(Not) the Same Old Story

In 1999, after writing a book about improving long-term care for the elderly, Bill Thomas did what authors do: He hit the road for a promotional tour. He appeared on radio and television. He also met with public officials, offering his perspective as a gerontologist -- a doctor who specializes in treating the elderly -- on what was wrong with nursing homes: They were utterly devoid of hope, love, humor, meaning -- the very stuff of life. He gave lectures on the changes he had in mind, which included adding pets, plants, and children to nursing-home life. But at each stop, he also demonstrated why this is no ordinary book and this was no ordinary tour -- and why he is certainly no ordinary doctor.

Thomas, now 42, didn't write a prosaic account of the principles behind Eden Alternative, the nonprofit organization that he and his wife, Jude, operate out of their farm in Sherburne, New York. Instead, he told a story, a fantastic tale interweaving fact and fiction. Learning from Hannah: Secrets for a Life Worth Living (VanderWyk & Burnham, 1999) is a novel that doesn't call itself a novel. It begins with Thomas and his wife completing a book about the medical aspects of aging and then taking a much-needed vacation. While sailing south from San Juan toward the island of Montserrat, they get caught in a storm that leaves them shipwrecked. For nearly a year, they live in a mysterious place called Kallimos, where they learn the ways of a society in which the elderly play a vibrant role in the community. Instead of living apart from younger generations, the oldest inhabitants are embraced by them. The wisdom and experience of the elderly are valued as a resource. When Thomas and wife eventually return home, the lessons from Hannah, the old woman who mentored them, become the inspiration and foundation for Eden Alternative.

It wasn't enough for Thomas to communicate his vision for better long-term care through an imaginative book. He also developed a one-man show based on the tale. In the summer of 1999, the Harvard-educated doctor turned novelist turned actor launched the Eden Across America Tour, traveling by private bus to 27 cities in 31 days with his wife, their five children, and his parents. It's not hard to imagine Thomas on stage; he's alternately funny, exuberant, and sincere, offering glimpses of a natural theatricality. After a performance at a medical school in the Midwest, he wrote in his online journal, "I had the strange sense that the ghosts of medical professors past were looking on us and clucking their tongues. I didn't care."

For Thomas, the Eden Across America Tour never ended. It can't. Not if he's going to fix long-term care in this country. For all practical purposes, he says, the industry is broken. "Does anyone want to leave his home and go live in a nursing home?" he asks. "Does anyone want to put a parent, spouse, or loved one there? That's why we're turning the industry upside down."

It's an audacious mission and a truly big fix -- one that requires more than just fresh ideas. It demands an unorthodox approach to mobilizing and motivating a wide range of forces, many of which have little incentive to change. "You need to have people go a little nuts about what you want to do," Thomas says. On its own, the industry isn't going to do an about-face and overhaul its core ideas. And individual nursing homes are often too overwhelmed by the day-to-day demands of caring for residents in a heavily regulated field to try anything new. Hoping to prod people into going a little nuts about radical reform, Thomas appeals to their imaginations and their hearts. Hence the book, the tour, and the play. "A lot of innovators don't focus enough on the story that they're telling," he says. "But the story is the only thing that ever gets people to change. It captures your passion and conviction and inspires others to feel the same way."

It's no accident that Eden Alternative evokes another story: that of the Garden of Eden. A garden is the central metaphor behind Thomas's vision. "Human beings aren't meant to live in institutions," he says, "but that's what most nursing homes are: big, impersonal, cold institutions that don't treat people the way they want to be treated. People are meant to live in a garden, a place where they can grow and thrive as human beings."

So far, about 300 nursing homes in the United States (as well as a handful in Europe and Australia) have been "Edenized." Which is to say that these institutions have been deinstitutionalized and turned into warm, nurturing human habitats. The results have proven not only good for residents but also good for business. Impressed by the improved quality of care, residents' health, and staff retention, several states have begun offering Eden grants -- using the fines that more backward-looking facilities pay for violating regulations.