it is #disruptaging! I, like Dr. Thomas started working in a nursing home 25 years a go. A year after graduating UC Berkeley with a degree in History and thinking the only thing I wanted to do was go to law school and somehow change the world, I changed my mind and my world by beginning the journey of my life as an activity director in a skilled nursing facility. I quickly advanced through the ranks and became a certified nursing home administrator. I remember the first day I walked into the nursing home, not even hired yet, I knew that change was needed because what I saw could not go on for one more day. I knew that I could affect change and I knew then that it would take more than most people were willing to give. Today, I own an Assisted Living Community specializing in Memory care. I have watched Dr. Powers’ career and again like he, I am more committed than ever to breaking the barriers to care, dignity and the removal all things that break our seniors and their families. I created a community within a community…where our residents are the creators and drivers of their own care; where they can be who they are, where they are in their own personal journey. While I have seen the benefits of medications, I see the bigger benefits of Music(Music and Memory/Alive Inside), art, animals and touch. “Once an activity director always an activity director”, the power of engagement and the power of all things organic, including natural essential oils, is amazing. I too am at a point in my life, a cumulation of my 25 years of experience in senior care and my life as a granddaughter(1 grandmother passed away last year at 99 years of age), that I will not go quietly into the abyss of aging as set out today. The future of Pharmaceutical companies should be in jeopardy, the future of funding natural and organic aging should be flush; the alternatives to nursing home’s “housing of seniors” will end and we will be aging in communities, in villages of support and access for all. Please spread the word and Thank you Dr. Powers.
I’m in. Let’s hear more.
Dr Thomas, I met you several years ago while working at a non-profit Providence LTC facility in Olympia WA. I also attended the Eden alternative training prior to our meeting. At this point, I no longer work with elders. It seems that until we “abolish” the for-profit institutions in LTC things will continue as status quo. The “for-profit” companies espouse to care for residents. Yet, they are primarily interested in lining their pockets “rehabing” people in their 90s and 100s. That kind of “rehab” is criminal. They maximize “minutes” in abusive unethical practices. We need a new term to ‘rehab’ elders instead of torturing many as they age and/or to death as the companies gain financial profit at the cost of the elders. At this point in my career, I have returned to working with the very young population. However I commend and support you in trying to change (aka abolish) the “nursing home” institution. You have my support!
I respect your stand with and for elders!