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A Revolution in Life Beyond Adulthood

The creator of a new model for residential care argues that we need to change the way we think about aging, right now

posted by William H. Thomas, Ph.D., August 20, 2012 More by this author

a senior woman and a worker at the greenhouse project

William H. Thomas, Ph.D. is a geriatrician and a professor at the Erickson School at the University of Maryland, Baltimore County. He has founded two movements that aim to reshape nursing-home care: The Eden Alternative and the Green House Project. His most recent book is the novel Tribes of Eden (Sana Publications, 2012).


a senior woman and a worker at the greenhouse project
Courtesy of the Green House Project
Everywhere I go, I meet people who are reimaging their lives. But for those who are beyond midlife, the support for such thinking is scant. Members of the postwar generation, in particular, often don't know how to make a change. We can see this reflected in something as simple as where a person chooses to live.

Today one in three baby boomers lives alone, without close family members nearby, and a recent AARP report found that 89 percent of people 50 or older want to remain in their homes indefinitely. This is seen as success in American society, even though many of these people are not financially prepared for retirement and have little idea how to get the help they might need if they experience a temporary decline in health. Even though living alone in old age often (but not always) brings loneliness, isolation and fear, nearly 90 percent of people say it is what they want. This is both foolish and unsustainable. We can do better.

(MORE: How to Find the Best Residential Care)

Aging is, and has always been, a team sport. The myth of "aging in place" harms people by defining the decision to share one's daily life with others as failure. But a big piece of the reluctance to seek out new ways of living with others is the dread of institutionalization. People cling to their homes in large part because they fear life in a nursing home more than they fear death. These are solvable problems, but we can't and won't make much progress until we come to a vastly deeper appreciation for the value of "life beyond adulthood." 

Break Out of the Institutional Model

One important way we can reduce the fear associated with communal living arrangements, and improve the lives of frail elders and their families, is to abolish nursing homes in America. Currently we have more nursing homes than Starbucks outlets. Our archipelago of institutional long-term care facilities houses 1.6 million elders and adults living with disabilities. Most of them are serving life sentences, stripped of privacy, independence and choice. Ironically, the buildings are aging even faster than the people in them. They won't survive to house the coming boom of elders. Should we rebuild them, as thousands of developers are already doing, and subject another generation to the cruel embrace of the institution? 
 
The fact that so many people, whose only crime is frailty, are confined in this way is powerful evidence that we live in a deeply ageist society. We dread aging because we associate growing older exclusively with disability, depression, dementia and death. In fact, old age is a complicated life stage with abundant opportunities for growth, joy, meaning and worth. Around the world and through the ages, elders have proven their value as peacemakers, storytellers and sages. They are the glue that holds families and communities together, and we need them now more than ever. 

The aging of the postwar generation offers us a chance to launch a much-needed revolution. We can turn the challenge of caring for an aging population into an opportunity to abolish nursing homes as we know them. We can use the historic strengths and values of elderhood as the basis for creating real homes and communities that can protect, sustain and nurture the most vulnerable among us. We can create a vibrant alternative to the impoverished vision of "long-term care" of the past half century. 

This is the approach I took in founding The Green House Project, a new model aimed at creating a real home that provides care but also supports those seeking to redefine the worth and meaning of late life. With support from the Robert Wood Johnson Foundation, more than 100 Green House Project homes have opened in 32 states since 2003, and more than 100 others are in development.

The Green House Project represents a massive shift toward the deinstitutionalization of older people. It generates human warmth, as opposed to institutional coldness, through its commitment to small size (7 to 10 residents in each house), its de-emphasis on hierarchy, and its complete dedication to fostering a new expression of elderhood.

How a Green House Works

The Green House replaces a traditional nursing home with a cluster of houses or apartments that allow elders to live within their communities. The Green House model creates a true home where each elder gets a private room and bathroom with space for personal items. When you visit, you knock on the door and wait for a resident to let you in. Round-the-clock care is provided, but medical routines do not take precedence over the natural rhythms of daily life. There is a kitchen, as in any home, and a central hearth and table provide a common area to socialize and enjoy a home-cooked meal every day. "It looks like you’re walking into a living room," one family member says. "There is always someone cooking and it smells good. It’s a homey, warm setting.”

(MORE: The Village Movement: Redefining Aging in Place)

Most important, The Green House is not a luxury option only for the wealthy. It is designed to operate successfully within existing regulatory and cost frameworks. Independent research has found that Green Houses cost the same or less to operate than traditional nursing homes, while delivering four times more personal and social contact. Happier, healthier elders are the most striking evidence of the model's success.

The Green House is just one of many innovative alternatives I expect will rise to challenge the status quo of aging in America. These models embrace and foster the proper gifts of old age — meaning, beauty and worth.
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