New age of enlightenment

Bill Thomas, the charismatic head of a global organisation dedicated to transforming care homes, tells Mark Gould what set him on his mission to eliminate the loneliness, helplessness and boredom that so often blights later life.

The twinkling eyes, full-on fuzz of beard and good-humoured, impassioned conversation are reminiscent of Hollywood actor Robin Williams in full messianic mode. But Bill Thomas is no actor. He is a charismatic social entrepreneur and Harvard-educated authority on geriatric medicine and elder care. And his mission is to save us all from an old age blighted by the tedium, loneliness and over-medication that he says sums up much conventional "care".

His Eden Alternative, a global not-for-profit organisation that teaches how to de-institutionalise care homes, was established in 1991. It has 15,000 affiliate trainers covering the UK, Europe, Australia and Japan, with close on 300 care homes having been given the Eden treatment. The organisation's motto is "eliminating loneliness, helplessness and boredom" - a message that couldn't be more timely, with a report out yesterday from the newly-merged older people's charity, Age Concern and Help the Aged, highlighting the isolation, poverty and lack of care and support facing millions of older people in the UK.

Thomas, who qualified from Harvard as a medical doctor, has just visited the UK to share ideas with policymakers and the care industry, as a guest of the Anchor Trust, the largest not-for-profit provider of housing, support and care in England.

But is it really possible to transform care, however well-intentioned, into some leafy gerontopia?

There is a pause before Thomas responds passionately: "It's not impossible. What's happening is the greatest ageing adventure in the history of humankind. The old are succeeding as they never have before. But here's the kicker: we have got to invent a new old age. The baby boomer generation aren't going to sit still and accept the sort of 19th-century elder care around now. In years to come, people will compare the way we care for the old to the way we look at the slave trade."

But the size of the task is daunting. In the UK, for example, it is predicted that there will be 15 million over-65s by 2030 - outnumbering teenagers two to one. And as western society ages, more and more people will be diagnosed with dementia. So where do we start?

The Thomas approach begins by changing the minds of care managers. He says: "I don't deal with bad people, I deal with bad systems. You need to change the relationship between management and staff. Too often, management is focused on tasks that they feel need to be done, almost losing sight of the people and creating a culture characterised by pessimism, cynicism and stinginess." Moving decision-making closer to the people who live in these homes improves their quality of life, he adds.


Laughter and light

Four years ago, Thomas received a $10m (£6.75m) charitable donation to develop a network of 50 Green House elder care homes across the US, turning the "medical model" of nursing home care on its head. The homes are small-scale, for six to 10 residents, and instead of the sterile touch of wipe-clean furniture and the ominous rumble of the drug trolley, he says, there is "laughter and light", as well as gardening, animals and regular visits from children.

Homes that have had an Eden makeover often report improved staff satisfaction and retention, and significant decreases in the use of medication and restraints. "Most importantly, elders, supported by their care-givers, can once again direct their own daily lives," Thomas says.

Eden Alternative UK and Ireland, based in Bradford-on-Avon, Wiltshire, has a network of regional trainers. The basic course for managers costs around £500, and it takes some 18 months for a home to be given a complete Eden turnaround.

Change also makes business sense. "Any upfront costs - for example, for staff education - are recovered through improved operations and better quality," Thomas says. And his homes save on the cost of medication. Recent analysis by the Institute for Public Health in the US showed that the bill for treating the side-effects of medication for elderly people was equal to the bill for the original medicine. So why do doctors turn older people into pill-popping patients? "Because we think ageing is a disease. It's not; it's a normal part of human development."

Thomas's trip to the UK involved visits to Anchor homes and meetings with Liberal Democrat MP Paul Burstow, co-chair of the parliamentary group on ageing and older people, Jeff Jerome, national director for social care transformation, and representatives of the social care industry and its regulators. He believes that the UK dementia strategy, with its promise of high street memory clinics and increased awareness, early intervention and support for carers, is a "good first step".

Dementia, alongside loss of continence, is one of the main reasons why people are put in care homes, but Thomas insists that institutionalisation can also be defeated by extending schemes that allow older people and carers to hold budgets and choose their own services. For example, the Anchor Trust is helping people to stay at home longer - a theme that Eden is also developing.

Thomas speaks passionately of the need to restore the social worth of older people. "We lose a lot when the elderly are segregated," he says. "These are people who can influence young people; they have experiences and terrific insights to share. There is a social obligation of the young to the old. It's not in the DNA, but it's part of the culture. If you don't transfer that obligation to every generation, it will be lost."

He also approves of the "mixing" that already takes place in some forward-thinking UK care homes, such as Shaftesbury Lodge in the East End of London, where medical students live next door to older people - socialising with and learning from each other. Songs and tales from the Blitz are swapped with computer and iPod tutorials.


Mixed communities

So where are older people still cherished? "The typical answer is in a tribal society, but I am not interested in living in a tribal society," Thomas replies. "Of the modern industrial societies, Scandinavia does the best job. Its planners and architects build with mixed communities in mind."

It could all have been so different for Thomas. On graduation, he was set for a high-flying career in emergency medicine. But a stop-gap job at a local nursing home changed the course of his life, and the lives of many others.

"I was called to see a woman with an arm rash," he recalls. "I said that the rash was easy to treat, but there was something else on her mind. She pulled me close and said: 'I am so lonely.'

"It struck me that nothing in the medical texts could help, so I thought about creating a better place for humans to live, not just to die."


Courtesy: http://www.guardian.co.uk/society/2009/apr/08/interview-bill-thomas