When geriatrician Bill Thomas was the medical director of a nursing home in upstate New York in the early 1990s, he was asked to a see a patient -- a very old woman who had a rash on her arm. "I went to see her and diagnosed her rash and told her I was going to make it all better," Thomas says. "But before I left the room, she took hold of my arm and pulled me down over the bed and looked right up into my eyes and said, 'I'm so lonely.'
"I realized then that I was running around treating skin rashes while the people I was caring for were dying of loneliness. And that was not an acceptable state of affairs."
It’s not just that 12 years of medical training had not prepared him how to be a caregiver -- although he readily admits that that is the case -- but Thomas realized the whole medical model of nursing homes needed to be revamped. So he set about revitalizing the environment of the home by bringing in animals and plants, and shifting the model of care to one that focused on the emotional well-being of its residents, not efficiency of operations. Based on its success, he went on to found Eden Alternative and the Green House Project, nonprofit foundations that are creating homelike alternatives to institutional care.
The key to eldercare, Thomas learned from his elderly patient, is to provide love, which institutions can't do. "Human caring does not function according to economies of scale. Things like accounting and food service have economies of scale, but general caring does not. So what we're doing in traditional nursing homes is sacrificing the thing that is most important -- genuine caring -- for things that don't matter as much. It used to be that we had to do that because there was no other choice, but now there are other choices."