Over the past 15 years, noted gerontologist Dr. Bill Thomas has been at the helm of some revolutionary and progressive work that challenges the status quo on how people's long term care needs can be met in a way that preserves their dignity and independence. He has spearheaded a small but mighty and growing movement that changes how residential long term care services are delivered, putting power and control back into the hands of people needing care. This represents a radical departure from the medical care model where decision making on services needed and received rests with the health care professional.

As background, in the mid 1980's and armed with a Harvard medical degree, Dr. Thomas became medical director of a nursing home and it is here that the seeds of change were planted. There he learned that even in the best run nursing homes where excellent medical care was given, people's spirits were withering and dying. This decline in psychological and spiritual health, he found, related to three plagues: loneliness, helplessness, and boredom. In studying the effect of the mechanized and efficient routine delivery of service, people were being robbed of life enriching companionship, their need to care for others, and their ability to care for themselves in whatever manner they were able. They were bored with a life devoid of meaning to the point of depression and dementia.

Dr. Thomas also found that the staff called upon to do the sacred work of caring for frail elders--because it takes very special people to do this important work--were locked into this system as well. In their heartfelt efforts to provide loving care to the elders they served, staff fell into a pattern of mistaking treatment for actual care.

When a system built on efficiency couples with a reimbursement system built solely on payment for treatments and procedures, a perfect storm has been created for assembly line care. Human beings in nursing homes are fed, bathed, given medicine, and provided other services in a mechanized fashion. This approach works for building cars, but it doesn't help human beings grow and thrive.

His experience and findings led Dr. Thomas to develop the "Eden Alternative" - a principle-driven method of addressing the plagues of loneliness, helplessness, and boredom which puts residents at the center of decision-making; acknowledges the needs of staff to be well-cared for; and fills residential long term care settings with life, enough time and ability to form relationships, pets, plants and all the elements crucial to continued growth and life.

While the Eden Alternative was the first major culture change method to be adopted, it is not the only culture change method available today. The Neighborhood Model, Green Houses, and many other new models are emerging.

Visit these links to learn more about culture change in long term care:

• The Eden Alternative
• Green Houses
• Action Pact
• The Pioneer Network