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Building the New Culture of Aging-One Leader at a Time

August 1, 2004
by root
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An interview with Bill Thomas, MD, founder of The Eden AlternativeÖ by Bill Keane, MS, MBA, Director of Special Programs, Mather LifeWays
Building the new culture of aging-One leader at a time

Bill Keane, MS, MBA, Director of Special Programs, Mather LifeWays, interviews Bill Thomas, MD, founder of The Eden Alternative and The Green House Project In observation of this month's 5th annual Pioneer Network Conference, two long-term care pioneers in their own right focus on the much-discussed problem of culture change-most specifically, on the kind of leadership it takes. Following Keane's introduction is his interview with Dr. Thomas.

The phenomenon generally referred to as "culture change" (which is getting almost monthly coverage in this publication) is rapidly taking on the shape and content of a movement. Balanced against its growing number of passionate advocates, however, is the tendency to dismiss it all as a "flavor of the month." In fact, the trend toward making person-directed care the organizing principle of long-term care is beginning to show measurable results in both quality of care and residents' quality of life.

The "culture" of aging in America is a sprawling, evolving structure of values, behaviors, ideas, habits, systems, customs, language, rituals, and practices that have been collected into an entrenched "conventional wisdom." Proponents of reform are increasingly taking issue with the debilitating effects of the status quo, with its blind devotion to the institutional medicalization of late life and the dismissal of frail older people from the heart of our society. Overcoming that culture and creating the potential for a society that celebrates the elder as a still complex, growing person with an equal opportunity for dignity in daily life is our generation's greatest challenge.

It begins with a personal journey that allows us to explore the consequences of our own aging. It is the private reconsideration of what we believe about aging and longevity (our own and others') that provides the foundation for a successful experience with organizational change strategies like The Eden AlternativeÖ, Wellspring, and others.

This new culture must be sustainable if it is ever going to take root in our national consciousness. Only then can it evolve into a force capable of influencing American life and our economic and social systems. Change on this scale will require a new kind of leadership. That is why the Pioneer Network, in planning its 5th national conference this month in Overland Park, Kansas, has chosen to emphasize leadership development. A specific track within the conference is designed to give participants a focused opportunity to develop their culture-change leadership skills addressing such topics as self-assessment, collaboration, leadership competencies, sustaining change, and building external change agents. This latter topic focuses on the "movement leader" and how to reach out from our individual organization work to affect the greater society and develop the kind of deep system change that will affect future generations of elders, especially today's aging baby boomers.

Perhaps the most dramatic exemplar of this new generation of leadership is Dr. William Thomas, a practicing geriatrician from upstate New York, who founded The Eden Alternative 14 years ago and has extended his own journey for culture change into a number of spheres, including the fast-growing Green House Project that had its "bricks-and-mortar" inception last year in Tupelo, Mississippi. I asked him to share his leadership insights with the present and future culture-change leaders who read Nursing Homes/Long Term Care Management.

So how did you get started on this journey we call culture change?

Thomas:
What attracted me in the beginning was simply the opportunity to give better care to my patients. I got started seeking to improve their overall well-being by going beyond simply treating their physical symptoms.

How has this evolved over the past 14 years for you?

Thomas:
The ideas around a new culture of aging have actually been bubbling in our society for more than 150 years (read Tennyson's poem "Ulysses" sometime). Within long-term care itself, the struggle for more person-directed care has been going on for decades. Our work today is inspired by the courage and imagination of leaders who gave us the concepts embodied in OBRA '87 (Elma Holder and others), restraint-free care (Carter Williams), individualized care (Joanne Rader), the regenerative community (Barry Barkan), and many others. The movement really started to take off, though, in the 1990s.

What are the key outcomes that you want to achieve?

Thomas:
First, we must make it our goal to abolish the institutional long-term care facility. They are a very recent creation (in historical terms) and they have served us all very poorly indeed. The idea of placing millions of elders in these settings is simply not conceivable anymore. The system is broken and must be replaced. Second, we must make person-directed care the culture of our healthcare system in general. Long-term care is leading the charge in this new evolution, although our acute-care systems must respond as well because they also play a crucial role in the care of older Americans. Finally, we must work to strengthen "elderhood" and return this component of the human life cycle to its rightful place in our society.

How would you define the successful culture-change leader?

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