“I have a confession to make,” Bill Thomas announced several months ago at a conference on aging in Oregon. “I am an old man.”
“No, you’re not!” an audience member called out. It was meant, no doubt, as a compliment: Despite his gray-streaked beard and crow’s feet, the 56-year-old geriatrician-cum-thespian crackles with high-octane energy. And isn’t that what we all want to hear as we age? That we don’t look old? That we seem younger than we are?
It’s not what Thomas wants to hear. After more than 20 years of trying to make life better for old people, he believes the correct message is the opposite: That we are lucky if we get to grow old. That there is a “third” phase of life beyond adulthood that can be as rich as either of the phases that came before.
“Man, I’ve got a lot of work to do,” he said to himself that day in Oregon.
In the land of Botox and celebrity teenagers and the 18-to-34-year-old target consumer, the idea that old age can be as rewarding as youth is not an easy sell. In fact, Thomas believes that Americans have bought so willingly into the idea of aging as something to be feared that it has become a self-fulfilling prophecy leading to isolation, loneliness and lack of autonomy.
He wants to change that, and he is well qualified for the job.
The Harvard Medical School-trained physician and professor at the University of Maryland Baltimore County’s Erickson School of Aging is known for sparking explosive new ideas in elder care. He is particularly well-known for pioneering “The Eden Alternative” — a radical system of humanizing nursing homes by introducing live animals and plants.
The Wall Street Journal has called Thomas one of America’s top 10 innovators, and a chapter of the bestselling book “Being Mortal” by physician-writer Atul Gawande is devoted to Thomas, whom Gawande calls a “serial entrepreneur.”
But for all his innovation, Thomas has not yet been able to pull off a revolution — perhaps because he’s always been ahead of his time.
As a doctor, he says he was “trained and taught that I had to help older people compensate for their losses — well, that’s a horrible frame around which to construct your life.”
So now Thomas has given up practicing in favor of proselytizing. For the past two years, he has traveled the country on a mission to raise public consciousness — strumming a guitar and presenting a stage show that touts a “post-adulthood” period when age and experience are associated with enrichment rather than decrepitude.
He believes that his generation, which reinvented what it means to be young, should now be reinventing what it means to grow old. “We need to get people out of hospitals, we need to create a rich set of community-based alternatives.” In essence, he argues, the goal is “normalizing the entire lifespan instead of separating and stigmatizing one part as something different.”
Instead, he sees too many baby boomers clinging to tropes that no longer serve them.
“It’s very American language — ‘You’re as young as you feel, and I feel like I’m 22 years old.’ That’s not good, that’s not right . . . and the reason it’s wrong is it doesn’t allow you to be who you are.”
As doctors and advocates prepare for the aging of this cohort, many are starting to draw similar conclusions.
Increasingly, research has shown that regimentation and institutionalization work against well-being and good health in old age and that people with negative conceptions of aging are more likely to experience dementia later in life. Gawande and others are urging people to overturn common wisdom about caregiving and quality of life for the aging.
It’s enough to make one think that perhaps Thomas’s time has finally come.
In 1991, Thomas was an exhausted emergency room doctor when he got a call asking him to be medical director of a nursing home in Upstate New York. He accepted, but when he got there, he found the place depressing, a repository for old people whose minds and bodies seemed dull and dispirited.
It was the opposite of what he’d grown up with. Thomas, whose father was a factory worker and mother was a Methodist minister in tiny Nichols, N.Y., came of age surrounded by older relatives.
“Their age was not significant in any way. They were integral members of a family unit. My great-grandmother was in her 80s, but there was no caregiving going on. Did the relatives support Great-Grandma? Well, yeah, but Great-Grandma did stuff for the relatives.”
But in the professional world of geriatrics, Thomas found that the idea of interdependence among generations “runs smack dab into the idea that old age is a train wreck and that older people are not contributing, that they’re a burden on us.”
So he decided to transform the nursing home. Based on a hunch, he persuaded his staff to stock the facility with two dogs, four cats, several hens and rabbits, and 100 parakeets, along with hundreds of plants, a vegetable and flower garden, and a day-care site for staffers’ kids.
All those animals in a nursing home broke state law, but for Thomas and his staff, it was a revelation. Caring for the plants and animals restored residents’ spirits and autonomy; many started dressing themselves, leaving their rooms and eating again. The number of prescriptions fell to half of that of a control nursing home, particularly for drugs that treat agitation. Medication costs plummeted, and so did the death rate.
He named the approach the Eden Alternative — based on the idea that a nursing home should be less like a hospital and more like a garden — and it was replicated in hundreds of institutions in Canada, Europe, Japan and Australia as well as in all 50 U.S. states (the animal restriction in New York was voted down).
But despite glowing results where the Eden Alternative had been applied, most nursing homes still languished in the institutional-warehouse model.
Thomas calls himself a “cultural jammer” — someone who upturns orthodoxies and tries unproven methods, someone who throws spaghetti against the wall to see what will stick. So he tried something new.
He moved beyond nursing homes to set up small, intimate residences called Green Houses. With private bedrooms and bathrooms, they offered dignity and privacy. Their size had an unexpected effect.
“Within six weeks, they had to send a truck around to pick up all the wheelchairs,” Thomas said of one house. “You know why most people [in nursing homes] use wheelchairs? Because the buildings are so damn big. . . . The buildings disable elders.”
Once again, success: His idea won multiple awards and was widely replicated. Green Houses and the Eden Alternative were clearly good ideas. But they failed to do what Thomas had hoped they would: fundamentally change how society thinks about old people.
He chalks this up to apathy. “In a contest between doing difficult cultural-transformation work and doing nothing, doing nothing wins, over and over. . . . I learned that even if you put up compelling proof, the structure of the nursing home is tilted strongly toward not changing.”
Thomas is, admittedly, more flexible than most. Partly this is because he has had to be. He has three healthy sons and two daughters born with a rare condition that limits development to that of a 1-month-old. In March, his 18-year-old daughter, Hannah, died of the condition.
Living with their devastating illness influenced his understanding of aging. “The grievous lesson was that even though I believed in medicine, there’s no magic path of flowers and unicorns,” he recently told a roomful of alumni at UMBC’s Erickson School. “So you have to acknowledge that two of your children will never speak your name, touch your face, call for you. What I’ve learned from that is you settle into a new normal. . . . Yes, you grieve the loss of the old normal, but there’s always going to be a new normal.”’
Aging, with its constant barrage of new infirmities, requires similar adjustments, he says. If people could understand it this way, perhaps they could change their attitudes about growing old.
“His genius was to recognize in the nursing-home situation a larger societal problem,” said Judah Ronch, dean of the Erickson School, who first met Thomas three decades ago. “He’s two, three, four steps ahead of most people, and they don’t necessarily see how to get there. He’s working on ways to get there, but he’s fighting an uphill battle, because people and society have very entrenched views of aging and what aging is about.”
Clearly, changing attitudes required a more seismic shift than just improving upon nursing homes. And, so, Thomas switched direction again. Maybe it was time to challenge the status quo not as a doctor in a white coat, but as a man in a sweatshirt and Birkenstocks, standing on a stage.
Before the lights go up, while the audience is still chattering, a burly, bearded figure saunters across the stage with a giant homemade gong mallet slung over his shoulder. “Good evening,” he says as his co-star takes a seat beside a lineup of musical instruments. “I’m Dr. Bill Thomas, and this is Nate Silas Richardson, and we’re a physician and a musician.”
The performance, part of his current tour, called “Age of Disruption,” is a combination of sociological analysis, memoir, myth and singalong. He employs an actor’s crescendos and diminuendos and a careful enunciation that makes people sit forward to listen. At times, it resembles a TED talk (Thomas has also given those), but rather than being tightly scripted, it rolls loosely between genres, morphing a little each time. There are charts and slides, but also guitar-strumming and video clips.
The message: Old and young are two distinct times of life, neither one better or worse than the other. He talks about the different ways brains process information and foster creativity at different times of life (the young are more literal and mathematical; the old are better at improvisation and making associations).
The show, which is sponsored in part by AARP, includes a fable about a woman passing into old age who serenely gives up the physical attributes of youth in exchange for wisdom and a revered place in her community. “The crone finds new beauty in age,” Thomas proclaims to his audience. “It’s a loveliness the maiden cannot know. Honor this beauty, and it will honor you.”
It is a Utopian view — or as he puts it, a countercultural message. The tour, he says, is as carefully designed as the Eden Alternative and Green Houses. But because it does not offer concrete solutions as they do, its message can be harder to digest.
One woman came up to him after a show and said, “I was expecting you to tell me what to do.”
“Telling her what to do is not the answer — the answer is to raise consciousness,” he says. “If people can see this in a new way, they will find their own specific solutions.”
Despite the show’s absence of clear instructions, “it’s resonating,” said Kevin Donnellan, executive vice president and chief of staff at AARP. “We hear from lots of the folks that attend these events. It’s creating a dialogue.”
Much of the response is sparked by Thomas’s engaging personality. “Bill is so joyful, and joy is in short supply especially in the world of aging,” said Ashton Applewhite, who runs the anti-ageism blog “This Chair Rocks” and accompanied Thomas on a 2014 tour based on his book “Second Wind,” about how boomers cope with their lifespans.
But is it enough? In two years, he figures he has reached 25,000 people, from middle-aged audiences to college students. At that rate, in a country of nearly 300 million people, can Thomas spread his message widely and quickly enough to help his own generation age better?
He concedes it may not happen. “I get it — ‘Dude, you’re one dude, and you’ve got this one little carnival show that you take around the country — that ain’t gonna do [anything].’ I’m willing to accept that. But I’m willing to conclude my working life and say I did everything I could — the challenge was bigger than I was.”
That won’t mean it was insurmountable, not if you take the long view, Ronch said. “Social visionaries have a tough time,” he said. “The change he advocates for likely won’t happen soon and may not happen in his lifetime. . . . It may take another generation for his ideas to reach critical mass.”
For now, the latest incarnation of Thomas’s career is, like each stage of life, no better or worse than the last. Just different.
“I’m incredibly well-trained in physiology, biochemistry, pharmacology — I believe in them,” he says, but now it’s time to scatter seeds of a different sort and hope they will eventually take root.
“I’ve given up on the idea that change will come from inside the field. It will come, but it will come from the outside. And that’s where I’ll be.”
Correction: An earlier version of this story misstated the name of the University of Maryland Baltimore County. This version is correct.