Dr. Bill Thomas

Co-Founder, the Eden Alternative

Dr. Bill Thomas

American society views its elders as left-over products, I'm sorry to say. Our elders primarily are seen as a burden in our society and not as a gift. And the work of caring for our elders is seen as a drag on our economy and not as a gift to us as a people. As a geriatrician it's very clear to me that once an older person moves past the jolly period of barefoot water skiing and telling fun stories to the grandkids, and needs some real care and maybe is struggling with some real disability, they are regarded as a burden in our society.

It's a great loss to all of us when we adopt the idea that elders are only worth what they can do and not what they can be.

What is the state of nursing home care in our country today?

I'll put the American nursing home on the critical list. It's not going to make it. In fact my work, my whole passion and my whole work is pulling the plug on the American nursing home. It's really an institution, not just from the 20th century but really from the 19th century. It's a relic. It's a left-over vestige of a factory, assembly-line approach to care that is just not going to meet the needs of elders in the 21st century. And in fact, I'll do everything that I can to see that, as we move forward, nursing homes cease to exist.

Why do you think nursing homes have to be unplugged?

In America there are almost 300 million horror stories that people can tell about nursing homes. Everyone's got a story to tell. And the reason there are all these stories to be told is because the nursing home is a relic. The nursing home is supposedly a place for care, but it really becomes a factory of service, where people are provided with services and the art, the gentle art of caring is set aside. And that's a real tragedy for millions of American families.

When you're looking at the American elderly population, the population that needs care, what percentage of those are now in nursing homes? And how should that change?

Right now in America there are about 1.7 million people living in a nursing home. And any adult American who reaches the age of 65 has a 50% chance of spending time, significant time, in a nursing home. That's a vast proportion of our society. Let me give you an example. The only other segment of our society that is more likely to be institutionalized are convicted criminals. We have about 2 million people living in prisons. So here we have a society that uses an institutional pattern for convicted and violent felons and our frail mothers and fathers. And that, that is, that is a losing proposition in the 21st century.

What has to be done? What does our society have to do to change that paradigm?

The first thing we've got to do is to get away from the idea that there is a long-term care industry. Just the words "long-term care industry" make me want to throw up. Long-term caring for our elders is not an industry. And making it an industry perverts the real value in this. So, first thing we got to do is move decisively away from care as a big business, as a business opportunity.

And I think we can do that by moving away from the idea that care for frail elders has to be localized in buildings we call nursing homes. I think what we're going to see going forward is care for elders being diffused through the community in different places, in different communities, in different ways.

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